Business and Industry
The business and industry sector encompasses public and private employers, large and small, as well as worksite wellness programs, including those that provide access to fitness facilities and activities.
Table of Contents
Making the case
Arthritis is common and costly
Arthritis is the most common cause of disability in the United States.
- 54.4 million U.S. adults (22.7%) have arthritis.
- 8.6 million U.S. adults (19%) report disability due to arthritis. In this context, disability is defined as a limitation or loss of function, most often manifested as difficulty climbing a flight of stairs and walking 3 city blocks (a distance equal to walking from the parking lot to the back of a large store or through a mall).
- Two-thirds of people with arthritis are working aged, 18 to 64.
- As the number of older Americans continues to grow, and the rates of obesity and overweight increase, the number of people with arthritis will only increase.
To learn more:
Cheng YJ, Hootman JM, Murphy LB, Langmaid GA, Helmick CG. Prevalence of Doctor-Diagnosed Arthritis and Arthritis-Attributable Activity Limitation – United States, 2007–2009. MMWR2010;59(39):1261–1265. html pdf [1.61 MB]
Arthritis and other rheumatic conditions cost our nation $128 billion each year – or 1.2% of the gross domestic product (in 2003). $47 billion of that cost is due to lost earnings. Without proper management and appropriate environmental supports, arthritis can present difficulties and unique challenges for affected adults in the workplace. Taking these challenges into account and supporting physical activity in the workplace not only contributes to greater health for employees but also helps employers lower direct (e.g., decreases in insurance premiums) and indirect costs (e.g., decreases in absenteeism and increases in worker productivity).
To learn more:
Medical care expenditures and earnings losses among persons with arthritis and other rheumatic conditions in 2003, and comparisons with 1997 http://www.ncbi.nlm.nih.gov/pubmed/17469096?dopt=AbstractPlus
CDC arthritis cost statistics http://www.cdc.gov/arthritis/data_statistics/cost.htm Naydeck BL, Pearson JA, Ozminkowski RJ, Day BT, Goetzel RZ. The impact of the Highmark employee wellness programs on 4-year health care costs. J Occup Environ Med. 2008;50(2):146-156. Goetzel RZ, Ozminkowski RJ. The health and cost benefits of work site health-promotion programs. Annu Rev Public Health. 2008;29: 303-323.
Musculoskeletal conditions, meaning arthritis and other conditions of the muscles, bones, and joints, are the most common causes of work limitation among US adults.
To learn more:
Theis KA, Helmick CG, Hootman JM. Musculoskeletal Conditions Are the Most Common Causes of Work Limitation in U.S. Adults. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :795. http://www.blackwellpublishing.com/acrmeeting/abstract.asp?MeetingID=781&id=95541
Adults with arthritis often have other chronic conditions and arthritis makes managing these other conditions more difficult:
- Of these comorbid conditions — heart disease (49%), chronic respiratory conditions, obesity (31%), diabetes (47%), and stroke are among the most common
To learn more:
Adults with arthritis are more likely to fall.
Because of physical limitations and disease progression over time, adults with arthritis are prone to falling. This could be because of pain, awkward gait, tripping or slipping easily, or not being able to “catch” themselves if they are off balance. Engaging regularly in balance activities, such as Tai Chi, has been shown to prevent falls and improve stability.
To learn more:
Physical activity benefits all adults — INCLUDING adults with arthritis.
- It offers immediate and measurable health benefits: decreased pain, delayed onset of disability, and improved physical functioning, mood, and independence.
- It also enhances quality of life, aerobic capacity, and muscle strength.
- It is a low-cost, effective, and sustainable approach to arthritis management.
To learn more:
- Arthritis Foundation publications on fitness and nutrition
- CDC’s evidence-based physical activity programs for people with arthritis
- Kelley GA, Kelley KS, Hootman JM, Jones DL. Effects of community-deliverable exercise on pain and physical function in adults with arthritis and other rheumatic diseases: a meta-analysis. Arthritis Care Res (Hoboken). 2011 Jan;63(1):79-93. http://www.ncbi.nlm.nih.gov/pubmed/20824798
- Zhang W, Nuki G, Moskowitz RW, Abramson S, Altman RD, Arden NK, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M, Dougados M, Hochberg M, Hunter DJ, Kwoh K, Lohmander LS, Tugwell P. OARSI recommendations for the management of hip and knee osteoarthritis: part III: Changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthritis Cartilage. 2010 Apr;18(4):476-99. http://www.ncbi.nlm.nih.gov/pubmed/20170770
- Department of Health and Human Services. Physical Activity Guidelines Advisory Committee Report. Musculoskeletal Health. Available at http://www.health.gov/paguidelines/Report/pdf/G5_musculo.pdf.
- Conn VS, Hafdahl AR, Minor MA, Nielsen PJ. Physical activity interventions among adults with arthritis: meta-analysis of outcomes. Semin Arthritis Rheum. 2008 Apr;37(5):307-16. http://www.ncbi.nlm.nih.gov/pubmed/17888500
- Fransen M, McConnell S. Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev. 2008 Oct 8;(4):CD004376. http://www.ncbi.nlm.nih.gov/pubmed/18843657
People with arthritis can safely engage in physical activity
Moderate intensity exercise is safe for people with arthritis due to its low risk of injury and has been shown not to aggravate joint symptoms. Walking, in particular, has more than half the risk of musculoskeletal injury compared to other vigorous activities like running. A variety of physical activity programs have been tested and proven appropriate and safe for adults with arthritis.
To learn more:
- CDC’s list of evidence-based physical activity programs for people with arthritis
- Ory M, Resnick B, Jordan PJ, Coday M, Riebe D, Ewing Garber C, Pruitt L, Bazzarre T. Screening, safety, and adverse events in physical activity interventions: collaborative experiences from the behavior change consortium. Ann Behav Med. 2005 Apr;29 Suppl:20-8.
- Colbert LH, Hootman JM, Macera CA. Physical activity-related injuries in walkers and runners in the aerobics center longitudinal study. Clin J Sport Med. 2000 Oct;10(4):259-63.
Unfortunately, far too few adults with arthritis participate in recommended physical activity.
Adults with arthritis are less likely to be physically active than those without the disease, and this gap widens even further for adults with arthritis who also have diabetes or heart disease or for those who are obese.
To learn more:
- Hootman JM, Kamil E. Barbour KE, Watson KB, Fulton JE. State-Specific Prevalence of Walking Among Adults with Arthritis — United States, 2011. MMWR Weekly May 3, 2013 / 62(17);331-334. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6217a3.htm?s_cid=mm6217a3_w
- Dunlop DD, Song J, Semanik PA, Chang RW, Sharma L, Bathon JM, Eaton CB, Hochberg MC, Jackson RD, Kwoh KC, Mysiw WJ, Nevitt MC, Hootman JM. Objective physical activity measurement in the osteoarthritis initiative: Are guidelines being met? Arthritis Rheum. 2011 Jul 26. doi: 10.1002/art.30562. http://www.ncbi.nlm.nih.gov/pubmed/21792835
- Barbour KE, Hootman JM, Murphy LB, Helmick CG. Arthritis as a Potential Barrier to Physical Activity Among Obese Adults–United States, 2007 and 2009. MMWR 2011;60(19):614–618. html pdf [1.7MB] http://www.cdc.gov/mmwr/pdf/wk/mm6019.pdf
- Hootman JM, Barbour KE, Watson KB, Harris C. State-specific prevalence of no leisure-time physical activity among adults with and without doctor-diagnosed arthritis – United States, 2009. MMWR 2011;60(48):1641-1645. html pdf [1.10MB] http://www.cdc.gov/mmwr/pdf/wk/mm6048.pdf
- Bolen J, Murphy L, Greenlund K, , Helmick CG, Hootman J, Brady TJ, Langmaid G, Keenan N. Arthritis as a potential barrier to physical activity among adults with heart disease — United States, 2005 and 2007. MMWR 2009;58(7):165-169. html; pdf [1.25Mb] http://www.cdc.gov/mmwr/PDF/wk/mm5807.pdf
- Bolen J, Hootman J, Helmick CG, Murphy L, Langmaid G, Caspersen CJ. Arthritis as a potential barrier to physical activity among adults with diabetes — United States, 2005 and 2007. MMWR 2008;57(18):486-489. html; pdf [1.3Mb] http://www.cdc.gov/mmwr/PDF/wk/mm5718.pdf
What can you do?
“Because of their close ties to employees, business and industry can encourage positive physical activity behavior change in a supportive context of workplace policies and culture. By leveraging community resources and using health benefits incentives, business and industry also have an opportunity to reach families and the broader community.” Providing employees opportunities to be physically active can be as simple as identifying safe walking routes and encouraging their use or disseminating information on local fitness facilities and classes through worksite newsletters, employee orientation packets, and company websites. Having a worksite wellness programs does not mean an employer has to establish an onsite exercise facility, although having one certainly makes physical activity opportunities and programming easier. Worksite wellness programs may provide access or discounted membership rates to fitness facilities off-site or offer onsite fitness classes. This Guide provides tips for a range of options that businesses of various sizes, types, and interests can consider to support physical activity among their employees. Tips are provided for employers with worksite wellness programs who want to meet the needs of people with arthritis. Additionally, strategies are provided for worksites that do not have formal programs but are interested in helping their workforce become more active.
 Source: The National Physical Activity Plan (http://www.physicalactivityplan.org/theplan.php)
To learn more:
Zaza S, Harris KW, Briss PA, Task Force on Community Preventive Services (U.S.). The guide to community preventive services: what works to promote health? New York: Oxford University Press; 2005. http://www.thecommunityguide.org/library/book/Front-Matter.pdf
A few tips—
- Embrace the mission of increasing physical activity for all employees, and then identify site-specific barriers for employees with arthritis.
- Gather information from your employees on what they want, perhaps through surveys, focus groups, or worksite wellness committees. Getting their input and buy-in will help ensure their participation.
- Consider physical activity in the context of a comprehensive wellness approach for all employees—along with tobacco cessation, nutrition, and healthy weight—and integrate it into worksite wellness goals and strategies.
- Work through and with local business coalitions and chambers of commerce. You will learn what others are doing to increase physical activity and how you might collaborate.
- Think broadly. Consider ways to offer onsite arthritis appropriate evidence-based physical activity interventions at your workplace or to encourage use of local community Y’s, fitness centers, walking paths, parks, etc.
- Address the needs of all employees regardless of their physical limitations.
- Ensure that settings and facilities where programs are offered are accessible and safe (and in compliance with applicable laws).
- Encourage program facilitators to learn how to adapt exercises and programs to persons with disabilities and/or chronic pain conditions and become familiarized with adapted equipment for persons with disabilities and/or limited mobility.
- Make sure that any worksite wellness program you implement complies with applicable disability and health privacy laws, such as ADA and HIPPA.
To learn more:
William Mitchell College of Law PHLC. Worksite Wellness and the Americans with Disabilities Act Medical Information. http://www.publichealthlawcenter.org/sites/default/files/resources/ship-fs-ww-adamedinfo-2010.pdf. Accessed December 29, 2010.
Task Force on Community Preventive Services. Recommendations for worksite-based interventions to improve workers’ health. Am J Prev Med 2010;38(2 Suppl):S232-6. http://www.thecommunityguide.org/worksite/Worksite2010Recommendations_TaskForce.pdf
Strategy 1. Set worksite wellness goals to increase physical activity among adults with physical limitations such as arthritis, in addition to supporting other healthy behaviors such as smoking cessation and healthy weight/nutrition.
Almost half of all adults with arthritis also have at least one other disease or condition (2007 National Health Interview Survey). Heart disease is very common among adults with arthritis, as well as chronic respiratory conditions and diabetes. Adopting worksite wellness goals for physical activity will send the message that this intervention is critical to the health of all employees. It may also set the stage for movement towards adopting a comprehensive worksite wellness policy.
To learn more:
Strategy 2: Offer opportunities and scheduling flexibility so all employees can engage in physical activity during the workday.
Several toolkits offer ideas, steps, and resources for providing employees a range of options to make physical activity a regular part of their workday. All can be implemented at any worksite either individually or as part of a comprehensive worksite wellness program. It is important to keep in mind that any physical activity is better than none and that activity can be broken up into small amounts, at least 10 minutes at a time, during the day. Offering employees the flexibility to fit physical activity into their workload and personal needs is key.
Strategy 3: Use audits or walk-ability checklists to assess whether worksite walking trails, paths, and indoor walking routes are accessible to persons with arthritis.
Walkability audits are designed to assess availability, safety, and attractiveness of walking routes in and around your worksite. They help you map out the most commonly used walking routes and identify the most common safety hazards and inconveniences that can keep employees from walking at work. Audits may identify, for example, that chairs or benches for resting may increase the use of walking routes.
- Pedestrian and Bicycle Information Center Walk-ability Checklist
- Worksite walkability
- A Walkable 101: The Walkability Workbook
- Neighborhood Wayfinding Assessment Pocket Guide
- National Recreation and Park Association article, Walk This Way
- National Recreation and Park Association’s Parks Build Healthy Communities: Success Stories
- America Walks
- Pedestrian and Bicycle Center
- Analytic Audit Tool and Checklist Audit Tool
- Systematic Pedestrian and Cycling Environmental Scan (SPACES) Instrument
- Irvine Minnesota Inventory
- Measurement Instrument for Urban Design Quantities Related to Walkability
- Pedestrian Environment Data Scan (PEDS) Tool
- Path Environment Audit Tool (PEAT)
Strategy 4: Establish a worksite wellness program that includes at least one arthritis-appropriate physical activity intervention in your schedule of offerings; ensure the availability of physical activity interventions that are inclusive of adults with arthritis but not branded specifically for arthritis.
Six physical activity programs have been proven to enhance the symptoms, function, and quality of life of adults with arthritis. In addition, CDC has developed a guidance document to help select the appropriate interventions for your situation.
- Arthritis Appropriate Physical Activity and Self-Management Education Interventions, A Compendium of Implementation Information
- Six physical activity programs
- Suggestions for implementing Arthritis Foundation Walk With Ease in the Worksite
- Strategies to Prevent Obesity and Other Chronic Diseases: The CDC Guide to Strategies to Increase Physical Activity in the Community
- AF Community Programs for Better Living
- CDC Community Transformation Grants
If your worksite has a fitness facility, a few specific recommendations to make the equipment and classes more accessible for employees with arthritis should be considered. They are adapted from The National Center on Physical Activity and Disability:
- Fewer pieces of equipment that are more spread out so users have a choice of getting on the equipment from the right or left side and more space to place a mobility device
- More space between the equipment and the wall to allow adequate room to get on the equipment
- Clear paths to the equipment to prevent any impediments to access
- No minimum speed on cardiovascular equipment so equipment can be used at any desired speed
- Classes that an instructor can adapt for a person with restricted mobility
- A facility that is accessible by both stairs and elevators
- No heavy doors and/or closets that can be a problem for people with strength difficulties
- Areas of additional seating for people who might need periodic rest
- No door knob handles that may be difficult for people who lack hand dexterity
- Sufficient handlebars on equipment to add stability to all types of equipment
- Seats on stationary bicycles that provide adequate back support and allow users with back problems to use the equipment safely.
To learn more:
Employee Wellness Policy from Partners in Care Foundation-San Fernando Site
Partners in Care Foundation-San Fernando Site Employee Wellness Policy Adopted March 1, 2012, Employee Wellness Policy Partners in Care Foundation supports and is committed to the overall health and well-being of its employees. A healthy workforce results in a more productive workforce with less absenteeism, fewer accidents, lower health care demands, and greater overall savings by reducing the incidence of disease and disability. Partners in Care, San Fernando site, employees are encouraged to participate in education classes that help identify and reduce health risks before serious health problems occur or allow better management of existing conditions. Purpose Through the Partners Employee Wellness Program and partnerships with community organizations employees are able to access classes, information, seminars and informational resources to identify and manage health issues and preventable illness. Guidelines for Employee Wellness Partners in Care Foundation encourages healthy lifestyles by:
- Promoting wellness programs through the Partner’s break room information bulletin board.
- Encouraging the inclusion of healthy food options at meetings, potlucks, and special events.
- Encouraging employees to utilize breaks for walking, stretching or other physical activity.
- Incorporating exercise/stretch breaks into meetings when practical.
- Providing educational resources/classes that promote exercise, good nutrition and healthy lifestyles within and outside the workplace.
- Providing 45 minutes of work time to staff participating in approved Evidence-Based programs.