40% of Arthritis Patients Fail to Receive Exercise Guidance Save

The latest issue of CDC’s MMWR reports that exercise counseling among arthritis patients increased from 52% to 61% (2002 to 2014); hence ~40% do not receive health care provider counseling, suggesting the need for provider education and training in exercise counseling, and improved electronic medical record reminders.

An estimated 54 million adults in the United States are affected by arthritis. Both American College of Rheumatology’s osteoarthritis management guidelines and Healthy People 2020 recommend regular physical activity or exercise among adults with arthritis.

The CDC analyzed 2002 and 2014 National Health Interview Survey (NHIS) data that included 36,697 adults; response rate = 58.9%). They were asked, “Have you ever been told by a doctor or other health care professional that you have arthritis, rheumatoid arthritis, gout, lupus or fibromyalgia?” and “Has a doctor or other health professional ever suggested physical activity or exercise to help your arthritis or joint symptoms?”

They found that between 2002 and 2014 there was a 17.6% increase (51.9% to 61.0% in the counseling of adult arthritis patients. This increase was greater (20.1%) in those who described themselves as inactive. 

By 2014, all subgroups exceeded the Healthy People 2020 age-standardized target of 57.4% for adults with arthritis, with the exception of non-Hispanic other races (53.8%), underweight/normal weight persons (50.0%), current smokers (56.9%), inactive persons (56.7%), and persons without a primary care provider (50.7%).

The CDC points out that Exercise is Medicine (EIM) website has free tools and resources to help providers incorporate these principles to improve chronic disease management in their practices.

Providers can reduce arthritis-specific barriers to exercise by referring patients who are uncertain about exercising safely to evidence-based, community programs. Several community group and self-directed exercise programs are available for adults with arthritis (e.g., Enhance Fitness, Walk with Ease, and Active Living Every Day) and can reduce pain and improve function, mobility, and mood. Community based organizations, including the National Parks and Recreation Association and the YMCA disseminate these evidence-based physical activity programs throughout the United States.

Particular attention should be paid to subgroups that have not reached the Healthy People 2020 target, including underweight/normal weight persons, current smokers, and certain racial/ethnic groups

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 (8), 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.