Prevalence of Leisure-Time Physical Activity Among Persons with Arthritis and Other Rheumatic Conditions -- United States, 1990-1991

Although regular physical activity is associated with important physical and mental health benefits (1), an estimated 53 million U.S. adults are inactive during their leisure time -- the period most amenable to efforts to increase physical activity. The presence of chronic conditions, especially those associated with disabilities, may reduce levels of leisure-time physical activity (LTPA). Arthritis and other rheumatic conditions (e.g., osteoarthritis, rheumatoid arthritis, gout, fibromyalgia, and other diseases of the joints) are leading causes of disability (2) and are among the most prevalent chronic conditions in the United States, affecting approximately 40 million persons in 1995 and a projected 60 million persons in 2020 (3). This report uses data from the Health Promotion and Disease Prevention (HPDP) supplement of the 1990-1991 National Health Interview Survey (NHIS) to provide estimates of LTPA among persons with arthritis and other rheumatic conditions by disability status and compares these estimates with those for persons without arthritis and other rheumatic conditions. The findings indicate that the prevalence of LTPA among persons with arthritis and other rheumatic conditions is less than that among persons without arthritis and other rheumatic conditions.

NHIS is a probability sample of the U.S. civilian, noninstitutionalized population. In 1990 and 1991, approximately 120,000 persons in 47,000 households were surveyed each year (4). The survey population was persons in the one-sixth sample of respondents who were asked questions about the presence of musculoskeletal conditions during the preceding 12 months. Each condition was assigned an International Classification of Diseases, Ninth Revision (ICD-9), code. The category arthritis and other rheumatic conditions was classified as a condition that matched ICD-9 codes * selected by the National Arthritis Data Workgroup; this definition excludes other musculoskeletal conditions such as tumors, bone disorders, fractures, and back and neck disorders. In this report, "arthritis" denotes arthritis and other rheumatic conditions.

Responses to core NHIS questions were used to determine disability, defined as long-term reduction in a person's capacity to perform the average kind or amount of activities associated with his or her age group and typically resulting from chronic disease or impairment. Responses to the HPDP supplement were used to determine LTPA. For the HPDP supplement, one adult (aged greater than or equal to 18 years) per household was randomly selected to answer questions; only those who self-reported were included (response rate for combined NHIS and HPDP supplement: 83%). Each respondent was asked whether he or she had engaged in any of 21 physically active hobbies, sports, or exercises during the 2 weeks preceding the interview; the respondent also was allowed to list two additional hobbies, sports, or exercises in which he or she had participated. For each activity, frequency, duration, and relative intensity were assessed. LTPA was divided into four categories: no reported LTPA, regular vigorous LTPA, regular light-to-moderate LTPA, and less than regular LTPA. ** To account for the complex sample design, variances were computed using SUDAAN, and rates were compared using a two-tailed t-test.

In 1990 and 1991, arthritis was present in approximately 20% (95% confidence interval=plus or minus 0.4%) of the U.S. population aged greater than or equal to 18 years. Among these persons, the rate of no reported LTPA was higher than that for persons without arthritis; the rates of less than regular LTPA and regular light-to-moderate LTPA were similar to that for persons without arthritis; and the rate of regular vigorous LTPA was lower than that for persons without arthritis (Table_1). Persons with nondisabling arthritis had higher rates of no reported LTPA, similar rates of less than regular LTPA and regular light-to-moderate LTPA, and lower rates of regular vigorous LTPA when compared with persons without arthritis and without disability. Persons with disabling arthritis had higher rates of no reported LTPA, similar rates of light-to-moderate LTPA, and lower rates of less than regular and regular vigorous LTPA when compared with persons without arthritis and with a disability caused by another condition.

Reported by: MP LaPlante, Dept of Social and Behavioral Sciences and the Institute for Health and Aging, Univ of California, San Francisco. Health Care and Aging Studies Br, Div of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: The findings in this report indicate that, independent of the presence of disability, compared with persons without arthritis, persons with arthritis had substantially higher rates of no reported LTPA and lower rates of regular vigorous LTPA. Rates of LTPA among persons with arthritis may be low because some of these persons may have been advised not to exercise to avoid a perceived risk for exacerbating their underlying rheumatic condition. However, previous studies indicate that persons with arthritis can adapt to increased levels of physical activity without adverse effects (5); that physical activity produces improvements in muscle function, cardiorespiratory capacity, and physical performance (6); and that older adults with arthritis have had subjective and objective improvement in their condition as a result of physical activity (7). In addition, for persons with osteoarthritis, regular physical activity is necessary for maintaining normal muscle strength, joint structure, and joint function and is not associated with joint damage or further progression of osteoarthritis. As in the total population, physical activity among persons with osteoarthritis can reduce the risk for premature death, heart disease, diabetes, high blood pressure, colon cancer, overweight, depression, and anxiety (1).

Although self-reported data sometimes can produce unreliable or incomplete estimates, previous studies have documented the validity and reliability of self-reported data for LTPA (8). In addition, self-reported data provide a more complete assessment of the occurrence of arthritis than do medical records (9).

Persons with arthritis have low rates of physical activity and, therefore, should be a priority for programs to improve overall levels of physical activity (1,10). However, these persons should consult their physicians before increasing LTPA to determine optimally sustainable regimens of physical activity. Health-care providers and organizations should encourage these patients to increase their LTPA. Information about land- and water-based exercise programs and individualized and group approaches to increasing physical activity is available from the Arthritis Foundation, telephone (800) 283-7800, or on the World-Wide Web, http://www.arthritis.org.

References

1. US Department of Health and Human Services. Physical activity and health: a report of the Surgeon General. Atlanta: US Department of Health and Human Services, Public Health Service, CDC, 1996.

2. LaPlante MP, Carlson D. Disability in the United States: prevalence and causes, 1992. Disability Statistics Report 1996;7:1-177.

3. CDC. Arthritis prevalence and activity limitations -- United States, 1990. MMWR 1994;43:433-8.

4. Massey JT, Moore TF, Parsons VL, Tadros W. Design and estimation for the National Health Interview Survey, 1985-94. Vital Health Stat 1989;2:1-4.

5. Minor MA. Physical activity and management of arthritis. Annals of Behavioral Medicine 1991;13:117-24.

6. Stenstrom CH. Therapeutic exercise in rheumatoid arthritis. Arthritis Care Res 1994;7:190-7.

7. Panush RS, Holtz HA. Is exercise good or bad for arthritis in the elderly? South Med J 1994;87:S74-S78.

8. Jacobs DR Jr, Ainsworth BE, Hartman TJ, Leon AS. A simultaneous evaluation of 10 commonly used physical activity questionnaires. Med Sci Sports Exerc 1993;25:81-91.

9. Anonymous. Evaluation of the National Health Survey Diagnostic Reporting. Vital Health Stat 1994;2:1-116.

10. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives -- full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50212.

TABLE 1. Prevalence rates * of participation in leisure-time physical activity (LTPA) + during the 2 weeks preceding interview among persons aged >=18 years, for
all persons, those with and without arthritis&, and those with and without disability @ -- Health Promotion and Disease Prevention Supplement, National Health Interview
Survey, United States, 1990-1991
===========================================================================================================================================================================
                % Engaging in LTPA
                                                                                             ------------------------------------------------------------------------------
                      Regular
                                                                     Weighted                                                      ----------------------------------------
Category                                        Sample size        population ++             No reported     Less than regular     Light-to-moderate          Vigorous
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Total population                                  14,071             181,829                        29.1                34.9                 21.4               14.5
With arthritis                                     3,223              36,917                        34.8 &&             34.1                 20.5               10.7 &&
Without arthritis                                 10,848             144,913                        27.7                35.2                 21.7               15.5

With nondisabling arthritis                        2,512              29,282                        31.5 &&             35.7                 21.1               11.6 &&
Without arthritis and without disability           9,631             130,116                        26.4                35.4                 22.2               15.9

With disabling arthritis                             711               7,635                        47.4 &&             27.8 &&              17.8                7.1 &&
Without arthritis and with a disability            1,217              14,796                        38.5                33.1                 16.7               11.7
caused by another condition
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------
*  95% confidence intervals ranged from  0.8% to  4.2%.
+  During the interview, each respondent was asked whether he or she had engaged in any of 21 physically active hobbies, sports, or exercises during the 2 weeks preceding
   the interview; the respondent also was allowed to list two additional hobbies, sports, or exercises in which he or she had participated. For each activity, frequency,
   duration, and relative intensity were assessed. LTPA was divided into four categories: no reported LTPA; regular vigorous LTPA (i.e., any reported LTPA engaged in
   three or more times per week for 320 minutes per occasion at a level 36.0 metabolic equivalents {METs} {MET=3.5 mL of oxygen consumed/kg body weight/minute} among
   persons aged 360 years or 37.0 METs among those aged 18-59 years); regular light-to-moderate LTPA (i.e., any reported LTPA engaged in on 35 days per week for an
   accumulation of 330 minutes per day (minimum of any bout of activity of 310 minutes) at a level of exertion <6.0 METs among persons aged 360 years or <7.0 METs among
   those aged 18-59 years); and less than regular LTPA (i.e., any reported LTPA less than that required for regular light-to-moderate LTPA).
&  Arthritis is defined using the following International Classification of Diseases, Ninth Revision, codes selected by the National Arthritis Data Workgroup: 95.6,
   95.7, 98.5, 99.3, 136.1, 274, 277.2, 287.0, 344.6, 353.0, 354.0, 355.5, 357.1, 390, 391, 437.4, 443.0, 446, 447.6, 696.0, 710-716, 719.0, 719.2-719.9, 720-721, 725-727,
   728.0-728.3, 728.6-728.9, 729.0-729.1, and 729.4. The definition excludes other musculoskeletal conditions such as tumors, bone disorders, fractures, and back and
   neck disorders. In this table, "arthritis" denotes arthritis and other rheumatic conditions.
@  Long-term reduction in a person's capacity to perform the average kind or amount of activity associated with his or her age group and typically resulting from
   chronic disease or impairment.
** 2-year average. ++In thousands. Significantly different for persons with arthritis compared with persons without arthritis for the corresponding category of total
   population, persons without disability, and persons with disability at p<0.05, using a two-tailed t-test.
===========================================================================================================================================================================

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