Physical Activity Adherence and Quality of Life among Individuals with Arthritis
By Kelsey Stamps
Austin, S., Qu, H., & Shewchuk, R. M. (2011). Association between adherence to physical activity guidelines and health-related quality of life among individuals why physician-diagnosed arthritis. Quality of Life Research, 21, 1347-1357.
Physical activity is an important, non-pharmacological intervention to diminish pain and discomfort and to improve health-related quality of life in individuals with one of the most prevalent chronic conditions, arthritis. Health-related quality of life (HRQOL) is an indicator of physical and mental health, and a population’s chronic disease load. It evaluates the impact of arthritis, which is a leading cause of disability both in the U.S. and internationally. Adults with arthritis have poor HRQOL and, on average, report four more physically unhealthy days and 2.3 more mentally unhealthy days (within a 30 day period), compared to those without arthritis. After assuming that HRQOL for adults with arthritis would be predicted by adherence to physical activity guidelines controlling for health system factor (physicians’ recommendations for physical activity), pre-disposing, enabling, and need-relation factors, the authors hypothesized that individuals who did not adhere to recommended levels of physical activity would report more physically and mentally unhealthy days compared with those who did, controlling for physicians’ recommendations, predisposing, enabling, and need-related factors.
Using data from the 2007 Behavioral Risk Factor Surveillance System (BRFSS) survey, a cross-sectional sample of 33,071 adults 45 years or older with physician-diagnosed arthritis was obtained. The BRFSS survey is a random-digit dial telephone survey for non-institutionalized U.S. citizens 18 or older, and was established by the Centers for Disease Control and Prevention (CDC). To examine HRQOL as a function of adherence to physical activity guidelines (independent variable), data were analyzed using a negative binomial regression. Based on the Behavioral Mode of Health Services Utilization, factors controlled for included demographics (e.g., age, race, etc.), physicians’ recommendations for physical activity, health insurance, personal physician, emotional support, body mass index, activity limitations, health status, and co-morbidities. Adherence to recommended levels of physical activity was derived from the CDC and calculated to measure both individuals who adhered to physical activity guidelines with at least 30 minutes of low to moderate physical activity during five or more days per week and individuals who did not adhere to the physical activity guidelines, including those who were physically inactive and those who did not meet the recommended amount of physical activity. These classifications are recommendations for physical activity by the American College of Rheumatology. The dependent variable was the HRQOL in physician-diagnosed arthritis, measured by the number of physically and mentally unhealthy days within a 30 day period.
The statistics from the survey of the study sample reveal that among the 33,071 adults with arthritis, only 40% adhered to the physical activity guidelines. Those individuals, on average, had 7.7 physically unhealthy days and 4.4 mentally unhealthy days for the period of 30 days prior to the survey date. Individuals who did not adhere to physical activity guidelines had, on average, 9.3 physically unhealthy days and 5.1 mentally unhealthy days. All in all, adults who did not adhere to the guidelines had 1.14 physically unhealthy days compared to those who did. The study found that unemployed individuals had more physically and mentally unhealthy days. In addition, individuals who did not receive emotional support also had more physically and mentally unhealthy days. Individuals who reported a poor health status exhibited the same trend. An interesting finding was that individuals who did not receive physicians’ recommendations had fewer physically and mentally unhealthy days.
Individuals who did not adhere to the physical activity guidelines had more physically and mentally unhealthy days. By engaging in low- to moderate-intensity physical activity of approximately 150 minutes per week, evidence shows that individuals with arthritis had some degree of relief from pain, improved their physical function, and delayed onset of disability. The 150 minutes per week consisted of five 30-minute sessions. However, this study proved that adherence to physical activity is low in this population and interventions are needed to connect adults with arthritis to participate in physical activity. It is recommended that even if adults with other co-morbidities cannot meet at least 150 minutes per week they should still be physically active as much as possible whenever their conditions and abilities allow. Future studies should focus on barriers to adhering to physical activity guidelines as well as motivators of physical activity.