Healthcare practitioners (HCPs) are increasingly providing exercise counseling to their patients with arthritis, according to a study, but there is still room for improvement. Resources are available to further educate HCPs on physical activity and exercise counseling.
Arthritis affects approximately 54 million adults in the United States, and many of these patients have other comorbidities, such as diabetes, cardiovascular disease, and obesity. In addition to pain caused by arthritis, other comorbidities often serve as a barrier or limitation to participation in regular physical activity or exercise. Guidelines from the American College of Rheumatology recommend exercise as a first-line, non-pharmacologic strategy to manage arthritis symptoms. In addition, one of the Healthy People 2020 objectives is to increase healthcare professional (HCP) counseling for physical activity and exercise among adults with arthritis.
For a study published in the Morbidity & Mortality Weekly Report, Jennifer Hootman, PhD, and colleagues examined the prevalence and trends of HCP counseling for physical activity or exercise among adults with arthritis over a 12-year period using 2002 and 2014 National Health Interview Survey data. In total, the analysis included responses from 31,044 adults in 2002 and 36,697 adults in 2014.
“Results from our study showed that the prevalence of receiving HCP counseling for exercise among adults with arthritis increased, rising from about 52% in 2002 to 61% in 2014,” says Dr. Hootman. “However, about 40% of these patients still do not receive HCP counseling for exercise.” Among inactive individuals, the age-adjusted prevalence who received counseling increased by slightly more than 20%, rising from approximately 47% in 2002 to nearly 57% in 2014 (Table).
The study also examined subgroups of adults with arthritis and assessed data with regard to the Healthy People 2020 age-standardized target of achieving more than 57%. Several subgroups were below this Healthy People 2020 target, including non-Hispanic other races, underweight and normal weight people, current smokers, inactive individuals, and people without a primary HCP. Overall, adults with arthritis and obesity had a higher prevalence of having received counseling for exercise than did those who were underweight or normal weight.
Although the improvement among all HCPs is encouraging, opportunities exist to further increase counseling for exercise among adults with arthritis. “In addition to referring patients to physical therapy, there are free and low-cost resources that can help clinicians get their patients more active, such as http://www.exerciseismedicine.org and http://www.prescriptionforactivity.org,” Dr. Hootman says. “Community groups and self-directed exercise programs are also available, such as Walk With Ease, Enhance Fitness, and Active Living Every Day. HCPs should refer patients to these programs, as well as other community-based organizations, because they can help reduce pain and improve function, mobility, and mood.”
Another potential solution is to add prompts for exercise and physical activity counseling in arthritis to electronic medical records so that HCPs can more easily tailor exercise prescriptions. “It’s difficult for HCPs to discuss all the necessary health topics during patient visits because time is limited,” Dr. Hootman says. “To overcome this problem, HCPs can have other clinical staff, such as nurses or medical assistants, gather health behavior information regarding exercise and physical activity at every patient visit, similar to how typical vital signs like height, weight, and blood pressure are currently gathered.”
Dr. Hootman says that simply counseling arthritis patients about exercise can motivate them to make better heath behavior choices, including being more physically active. “HCPs need to recommend exercise and physical activity along with any medical interventions,” she says. “What HCPs say really matters to patients. Although our study results were encouraging, there is still room for improvement because two of every five adults with arthritis are not receiving this potentially effective counseling. HCPs can serve as valuable sources of exercise advice.”
Hootman JM, Murphy LB, Omura JD, et al. Health care provider counseling for physical activity or exercise among adults with arthritis— United States, 2002 and 2014. MMWR Morb Mortal Wkly Rep. 2018;66:1398-1401. Available at: https://www.cdc.gov/mmwr/volumes/66/wr/mm665152a2.htm?s_cid=mm665152a2_w#suggestedcitation.
Maserejian NN, Fischer MA, Trachtenberg FL, et al. Variations among primary care physicians in exercise advice, imaging, and analgesics for musculoskeletal pain: results from a factorial experiment. Arthritis Care Res (Hoboken). 2014;66:147-156.
Hurkmans EJ, de Gucht V, Maes S, Peeters AJ, Ronday HK, Vliet Vlieland TP. Promoting physical activity in patients with rheumatoid arthritis: rheumatologists’ and health professionals’ practice and educational needs. Clin Rheumatol. 2011;30:1603-1609.