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Background and Purpose. When factors that influence exercise behavior are known, health care professionals can more likely design and modify patient education materials targeted to promote exercise behavior. This study aimed to identify predictors of exercise behavior in patients with rheumatoid arthritis 6 months after a visit with their rheumatologist. Subjects and Methods. Twenty-five rheumatologists and 132 patients with rheumatoid arthritis participated. One hundred thirteen patients (85.6%) completed the 6-month follow-up. Rheumatologists and patients completed baseline questionnaires and were audiotaped during a subsequent visit. Physical function and exercise behavior were ascertained via questionnaire 6 months following the visit. Multivariate logistic regression identified predictors of exercise behavior at 6 months. Eighty-nine patients (79%) were female. The average age was 54.8 years (SD=14.4, range=20-94). The mean duration of illness was 9.8 years (SD=8.7, range= Key Words: Exercise behavior, Rheumatoid arthritis., During the past decade, our knowledge of the importance of exercise as part of the management of musculoskeletal diseases such as arthritis, osteoarthritis (OA), and fibromyalgia has increased. (1) Studies [...]

Blacks and other minorities continue to experience a greater rate of illness and death than the rest of the US population, and the experience with systemic lupus erythematosus (SLE) follows this trend. Health status in minorities is most strongly affected by socioeconomic status, nutritional status and dietary practices, environmental and occupational experience, and patterns of stress and coping. Some feel that socioeconomic status, although understudied, is the most important of these. The relationship of the rate of illness and death to socioeconomic status in blacks with SLE is reviewed. The epidemiology of the disease is reviewed, with particular attention to SLE in blacks and to genetic and environmental factors. Decreased survival in SLE is related to kidney impairment, brain involvement, anemia, low platelet levels, and race. Health outcome in other chronic diseases is influenced by socioeconomic status regardless of race. This status is, in turn, associated with other factors, such as access to quality health care, understanding of the disease and compliance with treatment, opportunities to continue meaningful occupations and activities, and interventions to enhance self-confidence and social support. The relationship between poverty and health is complex and would be difficult to modify by programs unless the roots of poverty are addressed. However, resulting disability and disease severity from other chronic diseases, and probably SLE, can be modified by several strategies. These include improved access to good medical care, programs developed to educate people about SLE and associated conditions such as hypertension, increased opportunities for patients to continue normal activities, and programs that enhance patients' self-confidence and social support. (Consumer Summary produced by Reliance Medical Information, Inc.)

Patient education can be defined as any form of learning experience that results in behavioral changes that improve the health of the patient. There are several different forms of patient education, including lectures, seminars, written material (pamphlets), and private consultations with physicians. The goals in educating patients with chronic diseases are to control the severity of the disease so that the patient can perform daily activities and have a job, to improve the psychological well-being of the patient, and to allow the patient to maintain social interactions with others. Patient education can be broken down into three separate parts: knowledge, behavior and health outcomes. The first part, knowledge, involves providing the patient with appropriate background information. Several programs have been established for educating patients who have arthritis. A recent review of 34 of these education programs concluded that 94 percent of the programs succeeded in increasing the knowledge of the patients. The second part, behavior, involves making changes in daily habits and life style, such as exercise, relaxation, joint protection, and following the prescribed drug treatments. In a recent study, 48 different programs for modifying the behavior of patients with arthritis were identified. A review of these programs showed that 77 percent actually succeeded in changing patient behavior for the better. However, compliance with drug treatments and physical therapy was only 50 percent. The third part, health outcomes, evaluates whether the knowledge and changes in behavior improve the health of the patient. A review of 76 health education programs for patients with arthritis concluded that 61 percent of the patients did show signs of improved health after completing the program. It was reported that these programs helped the patients to reduce pain, disability and depression. It is concluded that education programs for patients with arthritis can be effective in improving the health of the patient. (Consumer Summary produced by Reliance Medical Information, Inc.)

Little is known about the features and role of exercise discussions between rheumatologists and patients. The goals of this study were to: 1) describe rheumatologists' and patients' attitudes and beliefs regarding exercise and physical therapy for rheumatoid arthritis (RA); 2) describe frequency and length of exercise discussions; 3) determine the accuracy of recall for exercise discussions; and 4) assess the influence of attitudes regarding exercise on communication about exercise. Goals 1–3 were addressed with analysis of baseline questionnaires and audiotaped encounters. The influence of attitudes and beliefs regarding exercise on the frequency and length of exercise discussions was assessed prospectively. Patients and rheumatologists were enrolled from a large tertiary care institution. Clinical encounters were audiotaped, transcribed, coded, and analyzed to identify specific characteristics of the exercise discussions. One hundred thirty-two patients and 25 rheumatologists participated in the study. Rheumatologists and patients discussed exercise in 53% of the encounters. Rheumatologists' beliefs regarding the usefulness of exercise for RA varied, with the least positive beliefs being reported for aerobic exercise. Exercise discussions were more likely to occur if the patient was currently exercising, odds ratio (OR) = 2.4; 95% confidence interval (CI) (1.2–4.9), and when the rheumatologist believed aerobic exercises were useful in managing RA, OR = 1.4; 95% CI (1.1–1.9). Current exercise behavior was associated with patients' positive attitude toward exercise (χ²1 = 8.4; P = 0.004) and perceived social support for exercise (χ²1 = 4.5; P = 0.04). When rheumatologists initiated exercise discussions, there was nearly twice as much discussion (β = −8.4; P = 0.001). Exercise talk was influenced by patients' and rheumatologists' beliefs and attitudes regarding the effectiveness of exercise and physical therapy in managing RA, patient experience with exercise, and by characteristics of the rheumatologist.