Action Brief

Community and Public Health Professionals Make a Difference!

Making the case

Arthritis is common and costly

Arthritis is the most common cause of disability in the United States.

• 58.5 million U.S. adults (23.7%) 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-attributable activity limitations will only increase.

To learn more:

Theis KA, Murphy LB, Guglielmo D, et al. Prevalence of Arthritis and Arthritis-Attributable Activity Limitation — United States, 2016–2018. MMWR Morb Mortal Wkly Rep 2021;70:1401–1407. html; pdf  [391K] https://www.cdc.gov/mmwr/volumes/70/wr/pdfs/mm7040a2-H.pdf

Hootman JM, Brault MW, Helmick CG, Theis KA, Armour BS. Prevalence and Most Common Causes of Disability Among Adults — United States, 2005. MMWR 2009;58(16):421-426. html; pdf  [1.3Mb] http://www.cdc.gov/mmwr/PDF/wk/mm5816.pdf

Arthritis and other rheumatic conditions costs our nation $128 billion each year – or 1.2% of the gross domestic product (in 2003). $81 billion of that cost is due to health care expenses, and $47 billion to lost earnings.

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

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:

About arthritis comorbidity

About arthritis and anxiety and depression

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:

About Tai-chi

CDC Compendium of Effective Fall Interventions: What Works for Community-Dwelling Older Adults, 2nd Edition

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. Available at https://health.gov/sites/default/files/2019-09/PAG_Advisory_Committee_Report.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

Shih M, Hootman JM, Kruger J, Helmick CG. Physical activity in men and women with arthritis National Health Interview Survey, 2002. Am J Prev Med. 2006 May;30(5):385-93. http://www.ncbi.nlm.nih.gov/pubmed/16627126

What can you do?

“Historically, the primary role of public health is to monitor, protect, and promote the public’s health. These functions complement the health care delivery system and community sectors. Complementing the public health sector are volunteer and non-profit organizations, long recognized as a source of social cohesion, a laboratory of innovation, and a continually adaptable means of responding to emerging ideas, needs, and communal opportunities. These community organizations have been in the forefront of developing and promoting physical activity recommendations and programs.”^[1]

Community and public health agencies are pivotal in reaching constituencies that may not be served traditionally or routinely by other sectors. In addition, they are key to promoting physical activity throughout towns, cities, and counties in ways that are safe and effective for, and inclusive of, persons with arthritis. This may include working across multiple sectors to launch evidence-based arthritis-appropriate physical activity interventions, forging community partnerships to expand physical activity opportunities, and managing up-to-date electronic databases and web-based listings of physical activity and arthritis-friendly resources in the community.

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. https://www.thecommunityguide.org/sites/default/files/publications/Front-Matter.pdf

A few tips—

Follow the recommended approaches for increasing physical activity provided in The Guide to Community Preventive Services, including informational approaches to change knowledge and awareness, behavioral and social approaches to teach behavior change skills and provide support, and environmental and policy approaches to change social networks, organizational norms and policies, and laws to support physical activity.

Promote the recommended interventions found in A National Public Health Agenda for Osteoarthritis, as well as the Physical Activity Guidelines for Americans.

Promote the recommended special considerations for people with chronic conditions, which state that “any activity is better than none (as) adults with chronic conditions obtain important health benefits from regular physical activity; when adults with chronic conditions do activity according to their abilities, physical activity is safe; and adults with chronic conditions should be under the care of healthcare providers (as) people with chronic conditions and symptoms should consult their healthcare providers about the types and amounts of activity appropriate for them.”

Work with aging services and senior centers to increase the functional ability of older adults.  Recommendations based on “Aging, Disability, and Frailty: Implications for Universal Design” include:

• Adequately wide doors of 32-36” width with thresholds ¼” or shorter,
• Lever door handles,
• Low level loop carpet or hard surface flooring (non slip, non glare),
• Contrasting color values between floor and baseboard or furniture,
• No steep entry,
• Handrails on both sides of stairs, and
• Adequate night lighting for safe walking.

Encourage and support senior centers and facilities that house older adults to enact policies that promote evidence-based disease management and health promotion activities.

Identify and partner with state health departments who receive CDC funding to operate state arthritis programs.   These programs are charged with strengthening partnerships with other chronic disease programs, state Arthritis Foundation chapters/regions and other partners; improving their ability to monitor the burden of arthritis; coordinating state activities; increasing awareness that something can be done to address the burden and impact of arthritis; and promoting self-management education and physical activity.

Leverage other public health funding from foundations (e.g., the Robert Wood Johnson Foundation), the Agency on Aging (AoA), and others.

To learn more:

Crews DE, Zavotka S. Aging, disability, and frailty: implications for universal design. J Physiol Anthropol 2006;25(1):113-8. http://www.ncbi.nlm.nih.gov/pubmed/16617216

National Association of States United for Aging and Disabilities. National Association of States United for Aging and Disabilities’ Policy Priorities. http://www.nasuad.org/federal_policy/index.html. Accessed October 13, 2010.

[1] Source: The National Physical Activity Plan

Strategies

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.

Tools

• Arthritis Appropriate Physical Activity and Self-Management Education Interventions, A Compendium of Implementation Information
• Six physical activity programs
  • Active Living Everyday
  • Arthritis Foundation Aquatic Program
  • Arthritis Foundation Exercise Program
  • Arthritis Foundation Walk With Ease Program (group led)
  • EnhanceFitness
  • Fit and Strong! 
• 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

 

 To learn more:

Additional Information on Physical Activity Programs for Individuals with Arthritis [can be found at end of this document]

Samples

• Activity Guides from the Milwaukee County Department on Aging’s five senior centers, listing many of the activities taking place including a regular fitness program in partnership with seniors’ physicians and a Walk with Ease Program and gardening activities outside of the senior centers during the warm months
• Wellness and prevention programs  that promote healthy living are coordinated by both the Area Agency on Aging and The Aging Resource Center of Milwaukee County.
• Resource Guide on how to stay connected in Milwaukee County with ongoing activities, times and transportation so people have information on when and how to get to various senior center locations.

Strategy 2: Establish community partnerships to expand physical activity opportunities (e.g., in senior centers, the Y, churches and synagogues, and other appropriate facilities).

Lack of availability of appropriate and effective programs can be a barrier to increasing physical activity among adults with arthritis. However, making a variety of physical activities accessible and convenient, in as many places throughout the community as possible, can reduce a major barrier prohibiting adults with arthritis from engaging in regular, routine exercise.  In addition to the tools expanding dissemination and delivery of public health activities below, additional ideas can be found in the Partnership section.

Tools

• The Community Healthy Living Index helps communities to assess opportunities for active living and healthy eating and to mobilize all sectors of society to conquer obesity and chronic disease. Its Neighborhood and Community-at-Large assessments address policies and built environment factors that influence community design in support of physical activity.
• Tips for using well-positioned national nonprofit networks like the YMCA, Boys & Girls Clubs of America, and National Council of La Raza to scale promising and proven programs, Measuring to Scale What Works at the YMCA. http://www.ssireview.org/blog/entry/measuring_to_scale_what_works_at_the_ymca

Strategy 3: Incorporate strategies to reduce arthritis-specific barriers to physical activity in all programmatic and policy initiatives, including those for adults with obesity, disabilities, heart disease, and diabetes.

In recent years, there has been movement towards coordination, integration, and consolidation of public health funding and programs. State and local health department plans have reflected this trend, with increasing attention to ways that physical activity for adults with arthritis can help serve the larger chronic disease population. Many of the physical activity strategies appropriate for adults with arthritis also benefit those with other chronic conditions. These include walking, swimming and riding a bike.

Tools

• Communities Putting Prevention to Work: Chronic Disease Self-Management Program
• Aging and Disability Resource Centers (ADRCs) are one stop shops for information, opportunities, and referrals to address needs of older adults and people with disabilities. They are great resource for knowing exactly who is offering what service in your community, and where and how it can be obtained.
• Self-management programs provide older adults with education and tools they need to help them cope with chronic diseases such as diabetes, heart disease, lung disease, or arthritis. The programs help participants manage stress, discuss the benefits of physical activity and good nutrition, and help participants communicate more effectively with health care providers. Participants develop action plans related to these topics through structured planning and feedback exercises. Since older adults disproportionately experience chronic diseases, the U.S. Administration on Aging supports the dissemination of self-management programs for chronic diseases by awarding grants to states. State governments then use these funds to develop an infrastructure (workforce, sites, enrollment system) to deliver these programs in communities around the country.

Samples

Shared Agenda for the Virginia Chronic Disease Prevention Collaborative Network

Strategy 4: Create joint-use agreements with schools, shopping malls, and other community buildings to host physical activity opportunities when not in use for other purposes.

Joint use is a method to increase opportunities for children and adults to be more physically active. In joint use agreements, two or more entities—often a school and a city or private organization—share indoor and outdoor spaces like gymnasiums, athletic fields, and playgrounds. The sharing of resources keeps costs down while boosting the health and connectedness of the community’s residents. Evidence-based physical activities should be promoted in these agreements to the extent possible.

Tools

• Making Effective Use of Existing Resources for Healthier Communities: Joint Use Dialogue Guide
• Joint use suggestions from ChangeLabSolutions
• NRPA’s Parks Build Healthy Communities: Success Stories
• NRPA’s Issue Brief on Creating Safe Park Environments to Enhance Community Wellness

Samples

The statewide Joint Use Task Force (JUST) in California, established in May 2008, includes organizations representing health, civil rights, community collaboratives, planners, local elected and appointed officials, park and recreation officials, school board administrators, academic researchers, and a growing list of groups interested in ensuring that all children and adults have a safe place to be active within easy reach.