Short- and long-term effects of intensive training and motivational programme for continued physical activity in patients with inflammatory rheumatic diseases.

BACKGROUND: Despite the positive health effects of (intensive) exercise in patients with inflammatory rheumatic diseases, they are very often inactive. Motivational exercise interventions in other patient samples have shown good effects in promoting exercise behaviours.

AIM: To evaluate the short- and long-term effects of an intensive exercise training programme in rheumatic patients with additional motivation for continued physical activity.

DESIGN: Controlled prospective intervention study with repeated measures over 12 months.

SETTING: Rheumatologic inpatient rehabilitation in two centres in Germany.

POPULATION: Three-hundred-and-seven patients with chronic polyarthritis or spondyloarthritis.

METHOD: The patients were assigned to a control group (CG, standard therapy, N.=156) or an intervention group (IG, motivation and intensive training, N.=151). Socio-demographic (age, gender, social background, employment) and health parameters (SF-36, HFAQ, HADS, pain, disease activity), exercise motivation, physical activity and costs of illness were assessed by questionnaires at baseline (t1), discharge (t2), and 12-months-follow-up (t5). Participants evaluated the rehabilitation programme at t2.

RESULTS: At t2, IG-patients rated their rehabilitation better than CG-patients and reported higher exercise motivation. All patients had a better health status at t2 compared to t1. At t5, IG-patients reported more physical activity in everyday life. An unexpected lower physical component score (SF-36) of the IG compared to the CG lacked clinical relevance. No other variable showed significant group differences. Both CG- and IG-patients showed improvements in their health-related quality of life, pain, psychological well-being, sports activities, and exercise self-efficacy.

CONCLUSION: The rehabilitation programme that included intensive training was perceived to be better than the conventional programme and the patients benefited more from the motivation intervention. Long-term improvements in all participants may be indicators of the positive effects of conventional rheumatic rehabilitation in Germany. Intensive training with motivation also improves physical activity and may have positive socio-economic effects. Future research needs to identify the most effective factors of the intervention and the patient groups that benefit most.

CLINICAL REHABILITATION IMPACT: Intensive training with motivation is appropriate for patients with inflammatory rheumatic diseases aged up to at least 60 years and without severe health impairments. It enhances patients' exercise motivation and increases physical activity over at least 1 year.