Motivation

Low motivation a barrier to vigorous cardiorespiratory training for axial SpA patients

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Although patients and physiotherapists noted that a lack of motivation was among the leading barriers impeding individuals with axial spondyloarthritis from vigorous cardiorespiratory training, rheumatologists instead cited a lack of information and patient disinterest as the primary hurdles, according to findings published in Arthritis Care and Research.

“Large observation studies provide strong evidence that the intensity, but not the amount, of cardiorespiratory exercise is of significance for an effective reduction of the [cardiovascular disease] risk in healthy people,” Karin Niedermann, PhD, MPH, of the Zurich University of Applied Sciences, and colleagues wrote. “Given the increased [cardiovascular disease] risk in patients with axial SpA and the potential protective effect of cardiorespiratory fitness and its safety, the inclusion of vigorous cardiorespiratory training in exercise programs for patients with axial SpA is highly relevant.”

To determine and analyze the views of patients, physiotherapists and rheumatologists regarding the barriers and facilitators for vigorous cardiorespiratory training among individuals with axial SpA, the researchers conducted a cross-sectional comparative study via online survey. Using the SurveyMonkey website, the researchers tailored their online polls to the three stakeholder groups.

Patients and physiotherapists noted that a lack of motivation was among the leading barriers impeding individuals with axial SpA from vigorous cardiorespiratory training, while rheumatologists cited a lack of information and patient disinterest as the primary hurdles, according to findings.

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A total of 704 patients with axial SpA, 47 physiotherapists and 75 rheumatologists participated in the online polls, although some did not complete the survey. Those who did not complete the poll were allowed to remain in the study if they had answered the questions regarding barriers. As a result, 575 patients were included in the final result, as well as 40 physiotherapists. Among the rheumatologists, 54 answered the barrier questions and 68 answered the facilitator items.

According to the researchers, among the 575 patients included in the final result, 59% named “low motivation” as a leading barrier for vigorous cardiorespiratory training, with 55% naming “unsuccessful timing in daily routine” and 51% answering “hindering disease symptoms.” The top facilitators, according to patients, were “high motivation,” named by 47%; “good organizational conditions,” as answered by 41%; and “facilitating disease symptoms,” stated by 40%. Patients who were more active more often chose a lack of motivation as a barrier (P = .01).

Among the 40 included physiotherapists, 70% named “heterogeneous group composition” as leading barrier category, with “difficult organizational conditions” and “low motivation” each garnering 51%. Regarding facilitators, 54% said “knowledge,” while “homogeneous group composition” and “high perceived motivation” were named by 46%.

Among the rheumatologists, 47% named “not enough information” as a leading barrier, with 50% stating “anticipated /perceived disinterest of patient.” Regarding the top facilitators, 96% of rheumatologists named “exercise important topic even in limited consultation time,” with 91% stating “clear evidence for effectiveness of flexibility exercises.”

“Each stakeholder-group perceived specific barriers and facilitators for vigorous cardiorespiratory training,” Niedermann and colleagues wrote. “For patients and physiotherapists these were mainly related to motivation, whereas rheumatologists focused more on the evidence-base. Moreover, there was a diverging extent of perceived barriers and facilitators among active and inactive patients. All these findings emphasize the need to develop target-group specific, and, for patients, individualized implementation strategies.” – by Jason Laday

Disclosure: Niedermann reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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