Getting Active: A Real Life Example
- Introduction
- The Program
- A Few Words About Pedometers
- Results of Actual Study Group
- Step Counter Form
- Reference
It has recently been shown that 60% of US adults who report having some form of arthritis are either completely sedentary or insufficiently physically active to obtain any health benefits(1). This is troubling because regular physical activity has been shown not only to improve some arthritis symptoms (e.g., fatigue, pain, mood) but also to promote general health. As such, it is important that everyone with arthritis consider developing a more active lifestyle.
However, as we have noted in a previous article, many persons with arthritis are reluctant to begin a traditional exercise program for fear that intensive and repetitive activity might make their symptoms and/or disease worse. The good news is that recent research indicates that simply accumulating 30 minutes of moderate–intensity physical activity (roughly the equivalent of brisk walking) on most, and preferably, all days of the week can increase fitness and reduce the risk of developing a number of life threatening diseases. This so-called lifestyle physical activity model can also assist people with arthritis to better manage their disease.
In this brief article, we describe a lifestyle physical activity intervention that we have used with a number of our patients.
We asked a sample of patients with fibromyalgia, a disease characterized by persistent pain and fatigue, to gradually work toward accumulating 30 minutes of moderate-intensity lifestyle physical activity 5 to 7 days each week. We defined moderate-intensity physical activity for the participants as a level of intensity where they could perform the activity while holding a conversation with someone. In other words, moderate-intensity activity does not mean that you are out of breath or that you are breathing so heavily that you feel your heart racing. This level of intensity was demonstrated by walking down a hall as a brisk pace.
Participants were then asked to accumulate 10 minutes of this type of activity 5 to 7 days each week for 2-weeks. Participants were given an inventory of a variety of moderate-intensity physical activities. Some examples were: brisk walking, gentle swimming, vacuuming the living room rug, gardening, and the like. When asked, most participants reported that they accumulated their physical activity by walking or by doing light housework (e.g., carrying laundry, dusting furniture, vacuuming).
In addition, each participant was given a pedometer (step counter) and asked to wear it during their waking hours to help them track their physical activity (see below for more details about pedometers).
When participants returned in 2-weeks they were asked to increase their daily moderate-intensity physical activity by 5 minutes per day so that they would now be accumulating 15 minutes of activity 5 to 7 days per week for 2-weeks. Five additional minutes of accumulated activity were prescribed at each biweekly visit until participants were accumulating 30 minutes of moderate-intensity physical activity most days of the week. They continued to wear the pedometer each day to keep track of their physical activity.
Throughout the intervention we stressed that if they experience an increase in pain or disease activity, they were to reduce their physical activity as needed. One participant experienced a flare and reduced her activity to 10 minutes per day for about a week and then slowly increased it as her flare subsided. Participants were also asked to continue to treat their disease as they had prior to the intervention (i.e., not to change medications or other treatments without first talking with their doctor). Here is a summary of what was asked of participants during the intervention, as well as a step counter form that they were asked to complete.
- Accumulate 10 minutes of moderate-intensity lifestyle physical activity 5 to 7 days during the first week of the program
- Wear the step counter each day and record the number of steps you take
- Compute an average step count by adding the total number of steps you take in a week and divide that number by 7
- Add 5 minutes of moderate-intensity lifestyle physical activity each week until you are accumulating 30 minutes per day on most days of the week
- Continue to wear the step counter and compute an average step count each week. If you are becoming more active, you should notice a gradual increase in your average step count
- As you become more active try to focus on the becoming more active on your energy level, your pain, and your general outlook on life
REMEMBER: If you experience a flare or a worsening of your pain, cut back on your activity level, but keep wearing the step counter so you can evaluate how much activity you can tolerate. When you feel better, slowly increase your activity again.
A pedometer, sometimes called a step counter, is a convenient way for you to keep track to your physical activity. Without getting complicated, a pedometer measures and counts the motion of the hips. The device, about the size of a pager, is worn on the waistband during the time that you want to keep track of your physical activity.
There are many different types of pedometers on the market. Some not only count steps, but also estimate caloric expenditure - indeed, some pedometers even have an FM radio built in! As such, the prices of pedometers vary considerably. A pedometer can be purchased for as little as $10 but can go as high as $75, depending on all of its additional features. The pedometer shown retails for about $10 and is adequate for reliable step counting. If you decide to try this program, this basic pedometer will be fine to get you started. As you progress, you may decide that you’d like a pedometer with more features, such as the ability to store a months worth of step counts. However, I wouldn’t invest in a top of the line pedometer until you are confident that you have incorporated this physical activity program into your lifestyle.
As shown in the graph below, we were able to increase the physical activity of the participants by 59% over about 6 weeks. A number of participants reported an increase in energy, improved sleep, and a slight reduction in joint pain. Moreover, many reported an overall improvement in mood and quality of life.
*Printer friendly version of this Step Counter Form using Adobe Acrobat Reader. This can be downloaded at no cost.
| Day | Date | # of Steps |
Please remember:
- Wear the step counter everyday during your waking hours
- Press the “reset” button every morning before you wear the step counter
- Remove the step counter when you are in the bathroom
- When you remove the step counter before retiring in the evening, record the number of steps on this form
Fontaine KR, Heo M, Bathon JM. Are US adults with arthritis meeting public health recommendations for physical activity? Arthritis & Rheumatism 50:624-628, 2004.