Physical activity, specifically that involving traditional exercise regimens, has been shown to be beneficial among persons with arthritis (1, 2). Indeed, a recent work group of the American College of Rheumatology (ACR) concluded that some level of physical activity is “necessary for the maintenance of joint health for both normal and arthritic joints” (3). Apart from arthritis-related benefits, regular physical activity decreases mortality and morbidity related to a number of diseases such as cardiovascular disease, cancer, and diabetes (4, 5). Despite this, the majority of US adults do not get enough physical activity to derive health benefits (5).
In 1996, the US Surgeon General identified physical inactivity as a public health problem and recommended that all US adults participate in regular, moderate-intensity leisure-time physical activity (4). Specifically, the Surgeon General recommends that every adult should accumulate at least 30 minutes of moderate-intensity physical activity (e.g., brisk walking, recreational swimming) at least 5 days per week or 20 minutes of vigorous-intensity physical activity (e.g., jogging, competitive sports) at least 3 days per week. To investigate whether US adults with arthritis are meeting this public health recommendation, we analyzed data from a recent large population-based survey.
- Top of page
- SUBJECTS AND METHODS
- APPENDIX A
Table 1 presents prevalence estimates of physical activity in adults with and without arthritis from the 2001 BRFSS. These data were broken down by a variety of demographic characteristics. Overall, 16.0 ± 0.8% of US adults (mean ± SEM) were estimated to be physically inactive, 38.7 ± 0.01% reported having insufficient levels of physical activity, and 45.3 ± 0.01% reported engaging in recommended levels of physical activity.
Table 1. Prevalence of physical activity (PA) in adults with or without arthritis from the 2001 Behavioral Risk Factor Surveillance Survey*
|Demographics||PA level prevalence, %†|
|Total||With arthritis||Without arthritis||Total||With arthritis||Without arthritis||Total||With arthritis||Without arthritis|
|Sex|| || || || || || || || || |
|Age group, years|| || || || || || || || || |
|Race/ethnicity|| || || || || || || || || |
| African American||24.1||35.4||20.8||39.8||39.8||39.8||36.2||24.9||39.4|
|BMI|| || || || || || || || || |
|Education, years|| || || || || || || || || |
| 12 or equivalent||18.7||25.2||16.6||38.3||38.9||38.1||43.0||35.9||45.3|
|Smoking|| || || || || || || || || |
Nearly one-quarter (23%) of the surveyed US adults reported having doctor-diagnosed arthritis. Among those persons reporting arthritis, 23.8 ± 0.2% were physically inactive, 38.0 ± 0.2% were insufficiently active, and 38.3 ± 0.2% met the public health recommendations for physical activity.
As shown in Table 1, by level of education, the prevalence of physical inactivity among adults with arthritis was highest among those subjects with 8 or fewer years of education (47.6%), followed by those with 9–11 years of education (35.5%). Subjects with arthritis in the oldest age category (age 65 years or older) had the highest prevalence of inactivity (31.1%). When classified according to race, African American and Hispanic subjects with arthritis had the highest prevalences of physical inactivity (35.4% and 30.4%, respectively).
- Top of page
- SUBJECTS AND METHODS
- APPENDIX A
These cross-sectional population-based survey data indicate that fewer than 4 of 10 US adults with self-reported, doctor-diagnosed arthritis reported meeting the public health recommendations for physical activity, and thus failed to accumulate at least 30 minutes of moderate-intensity physical activity on 5 or more days per week or 20 minutes of vigorous-intensity physical activity on 3 or more days per week. This observed prevalence rate falls well below the nearly 50% of US adults without arthritis who reported meeting the physical activity recommendations. Moreover, about one-quarter of the adults with arthritis reported being physically inactive, compared with 14% of adults without arthritis, whereas a similar rate of adults with or without arthritis were classified as insufficiently active (∼38%). We also found that the highest rates of physical inactivity were among persons with less formal education, African Americans, persons age 65 years or older, and Hispanics.
Our estimated prevalence rates of physical activity in adults with arthritis differed by ∼3–20% from those reported by Hootman and colleagues (10) from the 2000 BFRSS. For example, we observed a prevalence rate of physical inactivity of 21.7% among men with arthritis, whereas they reported a prevalence of 27.6% among men. It is important to note, however, that in 2001, the BRFSS Physical Activity Module was modified to improve the assessment of moderate-intensity physical activity. Moreover, Hootman et al defined arthritis as either doctor-diagnosed arthritis or the presence of chronic joint symptoms, whereas we restricted our arthritis group to only those persons who reported doctor-diagnosed arthritis. Thus, comparing estimates between the 2 studies may not be worthwhile.
Nonetheless, both sets of findings suggest that the majority of persons with arthritis do not meet the public health recommendations for physical activity. This is troubling, since physical activity has not only been shown to reduce pain and improve functioning and overall health in persons with arthritis (1, 2, 11), but also reduces medical costs (12). The reasons why the majority of persons with arthritis are not meeting physical activity recommendations are unclear, but may be related to arthritis-specific barriers to physical activity such as fear of making their arthritis worse, the lack of a physical activity recommendation from their physician/rheumatologist (13), and fatigue, as well as general barriers to physical activity such as lack of time, inclement weather, lack of self-motivation, and similar factors (14). It is also unknown why certain subgroups with self-reported arthritis (e.g., older adults, minorities) have a higher prevalence of inactivity, but this may be related to specific barriers unique to these groups that have yet to be identified.
From a public health perspective, the ∼25% of adults with arthritis who are currently inactive should be the priority of any efforts designed to promote physical activity in adults with arthritis. Our findings also suggest that a considerable proportion of adults with arthritis (∼38%) are physically active but not active enough to meet the recommendations. Finding ways to promote increased activity among this group may not be as challenging as promoting physical activity in subjects who are inactive, since these persons are already somewhat active, and promoting a modest increase in the duration and frequency of their current level of physical activity would allow them to meet the recommendations. Fortunately, there are many forms of moderate-intensity physical activity (e.g., swimming, bicycling, walking) that are gentle to the joints and can be performed regularly, both to improve functional status and to promote health in adults with arthritis.
Our findings are subject to limitations. First, the BRFSS is a self-report telephone survey and, therefore, prone to measurement error. Second, the self-reported arthritis was not confirmed by a physician, nor were the different types of arthritis/rheumatic diseases distinguished within the survey. Thus, interpreting and/or generalizing these findings to patients with specific arthritic or rheumatic diseases should be done with caution. Third, physical activity levels were also self-reported and not verified independently. Moreover, the way the BRFSS classifies the 3 levels of physical activity has shortcomings. For example, the classification scheme makes it possible for someone who accumulates 30 minutes of moderate-intensity physical activity in short bouts (i.e., 6 five-minute bouts) to be classified as insufficiently active, even though he or she is actually meeting the physical activity recommendations. Thus, it is possible that some proportion of those in the insufficiently active category were misclassified. Fourth, the BRFSS does not include the estimated 3–5% of the population that does not have telephones (7).
In conclusion, the majority of adults with arthritis do not meet the public health recommendations for physical activity. Thus, efforts should be made to ensure that persons with arthritis not only are made aware of the benefits of physical activity, but also are prescribed interventions to assist them in becoming more physically active. In particular, interventions should be developed that target those subgroups with the highest prevalences of inactivity (those with lower levels of formal education, minorities, and those age 65 years or older) to ensure that they can enjoy both the general health and arthritis-specific benefits that come from being physically active. Indeed, conducting market research to identify the preferences of subgroups of adults with arthritis, which would inform the development and promotion of tailored physical activity interventions, has recently been identified by the ACR exercise/physical activity work group as a research priority (15). Our findings support the importance of this research recommendation.