Physician's exercise recommendations 'critical' to relieving arthritis symptoms
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Among patients with arthritis, receiving exercise recommendations from a physician is “critical” to meeting physical activity guidelines and relieving symptom burden, regardless of race and ethnicity, researchers noted in BMC Public Health.
The data also suggest that, compared with whites, Black and Latino patients report more severe joint pain, while Asian patients report less severe pain, the researchers wrote.
“Several studies have demonstrated that African Americans and Latinos with arthritis were less likely to receive [physical activity (PA)] advice from physicians than their white counterparts,” Jeremy Huckleby, MD currently a resident at the Washington University School of Medicine, in St. Louis, but at the time of the study was a medical student with the NIH’s Medical Resident Scholar Program, and colleagues wrote. “It is plausible that physician implicit bias could affect whether a physician gives an exercise recommendation for patients from certain racial/ethnic groups because evidence shows African Americans are less likely to receive appropriate pain management compared to white Americans.”
“Also, patients most likely to benefit (obese/overweight and those with higher pain levels, comorbidities, and activity limitations) were less likely to have received a physician recommendation to exercise,” they added. “Yet, studies support recommending PA to reduce arthritis symptoms regardless of patient profile, including radiologic severity and pain levels. Disparities in receipt of physician recommendation for PA for arthritis symptoms could help explain disparities in symptom burden.”
To analyze the association of race and ethnicity with arthritis symptoms and meeting physical activity guidelines, as well as the link between receiving exercise recommendations from a physician and physical activity levels and symptoms across races and ethnicities, Huckleby and colleagues conducted a retrospective, cross-sectional study of CDC survey data. The study included data from 27,877 adults with arthritis who participated in the National Health Interview Survey (NHIS), an ongoing, in-person household survey of a nationally representative sample of the U.S. noninstitutionalized population in all 50 states and the District of Columbia.
The researchers pooled NHIS data from 2002, 2006, 2009 and 2014. Patients with arthritis were identified through a question in the survey that asked respondents if they have ever been told by a physician or health professional that they have “some form of arthritis, rheumatoid arthritis, gout, lupus or fibromyalgia.” Those who answered “no” were excluded.
Outcomes included meeting aerobic and strengthening guidelines, as well as arthritis-associated activity limitations and arthritis-related pain. Race and ethnicity groups, and the receipt of exercise recommendations from a physician, were used as predictors. Covariates included demographic and health characteristics.
According to the researchers, after adjusting for covariates, Black respondents were more likely (AOR=1.27; 95% CI, 1.12-1.43), and Asians were less likely (AOR=0.75; 95% CI, 0.61-0.92), than whites to meet muscle strengthening activity guidelines. Compared with whites, Black (B=0.48; 95% CI, 0.24-0.72) and Latino (B=0.44; 95% CI, 0.15-0.72) respondents reported more severe joint pain, while Asian respondents reported less severe joint pain (B=–0.68; 95% CI, –1.22 and 0.14).
After controlling for covariates, exercise recommendations from a physician were associated with meeting aerobic (AOR=1.2; 95% CI, 1.11-1.3) and strengthening (AOR=1.21; 95% CI, 1.11-1.33) guidelines regardless of race and ethnicity, save for a weak negative association with meeting strengthening guidelines among Latino patients (AOR=0.85; CI, 0.74-0.99).
“Our data suggest that physicians’ exercise recommendations are associated with meeting PA guidelines regardless of race/ethnicity and that both rates of receipt of physician recommendation and adherence to PA guidelines among persons with arthritis need improvement,” Huckleby and colleagues wrote. “With the arthritis population expected to increase by over 30 million in 20years, it is imperative that we reduce disability among this population, especially among Latinos and African Americans.”
“Barriers to exercise must be better characterized among the arthritis community,” they added. “Finally, although the importance of PA to reduce arthritis symptoms is clear, social, and biological mechanisms that might explain disparities in arthritis-related symptoms need to be better understood.”
Perspective
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Douglas B. Smith, MD
For the past 2 years, our attention – rightly so – has been focused on the pandemic caused by COVID-19. However, as rheumatologists, we must not lose sight of another epidemic that is also straining our health care system: arthritis.
As Huckleby and colleagues point out, the number of US adults affected by arthritis is expected to grow from in 54.4 million in 2015 to 78.4 million in 2040, and those with arthritis-related disability projected to grow from 22.7 million to 34.6 million. Finding effective and inexpensive means of treatment is critical.
As rheumatologists, we know that physical activity is a safe and low-cost treatment option for arthritis, which has been substantiated by numerous clinical articles. The benefits include reduction in pain and stiffness, improvement in quality-of-life measures, weight loss and cardiovascular benefits. Despite this, Huckleby and colleagues found that 40% of respondents reported never having been advised to exercise and only 34% met predetermined exercise aerobic guidelines and 16% met strengthening guidelines across all ethnicities.
The most important conclusions that I took away from this study were that physician recommendations to exercise positively correlated with achieving aerobic and strengthening guidelines across all races; therefore, this treatment option needs to be discussed with all arthritis patients.
Based on this data, physicians need to be more diligent in recommending exercise as part of arthritis treatment. In the process, remove impediments to exercise to improve success. With the growing arthritis epidemic, these recommendations are becoming increasingly important. Since rheumatologists are seeing only a fraction of the patients with arthritis, primary care providers must be educated about the importance of exercise as part of the treatment approach in the management of arthritis.
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