SEARCH

SEARCH BY CITATION

Abstract

  1. Top of page
  2. Abstract
  3. Introduction
  4. Materials and methods
  5. Results
  6. Discussion
  7. AUTHOR CONTRIBUTIONS
  8. Acknowledgements
  9. REFERENCES

Objective

To estimate the prevalence of overweight and obese Canadians with arthritis and to describe their use of arthritis self-management strategies, as well as explore the factors associated with not engaging in any self-management strategies.

Methods

Respondents to the 2009 Survey on Living with Chronic Diseases in Canada, a nationally representative sample of 4,565 Canadians age ≥20 years reporting health professional–diagnosed arthritis (including more than 100 rheumatic diseases and conditions), were asked about the impact of their arthritis and how it was managed. Among the overweight (body mass index [BMI] 25–29.9 kg/m2) and obese (BMI ≥30 kg/m2) individuals with arthritis (n = 2,869), the use of arthritis self-management strategies (i.e., exercise, weight control/loss, classes, and community-based programs) were analyzed. Log binomial regression analyses were used to examine factors associated with engaging in none versus any (≥1) of the 4 strategies.

Results

More than one-quarter (27.4%) of Canadians with arthritis were obese and an additional 39.9% were overweight. The overweight and obese individuals with arthritis were mostly female (59.5%), age ≥45 years (89.7%), and reported postsecondary education (69.0%). While most reported engagement in at least 1 self-management strategy (84.9%), less than half (45.6%) engaged in both weight control/loss and exercise. Factors independently associated with not engaging in any self-management strategies included lower education, not taking medications for arthritis, and no clinical recommendations from a health professional.

Conclusion

Fewer than half of the overweight and obese Canadians with arthritis engaged in both weight control/loss and exercise. The provision of targeted clinical recommendations (particularly low in individuals that did not engage in any self-management strategies) may help to facilitate participation.


Introduction

  1. Top of page
  2. Abstract
  3. Introduction
  4. Materials and methods
  5. Results
  6. Discussion
  7. AUTHOR CONTRIBUTIONS
  8. Acknowledgements
  9. REFERENCES

Arthritis is one of the most common chronic health conditions in the developed world and has a major impact on people's lives. In 2008, nearly 21% of US adults (46.4 million) had self-reported arthritis (1). Similarly, in 2007–2008, 16% of Canadians age ≥15 years (4.2 million) reported that they had arthritis (2). With the aging population, these numbers are expected to increase.

The most prevalent form of arthritis is osteoarthritis (OA) and obesity is a key risk factor for symptomatic OA. A recent meta-analysis showed that the physical disability of obese individuals with knee OA improved after moderate weight reduction (3). In addition to achieving and maintaining a healthy weight, physical activity has the potential to ease the pain associated with all types of arthritis (4). Maintaining optimal weight and exercising/engaging in physical activity are 2 evidence-based self-management strategies recommended for inclusion in public health efforts to reduce pain and limit arthritis-related disability. Other strategies include education or information on ways that individuals can manage problems related to their arthritis, such as self-management education programs led by lay leaders and/or health professionals that are designed to promote self-care for people with arthritis (5).

Increasing emphasis has been placed on arthritis self-management in the community (6). However, little is known about the uptake on a population level. Of particular interest is the participation of overweight and obese individuals with arthritis in self-management strategies, given that this population experiences more severe arthritis-related symptoms and impaired quality of life compared to those who maintain a healthy weight (7, 8), and therefore they are more likely to benefit.

The aim of our study was to provide up-to-date prevalence estimates of being overweight and obese among Canadians with arthritis, to describe this population's use of arthritis self-management strategies, and to examine the factors associated with not engaging in these self-management strategies.

Significance & Innovations

  • Using a national population-based sample, the present evidence emphasizes that there is a moderately (and statistically significant) greater proportion of Canadians with arthritis that are obese or overweight compared to the general Canadian population.

  • One in 10 overweight and obese Canadians with arthritis did not use any self-management strategies. Less than half (45.6%) of overweight and obese Canadians with arthritis are attempting to both optimize weight and engage in exercise/physical activity.

  • The provision of targeted clinical recommendation(s) from a doctor or other health professional and/or arthritis-related information from health professionals and/or public education campaigns may help to facilitate overweight and obese individuals with arthritis to engage in self-management strategies and reduce the consequences of physical inactivity.

Materials and methods

  1. Top of page
  2. Abstract
  3. Introduction
  4. Materials and methods
  5. Results
  6. Discussion
  7. AUTHOR CONTRIBUTIONS
  8. Acknowledgements
  9. REFERENCES

Data sources.

We used data from the arthritis component of the 2009 Survey on Living with Chronic Diseases in Canada (SLCDC), which was developed by the Public Health Agency of Canada and Statistics Canada in consultation with an expert working group on arthritis to provide information on how arthritis impacts Canadians and how it is managed (9). It is a cross-sectional survey of adults age ≥20 years living in private dwellings in the 10 Canadian provinces. Participants were drawn from the respondents to the 2008 Canadian Community Health Survey (CCHS) who reported having been diagnosed with arthritis by a health professional. Residents of the 3 Canadian territories, persons living on Indian reserves, residents of institutions, and full-time members of the Canadian Armed Forces were excluded from the survey (these exclusions represent <2% of the overall Canadian population). The arthritis component of the 2009 SLCDC was administered by trained personnel via a structured telephone interview (English or French) in February and March of 2009 (10).

A copy of the questionnaire is available at www.statcan.gc.ca/imdb-bmdi/instrument/5160_Q3_V1-eng.htm. To identify arthritis, the questionnaire includes the following queries: 1) “To begin, do you have arthritis, excluding fibromyalgia, which has been diagnosed by a health professional?” (response options: yes, no), 2) “Do you know the kind of arthritis you have?” (response options: yes, no), and 3) “What kind of arthritis do you have?” (with a list of 14 possible responses). As mentioned above, the aim of our study was to provide up-to-date prevalence estimates of being overweight/obese among Canadians with arthritis, to describe this population's use of arthritis self-management strategies, and to examine the factors associated with not engaging in these self-management strategies. To identify overweight and obese habitus, we constructed the body mass index (BMI) of each survey respondent by using their self-reported height and weight and dividing the weight (in kilograms) by the squared height (in meters).

Study population.

An overall sample of 7,062 respondents with arthritis was selected from the 2008 CCHS. A total of 5,820 respondents were contacted and 4,565 agreed to take part. These 4,565 respondents reported having been diagnosed with arthritis, consented to share their data with the Public Health Agency of Canada, Health Canada, and provincial governments, and to link the SLCDC information to their 2008 CCHS responses, thereby representing a response rate of 78.4% (9, 10). Of these respondents, those who were overweight or obese, defined according to the World Health Organization's international standards as a BMI of 25–29.9 kg/m2 or 30 kg/m2, respectively (11), served as the study population (n = 2,869).

Measures.

Outcome.

Self-management strategies were defined as things that individuals can do to help them cope with their arthritis, improve their arthritis symptoms, or keep further problems from developing. The respondents' use of self-management strategies was determined by asking whether they: 1) currently exercise or participate in physical activities to help manage problems related to their arthritis, 2) are currently trying to control or lose weight to help manage their arthritis, 3) have ever taken a course or class on how to manage problems related to their arthritis, and 4) have used any community-based facilities, services, or programs to help manage their arthritis in the past 12 months. Respondents were assigned into 1 of 2 groups on the basis of their engagement in either “none” versus “any” (1 or more) of the 4 self-management strategies mentioned above.

Potential correlates.

The analysis controlled for factors, selected a priori based on a review of the literature, that are known to be associated with engaging in self-management strategies (12, 13). These included sociodemographic factors, self-rated general health, number of painful joints in the past month, self-rated joint pain and/or fatigue in the past month, restrictions in activities of daily living (ADLs) in the past month, having seen or talked to any health professional about their arthritis during the past 12 months, use of prescription and nonprescription medications or natural treatments for their arthritis in the past month, and having ever received information and/or clinical recommendation(s) from a doctor or other health professional to help manage their arthritis. Based on the literature, severe joint pain and fatigue were defined as ≥7 on a scale of 1–10, with 10 being pain and fatigue as bad as it can be. Severe restriction in ADLs was defined as being limited a lot (versus a little or not at all) in at least 1 of the following: bathing or dressing, getting around the house, doing household chores, running errands or shopping, and activities such as recreation, leisure, hobbies, or social. Finally, we included type of arthritis as covariates (as self-reported in the questionnaire), i.e., OA, rheumatoid arthritis, other, multiple types, and not stated.

Statistical analysis.

To account for sample allocation and survey design, all estimates were weighted using survey weights generated by Statistics Canada to reflect the number of people in the Canadian population with arthritis (9, 10). Descriptive analyses were performed to compare those who were engaged in self-management strategies to help manage their arthritis versus those who were not in terms of demographic and clinical characteristics and use/receipt of clinical interventions for arthritis.

Multivariate log binomial regression models were used to estimate the crude and adjusted prevalence rate ratios (PRRs) for associations between the potential correlates and the engagement of overweight and obese individuals with arthritis in self-management strategies (14, 15). The 95% confidence intervals (95% CIs) around the PRRs were calculated using exact standard errors generated through bootstrap re-sampling techniques. For our primary analyses, we chose the comparison between engagement in any of (versus none of) the self-management strategies, since we were interested in the patient's global use of these strategies.

The overall missing data counted for <10% of the original data. However, to confirm that the estimates were not biased due to missing data, we used multiple imputation methods to account for this loss. Since the results were similar to those obtained by complete case analysis, we conducted the analyses without multiple imputation. The analyses were performed with SAS Enterprise Guide, version 4.1.

Results

  1. Top of page
  2. Abstract
  3. Introduction
  4. Materials and methods
  5. Results
  6. Discussion
  7. AUTHOR CONTRIBUTIONS
  8. Acknowledgements
  9. REFERENCES

Among surveyed Canadians with arthritis, more than one-quarter (27.4%; 95% CI 24.6–30.1%) were obese and an additional 39.9% (95% CI 36.8–43.0%) were overweight. Therefore, in our sample, more than two-thirds (67.3%) of Canadian adults (age ≥20 years) with arthritis were overweight or obese. In comparison, the 2007–2008 CCHS data demonstrate that half (52.0%) of the general adult Canadian population (age ≥20 years) were obese or overweight (2).

Among the overweight and obese Canadians with arthritis, the majority were women (59.9%), age ≥45 years (89.7%), and reported postsecondary education (69.0%). Close to half (44.2%) were unable to report the type of arthritis. Most reported being engaged in at least 1 of the 4 self-management strategies (84.9%). Approximately 60.9% reported current engagement in physical activity/exercise and 68.0% stated they were trying to control/lose weight to help manage their arthritis. Only 45.6% were engaged in both these strategies. Far fewer respondents reported ever taking a course/class and/or the use of community-based facilities, services, or programs in the past 12 months for arthritis management (9.2% and 10.9%, respectively). Only 2.2% reported being engaged in all 4 strategies. The proportion of overweight and obese individuals with arthritis that reported receiving a clinical recommendation from a doctor or other health professional to participate in physical activity/exercise, control/lose weight, or take a course/class to help manage their arthritis was also quite low at 49.5%, 45.5%, and 8%, respectively.

The characteristics of the overweight and obese Canadians with arthritis by self-management status are included in Table 1. The 2 groups were similar in most respects with the exception of those who engaged in at least 1 self-management strategy. They were more likely to be women, white, and have fair or poor general health, multiple painful joints, severe joint pain and fatigue, frequent joint pain, and severe limitation in ADLs.

Table 1. 2009 Survey on Living with Chronic Diseases in Canada: sociodemographic and clinical characteristics in overweight and obese individuals with arthritis (n = 2,869) according to their engagement in self-management strategies*
 Engaged (≥1 strategies)Not engaged (no strategies)
No.% (95% CI)No.% (95% CI)
  • *

    None of the continuous variables (age, body mass index [BMI], years living with symptoms and with a diagnosis of arthritis) had a normal distribution, therefore median and interquartile range (IQR) are presented. ADLs = activities of daily living.

  • Third decile and above.

  • Depression, bipolar disorder, mania, or dysthymia.

  • §

    High sampling variability (the coefficient of variation is between 16.6–33.3%).

  • Any one of the following chronic conditions: asthma, osteoporosis, hypertension, migraines, chronic obstructive lung disease, emphysema, diabetes mellitus, coronary artery disease, heart disease, cancer, gastrointestinal ulcers, stroke, urinary incontinence, inflammatory bowel disease, irritable bowel syndrome, dementia, anxiety disorder, Parkinson's disease, cataracts, glaucoma, or thyroid condition.

  • #

    Always or often (versus sometimes, rarely, or never).

  • **

    On average being ≥7 on a pain intensity/fatigue scale of 1–10 (with 10 being pain/fatigue as bad as it can be).

  • ††

    Being limited a lot (versus a little or not at all) due to their arthritis in at least 1 of the following activities: bathing or dressing, getting around the house, doing household chores, running errands or shopping, and activities such as recreation, leisure, hobbies, or social.

Age, median (IQR) years2,35862 (53–70)50665 (53–74)
BMI, median (IQR) kg/m22,35829.1 (27.2–32.7)50628.7 (26.6–31.8)
Years living with arthritis, median (IQR)2,35810 (4–19)5067 (4–15)
Women1,46561.7 (58.4–65.0)13847.8 (41.0–54.5)
Race (white)2,18784.2 (79.3–89.1)47996.0 (94.2–97.8)
Higher income1,53874.8 (70.7–78.9)32374.2 (67.9–80.4)
Postsecondary graduate1,40370.5 (67.0–74.1)26860.3 (53.3–67.2)
Married/common-law1,37971.1 (67.8–74.4)28264.3 (57.8–70.8)
Currently employed1,60665.7 (61.0–70.4)34461.7 (54.8–68.6)
Urban residence1,62376.3 (72.9–79.6)35278.9 (74.2–83.5)
Fair or poor self-rated general health72435.4 (30.3–40.4)13023.3 (18.0–28.7)
Back problems1,09148.4 (43.5–53.3)19239.1 (32.3–46.0)
Mood disorder30914.2 (10.8–17.6)4810.7 (6.4–15.1)§
At least 1 nonarthritic condition1,65479.7 (77.2–82.1)35676.7 (70.8–82.6)
Osteoarthritis1,02772.1 (67.3–76.9)15067.9 (57.3–78.6)
Rheumatoid arthritis31023.8 (19.2–28.3)5629.6 (19.1–40.2)§
Doesn't know type of arthritis92442.8 (37.9–47.7)27952.3 (45.4–59.2)
Family history of arthritis1,60668.6 (63.7–73.5)27958.0 (50.8–65.1)
Frequent joint pain in past month#1,45561.9 (57.3–66.4)23349.7 (42.7–56.7)
Severe joint pain in past month**73632.6 (28.2–36.9)10219.2 (14.3–24.2)
Multiple (>4) painful joints in past month1,14049.8 (45.2–54.4)16129.7 (23.9–35.4)
Frequent fatigue in past month#92239.6 (34.9–44.2)16733.0 (23.4–39.6)
Severe fatigue in past month**54229.4 (24.6–34.3)8415.4 (10.3–20.7)§
Severely limited ADLs in past month††87039.4 (34.4–44.4)10819.3 (14.4–24.2)
Has a medical doctor2,21995.7 (94.5–96.8)46490.3 (86.0–94.6)

The clinical strategies used/received by overweight and obese Canadians, according to their self-management status, are presented in Table 2. Those who engaged in at least 1 self-management strategy were more likely to use an assistive device or have taken medication(s) in the past month to manage their arthritis. They were also more likely to have received information on different aspects of arthritis, to have had contact with a health professional in the previous 12 months about their arthritis, and to have received a clinical recommendation from a health professional.

Table 2. 2009 Survey on Living with Chronic Diseases in Canada: use/receipt of clinical strategies among overweight and obese individuals with arthritis (n = 2,869) according to their engagement in self-management strategies*
 Engaged (≥1 strategies)Not engaged (no strategies)
No.% (95% CI)No.% (95% CI)
  • *

    95% CI = 95% confidence interval.

  • High sampling variability (the coefficient of variation is between 16.6–33.3%).

  • Including a general internist, mental health professional (such as psychiatrist, psychologist, social worker, or counselor), or a complementary or alternative health professional (such as massage therapist or osteopath).

  • §

    Course or class, use of assistive device, or contact with mental health professional.

Assistive devices currently used to help with arthritis problems    
 Any assistive device1,25249.2 (44.4–53.9)14724.6 (19.1–30.1)
 For walking/getting around49822.7 (18.3–27.1)679.4 (5.9–13.0)
 For dressing2287.9 (6.2–9.5)223.1 (1.4–4.9)
 An orthotic43118.6 (14.9–22.4)277.5 (3.8–11.2)
 Built up or special tool48719.6 (15.6–23.7)415.7 (3.4–7.9)
 Built up or special chair2005.7 (4.2–7.1)151.4 (0.6–2.2)
 A safety device62221.7 (18.6–24.8)7210.4 (6.9–14.0)
Medications taken in the past month for arthritis    
 Any medication2,11389.6 (86.5–92.6)37570.3 (63.9–76.8)
 Prescription98542.2 (37.7–46.8)15231.4 (24.7–38.2)
 Nonprescription1,60366.7 (62.0–71.4)27148.4 (41.4–55.4)
 Natural health products1,05042.1 (37.4–46.8)11821.9 (16.4–27.4)
Contact with health professionals in the past 12 months about arthritis    
 Any health professional1,87380.6 (77.0–84.2)29361.3 (54.6–68.1)
 Family doctor or general practitioner1,63369.6 (65.0–74.1)25050.9 (43.9–58.0)
 Orthopedic surgeon37416.0 (12.6–19.4)375.9 (2.6–9.2)
 Rheumatologist1847.6 (5.9–9.2)257.4 (3.0–11.7)
 Pharmacist59426.3 (21.6–30.9)6612.7 (8.0–17.4)
 Physical/occupational therapist45317.8 (14.3–21.3)348.6 (3.8–13.4)
 Other health professional53122.0 (17.8–26.1)439.1 (5.1–13.0)
Clinical recommendations made by health professionals to help manage arthritis    
 Any clinical recommendation1,71473.0 (68.1–78.0)16236.0 (29.0–43.1)
 Physical activity/exercise1,30654.5 (49.4–59.6)10321.2 (15.6–26.7)
 Weight control/loss1,10549.9 (45.2–54.5)7121.0 (14.3–27.6)
 Other recommendation§55022.9 (18.8–27.0)5010.4 (6.4–14.5)
Information received to help manage arthritis    
 Any kind of information1,74674.3 (70.0–78.6)26456.3 (49.4–63.2)
 Type of arthritis1,03944.4 (39.8–49.1)14833.9 (27.1–40.8)
 Protection of joints73734.8 (29.9–39.7)8118.5 (13.2–23.8)
 Energy conservation techniques58328.6 (23.6–33.6)4211.7 (6.4–17.0)
 Correct use of prescription medication1,15449.6 (44.9–54.3)13630.0 (23.0–37.0)
 Emotional impact of arthritis36114.2 (11.8–16.5)233.6 (1.8–5.4)
 Where to receive support42717.0 (13.7–20.3)318.9 (4.6–13.2)
 Where to find additional information60323.2 (19.7–26.6)5415.3 (9.5–21.2)

Factors independently associated with not engaging in any self-management strategies for arthritis included a lower education level, not taking medications for their arthritis in the past month, and no reported clinical recommendation to help manage their arthritis from a health professional (Table 3).

Table 3. 2009 Survey on Living with Chronic Diseases in Canada: factors independently associated with not engaging in any self-management strategies among overweight and obese individuals with arthritis*
 Prevalence rate ratio (95% CI)
CrudeAdjusted
  • *

    95% CI = 95% confidence interval.

  • Adjusted for all other covariates shown in Table.

  • P < 0.05.

  • §

    Having >4 painful joints in the past month.

  • Being ≥7 on a pain/fatigue scale of 1–10 (with 10 being pain/fatigue as bad as can be).

  • #

    Being limited a lot (versus a little or not at all) in at least 1 of the following activities: bathing or dressing, getting around the house, doing household chores, running errands or shopping, and activities such as recreation, leisure, hobbies, or social.

  • **

    P < 0.00001.

Sex  
 Male1.62 (1.24–2.13)1.17 (0.89–1.53)
 FemaleReferentReferent
Age, years  
 65–971.27 (0.79–2.04)1.06 (0.71–1.60)
 50–640.78 (0.47–1.29)0.95 (0.71–1.28)
 20–49ReferentReferent
Education  
 Less than postsecondary1.47 (1.10–1.96)1.41 (1.04–1.90)
 PostsecondaryReferentReferent
Self-rated general health  
 Good, very good, or excellent1.66 (1.19–2.31)1.13 (0.77–1.66)
 Fair or poorReferentReferent
Multiple painful joints§  
 No 1.26 (0.91–1.75)
 YesReferentReferent
Severe joint pain in the past month  
 No 1.32 (0.85–2.03)
 YesReferentReferent
Severe fatigue in the past month  
 No 1.44 (0.90–2.30)
 YesReferentReferent
Severe limitation in any ADLs in the past month due to arthritis#  
 No2.40 (1.71–3.36)1.39 (0.93–2.08)
 YesReferentReferent
Has consulted any health professional in previous 12 months about arthritis  
 No2.20 (1.64–2.92)1.03 (0.74–1.43)
 YesReferentReferent
Taken any medication in the past month for arthritis  
 No2.74 (2.01–3.74)1.54 (1.10–2.14)
 YesReferentReferent
Received any clinical recommendations to help manage arthritis  
 No3.67 (2.64–5.11)2.82 (1.99–3.99)**
 YesReferentReferent
Received any information on arthritis  
 No1.96 (1.47–2.60)1.33 (0.99–1.79)
 YesReferentReferent

Discussion

  1. Top of page
  2. Abstract
  3. Introduction
  4. Materials and methods
  5. Results
  6. Discussion
  7. AUTHOR CONTRIBUTIONS
  8. Acknowledgements
  9. REFERENCES

Using a national population-based sample, the present study emphasizes that there is a moderately (and statistically significant) greater proportion of Canadians with arthritis that are obese or overweight compared to the general Canadian population. This association between being overweight and obese and OA is well known.

Self-management activities are important in the management of arthritis and are recommended by authorities such as the American College of Rheumatology and the Public Health Agency of Canada (2). On one hand, it is encouraging that our study demonstrated that most (84.9%) overweight and obese Canadians with arthritis engaged in at least 1 self-management strategy to help manage their arthritis. However, less than half (45.6%) reported that they were both attempting to control/lose weight and engaging in exercise/physical activity. The limited engagement of the obese/overweight sample in combined weight control/loss and exercise/physical activity, despite the known benefits, is a key finding of our study.

We found that not engaging in any arthritis-related self-management strategies was associated with lower education, not taking medications for arthritis, and no clinical recommendations from a health professional. Other studies that used data from the US Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance Survey (BRFSS) have shown educational attainment to be a predicator of whether individuals with arthritis were more likely to engage in physical activity/exercise (12, 13) and whether individuals with arthritis met the Surgeon General's physical activity recommendations. There is a wealth of evidence demonstrating that those who are less educated are less healthy and are not as likely to engage in good health behaviors. The mechanisms by which education influences health are multifactorial and have been shown to include (but are not limited to) interrelationships between demographic and family background indicators, effects of poor health in childhood, greater resources associated with higher levels of education, a learned appreciation for the importance of good health behaviors, as well as an individual's social support and network. The use of medications for arthritis is a potential indicator of disease severity, and individuals with arthritis with lower joint pain intensity may be less motivated to engage in self-management strategies known to reduce arthritis pain and disability. Lastly, it is not surprising that not receiving any clinical recommendations from a health professional, or targeted information about managing arthritis, was associated with not engaging in any arthritis-related self-management strategies. A study using data from the 2004 BRFSS found that the respondents who were more likely to have engaged in recent physical activity/exercise were those that were advised by a health professional that exercise/physical activity might benefit their arthritis and those who had taken an arthritis-related course (12).

In the US, race has been a focus of interest in self-management research, particularly for African Americans with arthritis since this subgroup may experience poor outcomes. In our study, the respondents were predominately white. Therefore, we were unable to explore the effects of race on the use of self-management strategies.

Other factors, such as sex and functional status, have also been variously reported as affecting whether people with arthritis make use of self-management strategies. However, we found no relationship between sex or functional status as it was measured and the use of self-management strategies. Our study has a number of considerable strengths, including the large, randomly selected population-based sample and the administration of the survey by trained personnel using a structured format. One possible limitation relates to the use of self-report data, including the respondents' diagnoses of arthritis. However, self-reported arthritis surveys like the CCHS have been shown to have high reliability with fairly high sensitivity (approaching 84%) and moderate specificity (71%) (14, 15). In addition, the respondents were asked if their arthritis was diagnosed by a health professional, which has been shown to optimize specificity (15). A similar approach is used in surveillance activities of many national health agencies, such as the CDC, which notes that since respondents are frequently not familiar with their specific type of arthritis, these data are useful for the most general definition of arthritis, where any misclassification is likely to occur among arthritis categories already included in the case definition (16).

In summary, most overweight and obese Canadians with arthritis are engaged in at least 1 self-management strategy to help manage their arthritis. However, 1 in 10 overweight and obese Canadians with arthritis did not use any self-management strategies. More worrisome is this population's limited engagement in weight control/loss and exercise/physical activity despite the known benefits of these strategies. That is, less than half (45.6%) of overweight and obese Canadians with arthritis are attempting to both optimize weight and engage in exercise/physical activity. The provision of targeted clinical recommendation(s) from a doctor or other health professional and/or arthritis-related information from health professionals and/or public education campaigns may help to facilitate overweight and obese individuals with arthritis to engage in self-management strategies and reduce the consequences of physical inactivity. This may require novel approaches, such as brief teaching interventions using a pedometer, which may be a tool to enhance exercise in sedentary populations (17).

AUTHOR CONTRIBUTIONS

  1. Top of page
  2. Abstract
  3. Introduction
  4. Materials and methods
  5. Results
  6. Discussion
  7. AUTHOR CONTRIBUTIONS
  8. Acknowledgements
  9. REFERENCES

All authors were involved in drafting the article or revising it critically for important intellectual content, and all authors approved the final version to be submitted for publication. Dr. Bernatsky had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study conception and design. Bernatsky, O'Donnell, Mackay, Hawker, Badley.

Acquisition of data. O'Donnell.

Analysis and interpretation of data. Bernatsky, Rusu, O' Donnell, Mackay, Hawker, Canizares, Badley.

Acknowledgements

  1. Top of page
  2. Abstract
  3. Introduction
  4. Materials and methods
  5. Results
  6. Discussion
  7. AUTHOR CONTRIBUTIONS
  8. Acknowledgements
  9. REFERENCES

The authors wish to acknowledge the input of Louise McRae, Chronic Disease Surveillance and Monitoring Division, Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada.

REFERENCES

  1. Top of page
  2. Abstract
  3. Introduction
  4. Materials and methods
  5. Results
  6. Discussion
  7. AUTHOR CONTRIBUTIONS
  8. Acknowledgements
  9. REFERENCES
  • 1
    Helmick CG, Felson DT, Lawrence RC, Gabriel S, Hirsch R, Kwoh CK, et al, for the National Arthritis Data Workgroup. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: part I. Arthritis Rheum 2008; 58: 1525.
  • 2
    Public Health Agency of Canada. Life with arthritis in Canada: a personal and public health challenge. Ottawa: Public Health Agency of Canada; 2010.
  • 3
    Christensen R, Bartels EM, Astrup A, Bliddal H. Effect of weight reduction in obese patients diagnosed with knee osteoarthritis: a systematic review and meta-analysis. Ann Rheum Dis 2007; 66: 4339.
  • 4
    Feinglass J, Thompson JA, He XZ, Witt W, Chang RW, Baker DW. Effect of physical activity on functional status among older middle-age adults with arthritis. Arthritis Rheum 2005; 53: 87985.
  • 5
    Foster G, Taylor SJ, Eldridge S, Ramsay J, Griffiths CJ. Self-management education programmes by lay leaders for people with chronic conditions. Cochrane Database Syst Rev 2007; 4:CD005108.
  • 6
    H.R.1283: Arthritis Prevention, Control, and Cure Act of 2007. URL: http://www.opencongress.org/bill/110-h1283/show.
  • 7
    Pearson-Ceol J. Literature review on the effects of obesity on knee osteoarthritis. Orthop Nurs 2007; 26: 28992.
  • 8
    Garcia-Poma A, Segami MI, Mora CS, Ugarte MF, Terrazas HN, Rhor EA, et al. Obesity is independently associated with impaired quality of life in patients with rheumatoid arthritis. Clin Rheumatol 2007; 26: 18315.
  • 9
    Statistics Canada. Survey on living with chronic diseases in Canada: arthritis component, 2009 questionnaire. Ottawa: Statistics Canada; 2009.
  • 10
    Statistics Canada. Data users guide 2009: survey on living with chronic diseases in Canada. Ottawa: Statistics Canada; 2009.
  • 11
    World Health Organization. Fact sheet: obesity and overweight. Geneva: World Health Organization; 2006. URL: http://www.who.int/mediacentre/factsheets/fs311/en/.
  • 12
    Fontaine KR, Haaz S. Risk factors for lack of recent exercise in adults with self-reported, professional diagnosed arthritis. J Clin Rheumatol 2006: 12: 669.
  • 13
    Miller CW, James NT, Fos PJ, Zhang L, Wall P, Welch C. Health status, physical disability, and obesity among adult Mississippians with chronic joint symptoms or doctor- diagnosed arthritis: findings from the Behavioral Risk Factor Surveillance System, 2003. Prev Chronic Dis 2008; 5: A85.
  • 14
    Bombard JM, Powell KE, Martin LM, Helmick CG, Wilson WH. Validity and reliability of self-reported arthritis: Georgia senior centers, 2000-2001. Am J Prev Med 2005; 28: 2518.
  • 15
    Sacks JJ, Harrold LR, Helmick CG, Gurwitz JH, Emani S, Yood RA. Validation of a surveillance case definition for arthritis. J Rheumatol 2005; 32: 3407.
  • 16
    Centers for Disease Control and Prevention. Arthritis basics. URL: http://www.cdc.gov/arthritis/basics/general.htm.
  • 17
    Sugden JA, Sniehotta FF, Donnan PT, Boyle P, Johnston DW, McMurdo ME. The feasibility of using pedometers and brief advice to increase activity in sedentary older women. BMC Health Serv Res 2008; 8: 169.