Regular exercise is shown to be beneficial for maintaining joint function and reducing pain and fatigue in patients with arthritis, and the American College of Rheumatology cites physical activity as an important nonpharmacologic intervention in the management of osteoarthritis. Although clinicians have increased their efforts to discuss the benefits of exercise with their patients, the results of a recent study indicate that approximately 40% of patients still are not being counseled on this topic (Hootman JM, et al. MMWR. 2018;66:1398-1401).
“Although the improvement among all health care providers is encouraging, opportunities exist to further increase counseling for exercise among adults with arthritis,” wrote Jennifer Hootman, PhD, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, and colleagues.
The researchers analyzed data from the National Health Interview Survey (NHIS), an ongoing survey that provides nationally representative estimates on a variety of health status and utilization measures among the nonmilitary, noninstitutionalized population of the United States. The analysis included responses from 31,044 adults in 2002 and 36,697 adults in 2014. Variations in age-adjusted prevalence of exercise counseling were studied across the 5 years in which both counseling for exercise and arthritis questions were included on the survey (2002, 2003, 2006, 2009, and 2014).
Between 2002 and 2014, the age-adjusted prevalence of individuals with arthritis who received exercise counseling from their providers increased by 17.6%, rising from 51.9% in 2002 (95% confidence interval [CI], 49.9%-53.8%) to 61.0% (95% CI, 58.6%-63.4%) in 2014 (P <.001). Among inactive individuals, the age-adjusted prevalence of individuals who received exercise counseling increased by 20.1%, from 47.2% (95% CI, 44.0%-50.4%) in 2002 to 56.7% (95% CI, 52.3%-61.0%) in 2014 (P = .001).
In 2014, the only subgroups that were below the Healthy People 2020 target of 57.4% were non-Hispanic other races (53.8%), underweight/normal weight individuals (50.0%), current smokers (56.9%), inactive individuals (56.7%), and individuals without a primary care provider (50.7%).
Despite an increase in the prevalence of exercise counseling, Dr Hootman and colleagues emphasized that approximately 40% of adults with arthritis are still not receiving this type of counseling from their providers. They suggested several strategies that could improve exercise counseling for this population of patients and noted that connections to community programs, such as the National Recreation and Park Association and the YMCA, may also be beneficial.
The researchers acknowledged several limitations of their study. The NHIS data were self-reported and response rates were low (74.3% in 2002 and 58.9% in 2014), which could bias results. The NHIS data only included information from civilian, noninstitutionalized individuals and may not apply to those in long-term care facilities, prisons, or in the military. In addition, the study could not address the quality and frequency of exercise counseling.
“Prevalence of health care provider counseling for exercise among adults with arthritis has increased significantly over more than a decade, but the prevalence of counseling remains low for a self-managed behavior (exercise) with proven benefits and few risks, especially among those who are inactive. Various strategies such as health care provider education and training in exercise counseling and electronic medical record prompts might increase health care provider counseling for exercise among adults with arthritis,” the researchers concluded.