Balance between sleep and exercise may be key to help osteoarthritis patients manage pain

Although osteoarthritis has no cure, researchers are developing a new intervention to improve patients’ chronic pain outcomes.

10:00 AM

Author | Noah Fromson

Police officer in uniform performing CPR to person lying on ground. Ambulance in  background.
Graphic

It may shoot through the hands while typing or flare in the knees when getting out of the car. Wherever the pain, over 32 million Americans living with osteoarthritis experience it.

To reduce that pain, patients living with the degenerative joint disease are often told to exercise.

It sounds simple.

But people with osteoarthritis may experience pain when they start to move more, which can be a deterrent to taking up, or sticking with, an exercise program.

Like Podcasts? Add the Michigan Medicine News Break on iTunes or anywhere you listen to podcasts.

"Pain during movement is an important reason why this population isn't more active, and we need to identify ways we can help to change this," said Daniel Whibley, Ph.D., research assistant professor of physical medicine and rehabilitation at Michigan Medicine. "Otherwise, they may end up in a loop of pain and inactivity that we know can lead to disability later down the line."

A growing body of research suggests that maintaining good sleep health – specifically good quality sleep for an appropriate duration – in patients with osteoarthritis may reduce pain. There is also strong evidence supporting links between sleep and being physically active.

"If you're sleeping well, you're more likely to be able to move more the next day or stick with a planned exercise program," Whibley said. "And those who are physically active during the day are more likely to get a good night's sleep."

Whibley's team looked to develop a new intervention that brought together insights from previous research that supports these relationships.

SEE ALSO: How Osteoarthritis and Rheumatoid Arthritis Differ

"There are many different physical activity or exercise programs for people with osteoarthritis, but they spend relatively little time on sleep," he said. "Conversely, some researchers have started to investigate the effectiveness of cognitive behavioral therapy, the process of rooting out problematic thoughts and changing cognitive patterns, for insomnia as a way of reducing osteoarthritis-related pain."

What hasn't been investigated is whether intensively and simultaneously targeting both sleep and physical activity – and the optimal balance between them – results in better pain outcomes. Alongside a team of researchers, Whibley introduced the concept of a hybrid sleep-exercise program to two focus groups composed of people living with osteoarthritis-related pain and sleep disturbances.

The sleep improvement component involves an automated program called Sleepio, which delivers cognitive-behavioral therapy for insomnia over the internet, as well as components focused on sleep education and behavioral modifications to sleep routines. In tandem with the six-week Sleepio course, users complete an exercise program with remote weekly support from a program coach.

During the focus groups, researchers explained the outline plan for the hybrid program and encouraged discussion between participants about how best to adapt design and delivery plans. These discussions informed the development of prototype materials which were then shared and refined with the same study participants at a second round of focus groups held a month later.

The findings, published in the British Journal of Pain and supported through Versus Arthritis and the Dan Barry Research Program, reveal that motivational language, personal accountability and accessible educational materials are important features to include in a successful program for sleep and exercise for osteoarthritis-related pain.

"The participants wanted to be encouraged to stick to the sleep and exercise components of the program using terms void of negative associations that made it seem like punishment," Whibley said. "They also wanted to share records of activity with health care professionals without feeling like they have no power in the dynamic."

Pain during movement is an important reason why this population isn't more active, and we need to identify ways we can help to change this.
Daniel Whibley, Ph.D.

These features, however, also present parallel challenges.

Previous negative interactions with health care providers – like feeling patronized or underestimated – and being asked to excessively record sleep and daily physical activity may cause people using the program to feel disinterested or discouraged, said Anna Kratz, Ph.D., a co-investigator on the study and associate professor of physical medicine and rehabilitation at Michigan Medicine. 

"Developing an understanding of what factors may present barriers to engaging with the program was a primary reason to conduct the focus groups," Kratz said. "In response to our findings, we were then able to create intervention materials that would be more attractive to potential users, including a workbook that supports adaptation of intervention content for the individual using it – they can set their own activity or sleep goals and keep track of their progress."

SEE ALSO: Could an Athlete's Own Stem Cells Stop Arthritis Development After an ACL Tear?

A test of the program's feasibility is currently underway with a small group of people living with osteoarthritis. Once complete, the team will conduct a full trial. The results, Whibley hopes, will provide more insight into the relationship between sleep, physical activity and exercise, and how their balance can impact pain in this population.

MORE FROM THE LAB: Subscribe to our weekly newsletter

"People living with osteoarthritis want to improve their sleep, physical activity and exercise behavior and reduce their pain – all of these are valued outcomes," Whibley said. "I'm not saying this new program will be a magic bullet for everyone, but I think the hybrid approach holds great potential for the future of osteoarthritis-related pain management."

Paper cited: "Development of a hybrid sleep and physical activity improvement intervention for adults with osteoarthritis-related pain and sleep disturbance: a focus group study with potential users," British Journal of PainDOI: 10.1177/20494637211026049

Move & Snooze research study participation: Do you have osteoarthritis? Do you want to move more and sleep better? Take part in a research study designed to improve activity levels and sleep for people with this condition by reaching out to the Epidemiology Group at the University of Aberdeen at [email protected]


More Articles About: Body Work Osteoarthritis Insomnia Sleep Study Joint Pain Exercise Rheumatology
Health Lab word mark overlaying blue cells
Health Lab

Explore a variety of health care news & stories by visiting the Health Lab home page for more articles.

Media Contact Public Relations

Department of Communication at Michigan Medicine

[email protected]

734-764-2220

Stay Informed

Want top health & research news weekly? Sign up for Health Lab’s newsletters today!

Subscribe
Featured News & Stories man holding cat in michigan sweater
Health Lab
Inside antiphospholipid syndrome: a patient's personal health journey
Antiphospholipid syndrome can cause many complications in the body making daily tasks difficult. With comprehensive medical care at University of Michigan Health, one patient is taking control of his diagnosis.
3 staff members holding up happy 20th wedding anniversary sign to patient in bed
Health Lab
A scleroderma clinical trial brings a better quality of life for one participant
The CAR-T treatment has been used in cancer patients for years. Now the approach is being used for those with severe scleroderma to teach the body to fight the autoimmune disorder.
two hearts next to each other with small figure people inside and out of it
Health Lab
How neutrophil calprotectin unmasks future atherosclerotic heart disease risk
The immune system is showing evidence of playing a roll in the emergence of atherosclerotic cardiovascular disease. A rush of neutrophils, or immune cells to the site could be an explanation for how this condition forms as well as how to prevent this heart disease in the future.
lungs beating pink and orange and yellow and white circles floating around
Health Lab
Protein found in rheumatic diseases causes inflammation in COVID-19 patients
Research on the inflammatory mediator called sCD13 has identified this molecule and its receptors as new targets for treatment of autoimmune rheumatic diseases. The data suggests that sCD13 may also be of great importance in severe complications of COVID-19.
ultrasound scan on yellow background with red dot found in two images
Health Lab
Using ultrasound technology to quickly diagnose giant cell arteritis
Ultrasound technology at University of Michigan Health is helping diagnose giant cell arteritis in patients to begin potentially moving away from using invasive surgical biopsy methods.
woman walking sleeping in photo above her.
Health Lab
Sleep health may impact mobility for women with chronic conditions
Women diagnosed with chronic conditions, such as osteoarthritis, multiple sclerosis and diabetes, experiencing poor sleep are at a higher risk of needing mobility aids sooner in life. Addressing sleep issues in these women may be crucial to better mobility.