Fatigue, Raynaud’s Among Top Barriers to Exercise, Survey Finds

Fatigue, Raynaud’s Among Top Barriers to Exercise, Survey Finds
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Common barriers to physical activity in people with scleroderma range from fatigue and poor hand dexterity to symptoms like gastrointestinal discomfort and stiff joints, a large and international patient survey reports.

Adjustments made to promote activity, like controlled and slow-movement exercises, regular stretching, and protective and warm clothing, however, were seen to be of help by those who used them. Healthcare providers should consider these “facilitators” in encouraging patients to be more active, its researchers said.

Survey findings were reported in the study, “Barriers and facilitators to physical activity for people with scleroderma: a Scleroderma Patient-centered Intervention Network (SPIN) Cohort study,” published in the journal Arthritis Care & Research.

Regular physical activity is associated with a host of health benefits to people, regardless of underlying conditions. But those with rare autoimmune diseases like scleroderma face a range of barriers that can limit engagement, many specific to their disease.

An international group of researchers, led by a team in Canada, reported the findings of a large survey identifying major barriers to physical activity in scleroderma patients, as well as the strategies they used to overcome them.

They invited 1,707 adults with scleroderma to complete an online survey. All were part of the Scleroderma Patient-centered Intervention Network (SPIN) project, an initiative aiming to develop strategies to help scleroderma patients better cope with and manage their condition.

Researchers noted that about 50% of SPIN participants did not regularly exercise, and those “who were active rarely engaged in activities other than walking.”

In the recent survey, each patient was asked to rate the importance of 20 potential barriers to physical activity, as well as the likelihood of adopting some of 103 possible strategies to overcome these barriers.

In total, 721 (42%) patients completed the survey and were included in the analyses. Most were women (89%) and of white ethnicity (85%); their median age was 59. Nearly half (46%) were employed, and most (64%) were either married or living as married.

Four difficulties related to scleroderma — fatigue, Raynaud’s phenomenon (decreased blood flow, making fingers and toes numb and frigid in response to cold temperatures or stress), joint stiffness and contractures, and difficulty grabbing objects — were identified as barriers by more than half of survey respondents.Of these, fatigue and Raynaud’s phenomenon were classified as “important” or “very important” by most participants (58% and 57%, respectively), and joint stiffness and contractures as “important” or “very important” by 49% of respondents.

About a third also considered shortness of breath, gastrointestinal issues, difficulty grasping objects, and pain as “important” or “very important” barriers to physical activity.

Of the 103 possible “facilitator strategies” considered in the survey, 23 were rated by at least 75% of respondents as “likely” or “very likely” to be used. The most common consisted of adapting exercises to make them easier to perform (slow and controlled movements), adopting healthy behaviors like stretching, and keeping warm and protecting the skin.

Patients who had previously tried some of these “facilitators” were more likely to use them again in the future, than were those who had never tried them.

“In summary, medical-related barriers to activity were most commonly experienced and considered important,” the scientists wrote. “Facilitators widely considered likely to be used addressed adapting exercise type or setting, using health behaviours to take care of the body, and using clothing or materials to protect the skin or to keep warm.”

“Health care providers can use facilitators identified in this study to adapt physical activity options so that people with scleroderma can overcome barriers to physical activity,” they added.

Joana holds a BSc in Biology, a MSc in Evolutionary and Developmental Biology and a PhD in Biomedical Sciences from Universidade de Lisboa, Portugal. Her work has been focused on the impact of non-canonical Wnt signaling in the collective behavior of endothelial cells — cells that made up the lining of blood vessels — found in the umbilical cord of newborns.
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José holds a PhD in Neuroscience from Universidade of Porto, in Portugal. He has also studied Biochemistry at Universidade do Porto and was a postdoctoral associate at Weill Cornell Medicine, in New York, and at The University of Western Ontario in London, Ontario, Canada. His work has ranged from the association of central cardiovascular and pain control to the neurobiological basis of hypertension, and the molecular pathways driving Alzheimer’s disease.
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Joana holds a BSc in Biology, a MSc in Evolutionary and Developmental Biology and a PhD in Biomedical Sciences from Universidade de Lisboa, Portugal. Her work has been focused on the impact of non-canonical Wnt signaling in the collective behavior of endothelial cells — cells that made up the lining of blood vessels — found in the umbilical cord of newborns.
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