Many Adults With Arthritis Not Receiving Exercise Counseling

Veronica Hackethal, MD

January 08, 2018

Although exercise counseling has increased, two in five adults with arthritis still do not receive it, according to results from a study published online January 4 in Morbidity and Mortality Weekly Report.

"[T]he 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," Jennifer Hootman, PhD, from the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, and colleagues write.

Approximately 54 million Americans have arthritis. Many of these people also have common comorbidities, such as diabetes, heart disease, and obesity, for which exercise is recommended to improve disease control.  However, arthritis pain can be a barrier to exercise for people with these conditions.

At the same time, exercise can decrease the pain of arthritis. The American College of Rheumatology recommends exercise as first-line nonmedication therapy for managing osteoarthritis symptoms. One of the goals of the Healthy People 2020 initiative is to increase counseling about the benefits of exercise for people with arthritis.

To see whether these recommendations are translating into clinical practice, the researchers analyzed data from the nationally representative National Health Interview Survey (NHIS). The analysis included responses from 31,044 adults in 2002 and 36,697 adults in 2014.

Between 2002 and 2014, the age-adjusted prevalence of people 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 who received 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).

The only subgroups that were below the Healthy People 2020 target of 57.4% were non-Hispanic other races (53.8%), underweight/normal weight people (50.0%), current smokers (56.9%), inactive individuals (56.7%), and people without a primary care provider (50.7%).

Despite the increase in counseling, the authors emphasize that approximately 40% of adults with arthritis are still not receiving exercise counseling from their providers.

They suggest several strategies that could improve exercise counseling for people with arthritis.  These include adding exercise counseling to clinical training curriculum and continuing medical education, adding prompts to electronic medical records, and improvements in provider training. Connections to community programs, such as the National Parks and Recreation Association and the YMCA, may also help.

The researchers also mention several limitations of the study. The NHIS survey 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 people in long-term care facilities, prisons, or the military. Finally, the study could not address the quality and frequency of exercise counseling.

The website for the Exercise Is Medicine initiative has free tools and resources to help providers incorporate exercise counseling into their practices.

The authors have disclosed no relevant financial relationships.

MMWR Morb Mortal Wkly Rep. Published online January 4, 2018. Full text

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