Background/Purpose: Strength training (ST) rates in people with rheumatoid arthritis (RA) are remarkably low (1-14%), reducing the potential health benefits of ST for this population (e.g., decreased fatigue, pain, muscle wasting, and inflammation). Compared to studies of factors that affect physical activity more broadly, studies on factors that affect ST in the general population are sparse; these studies are non-existent in RA. The purpose of this study was to examine patient-identified barriers, facilitators, and tailoring considerations for designing interventions to improve ST participation among people with RA.

Methods: Purposive sampling was used to include people with varying age (< /=40 vs >40), gender (male vs female), geographic location (rural vs urban), ST experience (none, less than the general population guidelines, meeting or exceeding the guidelines), and perceived RA severity (well-controlled/mild, moderate, severe). Semi-structured interview questions were co-developed with nine patient partners. Questions were iteratively modified to reflect new knowledge gleaned from interviews that were coded at mid-way points throughout data collection. Interviews were recorded and transcribed verbatim. We performed inductive thematic coding with the de-identified interview transcripts. Peer checking amongst researchers and patient partners was conducted to ensure credibility. We continued the interviews until content saturation was reached in the analysis.

Results: 13 participants were recruited through social media and email advertising across Canada (age range=25-70, male=3, rural=2, no ST experience=5, moderate-severe self-reported RA severity=6). Participants identified two barriers that were unique to the RA population. First, cognitive demand was an important barrier that was exacerbated by both disease/medication side-effects (e.g., ‘brain fog’ and poor memory) and increased focus required to perform ST compared to aerobic exercise (e.g., counting sets, reps, remembering the individual exercises and their techniques). Second, participants identified a knowledge gap in how much ST can be safely performed given their disease and how to distinguish between ST pain and RA pain. Several participants suggested the use of memory aids (e.g., videos, written programs) could assist in clarifying the steps to performing ST. Many also felt that RA-specific ST guidelines would be useful to improve understanding of how much ST is appropriate.  When developing tailored programs, participants highlighted the need to understand their unique situation by probing for goals, motivators, barriers, available time and resources, abilities and limitations, and preferred environment, activities and communication style.

Conclusion: Our results revealed challenges to ST that were unique to people with RA. Participants also identified potential opportunities for developing tailored interventions for supporting ST participation. These findings have also provided a foundation for testing hypotheses that explore the mechanisms for improving ST behaviour in this population.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/strength-training-for-people-with-rheumatoid-arthritis-barriers-facilitators-and-tailoring-considerations/