Health care providers' recommendations for physical activity and adherence to physical activity guidelines among adults with arthritis

Investigating the Relationship Between Physical Activity Disparities and Health-Related Quality of Life Among Black People With Knee Osteoarthritis

INTRODUCTION

Knee osteoarthritis (OA) is the most common form of arthritis, which is a leading cause of disability. Although no cure exists for knee OA, physical activity has been shown to improve functionality, which can improve an individual's health-related quality of life (HR-QOL). However, racial disparities exist in participating in physical activity, which can result in Black people with knee OA experiencing lower HR-QOL compared with their White counterparts. The purpose of this study was to investigate disparities of physical activity and related determinants, specifically pain and depression, and how these constructs explain why Black people with knee OA experience low HR-QOL.

METHODS

Data were from the Osteoarthritis Initiative, a multicenter longitudinal study that collected data from people with knee OA. The study used a serial mediation model to test whether a change in scores for pain, depression, and physical activity over 96 months mediated the effects between race and HR-QOL.

RESULTS

Analysis of variance models found Black race to be associated with high pain, depression, and lower physical activity and HR-QOL at baseline and month 96. The findings supported the prospective multi-mediation model, which found pain, depression, and physical activity to mediate between race and HR-QOL (β = -0.11, SE = 0.047; 95% CI, -0.203 to -0.016).

CONCLUSION

Disparities in pain, depression, and physical activity could explain why Black people with knee OA experience lower HR-QOL compared with their White counterparts. Future interventions should address sources of pain and depression disparities by improving health care delivery. Additionally, designing race- and culture-appropriate community physical activity programs would help to achieve physical activity equity.

Results From a National Survey of Asthma Provider Beliefs and Practices Regarding Exercise and Asthma: A Work Group Report of the AAAAI Committee on Sports, Exercise, and Fitness

BACKGROUND

National Heart, Lung, and Blood Institute guidelines recommend regular physical activity (PA) for patients with asthma. Health care provider (HCP) counseling represents an effective approach to optimizing patient PA. However, current exercise rates among asthma patients are suboptimal, which suggests that counseling may be improved.

OBJECTIVE

To understand PA counseling behaviors among HCPs who manage asthma.

METHODS

A voluntary 36-item survey assessing self-reported awareness of PA recommendations and current clinical practices was sent to 979 randomly selected HCP members of the American Academy of Allergy, Asthma & Immunology (AAAAI).

RESULTS

The overall response rate was 9.3% (91 of 979). Respondents were physicians (100%) and allergists/immunologists (96%) who reported an average of 18.1 ± 12.3 years in independent practice. Over half (58%) reported personally engaging in 150 min/wk or more of moderate to strenuous PA. Eighty percent of participants were unaware of specific PA guidelines for patients with asthma, yet 66% acknowledged evidence for improved asthma outcomes with moderate exercise. A large majority of respondents believed that patients with asthma (97%) and severe asthma (84%) should pursue exercise. Whereas 90% of respondents support incorporating exercise counseling into asthma care, only 69% regularly counsel asthma patients about PA. Barriers cited included limited time, lack of knowledge regarding how and where to refer patients for exercise, and other medical priorities. Potential facilitators of PA included increasing practitioner education and patient-directed posters in waiting areas.

CONCLUSIONS

Health care providers recognized PA as an important component of asthma care but were often unaware of specific guidelines. Promoting PA counseling may require using a time-efficient approach to implement counseling at each asthma patient encounter.

Household-specific physical activity levels and energy intakes according to the presence of metabolic syndrome in Korean young adults: Korean National Health and nutrition examination survey 2016-2018

BACKGROUND

Participation in exercise, and dietary and nutritional intakes have an impact on the risk and prevalence of metabolic syndrome (MetS), but these effects may differ according to whether a person lives alone or in a multi-person household. We analyzed differences in physical activity (PA) levels and energy intake according to household-type and MetS presence among young adults, to investigate the relationships among these factors.

METHODS

Data of 3974 young adults (aged > 19 years and < 40 years) were obtained from the Korean National Health and Nutrition Examination Survey (2016-2018). We analyzed PA levels (occupational and recreational PA, and transport) and energy intake (total, carbohydrate, protein, and fat).

RESULTS

Logistic regression data showed that low PA levels and higher energy intake were associated with MetS incidence and its components in young adults, after adjusting for body mass index, smoking, household-type, and sex. Overall, there was no significant difference in PA level between the MetS and non-MetS group. The total energy intake was higher in the MetS than in the non-MetS group (p <  0.05). These results were similar to those found in multi-person households. In single-person households, the MetS group had significantly lower PA levels (p <  0.01) and total energy intake (p <  0.05) than the non-MetS group.

CONCLUSIONS

We found significant association among low PA levels, high energy intake, and MetS components in young Korean adults, but with patterns differing according to household type. Energy intake was higher in young adults with than those without MetS, who lived in multi-person households, while young adults with MetS who lived alone had lower PA levels and lower energy intake than those without MetS. These findings highlight the need for different approaches of implementing PA and nutrition strategies according to the type of household in order to prevent MetS.

Adherence Factors Related to Exercise Prescriptions in Healthcare Settings: A Review of the Scientific Literature

Purpose: Physical activity on prescription (PAP) is being introduced in healthcare systems around the world. To apply a successful treatment is as important as to know if the patient is able to follow-up. In order to contribute to the development of effective PAP strategies, we have analyzed PAP-related adherence factors with a multi-dimensional approach. Methods PAP adherence factors in studies published in the WoS, Pubmed, and PsycInfo were reviewed, according to the WHO five dimensions adherence model. In a setting of prediction or adherence analysis of adults with high-risk factors or chronic diseases, the methods used to measure physical activity (PA), PAP treatments, PAP adherence, and mentioned theories related to human behavior change were analyzed. Results A total of 32 studies fulfilled our inclusion criteria. According to the WHO five dimensions adherence model, these total clustered adherence variables were observed: social/economic (n = 100), healthcare system/healthcare team (n = 18), condition-related (n = 61), therapy-related (n = 20), and patient-related (n = 47). PAP adherence has mainly been measured by adherence to measurement methods and by calculating attended versus total sessions scheduled. PA level was measured mainly by questionnaires and exercise referrals were the most frequent PAP resource in analyzed studies. Transtheoretical model of behavior change was the theory most referenced. Conclusion A lack of considering health system/healthcare-team factors and therapy-related factors has been identified, as most studies only analyze social/economic factors in non-pharmacological PAP adherence studies in healthcare settings. A multidimensional approach should be adopted to analyze PAP adherence in healthcare settings.

The effects of race/ethnicity and physician recommendation for physical activity on physical activity levels and arthritis symptoms among adults with arthritis

Background

Among U.S. adults with physician-diagnosed arthritis, we examined the association of 1) participant race/ethnicity with meeting physical activity guidelines and arthritis symptoms, and 2) the association of receipt of a physician exercise recommendation with physical activity levels and arthritis symptoms, and whether race/ethnicity moderates these associations.

Methods

Retrospective, cross-sectional study of National Health Interview Survey pooled data from 2002, 2006, 2009, and 2014 from 27,887 U.S. adults aged ≥18 years with arthritis. Outcomes were meeting aerobic (yes/no) and strengthening guidelines (yes/no), arthritis-associated activity limitations (yes/no) and arthritis-related pain (0–10; higher score = more pain). Predictors were race/ethnicity (White, African American, Latino, and Asian) and receipt of physician recommendation for exercise (yes/no). Covariates included demographic and health characteristics.

Results

Adjusting for covariates, African Americans were more likely (AOR = 1.27; 95% CI 1.12, 1.43) and Asians were less likely (AOR = 0.75; 95% CI 0.61, 0.92) than Whites to meet muscle strengthening activity guidelines. Compared to Whites, African Americans (B = 0.48; 95% CI 0.24, 0.72) and Latinos (B = 0.44; 95% CI 0.15, 0.72) reported more severe, while Asians reported less severe (B = -0.68; 95% CI -1.22, − 0.14) joint pain. Controlling for covariates, physician exercise recommendation was associated with meeting aerobic (AOR = 1.20; 95% CI 1.11, 1.30) and strengthening (AOR = 1.21; 95% CI 1.11, 1.33) guidelines, regardless of race/ethnicity except for a weak negative association with meeting strengthening guidelines (AOR = 0.85; CI 0.74–0.99) among Latinos.

Conclusions

Disparities in pain exist for African Americans and Latinos with arthritis. Physician exercise recommendation is critical among patients with arthritis to relieve symptom burden.

Factors Affecting Health-Promoting Lifestyle Among Older Women With Chronic Disease

The current cross-sectional descriptive study applies the Health Promotion Model to explore associations among sociodemographics, psychological factors (self-esteem), self-efficacy, perceptions of current health, and social support affecting older women with at least one chronic disease in South Korea. Convenience sampling of 232 older women aged ≥65 from a welfare center in South Korea showed that a health-promoting lifestyle is significantly and positively correlated with self-esteem, self-efficacy, perception of current health, and social support. Multiple regression analysis revealed that social support had the greatest effect on health-promoting lifestyle, explaining 49% of the dependent variable variance. Nurses serve a crucial role in providing care for older women by helping them within community settings to find resources for senior fitness, encouraging them to pursue health-related habits, and strengthening support systems by encouraging participation in social activities and maintaining strong relationships and interactions with family and friends. [Journal of Gerontological Nursing, 45(10), 29-38.].

Osteoarthritis physical activity care pathway (OA-PCP): results of a feasibility trial

BACKGROUND

To obtain information on feasibility and acceptability, as well as preliminary data on efficacy, of an Osteoarthritis Physical activity Care Pathway (OA-PCP).

METHODS

This was a single group pilot study involving 60 participants with symptomatic, physician diagnosed knee or hip OA, recruited from primary care clinics. Participants self-reported completing less than 150 min per week of moderate-to-vigorous physical activity (MVPA) at baseline. The 3-month OA-PCP intervention involved 3 physical activity (PA) coaching calls (focused on goal setting), three check-in emails and linkage with community-based or online resources to support PA. Efficacy outcomes were collected at baseline and 4-month follow-up. The primary efficacy outcome was minutes of MVPA, assessed via accelerometer. Secondary outcomes included minutes of light intensity activity, sedentary minutes, step counts, and Western Ontario and McMaster Universities (WOMAC) pain and function subscales. Participants were also asked to rate the helpfulness of the OA-PCP intervention on a scale of 0-10. Differences in efficacy outcomes between baseline and 4-month follow-up were assessed using paired t-tests.

RESULTS

Among participants beginning the study, 88% completed follow-up assessments and ≥ 90% completed each of the intervention calls. Average daily minutes of MVPA was 8.0 at baseline (standard deviation (SD) = 9.9) and 8.9 at follow-up (SD = 12.1, p = 0.515). There were no statistically significant changes in light intensity activity, sedentary time or step counts. The mean WOMAC pain score improved from 8.1 (SD = 3.6) at baseline to 6.2 (SD = 3.8) at follow-up (p < 0.001); the mean WOMAC function score improved from 26.2 (SD = 13.2) to 20.2 (SD = 12.5; p < 0.001). The mean rating of helpfulness was 7.6 (SD = 2.5).

CONCLUSIONS

Results supported the feasibility and acceptability of the study, and participants reported clinically relevant improvements in pain and function. PA metrics did not improve substantially. Based on these results and participant feedback, modifications including enhanced self-monitoring are being made to increase the impact of the OA-PCP intervention on PA behavior.

TRIAL REGISTRATION

NCT03780400, December 19, 2018.

Limitations in Activities of Daily Living in People With Chronic Pain: Identification of Groups Using Clusters Analysis

BACKGROUND

Chronic pain (CP) is a major public health problem affecting patients' lives and reducing physical activity. The aim is to establish subgroups of people with chronic pain (PCP) according to limitations in activities of daily living (ADLs), and to identify sociodemographic, pain-related, and psychosocial variables associated with each subgroup.

METHODS

Nationwide cross-sectional study on a representative sample of the Spanish adult population. Information on pain characteristics and ADL limitations was collected via telephone survey. A cluster analysis was used to identify subgroups of subjects according to the limitations on ADLs. Multivariate analysis was performed to analyze the variables related to each subgroup.

RESULTS

Out of the 1,957 surveys included in the original study, 325 PCP were identified according to the definition of the International Association for the Study of Pain. More than 50% reported some limitation in ADLs. Three groups of PCP were identified, with low, medium, and high ADL limitation. Older age, widespread and more intense pain, decrease in work activity, and belief that their pain affected the relationship with their friends were associated with higher limitations.

CONCLUSIONS

The identification of the characteristics of people with higher limitations could help guide future prevention and treatment initiatives to minimize the disabling impact of chronic pain on patients' family, work, and social life.

Pain Intensity And Attribution Mediate The Impact Of Patient Weight And Gender On Activity Recommendations For Chronic Pain

Background and purpose

Despite the notable benefits of physical activity for chronic pain, a large proportion of patients with chronic pain report that they do not receive activity-related recommendations from their providers. Research suggests that patient factors such as weight and gender influence activity-related recommendations for chronic pain. Research also suggests that appraisals of the intensity and cause of pain may explain these weight and gender effects. We investigated the influence of patient weight and gender on observers’ likelihood of recommending activity-related treatments for pain. We also explored the mediating effects of observers’ ratings of pain severity and the extent to which pain was due to medical and lifestyle factors (pain attribution).

Patients and methods

Healthy young adults (N=616; 76% female) viewed videos (Ghent Pain Videos of Daily Activities) and vignettes of 4 patients with chronic back pain performing a standardized functional task. Patients varied by gender (female, male) and weight (normal, obese), but were otherwise equivalent on demographic characteristics and pain behaviors. Participants rated how much pain they perceived the patients to be experiencing, the extent to which they attributed the pain to medical and lifestyle factors, and their likelihood of recommending exercise, physical therapy (PT), and rest.

Results

Patient weight and gender significantly interacted to influence exercise, PT, and rest recommendations. Both pain intensity and pain attribution mediated the relationships between patient weight and activity recommendations; however, these mediation effects differed across gender and recommendation type.

Conclusion

Patient weight and gender influenced laypeople’s activity recommendations for chronic pain. Moreover, the results suggest that observers’ perceptions of pain intensity and pain attributions are mechanisms underlying these effects. If these findings are replicated in providers, interventions may need to be developed to reduce provider biases and increase their recognition of the benefits of physical activity for chronic pain.

A survey across four European countries to determine rheumatology health professionals' awareness of physical activity measures in people with inflammatory joint diseases

OBJECTIVES

The objectives of this study were to determine rheumatology health professionals' (HPs)' awareness of and confidence in using physical activity (PA) measures in people with inflammatory joint diseases (IJDs), their own self-reported PA levels and to identify HP-related educational needs.

METHODS

Rheumatology HPs in Denmark, Sweden, Ireland and Belgium participated in an on-line survey. Descriptive statistics and latent class analysis (LCA) were undertaken SPSS (v21and SASv9.4) to describe data aggregates and range and to identify subclasses of groups with respect to use of PA measures.

RESULTS

322 (n=322, 75.5% women) HPs responded from Denmark (n=50, 15.5%), Sweden (n=66, 20.5%), Ireland (n=28, 8.7%) and Belgium (n=178, 55.3%) and the majority of respondents (n=286, 91.7%) reported it was important to measure PA in people with IJDs. Only 28.2% of HPs used simple body worn sensors to measure PA levels in their patients. The majority were interested in on-line education on measuring PA (82.9%). LCA, used to generate classes of PA measures employed by HPs, revealed three distinct classes reflecting differences in self-reported PA levels, awareness of PA measures, further education requirements and professional background.

CONCLUSIONS

The majority of respondents reported that they considered measuring PA as important in people with IJDs; however, the majority lacked confidence in how to measure it. There was strong interest in further education around measuring PA. Three distinct respondent classes were identified to inform targeted education on how to measure PA.

Healthcare Providers' Recommendations for Physical Activity among US Arthritis Population: A Cross-Sectional Analysis by Race/Ethnicity

Introduction

We examined racial/ethnic disparities in healthcare providers' recommendations for physical activity among individuals with arthritis and evaluated this association among groups of individuals who adhered to physical activity guidelines and those who did not.

Methods

With a cross-sectional design based on Behavioral Risk Factor Surveillance System, we analyzed individuals with self-reported physician-diagnosed arthritis, ≥18 years of age (n = 83,376). Outcome variable was healthcare providers' recommendations for physical activity. Race/ethnicity was categorized as African American, Hispanic, and White. Associations were examined using multivariate logistic regression.

Results

African Americans (Adjusted OR: 0.66; 95% CI: 0.55–0.79) and Hispanics (Adjusted OR: 0.68; 95% CI: 0.56–0.83) were less likely to receive providers' recommendations.

Conclusions

Although the importance of physical activity to improve health outcomes for adults with arthritis, as well as providers' influence on individuals' behavior change, is well established, providers are less likely to recommend physical activity to minorities. Further studies are required to identify the causes for this quality-of-care issue.

State of the Art Review: Physical Activity and Older Adults

Physical activity is an important component of a healthy lifestyle for all adults and especially for older adults. Using information from the updated 2008 Physical Activity Guidelines, 3 dimensions of physical activity are identified for older adults. These include increasing aerobic activity, increasing muscle-strengthening activity, and reducing sedentary or sitting behavior. Although the overall goal of the physical activity recommendations is to prevent chronic diseases and conditions from developing, many older adults are already affected. Therefore, suggested types of physical activity are described for specific diseases and conditions that are designed to mediate the condition or prevent additional disability. Finally, barriers to participation in physical activity specific to older adults are described, and possible solutions offered. Encouraging older adults to continue or even start a physical activity program can result in major health benefits for these individuals.

Adverse events experienced by participants in a back pain walking intervention: A descriptive study

OBJECTIVE

To understand the range and potential severity of adverse events reported by patients with back pain who were participating in a walking intervention.

METHODS

Data were obtained from participants in a randomized trial of a pedometer-based Internet-mediated intervention to promote walking and reduce back pain-related disability (n = 229 participants, 118 usual care, and 111 intervention). Participants reported adverse events throughout the 12-month study period. All reported events were reviewed and classified by system, severity, and study relatedness.

RESULTS

A total of 600 adverse events were reported, 250 by those in usual care and nearly 350 by those in the intervention. After worsening back pain (27%), musculoskeletal events were the most commonly reported events (19%), followed by cardiovascular events (14%), infection (11%), and medical procedures (9%). There were three times as many musculoskeletal events in the intervention compared to the usual care group. Cardiovascular events, which were generally not serious and not walking related, were far less common than musculoskeletal injuries.

CONCLUSIONS

Individuals with chronic back pain can safely engage in a pedometer-based, unsupervised walking program. However, patients may benefit from focused counseling about musculoskeletal risks with specific attention to injury prevention measures such as gradually incrementing activity levels.

Association between living alone and physical inactivity among people with and without disability, Florida Behavioral Risk Factor Surveillance System, 2009

People with disability may be at risk of developing diseases due to physical inactivity; social support from family and friends is positively related to engaging in regular physical activity. We compared the association between living alone and engagement in physical activity among people with and without disability in Florida. We used multivariate logistical regression to analyze 2009 Florida Behavioral Risk Factor Surveillance System data (n = 10,902) to assess differences in physical activity in disability levels for respondents who lived alone versus those who did not. Respondents with a disability were less likely to engage in physical activity than were people without a disability, regardless of disability type, and the lowest rates of engaging in physical activity were found for people with disability who lived alone. Public health efforts should consider the role of household composition when targeting physical activity interventions among people with disability.