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Small increase in physical activity prevents cancer, diabetes, CVD in OA patients
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CHICAGO — A recent mathematical modeling analysis revealed that a modest increase in physical activity among patients with knee osteoarthritis substantially improved their quality of life and prevented thousands of cancer, cardiovascular disease and diabetes cases.
Elena Losina, PhD, Robert W. Lovett Professor of Orthopedic Surgery at Harvard Medical School and director of Policy and Innovation eValuations in Orthopedic Treatments (PIVOT) Center at Brigham and Women's Hospital, said these new findings underscore the importance of developing public health campaigns to promote physical activity.
“Based on all the evidence we have, the regimen that has consistently shown to be efficacious for knee OA is physical activity and exercise,” she told Healio. “Despite this evidence, there is still a great number of people with knee OA who are not physically active.”
Of the 11.7 million people in the United States aged 45 to 85 years with knee OA, approximately 11% are physically active, 41% are insufficiently active and 47% are inactive, according to Losina. She said a possible explanation for the large proportion of inactive patients is a lack of infrastructure facilitating appropriate physical activity and teaching people what physical activity is and how to exercise.
To raise awareness of the public health impact of physical activity, Losina and colleagues conducted a study using the Osteoarthritis Policy Model (OAPol) to estimate quality-adjusted life years (QALYs) lost and the prevalence of cancer, cardiovascular disease (CVD) and diabetes among patients with OA and varying levels of physical activity.
“We did this work to try to develop a public health campaign and to show that even if we can move a small proportion of people who are physically inactive to becoming active, or even insufficiently active, we can gain an impressive number of QALYs saved and prevent a measurable number of cases of cancer, CVD and diabetes,” Losina said.
The researchers calculated and compared per person QALYs among patients who are active (defined as 150 or more minutes of moderate-to-vigorous physical activity per week), insufficiently active (defined as 10 to 149 minutes of moderate-to-vigorous physical activity per week) and inactive (defined as less than 10 minutes of moderate-to-vigorous physical activity per week). They multiplied per person QALYs that were lost due to physical inactivity or insufficient activity by the number of patients with knee OA in each activity group to determine the negative impact of inactivity and insufficient activity on public health. The positive public health impact of increasing physical activity was based on QALYs saved and cases of CVD, diabetes and cancer that were prevented.
If all inactive patients with OA would become physically active, Losina said it would increase QALYs by 4,357,774.
If only 5% of inactive patients become physically active, it would save 217,885 QALYs and prevent approximately 24,000 cases of cancer, 56,000 cases of CVD and about 54,000 cases of diabetes.
If 5% of inactive people become insufficiently active, it would save almost 67,000 QALYs and prevent about 14,000 cases of cancer, 23,000 cases of CVD and 24,000 cases of diabetes.
“This translates to very substantial public health benefits,” Losina said. “Hopefully, these data can encourage public health campaigns and provide information to plan those programs.”
Lessons from other public health campaigns, such those for smoking cessation, can help inform physical activity efforts, Losina said. According to the CDC, population-based interventions — including price increases in tobacco, smoke-free laws, anti-tobacco mass media campaigns and expanded access to tobacco cessation counseling and medications — have contributed to a considerable decline in cigarette smoking among adults in the U.S. In 2017, 14% of adults reported smoking cigarettes, down from 15.5% in 2016, and a 67% decrease since 1965.
“We know how to develop successful public health campaigns,” Losina said. “We do not need to wait to develop public health programs until everyone wants to become physically active because that is never going to happen. We need to take small, incremental steps. The next step is to figure out how much society is willing to pay for these programs.” – by Stephanie Viguers
Reference:
Losina E, et al. Abstract 1138. Presented at: ACR/ARHP Annual Meeting, Oct. 20-24, 2018; Chicago.
Disclosure: Losina reports receiving financial support from Samumed, LLC.