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Hootman JM, Shih M, Brady TJ. National Rates Of Provider Advice For Exercise And Weight Loss Among Adults With Arthritis. Med Sci Sports Exerc 2005. [DOI: 10.1249/00005768-200505001-01293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Okoro CA, Hootman JM, Strine TW, Balluz LS, Mokdad AH. Disability, arthritis, and body weight among adults 45 years and older. ACTA ACUST UNITED AC 2004; 12:854-61. [PMID: 15166307 DOI: 10.1038/oby.2004.103] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To examine the association between body weight and disability among persons with and without self-reported arthritis. RESEARCH METHODS AND PROCEDURES Data were analyzed for noninstitutionalized adults, 45 years or older, in states that participated in the Behavioral Risk Factor Surveillance System. Self-reported BMI (kilograms per meter squared) was used to categorize participants into six BMI-defined groups: underweight (<18.5), normal weight (18.5 to < 25), overweight (25 to < 30), obese, class 1 (30 to < 35), obese, class 2 (35 to < 40), and obese, class 3 (> or = 40). RESULTS Class 3 obesity (BMI > or = 40) was significantly associated with disability among participants both with and without self-reported arthritis. The adjusted odds ratio (AOR) for disability in participants with class 3 obesity was 2.75 [95% confidence interval (CI) = 2.22 to 3.40] among those with self-reported arthritis and 1.77 (95% CI = 1.20 to 2.62) among those without self-reported arthritis compared with those of normal weight (BMI 18.5 to < 25). Persons with self-reported arthritis who were obese, class 2 (BMI 35 to < 40) and obese, class 1 (BMI 30 to <35) and women with self-reported arthritis who were overweight (BMI 25 to < 30) also had higher odds of disability compared with those of normal weight [AOR = 1.72 (95% CI = 1.47 to 2.00), AOR = 1.30 (95% CI = 1.17 to 1.44), and AOR = 1.18 (95% CI = 1.06 to 1.32), respectively]. DISCUSSION Our findings reveal that obesity is associated with disability. Preventing and controlling obesity may improve the quality of life for persons with and without self-reported arthritis.
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Strine TW, Hootman JM, Okoro CA, Balluz L, Moriarty DG, Owens M, Mokdad A. Frequent mental distress status among adults with arthritis age 45 years and older, 2001. Arthritis Care Res (Hoboken) 2004; 51:533-7. [PMID: 15334424 DOI: 10.1002/art.20530] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To identify characteristics and behaviors among persons with arthritis through evaluation of self-perceived mental health status. METHODS Data were analyzed for adults with arthritis age 45 years or older from the 2001 Behavioral Risk Factor Surveillance System, an ongoing, state-based, random-digit-dialed telephone survey of noninstitutionalized adults living in the United States. RESULTS The prevalence of frequent mental distress (FMD; > or =14 self-reported mentally unhealthy days in the past 30 days) among persons with arthritis was 13.4%. Among persons with arthritis, those with FMD as compared with those without FMD were more likely to be underweight and obese than normal weight; they also were more likely to be insufficiently active or inactive than following recommended physical activity guidelines. In addition, those with arthritis and FMD were more likely to report disability and impaired physical and general health than were those with arthritis but without FMD. CONCLUSION Physicians should encourage their patients with arthritis and mental distress to participate in educational and behavioral interventions shown to have both physical and psychological benefits.
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Abell JE, Hootman JM, Helmick CG. Prevalence and impact of arthritis among nursing home residents. Ann Rheum Dis 2004; 63:591-4. [PMID: 15082494 PMCID: PMC1755004 DOI: 10.1136/ard.2003.015479] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the prevalence, characteristics, and impact of arthritis in the US nursing home population. METHODS A national cross sectional sample of US nursing homes (8138 sampled residents in 1406 nursing homes) from the 1997 National Nursing Home Survey provided demographic and functional characteristics for residents with primary arthritis, any arthritis, or no arthritis diagnosis at admission. RESULTS Of the estimated 1.6 million current nursing home residents in 1997, only 43,000 (3%) had a primary and 300,000 (19%) had any arthritis diagnosis at admission. People with a primary or any arthritis diagnosis received physical/occupational therapy, used wheelchairs and walking aids, and needed assistance with walking and transferring more often than those with no arthritis diagnosis. CONCLUSIONS These national estimates suggest that arthritis is underreported in nursing home residents. Because arthritis contributes to an increased physical burden on staff and decreased functional capability of residents, both staff and residents can benefit from better diagnosis, intervention, and education.
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Hootman JM, FitzGerald S, Dunn AL, Church T. Interrelationship Between Physical Activity, Depressive Symptoms, Functional Limitationsand Musculoskeletal Complaints. Med Sci Sports Exerc 2004. [DOI: 10.1249/00005768-200405001-00778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Steves R, Hootman JM. Evidence-Based Medicine: What Is It and How Does It Apply to Athletic Training? J Athl Train 2004; 39:83-87. [PMID: 15085215 PMCID: PMC385266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
OBJECTIVE: To introduce the concept of evidence-based medicine (EBM) to athletic trainers. This overview provides information on how EBM can affect the clinical practice of athletic training and enhance the care given to patients. DATA SOURCES: We searched the MEDLINE and CINHAL bibliographic databases using the terms evidence-based medicine and best practice and the online Index to Abstracts of Cochrane Reviews by group (injury, musculoskeletal injuries, and musculoskeletal) to identify reviews on topics pertinent to athletic training. DATA SYNTHESIS: Evidence-based medical practice has 5 components: defining a clinically relevant question, searching for the best evidence, appraising the quality of the evidence, applying the evidence to clinical practice, and evaluating the process. Evidence-based medicine integrates the research evidence, clinician's expertise, and patient's preferences to guide clinical decision making. Critical to this effort is the availability of quality research on the effectiveness of sports medicine techniques. Athletic training outcomes research is lagging behind that of other health care professions. RECOMMENDATIONS: Athletic trainers need to embrace the critical-thinking skills to assess the medical literature and incorporate it into their clinical practice. The profession should encourage more clinically related research and enhance the scientific foundation of athletic training. Evidence-based medicine provides an important next step in the growth of the athletic training profession.
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Hootman JM. Editorial: New Section in JAT: Evidence-Based Practice. J Athl Train 2004; 39:9. [PMID: 15085204 PMCID: PMC385254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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Hootman JM. Acromioclavicular Dislocation: Conservative or Surgical Therapy. J Athl Train 2004; 39:10-11. [PMID: 15085205 PMCID: PMC385255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
REFERENCE: Phillips AM, Smart C, Groom AFG. Acromioclavicular dislocation: conservative or surgical therapy. Clin Orthop. 1998;353:10-17. CLINICAL QUESTION: Among patients with acromioclavicular (AC) dislocation, does surgical intervention produce better outcomes than conservative therapy? DATA SOURCES: Studies were identified by a MEDLINE search (1966-1997) and a manual search of the reference lists of each relevant study identified. The medical subject heading of acromioclavicular dislocation was used as the primary search term. STUDY SELECTION: The search was limited to English-language journals listed in Index Medicus. Studies were included if they described severely displaced dislocations of the AC joint, mostly characterized as grade III injuries (Allman or Rockwood classification) or if there was at least 1-cm displacement of the clavicle. If more than 1 study included the same group or subgroups of patients, the study with the best assessed methods was used. Studies were divided into 4 classifications: group 1, randomized trials of surgery versus conservative therapy; group 2, nonrandomized trials of surgery versus conservative therapy; group 3, surgical trials only; and group 4, conservative trials only. DATA EXTRACTION: Data-extraction and study quality-assessment procedures were not explained in detail. The primary outcome measures were overall outcome, return to work, return to premorbid activities, complications, and radiographic features. Secondary measures were pain, range of motion, and strength. RevMan software (version 1.05; Cochrane Centre, Oxford, UK) was used for statistical analysis. MAIN RESULTS: Specific search criteria identified 600 articles for review, of which 24 met inclusion and exclusion criteria: 2 in group 2, 3 in group 3, 14 in group 4, and 5 in group 4. A total of 1172 patients were represented (surgical treatment = 833, mean = 43.7 months' follow-up; conservative treatment = 339, mean = 60.4 months' follow-up). Both surgically and conservatively treated patients reported similar overall satisfactory outcome (88% surgical versus 87% conservative). Patients with surgical treatment reported longer time to return to work and premorbid activities. Among patients treated surgically, 59% had additional surgery, 6% had wound breakdown, 20% had fixation failure, and 3% reported residual deformity. Only 1% of conservatively treated patients reported wound problems, 6% had additional surgery, and 37% reported residual deformity. In only 1 study did the authors report the incidence of posttraumatic arthritis: 25% among surgically treated and 43% among conservatively treated patients. Analysis of secondary outcomes suggests that both groups had little or no pain (93% surgical, 96% conservative) but more conservatively treated patients had normal to near-normal range of motion (95% versus 86%) and normal strength (92% versus 87%). Conservative treatment of AC dislocations is 21% more likely to result in a satisfactory outcome than surgical treatment (odds ratio = 0.79, 95% confidence interval = 0.36, 1.71). The need for additional surgery is 7.4 times more likely and infection is 3.2 times more likely with surgical management. CONCLUSIONS: These data suggest that the current evidence does not support surgical treatment of grade III AC dislocations with respect to overall patient satisfaction as well as clinical outcomes such as pain, range of motion, and strength.
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Abstract
PURPOSE OF REVIEW Prevention may occur in clinical, community, or population settings and is often classified into primary, secondary, and tertiary types. To provide a context for this review, we define the three types and provide general and arthritis-specific examples of prevention strategies. Next, we highlight recently published longitudinal cohort and intervention studies that focus on arthritis prevention in the following topic areas: cognitive and behavioral strategies, obesity, exercise, and occupational injury prevention. RECENT FINDINGS Few studies examined primary prevention strategies. In one study, an educational intervention significantly changed tick-related knowledge and behaviors among a population at risk of Lyme disease. Another population-based study used a mailed, stage-based educational program to successfully increase physical activity levels; this intervention may have practical application as a primary or tertiary prevention strategy for arthritis. Tertiary prevention research received much attention: Recent studies extend the benefits of exercise and cognitive-behavioral interventions to persons with different rheumatic conditions (eg, neck pain, low back pain, systemic lupus erythematosus, fibromyalgia). Longitudinal cohort studies improve our understanding of the relationships between computer use and carpal tunnel syndrome among office workers, birth weight and hand osteoarthritis, and baseline balance and functional declines among older adults with knee pain. SUMMARY Prevention of arthritis and its complications is an active focus of investigation. Primary prevention research remains a challenge because of the prolonged time frame for disease expression. Scientific evidence continues to provide support for tertiary prevention strategies among people with documented rheumatic disease.
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Hootman JM, Macera CA, Helmick CG, Blair SN. Influence of physical activity-related joint stress on the risk of self-reported hip/knee osteoarthritis: a new method to quantify physical activity. Prev Med 2003; 36:636-44. [PMID: 12689810 DOI: 10.1016/s0091-7435(03)00018-5] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The relationship between physical activity (PA) and the development of hip/knee osteoarthritis (OA) has not been clearly defined. The purpose of this study was to develop a method to quantify PA-related joint stress and to assess its influence on the risk of hip/knee OA. METHODS Participants in a large longitudinal study, without knee/hip OA (n = 5284), were asked about their PA participation in 1986. PA-related joint stress was calculated using information on the frequency, intensity, and duration of individual types of PA, and incorporated a quantification of joint stress. Self-reported, physician-diagnosed hip/knee OA was ascertained by survey in 1990, 1995, and 1999 (average length of follow-up: 12.8 years). METHODS The joint stress PA score was not associated with an increased risk of hip/knee OA. Also, among walkers and runners there was no association between the frequency, pace, or weekly training mileage and hip/knee OA. Older age, previous joint injury and surgery, and higher body mass index were confirmed as independent risk factors for hip/knee OA. CONCLUSIONS Participation in PA as an adult does not increase the risk of hip/knee OA and there does not seem to be a threshold of increasing risk with increased training among walkers and runners.
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Hootman JM, Macera CA, Ham SA, Helmick CG, Sniezek JE. Physical activity levels among the general US adult population and in adults with and without arthritis. ARTHRITIS AND RHEUMATISM 2003; 49:129-35. [PMID: 12579604 DOI: 10.1002/art.10911] [Citation(s) in RCA: 174] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Macera CA, Hootman JM, Sniezek JE. Major public health benefits of physical activity. ARTHRITIS AND RHEUMATISM 2003; 49:122-8. [PMID: 12579603 DOI: 10.1002/art.10907] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Sniezek J, Macera CA, Hootman JM, Eyler AA. Work group recommendations: 2002 Exercise and Physical Activity Conference, St. Louis, Missouri/Session II, The Problems and Challenges of Inactivity. ACTA ACUST UNITED AC 2003. [DOI: 10.1002/art.545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Hootman JM, Helmick CG, Schappert SM. Magnitude and characteristics of arthritis and other rheumatic conditions on ambulatory medical care visits, United States, 1997. ARTHRITIS AND RHEUMATISM 2002; 47:571-81. [PMID: 12522829 DOI: 10.1002/art.10791] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To describe ambulatory medical care utilization, defined to exclude injury-related visits, for persons with arthritis and other rheumatic conditions. METHODS National estimates, rates, and other characteristics of ambulatory care visits were calculated from a national sample of patient visits to physician offices and acute care hospital outpatient and emergency departments. RESULTS An estimated 36.5 million ambulatory care visits were related to arthritis and other rheumatic conditions. Visit rates increased with age and, overall, were twice as high among women as men. Rates of visits by race varied by ambulatory care setting. Soft tissue disorders (9.3 million), osteoarthritis (7.1 million), nonspecific joint pain/effusion (7.0 million), and rheumatoid arthritis (3.9 million) were the most common diagnoses. CONCLUSIONS Arthritis and other rheumatic conditions account for about as many ambulatory care visits as cardiovascular disease or essential hypertension. These visits serve as excellent opportunities to counsel patients regarding prevention messages for arthritis.
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Rogers LQ, Macera CA, Hootman JM, Ainsworth BE, Blairi SN. The association between joint stress from physical activity and self-reported osteoarthritis: an analysis of the Cooper Clinic data. Osteoarthritis Cartilage 2002; 10:617-22. [PMID: 12479383 DOI: 10.1053/joca.2002.0802] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose was to evaluate the association between estimated joint stress from physical activity (PA) and hip/knee osteoarthritis (OA). DESIGN A nested case-control study was performed using data from the Aerobics Center Longitudinal Study. Participants without self-reported OA at baseline who attended the clinic between 1974 and 1993 and returned a follow-up questionnaire in 1990 or 1995 were eligible. Cases were those who reported a physician diagnosis of OA of the knee and/or hip at follow-up (N = 415). A random sample of persons in the remaining cohort were classified as controls (N = 1995). PA was measured at baseline by self-report and subjects were classified as 'moderate/high' or 'low' joint stress by PA type. Those reporting no PA were classified as sedentary with 'no' joint stress (the reference group). Men and women were analyzed separately. Stratified analysis and multiple logistic regression were used to assess the relationship between hip/knee OA and joint stress as predicted by PA. RESULTS After adjustment for age, body mass index, years of follow-up, and history of hip/knee joint injury, among men, there was no association between hip/knee OA and low joint stress while moderate/high joint stress was associated with reduced risk of hip/knee OA (adjusted odds ratio (OR) = 0.62, 95% confidence interval (CI) = 0.43-0.89). Among women, both levels of joint stress were associated with reduced risk of hip/knee OA (OR = 0.58, 95% CI = 0.34-0.99 for low and OR=0.24, 95% CI = 0.11-0.52 for moderate/high). CONCLUSIONS PA may reduce the risk of hip/knee OA, especially among women. Further research should assess the combined effects of frequency, intensity, duration and joint stress level of PA on incidence of hip/knee OA.
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Hootman JM, Sniezek JE, Helmick CG. Women and arthritis: burden, impact and prevention programs. JOURNAL OF WOMEN'S HEALTH & GENDER-BASED MEDICINE 2002; 11:407-16. [PMID: 12173574 DOI: 10.1089/15246090260137572] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To characterize the public health burden and impact of arthritis among women, document the growing interest in addressing arthritis as a public health problem, and review new national (Centers for Disease Control and Prevention [CDC]) and state arthritis programs. RESULTS Arthritis and other rheumatic diseases are a major public health problem, affecting nearly 27 million women in 1997 and accounting for 23.9 million ambulatory medical care visits and 451,000 hospitalizations among women in that year. Arthritis is also the leading cause of disability and is associated with considerable functional limitations. The 1999 National Arthritis Action Plan: A Public Health Strategy prompted first-time congressional funding to the CDC to monitor the burden of arthritis and to establish state arthritis prevention programs through cooperative agreements. The CDC's Arthritis Program also used this funding to build the public health science base, develop national health communications campaigns, foster partnerships, and initiate health systems change. CONCLUSIONS Arthritis in general and selected types, such as rheumatoid arthritis, systemic lupus erythmatosus (SLE), and fibromyalgia, disproportionately affect women. The CDC, state health departments, and their partners are working toward improving the quality of life for women affected by arthritis. Effective, evidence-based interventions, such as self-management education and physical activity programs, are currently available and can reduce pain, improve function, and delay disability, but they remain underused. Future research should focus on improving earlier diagnosis and increasing access to effective interventions.
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Hootman JM, Macera CA, Ainsworth BE, Addy CL, Martin M, Blair SN. Epidemiology of musculoskeletal injuries among sedentary and physically active adults. Med Sci Sports Exerc 2002; 34:838-44. [PMID: 11984303 DOI: 10.1097/00005768-200205000-00017] [Citation(s) in RCA: 211] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE This study describes the types and frequencies of musculoskeletal injuries among a cohort of adults with above average activity levels who were enrolled in the Aerobics Center Longitudinal Study (Dallas, TX). METHODS Participants were adults aged 20-85 yr who completed a baseline clinical examination (1970-1982) and returned a mailed follow-up survey in 1986. Participants (5,028 men, 1,285 women) were measured for aerobic fitness, height, and body weight during the baseline examination. They reported detailed information about their physical activity levels and injury experiences on the follow-up survey (1986). An injury was defined as any self-reported soft tissue or bone injury that occurred within the previous 12 months. Activity-related injuries were those injuries participants attributed to participation in a formal exercise program. RESULTS A quarter of all participants reported a musculoskeletal injury. Of these, 83% were activity-related. More than 66% of activity-related injuries occurred in the lower extremity; the knee was listed as the joint most often affected. There were no significant sex differences in the prevalence of injury, regardless of cause. Sport participants had the highest proportion of all-cause and activity-related musculoskeletal injuries among both men and women. Self-perceived severe injuries had a significant negative impact on physical activity levels since almost 1/3 of subjects reported permanently stopping their exercise program after injury. CONCLUSION These results suggest the need for developing and implementing injury prevention programs targeted toward moderately active adults.
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Hootman JM, Macera CA, Ainsworth BE, Martin M, Addy CL, Blair SN. Predictors of lower extremity injury among recreationally active adults. Clin J Sport Med 2002; 12:99-106. [PMID: 11953556 DOI: 10.1097/00042752-200203000-00006] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To identify gender-specific predictors of lower extremity injury among a sample of adults engaging in running, walking, or jogging (RWJ) for exercise. DESIGN Prospective cohort study. SETTING Cooper Clinic Preventive Medicine Center, Dallas, Texas. PARTICIPANTS Participants were 2,481 men and 609 women who underwent a physical examination between 1970 and 1981 and returned a follow-up survey in 1986. Predictor variables measured at baseline included height, weight, and cardiorespiratory fitness. At follow-up, participants recalled information about musculoskeletal injuries, physical activity levels, and other predictors for lower extremity injury over two time periods, 5 years and 12 months. MAIN OUTCOME MEASURES An injury was defined as any self-reported lower extremity injury that required a consultation with a physician. Cox proportional hazards regression (HR) was used to predict the probability of lower extremity injury for the 5-year recall period, and unconditional logistic regression was used for the 12-month recall period. RESULTS Among men, previous lower extremity injury was the strongest predictor of lower extremity injury (HR = 1.93-2.09), regardless of recall period. Among women, RWJ mileage >20 miles/wk was the strongest predictor for the 5-year period (HR = 2.08), and previous lower extremity injury was the strongest predictor for the 12-month period (HR = 2.81). CONCLUSIONS For healthy adults, walking at a brisk pace for 10-20 miles per week accumulates adequate moderate-intensity physical activity to meet national recommendations while minimizing the risk for musculoskeletal lower extremity injury. Clinicians may use this information to provide appropriate injury prevention counseling to their active patients.
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Hachmuth FA, Hootman JM. What impact on PA education? A snapshot of ambulatory care visits involving PAs. JAAPA 2001; 14:22-4, 27-38; quiz 49-50. [PMID: 11824088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
This study uses data from the 1997 National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey to describe nonfederal physician office, hospital outpatient, and emergency department visits involving physician assistants (PAs). Of an estimated 959 million visits to health care practitioners, 2.55% (an estimated 24,532,000) involved PAs. Diagnoses associated with ambulatory care visits involving PAs included well-infant and well-child examinations and the care of uncomplicated injuries or wounds and respiratory tract infections. On average, 3.1 medications were ordered or provided at a visit with a PA. The problems that PAs address are similar across the 3 ambulatory care settings analyzed, with some expected variation between physician office and emergency department visits. Generally, ambulatory care visits with PAs mirror visits with all health care providers who practice ambulatory care medicine. PA education programs should ensure that students can competently perform the skills needed for typical ambulatory care practice.
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Hootman JM, Macera CA, Ainsworth BE, Martin M, Addy CL, Blair SN. Association among physical activity level, cardiorespiratory fitness, and risk of musculoskeletal injury. Am J Epidemiol 2001; 154:251-8. [PMID: 11479190 DOI: 10.1093/aje/154.3.251] [Citation(s) in RCA: 178] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
To help public health practitioners promote physical activities with a low risk of injury, this study determined the relation among type and duration of physical activity, cardiorespiratory fitness, and musculoskeletal injury in a sample of adults enrolled in the Aerobics Center Longitudinal Study. Subjects included 4,034 men and 967 women who underwent a baseline physical examination between 1970 and 1985 and who returned a mailed follow-up survey in 1986. At baseline, a treadmill graded exercise test was used to measure cardiorespiratory fitness. At follow-up, subjects reported injuries and type and duration of physical activity in the preceding 12 months. Polytomous logistic regression was used to estimate the association among physical activity type and duration, cardiorespiratory fitness, and injury. The risk of sustaining an activity-related injury increased with higher duration of physical activity per week and cardiorespiratory fitness levels. Results suggest that cardiorespiratory fitness may be a surrogate for unmeasured components of physical activity, such as exercise intensity. Among walkers, increasing duration of activity per week was not associated with an increased risk of injury. Results suggest that, for most adults, walking is a safe form of physical activity associated with a lower risk of injury than running or sport participation.
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Hootman JM, Annest JL, Mercy JA, Ryan GW, Hargarten SW. National estimates of non-fatal firearm related injuries other than gunshot wounds. Inj Prev 2000; 6:268-74. [PMID: 11144625 PMCID: PMC1730658 DOI: 10.1136/ip.6.4.268] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To characterize non-fatal firearm related injuries other than gunshot wounds (non-GSWs) treated in hospital emergency departments in the United States that occur during routine gun handling and recreational use as well as violence related use of a firearm. METHODS Cases were identified through the National Electronic Injury Surveillance System (NEISS). During the study period, 1 January 1993 through 31 December 1996, NEISS consisted of a nationally representative sample of 91 hospitals in the United States having at least six beds and providing 24 hour emergency services. RESULTS An estimated 65 374, or an average of 16,300 per year, non-fatal, non-GSWs were treated in American hospital emergency departments during the four year study period. Fifty seven per cent of all the non-fatal, non-GSWs were violence related, most of which involved being struck by a firearm. The majority of unintentional non-fatal, non-GSWs were self inflicted and occurred during routine gun handling or recreational use of a firearm; 43% of these injuries resulted from gun recoils. CONCLUSIONS Non-fatal, non-GSWs make a notable contribution to the public health burden of firearm related injuries. Firearm related injury prevention programs should focus on not only the reduction of gunshot wounds but also the reduction of unintentional and violence related non-GSWs.
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Colbert LH, Hootman JM, Macera CA. Physical activity-related injuries in walkers and runners in the aerobics center longitudinal study. Clin J Sport Med 2000; 10:259-63. [PMID: 11086751 DOI: 10.1097/00042752-200010000-00006] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the association between physical activity-related injuries and participation in walking versus running. DESIGN Nested case-control study. SETTING Cooper Clinic Preventive Medicine Center, Dallas. Texas. PARTICIPANTS 5,327 men and women undergoing exams between 1987 and 1995 and completing follow-up health history questionnaires in 1990 or 1995. Participants were classified as those reporting regular participation in walking or jogging/running at baseline. Those reporting both or neither activity were excluded from the study (n = 1404). Cases (698 men, 169 women) were those reporting physical activity-related injuries requiring physician visits in the previous year on the follow-up questionnaire. Controls (2,358 men, 698 women) were randomly selected from the remaining population. MAIN OUTCOME MEASURES Logistic regression was used to examine the risk of injury in walkers versus runners and risk of injury by exercise dose while considering age, body mass index, previous injury, and strength training. RESULTS There was a significantly lower risk of injury for walkers compared with runners in young (<45 years old) (odds ratio [OR] = 0.75, 95% confidence interval [CI] = 0.58-0.97) and older (> or = 45 years) men (OR = 0.64, 95% CI = 0.49-0.82), and a nonsignificantly lower risk among young (OR = 0.73, 95% CI = 0.39-1.37) and older women (OR = 0.72, 95% CI = 0.38-1.35). There was no effect of greater amounts of walking on injuries for either gender; however, there was a higher injury risk associated with running 15-30 min/day (OR = 1.36, 95% CI = 1.07-1.73) and 30+ min/day (OR = 1.52, 95% CI = 1.14-2.04) compared with <15 min/day among men, but not among women. CONCLUSIONS This low risk of musculoskeletal injury suggests that participation in walking can be safely recommended as a way to improve health and fitness.
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