Barriers to exercise in rheumatoid arthritis - a focus group study

Background: Rheumatoid arthritis (RA) is an inflammatory polyarthritis, which affects one percent of the population. Since RA is a progressive chronic disease there is a need for long-term adherence to treatments such as exercise to ensure efficacy and sustained health benefits. Little effort has been devoted to identifying characteristics related to adherence and very few methods for enhancing compliance have been developed. Objectives: The primary aim was to identify barriers to exercise in RA. Secondary aims were to identify facilitators to exercise and methods to increase compliance. These aims were to be achieved by using a qualitative grounded theory research approach and conducting two focus groups involving people with RA. Methods: Two focus groups were conducted including twelve participants with RA, which were video and audio taped, transcribed and subject to thematic content analysis. Results: The findings revealed that factors which influence RA patients exercise compliance, include disease, environmental and personal factors. The major barriers identified included fatigue, pain, decreased mobility, lack of professional input, inaccessible facilities, surgery, medications, potential embarrassment, fear of falling and the psychological effects of RA. Seven main facilitators were identified and included empathetic specialist professional input, correct exercise instruction, common ground, group therapy, heat, support and having psychological issues addressed. Conclusion: Findings from this study may be useful in the development of exercise interventions for people with RA, which could increase exercise participation. The research regarding exercise compliance is scarce and of poor methodological quality and there is a need for future research in this area.