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Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 2004 Jul;63(7):804–808. doi: 10.1136/ard.2003.011189

High intensity exercise or conventional exercise for patients with rheumatoid arthritis? Outcome expectations of patients, rheumatologists, and physiotherapists

M Munneke 1, Z de Jong 1, A Zwinderman 1, H Ronday 1, C H M van den Ende 1, V Vliet 1, J Hazes 1
PMCID: PMC1755060  PMID: 15194575

Abstract

Objective: To examine the outcome expectations of RA patients, rheumatologists, and physiotherapists regarding high intensity exercise programmes compared with conventional exercise programmes.

Methods: An exercise outcome expectations questionnaire was administered to 807 RA patients, 153 rheumatologists, and 624 physiotherapists. The questionnaire consisted of four statements regarding positive and negative outcomes of high intensity exercise programmes and four similar statements for conventional exercise programmes. A total expectation score for both conventional and high intensity exercise was calculated, ranging from –2 (very negative expectation) to 2 (very positive expectation).

Results: The questionnaire was returned by 662 RA patients (82%), 132 rheumatologists (86%), and 467 physiotherapists (75%). The mean (95% confidence interval) scores for high intensity exercise programmes were 0.30 (0.25 to 0.34), 0.68 (0.62 to 0.74), and –0.06 (–0.15 to 0.02), and for conventional exercise programmes were 0.99 (0.96 to 1.02), 1.13 (1.09 to 1.17), and 1.27 (1.21 to 1.34) for RA patients, rheumatologists, and physiotherapists, respectively. In all three respondent groups, the outcome expectations of high intensity exercise were significantly less positive than those of conventional exercise programme.

Conclusions: Despite the existing evidence regarding the effectiveness and safety of high intensity exercise programmes, RA patients, rheumatologists, and physiotherapists have more positive expectations of conventional exercise programmes than of high intensity exercise programmes. Physiotherapists were the least positive about outcomes of high intensity exercise programmes while rheumatologists were the most positive. To help the implementation of new insights in the effectiveness of physical therapy modalities in rheumatology, the need for continuous education of patients, rheumatologists and physiotherapists is emphasised.

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Figure 1.

Figure 1

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 Results of the exercise outcome expectations questionnaire (mean (95% confidence intervals)). Exercise belief scores are presented for conventional and high intensity exercise programmes. Scores can range from –2 (very negative expectation) to 2 (very positive expectation). *All differences between patients (n = 606), rheumatologists (n = 122), and physiotherapists (n = 119) are statistically significant with one exception for the difference between patients and rheumatologists concerning their expectations about conventional exercise.

Figure 2.

Figure 2

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 Proportions of patients, rheumatologists, and physiotherapists believing that high intensity exercise is attainable for no or a few RA patients (black bands), about half of all RA patients (upper grey bands), and for many or all RA patients (white bands). The proportion of respondents without an opinion is shown by the lower grey bands.

Figure 3.

Figure 3

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 Percentages of patients, rheumatologists, and physiotherapist agreeing with the statements high intensity exercise is better than conventional exercise (black bands), is as good as conventional exercise (light grey bands) and conventional exercise is better than high intensity exercise (white bands).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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