Faith in Exercise Benefit Boosts Actual Benefit in SpA Save

Patients with axial spondyloarthritis (SpA) got more bang for their exercise buck in a randomized trial when they had good opinions about their workout program, with better persistence with exercise at 1 year relative to a control group, researchers said.

Odds that a patient would be physically active 1 year after starting the trial -- and 9 months after a supervised exercise program had ended -- were 10% greater for each 1-point increment in a 100-point "exercise beliefs" scale that quantified participants' attitudes toward barriers to exercise, the expected benefit, and self-efficacy (P=0.003), according to Annelie Bilberg, PhD, of the University of Gothenburg in Sweden, and colleagues.

Exercise beliefs accounted for 33% of the variance in physical activity at 1 year in a statistical model adjusted for age, sex, baseline disease activity, and participation in the exercise program, the group reported in Arthritis Care & Research.

That patients' exercise beliefs correlated with improved physical activity "can assist health care professionals in their work of promoting exercise at a health-enhancing level for patients with axial SpA," Bilberg and colleagues wrote. In a separate survey study published in 2020, Bilberg and colleagues had found that SpA patients participating in a high-intensity workout regimen "strengthened respondents' faith in their own bodies" and helped them gain self-efficacy, loosely defined as feeling that they have some degree of influence over their condition.

The new findings emerged from a secondary analysis of data from a 100-patient randomized, controlled trial that evaluated a supervised, 3-month exercise program for axial SpA patients comprising endurance and strength training. Sessions lasted 40-60 minutes each and were given three times weekly. Half the group constituted a control group who were told merely to follow their usual exercise habits. Outcomes in the main analysis (published in 2020) were disease activity and other measures of heath and fitness. As part of the trial, participants completed the Exercise Health Belief questionnaire at baseline, month 3, and month 12.

Participants came from rheumatology clinics in Norway and Sweden. Their median age was 46 and about half were women. Just over half exercised once or less per week. At baseline, their total exercise beliefs score averaged 84.

By month 12, the beliefs score ticked upward by about 2 points in the exercise arm, whereas it dropped a point among controls (P=0.008). The difference was driven mainly by changes in self-efficacy and the perceived impact on arthritis in the exercise group. In contrast, there was little change over time in perceptions of barriers to exercise or in the expected benefits.

Nevertheless, scores for each of these categories of exercise beliefs were significantly higher in the exercise group than in controls, and, as noted earlier, higher exercise belief scores were associated with greater likelihood of being physically active (which was defined as at least 1 hour per week of moderate to vigorous activity).

Limitations to the study, the researchers said, included the lack of blinding and participants' self-reporting of many parameters, including their level of physical activity.

Source Reference: Bilberg A, et al "Supervised intensive exercise for strengthening exercise health beliefs in patients with axial spondyloarthritis: A multicenter randomized controlled trial" Arthrit Care Res 2022; DOI: 10.1002/acr.24556.