Patient Education, Sports Advice and Guiding Exercise Behavior Change

Bas starts education by asking what the patient already knows and ends by asking them to apply it to their own situation. Topics include the disease and its higher risk of osteoporosis and cardiovascular disease, physical activity, smoking cessation, diet, fall prevention, posture, and coping with pain, stress and fatigue. The 2018 EULAR recommendations confirm that general activity guidelines are safe and effective in spondyloarthritis. Sports advice adapted from the NASS Back to Action handbook sorts activities into recommended, use with caution and discouraged, based on pushing past limits, fast uncontrolled movements and fall or contact risk. About half of patients do not follow exercise advice. His PhD intervention mapping study found self-efficacy and motivation to be the key determinants, matched with methods such as guided practice, motivational interviewing, self-management training, group exercise and action planning across education, motivation, activation and maintenance phases. Change talk asks questions so the patient voices the reasons to exercise. Action plans set what, when, where and how long, with confidence of 7/10 or more.