Symptoms include fatigue, irritated sin, dryness of eyes an mouth, jaundice.

Psoriasis with Arthritis This condition causes a build up of new skin cells that grow deep in the skin. Arthritis causes pain and discomfort in the joints of the body. Symptoms include red patches with scale- like appearance affecting the head/elbows/knees, Painful, itchy. Painful joints. Back pain can occur if the condition affects the spine. Rheumatoid Arthritis (RA) The immune system attacks the lining of the joints. Symptoms include pain and stiffness of joints, deformity of joints, reduced movement and function of joints, fatigue. May also experience weight loss, fever, anaemia, lung disease, tissue formation under the skin (lumps). Scleroderma The condition causes abnormal growth of the connective tissue of the skin and the blood vessels. Symptoms include change in colour in hands and feet in response to heat and cold, painful joints, swelling and stiffness in joints, tightening of skin on face, weight loss, shortness of breath, difficulty swallowing, sores appearing on fingers and toes, thickening of skin, constipation. Sjögren’s Syndrome The immune system attacks the moisture producing glands of the body. Symptoms include dryness of eyes and mouth, mouth sores, difficulty swallowing, fatigue, swelling of joints, swollen glands, clouding vision, hoarse voice, dental cavities. Systemic Lupus Erythematosus The immune system can attack multiple systems and organs of the body including the joints, skin, kidneys, heart, and lungs. Symptoms include fatigue, fever, mouth sores, hair loss, weight loss, rash that can appear on face or other parts of the body, pain in joints, swelling of joints, muscle pain, sensitivity to the sun, chest pain, headache memory problems and change in behaviour.

Autoimmune conditions are a fascinating, yet poorly understood (1). Research (4, 5, 6, 7) has shown that exercise has benefits for this population, and thus a demand is placed upon the exercise professional to provide safe programmes for clients with these

conditions. A study by Williams (8) suggests that exercise can be beneficial in the management of symptoms of fatigue, self- efficacy and can increase energy levels in people with autoimmune conditions. Research based on resistance-type training has been demonstrated to be beneficial in several of the more common autoimmune conditions. Recent studies have highlighted the many benefits of endurance and strength training on people with multiple sclerosis (MS) to include improvement in mood, enhanced quality of life, an increase in strength, mobility and aerobic capacity (4). Studies had previously recommended low intensity, fixed range of movement isometric exercise for people with rheumatoid arthritis (RA), yet more recent research has shown that weight bearing exercise that increase aerobic capacity as well as an increase in muscle strength are beneficial (7). In another study (9) the effects of a home-based aerobic exercise intervention for patients with systemic rheumatic disease was investigated. The intervention involved three months of stationary cycling and resulted in reported decrease in depression, fatigue and improved tolerance to exercise.

Although these are promising studies, the dissemination of this academic research to the trainers and instructors at the ‘chalk face’ can be problematic. Information on conditions such as rheumatoid arthritis, systemic lupus erythematosus, MS, haemolytic anaemia and Type 1 Diabetes is evident in the academic and medical literature but there is little information available to exercise professionals when working with other autoimmune conditions, and a dearth of practical training or CPD to help personal trainers or instructors. In light of this, a small scale research study was conducted to investigate how personal trainers and gym instructors accessed information to help them design safe programmes for their clients with autoimmune conditions.

Method 10 personal trainers and 10 gym instructors were asked to take part in the initial phase of the study. They were actively working in gyms or were self-employed personal trainers and all conducted programme setting for clients. All were based in the East Midlands. The sample

Table 1: Participant’s knowledge on autoimmune conditions and experience of programme setting for clients with these conditions

CONDITION

Rheumatoid Arthritis Diabetes Type 1 Multiple Sclerosis Celiac Disease

Psoriasis with Arthritis Hemolytic Anemia Hashimoto’s Disease

Inflammatory Myopathies

Autoimmune Hepatitis Sjögren’s Syndrome

Primary Biliary Cirrhosis Myasthenia Gravis Guillain-Barre

16

DETAILED AWARE KNOWLEDGE 65% 55% 45% 45%

Inflammatory Bowel Disease 35% Graves’ Disease

30% 20% 20% 20% 15%

Systemic Lupus Erythematous 5% Scleroderma

5% 5% 0% 0% 0% 0%

35% 45% 55% 45% 55% 70% 65% 45% 75% 45% 45% 25% 55% 25% 25% 15% 15%

NO

OF KNOWLEDGE 0% 0% 0%

10% 10% 0%

15% 35% 5%

40% 50% 70% 40% 75% 75% 85% 85%

PROGRAMMED FOR 55% 55% 45% 30% 35% 35% 20% 0%

20% 10% 30% 5% 5% 0% 0% 0% 0%

Table 2: Training format and provider preferred by fitness professionals in the study

SOURCE OF

INFORMATION Internet

Co-worker/Manager as trainer Books

PERCENTAGE OF

PARTICIPANTS USED 38%

19% 19%

Other (in house training; downloadable data base) 16% General Practitioner as trainer

8%

Table 3. Table of main themes from the interviews

Development of specialist knowledge Working with Healthcare professionals Gaining Confidence Training/access to information Learning by working with clients

The REPs Journal 2013;28(September):15-17