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Rheumatic and musculoskeletal conditions and exercise: Getting on track with wearable activity trackers

The Bottom Line

  • Globally, 1 in 4 adults do not get enough exercise.
  • One group with an increased likelihood of being inactive is those living with a rheumatic and/or musculoskeletal disease.
  • In people living with rheumatic and/or musculoskeletal diseases, wearable activity trackers may increase the number of daily steps taken, as well as the amount of time spent engaging in moderate to vigorous activity.
  • Pain, disability, functioning, quality of life, and fatigue do not appear to worsen with increases in exercise that accompany short-term use of wearable activity trackers.
  • Consider using or trialing a wearable activity tracker as a tool to support you on your mission to being more physically active, but first consult your health care team on how you can do so safely.

Get more sleep, sit less, consume a diet rich in fruits and vegetables. There is a laundry list of things that we know are good for our health and well-being. But even with this knowledge in hand, many of us find them hard to do consistently or at all. Exercise at all or in sufficient quantity is one of those things that many know they should do but struggle to do. To be more precise, 1.4 billion adults around the world do not get enough exercise. That’s more than 25% of the adult population or 1 in 4 adults (1).


What is helping to fuel these numbers and hindering us from meeting recommended levels of physical activity? As a refresher, adults are encouraged to engage in at least 150 minutes of moderate to vigorous aerobic exercise (e.g., a brisk walk, cycling, jogging) per week and incorporate muscle strengthening activities into their routine at least two times per week (1;2). Factors that influence exercise behaviours include: not having enough time, social support, lack of energy, willpower, skill, and resources, and fear of injury (3).


Those living with disorders that impact their bones, spine, muscles, and other soft tissues are especially likely to be inactive. Osteoporosis, osteopenia, back pain, rheumatoid arthritis, and gout are just a few of the over 150 conditions that fit this bill (4-6). The lack of activity in this group is unfortunate, given that exercise may help some better manage symptoms and improve health outcomes, while not engaging in exercise can do the opposite (7-10). Take, for example, those living with rheumatoid arthritis. Fear of injury, which in this case means causing further damage to joints, lack of energy, which translates into fatigue, and pain are factors that push people away from exercise (7-13). However, research shows that exercise may help folks living with this inflammatory condition improve indicators of fitness and inflammation, as well as walking time, fatigue, and physical function (7).


Does a strategy exist to help people living with rheumatic and musculoskeletal diseases and conditions increase the amount of exercise they engage in? Let's turn our attention to wearable activity trackers, as well as the systematic review that took on learning about their effects in this population (4).


What the research tells us

The review looked at people with osteoarthritis, low-back pain, or a chronic inflammatory rheumatic disease using an activity tracker worn on their wrist or waist. Trackers ranged from simple pedometers to more advanced technologies, such as those that allow you to automatically relay information and connect to an app. Alongside the wearable activity tracker, most people participating in the studies included in the review also engaged in or received complementary strategies such as goal setting, educational walking booklets, and counselling. These folks were compared to those who were either: inactive, received education or usual care only, used a tracker alone with no other strategy, or used a tracker in combination with some other complementary strategy.


Although more research is needed on the long-term use of wearable trackers, as well as the best complementary strategies to pair them with, the review did find some promising results.


Frist, in people living with rheumatic and musculoskeletal diseases, adherence to consistently wearing activity trackers appears high. For instance, those using wrist trackers wore them 93% of the time for 10 weeks, which is a good first step. Second, wearable activity trackers may increase the number of daily steps taken by a large amount (e.g., 1,520 more steps per day). Third, the time spent engaging in moderate to vigorous activity may also increase by a small amount (e.g., 16 more minutes per day). What’s more, the increase in activity associated with short-term use of wearable activity trackers (up to 8 weeks) does not appear to come with worsening pain, disability, functioning, quality of life, or fatigue. However, a small increase in pain may occur with long-term use (more than 8 weeks) of wearable activity trackers. In terms of advanced trackers vs. simple pedometers, a limited amount of data shows better outcomes with the use of more innovative technologies (4).


Exercise is a feature of focus in guidelines that outline management and treatment options for rheumatic and/or musculoskeletal diseases, therefore signifying its importance (4;14-16). If you have been diagnosed with a rheumatic and/or musculoskeletal condition and are struggling to stay active, you may want to consider the support of a wearable activity tracker. Talk to your health care team about if and how you can safely incorporate both physical activity and wearable devices into your daily life and in a tailored way that meets the needs of your specific condition and abilities.


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References

  1. World Health Organization. Physical activity. [Internet] 2021. [cited August 2021]. Available from https://www.who.int/news-room/fact-sheets/detail/physical-activity
  2. Canadian Society for Exercise Physiology. Canadian 24-hour movement guidelines: An integration of physical activity, sedentary behaviour, and sleep. [Internet] 2021. [cited August 2021]. Available from https://csepguidelines.ca/
  3. US Department of Health and Human Services. Barriers to being physically active Quiz. [Internet] 1999. [cited August 2021]. Available from https://www.cdc.gov/diabetes/ndep/pdfs/8-road-to-health-barriers-quiz-508.pdf
  4. Davergne T, Pallot A, Dechartres A, et al. Use of wearable activity trackers to improve physical activity behavior in patients with rheumatic and musculoskeletal diseases: A systematic review and meta-analysis. Arthritis Care Res. 2019; 71:758-767. doi: 10.1002/acr.23752. 
  5. O’Dwyer T, Rafferty T, O’Shea F, et al. Physical activity guidelines: Is the message getting through to adults with rheumatic conditions? Rheumatology. 2014; 53:1812-1817. doi: 10.1093/rheumatology/keu177.
  6. World Health Organization. Musculoskeletal conditions. [Internet] 2021. [cited August 2021]. Available from https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions
  7. Hu H, Xu A, Gao C, et al. The effect of physical exercise on rheumatoid arthritis: An overview of systematic reviews and meta-analysis. J Adv Nurs. 2021; 77:506-522. doi: 10.1111/jan.14574.
  8. Greene BL, Haldeman GF, Kaminski A, et al. Factors affecting physical activity behavior in urban adults with arthritis who are predominantly African-American and female. Phys Ther. 2006; 86(4):510-519.
  9. Khoja SS, Almeida GJ, Wasko MC, et al. Association of light-intensity physical activity with lower cardiovascular disease risk burden in rheumatoid arthritis. Arthritis Care Res. 2016; 68(4):424-431. doi: 10.1002/acr.22711.
  10. Prioreschi A, Makda MA, Tikly M, et al. Habitual physical activity, sedentary behaviour and bone health in rheumatoid arthritis. Int J Sports Med. 2015; 36(12):1021-1026. doi: 10.1055/s-0035-1550049. 
  11. Schouller C, Maillefert JF, Casillas JM, et al. Physical activity level in rheumatoid arthritis: A systematic review. Ann Rheum Dis. 2019; 78:758-759.
  12. Thomsen T, Beyer N, Aadahl M, et al. Sedentary behaviour in patients with rheumatoid arthritis: A qualitative study. Int J Qual Stud Health Well-being. 2015; 10:28578. doi: 10.3402/qhw.v10.28578.
  13. van Zanten JJCSV, Rouse PC, Hale ED, et al. Perceived barriers, facilitators and benefits for regular physical activity and exercise in patients with rheumatoid arthritis: A review of the literature. Sports Med. 2015; 45(10):1401-1412. doi: 10.1007/s40279-015-0363-2.
  14. Van Der Heijde D, Ramiro S, Landewé R,  et al. 2016 Update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis. 2017. doi: 10.1136/annrheumdis-2016-210770.
  15. Hochberg MC, Altman RD, April KT, et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res. 2012; 64:465-474. doi: 10.1002/acr.21596.
  16. Qaseem A, Wilt TJ, McLean RM, et al. For the clinical guidelines committee of the American College of Physicians. Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017; 166:514-530. doi: 10.7326/M16-2367.

DISCLAIMER: Many of our Blog Posts were written before the COVID-19 pandemic and thus do not necessarily reflect the latest public health recommendations. While the content of these blogs identify activities that support optimal aging, it is important to defer to the most current public health recommendations such as social distancing and frequent hand washing. Some of the activities suggested within these blogs may need to be modified or avoided altogether to comply with current social distancing recommendations. To view the latest updates from the Public Health Agency of Canada, please visit their website.

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