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Developing and Refining an Acceptable Nordic Walking Intervention for People with Inflammatory Arthritis

Chief Investigator

Dates

Funding Stream

Amount

Melissa Domaille

Dec 2017 to Jul 2019

RCF Spring 2017

£17,112

Summary of work

The Nordic Walking (NW) intervention was co-developed with patient research partners, rheumatology specialists and a NW instructor. The intervention involved a 30-minute training session followed by one-hour group sessions over ten weeks. The intervention differed from standard NW in three key ways: (1) initial training was provided by a NW instructor with support from a rheumatology physiotherapist to small groups of 2 to 3, facilitating an individualised approach; (2) a central base with seats and drinking water was provided and flexible walking routes, radiating to and from the central base enabled participants to self-select their pace and distance; (3) an adapted warm-up and cool-down suitable for people with inflammatory rheumatic diseases.

Inclusion: adults with a confirmed diagnosis of an inflammatory rheumatic disease (IRD) from University Hospitals Bristol NHS Foundation Trust following informed consent.

The self-reported 36-item RAND Health Survey was selected as a measure of health-related quality of life and was completed at baseline and post-intervention. All participants took part in a semi-structured audio-recorded focus group or interview post-intervention to explore their experiences. Audio-recordings were transcribed verbatim and analysed thematically.

Target recruitment was achieved (n=24: 18F:6M; mean age 60 years, range 35-82) N=13 had a diagnosis of rheumatoid arthritis (RA), n=5 axial spondyloarthropathy, n=3 systemic vasculitis.  

n=1 psoriatic arthritis, n=1 connective tissue disease (CTD) and n=1 both RA and CTD.

Mean attendance was 8/10 sessions with 100% attendance at the initial training and 79% attended the requested minimum of 5/10 group sessions.

RAND data suggested a trend towards improvement in the domains of role functioning due to emotional limitations, energy/fatigue, emotional well-being and general health. The qualitative data from semi-structured interviews and focus groups provided insights into the acceptability of the intervention. Preliminary findings suggested emerging themes of 'enjoyment', 'learning a new skill', 'support from group', 'improvements in well-being' and 'physical benefits'.

The results reveal the importance of this tailored approach to NW. The individualised training session reassured participants that the intervention was safe and the flexible route and ability to self-select rests enabled participants to walk at their own pace whilst remaining in sight of their peers and instructor. The adapted warm-up and cool-down was an important part of the intervention which participants reported as contributing significantly to the benefits they experienced.

Participants said they would not join a standard NW group following the intervention due to fear of holding up other walkers or being 'stranded' if they experienced problems during the walk. They reported enjoying learning a new skill and that their training and development of technique continued throughout all 10 group sessions.

Since taking part at least 10 of the 24 participants have purchased NW poles to continue independently. Others said they would keep NW in their 'repertoire' of physical activities to potentially return to in the future. Barriers to continuing included work commitments and the cost of purchasing NW poles.

This tailored delivery of NW has the potential to offer an acceptable, beneficial and sustainable physical activity for people with inflammatory rheumatic diseases.

The research team are currently preparing an NIHR Public Health Research grant application to determine whether this intervention is scalable and replicable and whether increased physical activity is sustained after participating in this tailored NW programme.

Project outputs

Domaille M, Whybrow P, Carver E, Dures E, Greenwood R, Richards P, Robson J, Stellinga R, Cramp F (2019) "Is a novel delivery of NW acceptable for people with inflammatory rheumatic disease?" Rapid 5 platform presentation, Physio UK Conference, Birmingham, UK 1st-2nd November

Domaille M, Whybrow P, Carver E, Dures E, Greenwood R, Richards P, Robson J, Stellinga R, Cramp F (2019) "Is a novel delivery of NW acceptable for people with inflammatory rheumatic disease?" e-poster presentation, Public Health England Conference, Warwick University, 10th-11th September

Domaille M, Whybrow P, Carver E, Dures E, Greenwood R, Richards P, Robson J, Stellinga R, Cramp F (2019) "Is a novel delivery of NW acceptable for people with inflammatory rheumatic disease?" Poster presentation, Annual European Congress of Rheumatology (EULAR), Madrid, Spain, 12th - 15th June

Domaille M, Whybrow P, Carver E, Dures E, Greenwood R, Richards P, Robson J, Stellinga R, Cramp F (2019) "Is a novel delivery of NW acceptable for people with inflammatory rheumatic disease?" Poster presentation, British Society for Rheumatology Annual Conference, Birmingham, UK April 30 - May 2

Main findings

A total of 24 people with inflammatory rheumatic diseases (IRD) took part in this study and all 24 completed our questionnaires at the end. We ran one group for 12 people from May to July 2018 and a second group for 12 different people from September to November 2018. Everyone attended the initial training session and 79% of people attended at least 5 out of the 10 group sessions.

What did we find?

The questionnaire results suggested a trend towards improvements in fatigue, emotional well-being, and general health. At the focus groups and interviews people told us that benefits they had experienced included enjoyment, better posture, walking taller and improved well-being. We were interested to discover how valuable people had found the changes we had made to a standard NW group. We heard that it was essential to have a central base to leave valuables and for the route to be flexible. Being able to choose a comfortable walking pace and be able to rest whenever needed helped people to feel confident to take part. There were positive comments about how adaptable the NW was to suit each individual and several people liked learning a new skill. At least 10 people have told us they have purchased their own NW poles since taking part in the study and are continuing with this activity either by themselves, with friends and family or with people they met during the study.

In summary, we found that the tailored NW intervention we developed was not only acceptable to people with IRD, but also has the potential to be beneficial and sustainable in the longer term.

Impact

There has been a lot of interest in NW from rheumatology teams and physiotherapists in the UK. An article has been published on the Chartered Society of Physiotherapy website https://www.csp.org.uk/news/2018-12-11-study-finds-nordic-walking-could-help-inflammatory-rheumatic-diseases and in the printed publication 'Frontline'.

The results were presented as a poster at the British Society of Rheumatology Annual Conference in Birmingham in April 2019, the Annual European Rheumatology Congress in Madrid in June 2019, the Public Health England Conference in September 2019 and are due to be presented at the Physio UK Conference in Birmingham in November 2019. This study has also won a Public Health Research Award for Allied Healthcare Professions.

We are in the process of writing an application for funding for a larger study where we can further test whether this tailored NW intervention is beneficial, cost effective and sustainable for people with IRD. We are also preparing a paper for publication in a relevant, peer-reviewed journal.

In the longer term this tailored NW programme could be delivered in partnership with local council exercise schemes and government health walks making it cost-effective and sustainable. It may also be beneficial to people with other long-term conditions which could be investigated in a further study.

Updated 01/10/2019