February 2020: As February starts, if you are anything like me, the New Year’s resolutions that we made on the 1st of January start waning. My brand new trainers have had a few outings, but far less than I had hoped. Starting an exercise programme is hard, and keeping it going is even harder.
Physiotherapists who work with people with Axial Spondyloarthritis (axial SpA) prescribe exercises that improve spinal mobility, cardiovascular health, function and quality of life. Although evidence suggests that the exercises improve clinical outcomes, people with axial SpA don’t always manage to start their exercises, many (like me) struggle to do it as often as prescribed and some can stop all together. Here are five common reasons why people struggle to complete their exercises and some hints of where we can help……
1. Time.
Sounds simple. Time is the most commonly reported barrier to exercising. Time pressures come from work, family obligations and study; with these often prioritised before time for exercise. It has been suggested that lack of time actually represents lack of motivation, but a recent study found that those who report lack of time as a barrier to exercise actually had less free time than those who didn’t report lack of time as a barrier. What might help? Try including a support network, such as family, into the exercise programme and incorporate exercises into the working day.
2. Concurrent medical problems.
People with axial SpA often have other health problems, such as mental health problems, hypertension and osteoporosis. Following multiple medical regimes can overload people. What might help? Tailoring exercises regimes to the individual, keeping them simple, enjoyable and varied. Again, include any support networks such as family, friends, work colleagues or health care professionals.
3. Symptoms.
Axial SpA manifestations include inflammatory back pain, arthritis of the lower limbs, dactylitis (‘sausage’- like digits), enthesitis at the heel or other sites, uveitis, inflammatory bowel disease and psoriasis. Individuals with axial SpA commonly complain of fatigue, stiffness, flares and pain. These symptoms are variable, but for a proportion of individuals with axial SpA these will be intense, frequent and disabling. Those with troublesome disease symptoms may be less likely to do their exercises. What might help? Exercise may help some symptoms – but not everyone might be aware of this, so education on this will help. Also, start exercise plans off slowly and build up, and set simple achievable goals. Refer onto other colleagues who might also be able to help with the symptoms.
4. Fear.
Some people are scared the exercises are going to do more harm than good, or that they are not doing them correctly. What might help? Practise the exercises with the individual, provide digital resources so the person can see the exercises, and educational resources to reassure the person.
5. Self-efficacy.
This is an individual’s belief in their ability to complete specific tasks, in this case the exercises. People with low self-efficacy typically stop the task if they encounter problems such as understanding the regime, being physically unfit, busy or tired. Those with high level of self-efficacy, do their best to improve skills and overcome the obstacles. What might help? Interventions such as education resources and support can improve self-efficacy and feedback to the individual on how they are doing. Again, provide support.
There are probably not just five, but more than a hundred and five reasons why people find it difficult to adhere to their prescribed exercise programmes. The World Health Organisation suggests adherence is determined by a complex interaction between healthcare, personal, socioeconomic, treatment and condition constructs. If an individual is struggling, exploring with the person their reasons for why they are finding it difficult and considering tailoring interventions are steps to improving adherence.
MT McDonald, Physiotherapist, Glasgow
Email mmd7@gcu.ac.uk
Bibliography
ANONIMO et al. (2003) Adherence to Long-term Therapies: Evidence for Action. World Health Organisation.
Reichert, F.F. et al. (2007) “The role of perceived personal barriers to engagement in leisure-time physical activity” American Journal of Public Health, 97(3), 515-519
DiMatteo MR, Lepper HS, Croghan TW. Depression Is a Risk Factor for Noncompliance With Medical Treatment: Meta-analysis of the Effects of Anxiety and Depression on Patient Adherence. Arch Intern Med. 2000;160(14):2101–2107.
O’Dwyer, T., McGowan, E., O’Shea, F., & Wilson, F. (2016). Physical Activity and Exercise: Perspectives of Adults With Ankylosing Spondylitis, Journal of Physical Activity and Health, 13(5), 504-513