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Arthritis is a common health problem in the United States and the leading cause of disability (1). Exercise and physical activity (PA) can benefit persons with arthritis (2–4). The American College of Rheumatology recommends exercise or PA as part of the treatment of adults with arthritis (5). Apart from arthritis-related benefits, regular exercise or PA decreases morbidity and mortality from cardiovascular disease, cancer, and diabetes (6). However, we reported that <40% of US adults with self-reported, doctor-diagnosed arthritis report meeting the public health recommendation of accumulating at least 30 minutes of moderate-intensity PA on 5 or more days per week or 20 minutes of vigorous-intensity PA on 3 or more days per week (7). To describe the proportion and characteristics of adults with self-reported arthritis who were ever advised by a health professional to become more physically active and to assess whether the advice was associated with recent PA, we analyzed data from a recent, large, population-based survey.
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Nearly one-third (31.8%) of the adults surveyed reported having some form of arthritis. Sixty-eight percent of adults with arthritis were also administered the Arthritis Module containing the question regarding exercise/PA advice. As shown in Table 1, 42.3% of the 56,416 patients analyzed reported receiving advice from a health care provider. Respondents who received the advice were more likely than those who did not receive advice to be women, middle-aged or older, overweight or obese, African American or Hispanic, and have some college education. Inactive respondents were 11% more likely than those meeting PA recommendations to report receiving PA advice, while those who were insufficiently active were 19% more likely than those meeting PA recommendations to receive the advice.
Table 1. Demographics of patients with doctor-diagnosed arthritis, from 2003 Behavioral Risk Factor Surveillance Survey*
|Characteristic||Unweighted n||Received advice to increase PA, %||OR (95% CI)†|
|Sex|| || || |
| Female||32,159||46.2||1.59 (1.53–1.65)|
|Age, years|| || || |
| 25–34||4,996||35.2||0.97 (0.86–1.10)|
| 35–44||8,727||39.0||1.11 (0.99–1.24)|
| 45–54||12,361||43.3||1.32 (1.18–1.47)|
| 55–64||11,258||46.7||1.50 (1.35–1.68)|
| ≥65||16,669||43.6||1.47 (1.31–1.63)|
|Race/ethnicity|| || || |
| African American||3,448||48.8||1.21 (1.12–1.31)|
| Hispanic||2,714||45.0||1.21 (1.11–1.31)|
| Other||1,541||41.4||1.08 (0.96–1.20)|
|BMI, kg/m2|| || || |
| Overweight||19,656||40.1||1.22 (1.17–1.27)|
| Obese||15,473||51.1||1.87 (1.78–1.96)|
|PA level|| || || |
| Meet recommendations||9,439||41.6||1.00|
| Insufficient||20,923||45.0||1.19 (1.13–1.26)|
| Inactive||22,874||40.7||1.11 (1.05–1.17)|
|Education, years|| || || |
| 9–11||4,357||40.2||1.00 (0.89–1.13)|
| 12 or equivalent||18,379||41.4||1.07 (0.96–1.19)|
| 13–15||15,477||43.1||1.16 (1.04–1.29)|
| >15||15,806||43.5||1.26 (1.13–1.41)|
|Smoking|| || || |
| Current||12,322||38.6||0.96 (0.91–1.00)|
Forty-three percent who reported receiving advice had exercised within the past month (Table 2). However, those who ever received the advice were 17% less likely to report exercising within the past month than those who had not received the advice. These results were unchanged when we restricted the analysis to those who theoretically should get this advice (i.e., inactive and insufficiently active adults).
Table 2. Association between receiving advice to become more physically active from a physician or health care professional and exercise within the past 30 days among adults with arthritis
|Category||Unweighted n||Persons who have exercised within the past 30 days||OR (95% CI)*|
|Advised to become active|| || || |
| Yes||23,613||42.9||0.83 (0.79–0.87)|
In an analysis restricted to those who reported ever receiving the advice, we found that those with 13–15 years of formal education had nearly 3 times the odds of currently exercising, and those with >15 years of formal education had 4 times the odds of having exercised within the past month. Respondents who reported that they had not engaged in recent exercise or PA were more likely to be women, middle-aged or older, overweight or obese, current smokers, and minority race (Table 3). Again, these results were unchanged when we restricted our analysis to inactive and insufficiently active respondents.
Table 3. Factors associated with reporting PA within previous 30 days in respondents given advice to become more active*
|Characteristic||OR (95% CI)†|
| Female||0.77 (0.72–0.83)|
|Age, years|| |
| 25–34||1.02 (0.95–1.12)|
| 35–44||1.11 (0.97–1.19)|
| 45–54||0.41 (0.32–0.52)|
| 55–64||0.41 (0.32–0.52)|
| ≥65||0.30 (0.24–0.39)|
| African American||0.76 (0.68–0.85)|
| Hispanic||0.78 (0.68–0.89)|
| Other||0.77 (0.64–0.92)|
|BMI (kg/m2)|| |
| Overweight||0.84 (0.78–0.92)|
| Obese||0.51 (0.47–0.55)|
|Education, years|| |
| 9–11||1.15 (0.96–1.38)|
| 12 or equivalent||1.77 (1.51–2.07)|
| 13–15||2.59 (2.20–3.04)|
| >15||4.21 (3.56–4.97)|
| Current||0.59 (0.54–0.64)|
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These population-based survey data indicate that ∼40% of adults with self-reported arthritis report ever being advised by a health professional that PA might help their arthritis. This is troubling because increased PA has not only been shown to improve arthritis-related symptoms and overall health in persons with arthritis (2–5), but it also reduces medical costs (12).
We found that those most likely to be advised to become more physically active were individuals who were female, middle-aged or older, overweight or obese, and of higher levels of formal education. These results are similar to those obtained by others (13–18). For example, using data from the 2000 National Health Interview Survey, Honda reported that being middle-aged, having a college degree or higher, and being obese were associated with a higher likelihood of receiving physician advice to exercise (13). The reasons that demographic factors associate with receiving advice are unclear. It is possible that health professionals perceive that certain patient subgroups have greater need for or are more receptive to PA advice and target efforts towards these patients. The lower rates of advising men and those with lower education levels, even after adjusting for age, race, activity level, and weight status, are of concern because lower education tends to associate with poorer health outcomes (19).
Among those who report ever being advised, only ∼40% report exercising within the previous 30 days. Interestingly, receiving the advice was associated with lower odds of having recently exercised. Moreover, in analyses restricted to those who reported ever being advised to become more active, increased education was the only variable associated with reporting recent exercise or PA. Unfortunately, many factors associated with receiving the advice (e.g., being a woman, being obese) were negatively associated with recent exercise/PA, suggesting that the advice is not translating into behavior among the subgroups who might benefit most.
Although the cross-sectional nature of the BRFSS prohibits certainty about whether the advice preceded the recent exercise or PA, these findings suggest that merely advising increased PA is insufficient to promote a more active lifestyle. Glasgow et al reported that among patients who received exercise counseling from their physicians, only 40% reported receiving assistance in planning an exercise routine or followup support (14). As shown with smoking cessation (20), merely providing advice, in the absence of a discussion that is tailored to the needs of the individual, simply is not enough to help most patients adopt health behaviors. This may be especially so with arthritis patients who may have been previously (inappropriately) advised to limit their PA to protect their joints, and who have little knowledge about how to initiate exercise or PA in a safe and gradual manner. Iversen and colleagues reported that only about one-quarter of exercise-related discussions between rheumatologists and their patients culminated with an exercise prescription (21). This implies that, even within the context of a PA discussion for arthritis, health professionals may not provide enough specific information to help their patients become more active.
Our findings are subject to limitations. Apart from the previously mentioned cross-sectional nature of the BRFSS, all variables relied on self reports, including the diagnosis of arthritis. Moreover, we were unable to distinguish among the different types of arthritis/rheumatic diseases. Thus, these findings may not generalize to patients with specific arthritic or rheumatic diseases. The BRFSS also does not include persons without telephone service or those in the military or in institutions.
In conclusion, our results indicate that most adults with arthritis are not being advised to become more active. However, our results also suggest that those who receive the advice are less likely to be active than those who do not receive the advice, implying that advice alone is insufficient to promote PA. Given the efficacy of highly targeted PA interventions (21), systematic efforts should be made to ensure that not only are persons with arthritis advised to become more physically active, but that they are also given the education, resources, and support to do so.