**3. The impact of the health professional**

The health professional has an important role when prescribing exercise to a patient with RA. Due to the nature of their condition, RA patients are in frequent contact with their healthcare team and place great value on the information they provide (Lambert et al., 2000; Kamwendo et al., 1999). Hence, this regular contact forms an integral part of patient perceptions relating to exercise. However, evidence suggests that this is not a source from which they consistently get appropriate information (Lambert et al., 2000; Law et al., 2010). For example:

*'I would really like to know what they call exercise and whether or not it conforms to what I think is exercise'* (66 year old male).

On the other hand, health professionals are increasingly involved in conducting or referring to an exercise programme and those focus group patients who attended a specialised exercise class (an 8-week circuit-based exercise programme of 8–12 stations) demonstrated more experiential and education-derived knowledge of the types of exercise they could do. This is also consistent with findings comparing the views of active and inactive people with arthritis, with the active patients found to have additional exercise knowledge and the ability to draw from past experiences (Wilcox et al., 2006). An example is provided in a quote from a 65 year old female patient:

*'There are lots of exercises that you can do at home…I'll go to the stairs and spend 10 minutes as fast as I can up one step down, up down. Just that little exercise that we did.'* (65 year old female patient)

In contrast, the knowledge of non-attendees appeared to be mainly speculative. Nonetheless, whilst exercise class attendees did not highlight disadvantages to the same extent, queries relating to pain and its link with harm were still expressed, especially regarding exercises of a higher intensity. Therefore, it remains necessary that health professionals address these concerns, even with those who are currently exercising or have done so in the past.

It is also important to note further ways in which the health professional may impact upon patient perceptions and exercise behaviour. Unfortunately, interventions designed to provide advice and support for increasing physical activity levels have been largely unsuccessful in increasing long-term participation (Hillsden et al., 2002; van der Bij et al., 2002). Iversen et al. (2004a) examined the predictors of exercise behaviour in RA patients at six months following consultation with their rheumatologist and found that patients were more likely to be engaged in exercise if their rheumatologist was currently performing aerobic exercise themselves. This research also concluded that discussions

beneficial effects. Furthermore, there is a perception amongst patients that health professionals lack clarity and certainty regarding exercise, especially in relation to joint health. This perception of health professionals is also an important area to explore in order to determine if and where uncertainties exist, alongside the best way to deliver a clear and consistent message to the patient population. It may be that a firm and assertive approach to recommending exercise is important when prescribing exercise to people

The health professional has an important role when prescribing exercise to a patient with RA. Due to the nature of their condition, RA patients are in frequent contact with their healthcare team and place great value on the information they provide (Lambert et al., 2000; Kamwendo et al., 1999). Hence, this regular contact forms an integral part of patient perceptions relating to exercise. However, evidence suggests that this is not a source from which they consistently get appropriate information (Lambert et al., 2000; Law et al., 2010).

*'I would really like to know what they call exercise and whether or not it conforms to what I think is* 

On the other hand, health professionals are increasingly involved in conducting or referring to an exercise programme and those focus group patients who attended a specialised exercise class (an 8-week circuit-based exercise programme of 8–12 stations) demonstrated more experiential and education-derived knowledge of the types of exercise they could do. This is also consistent with findings comparing the views of active and inactive people with arthritis, with the active patients found to have additional exercise knowledge and the ability to draw from past experiences (Wilcox et al., 2006). An

*'There are lots of exercises that you can do at home…I'll go to the stairs and spend 10 minutes as fast as I can up one step down, up down. Just that little exercise that we did.'* (65 year old female

In contrast, the knowledge of non-attendees appeared to be mainly speculative. Nonetheless, whilst exercise class attendees did not highlight disadvantages to the same extent, queries relating to pain and its link with harm were still expressed, especially regarding exercises of a higher intensity. Therefore, it remains necessary that health professionals address these concerns, even with those who are currently exercising or have

It is also important to note further ways in which the health professional may impact upon patient perceptions and exercise behaviour. Unfortunately, interventions designed to provide advice and support for increasing physical activity levels have been largely unsuccessful in increasing long-term participation (Hillsden et al., 2002; van der Bij et al., 2002). Iversen et al. (2004a) examined the predictors of exercise behaviour in RA patients at six months following consultation with their rheumatologist and found that patients were more likely to be engaged in exercise if their rheumatologist was currently performing aerobic exercise themselves. This research also concluded that discussions

example is provided in a quote from a 65 year old female patient:

with RA.

For example:

patient)

done so in the past.

*exercise'* (66 year old male).

**3. The impact of the health professional** 

about exercise were four times more likely to occur when the rheumatologist initiated exercise discussion (Iversen et al., 2004a). These findings draw attention to the significance of health professionals and the influence they have on the exercise perceptions of this patient group.
