Physical activity and exercise are well known to enhance health and are recommended as part of the management of rheumatoid arthritis (RA). However, the level of physical activity among older adults with RA is found to be low and little research focuses on physical activity and exercise in older adults with RA. The overall aim of this thesis was to study different aspects of exercise with person-centred guidance in older adults with RA. Methods: A randomised controlled trial was performed to study the effects of exercise on disability, and health and fitness-related outcomes. Seventy-four older adults (>65 years) with RA were randomised to moderateto high intensity exercise with person-centred guidance or light home-exercise for 20 weeks. After the randomised study a qualitative interview study was performed to explore how older adults with RA experience exercise, and aspects that affect the transition to independent exercise. Finally, a long-time follow-up study was performed to evaluate physical activity and physical fitness after four years. Results: The result of the thesis show that exercise with person-centred guidance did not affect disability as assessed with the Health Assessment Questionnaire Disability Index, but positive effects were found on physical fitness, fatigue, and symptoms of depression when compared to controls. The exercise was experienced as manageable and several aspects affecting the transition to independent exercise were described, including development of a personal way to exercise. After four years, there was no significant difference between groups, when change in physical activity level was compared. In conclusion moderateto high intensity exercise is beneficial for older adults with RA and is experienced as manageable and prepares the transition to independent exercise. This thesis supports the recommendation of physical activity as part of routine management of RA in adults above 65 years of age. However, maintaining exercise over several years is challenging.

Exercise in older adults with rheumatoid arthritis - a person-centred approach

[Purpose] This study aimed to cross-sectionally examine the relationship between the practice of muscle-strengthening activities assessed according to Japanese and foreign physical activity guidelines and knee extensor strength in the elderly. [Participants and Methods] Overall, 223 (66 males and 157 females) participants aged ≥60 years were included. The questionnaire included four items on muscle-strengthening activities: undergoing strength training, performing vigorous farming and gardening, carrying heavy loads, and climbing stairs and hills. Thereafter, participant performance was classified as "sufficient" or "insufficient" based on whether they practiced each muscle-strengthening activity for ≥2 or <2 days a week, respectively. [Results] After the adjustment for age, gender, body mass index, physical activity level, and the practice of other muscle-strengthening activities, knee extensor strength was significantly higher in the elderly participants who sufficiently practiced strength training than in those who did not. Furthermore, those who sufficiently practiced farming and gardening had significantly higher knee extensor strength than those who did not. [Conclusion] Our findings suggest that the non-exercise muscle-strengthening activity of sufficient farming and gardening practiced according to physical activity guidelines is positively associated with knee extensor strength independent of other muscle-strengthening activities or the amount of physical activity in healthy elderly individuals.

Relationship between muscle-strengthening activities recommended by physical activity guidelines and knee extensor strength in the elderly.

The purpose of the present study was to examine the relationship between exercise group characteristics and participation intention in elderly individuals via conjoint analysis. A total of 977 individuals (591 males and 386 females) aged ≥60 years were enrolled in the study. The included exercise groups comprised five factors: 1) instructor (professionals, university students, or volunteers); 2) place (1, 5, or 10 km); 3) expected effect (maintaining or increasing physical fitness, preventing dementia, or relieving stress); 4) characteristics (interaction, gaming, or self-pace); and 5) fee (free, 500 yen, or 1,000 yen). A total of 18 exercise groups were created by the orthogonal table. The choice-based conjoint comprised nine choice tasks. Among these, participants were required to choose between two exercise groups or no-choice option. The utility was higher for each factor as follows: 1) professional instructor, 2) closer place, 3) expected maintenance or increased physical fitness, 4) self-pace, and 5) free. The degree of each factor’s utility differed according to sex or exercise habits. Specifically, females had higher utility for university students than males, and those who had regular exercise habits had higher utility for professional instructors than those who did not. The results of the present study may help develop strategies to stimulate elder individuals in exercise-group participation. Jpn J Phys Fitness Sports Med, 69(1): 143-155 (2020)

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Takenori Kawakami

Papers

Relationship between muscle-strengthening activities recommended by physical activity guidelines and knee extensor strength in the elderly.

Relationship between exercise group characteristics and participation intention in elderly individuals via conjoint analysis