# Exercise as it relates to Disease/Physical activity levels in men and women arthritis

This article is an original critical analysis of; Shih, Margaret, et al. "Physical activity in men and women with arthritis: National Health Interview Survey, 2002." American journal of preventive medicine 30.5 (2006): 385-393.

## What is the background to this research?

Arthritis is a universal term used to describe more than 100 varying types of musculoskeletal pain affecting joints. The joints most affected by arthritis include the knees, ankles, wrists and fingers; this is due to the breakdown of cartilage tissue surrounding the joints. Common symptoms experienced by sufferers; swelling, pain, stiffness and a decreased range of motion, with the severity of these symptoms fluctuating between mild, moderate and severe. Arthritis is the leading cause of disability within America with more than 50 million adults and 300,000 children suffering in 2011. The more prevalent types of arthritis include osteoarthritis, also known as 'wear and tear' and leads to the breakdown of cartilage resulting in bone on bone erosion, and rheumatoid arthritis, caused by antibodies attacking tissue surrounding the joints.
To prevent or slow down the decline of arthritis affecting men and women regular physical activity (PA) has shown to decrease pain, improve function and delay disability.

## Where is the research from?

The research was published by the American Journal of Preventive Medicine volume 30 issue 5 and was authored by:
* Margaret Shih MD, PhD, Office of Health Assessment and Epidemiology, Los Angeles Department of Health Services, Los Angeles California
* Jennifer M. Hootman, PhD, Centres for Disease Control and Prevention, Atlanta, Georgia
* Judy Kruger, PhD, Centres for Disease Control and Prevention, Atlanta, Georgia
* Charles G. Helmick, MD, Centres for Disease Control and Prevention, Atlanta, Georgia
This research was based on the National Health Survey from 2002, primarily from non-institutionalised U.S. civilian adults.

## What kind of research was this?

This research paper uses a multistage complex sampling designed survey aimed towards adults (18 years and older) in a non-institutionalised environment. The National Health Interview Survey (NHIS) is an ongoing national survey using a percentage of U.S. citizens to identify their physical health habits and PA levels in comparison to arthritis experience in persons.

## What did the research involve?

With the involvement of 205,825 participants, (48.0% males and 52.0% females), the study population was distributed into multiple categories based on selected characteristics including; gender, age, race/ ethnicity, education, body mass index (BMI), and frequency of anxiety/depression (specific question "During the past 12 months, have you been frequently depressed or anxious?").
The research analysed participants assessed on 16 self-reported medical conditions, nine functional and three social/leisure limitations and special equipment. The medical conditions listed were; hypertension; high cholesterol; back pain; neck pain; cardiovascular condition (angina, congestive heart failure, myocardial infarction), stroke; respiratory condition (asthma, chronic bronchitis); thyroid problem; neurologic condition (multiple sclerosis, Parkinson disease); cancer; diabetes; kidney disease; liver condition; vision problem (difficulty seeing, blindness, macular degeneration); hearing impairment and gastrointestinal condition (ulcer, inflammation, irritable bowel).
Nine functional and three social/leisure activities were listed with respondents answering on a scale from zero to four or more varying from "very difficult" or "unable to". The functional activities included; walk a quarter-mile, sit for 2 hours, grasp small objects, reach overhead, lift/carry 10 pounds, push/pull large objects, stoop/bend/kneel and walk ten steps. The leisure activities included; go out shopping, to the movies or sporting events, participate in social activities such as visiting friends, attending clubs and meetings, going to parties or relax at home.
The respondent's need for special equipment was determined by the following question, "Do you now have any health problem that requires you to use special equipment, such a cane, wheelchair, special bed or a special telephone?".

## What were the basic results?

Comparing adults with arthritis and adults without arthritis were most likely to be older, female, non-Hispanic, less educated, obese, have frequent anxiety/depression, have one or more functional or social limitations and needs special equipment. The highest prevalence of inactivity was among adults with arthritis who had four or more functional limitations, one or more social/leisure limitations, a need for special equipment and lacked access to a fitness facility.
$_{TableOne:Distributionofselectedcharacteristicsofthestudypopulationoverallandbyarthritisstatus}$ :
| Charactertistics | Overall | Doctor-diagnosed arthritis | No arthritis |
| Characteristics | Weighted % | Weighted % | Weighted % |
| Age (years) |
| 18-44 | 52.5 | 19.8 | 63.1 |
| 45-64 | 31.4 | 43.4 | 27.1 |
| 65 or older | 16.1 | 36.8 | 9.9 |
| Gender |
| Male | 48.0 | 39.4 | 49.9 |
| Female | 52.0 | 60.6 | 50.1 |
| Race/Ethnicity |
| White/non-Hispanic | 72.7 | 80.4 | 69.6 |
| Black/non-Hispanic | 11.2 | 10.5 | 11.6 |
| Hispanic | 11.0 | 6.2 | 12.9 |
| Other | 5.1 | 3.0 | 5.8 |
| Education |
| College or more | 52.8 | 46.7 | 54.8 |
| High school or less | 45.9 | 52.4 | 43.9 |
| Body mass index |
| Under/normal weight (<25) | 39.5 | 28.9 | 43.5 |
| Overweight (25-29.9) | 33.4 | 33.3 | 33.1 |
| Obese (>30) | 22.4 | 33.2 | 18.4 |
| Frequent anxiety/depression |
| Yes | 15.7 | 73.5 | 89.0 |
| No | 83.9 | 26.2 | 10.7 |
| Functional Limitations |
| 0 | 86.0 | 59.6 | 95.0 |
| 1-3 | 8.8 | 23.8 | 3.4 |
| 4 or more | 5.0 | 16.2 | 1.4 |
| Social/leisure limitations |
| 0 | 96.2 | 89.4 | 98.5 |
| 1 or more | 3.4 | 9.9 | 1.8 |
| Need special eqipment |
| No | 94.4 | 83.3 | 98.1 |
| Yes | 5.5 | 16.6 | 1.2 |
| Physical activity recommendations |
| Inactive | 37.5 | 43.6 | 36.4 |
| Moderate/vigorus | 31.9 | 25.8 | 33.4 |
| Vigorous | 23.5 | 16.3 | 25.4 |
| Strengthening | 20.5 | 16.3 | 21.5 |

## What conclusions can we take from this research?

Arthritis was found to significantly affect health-related quality of life and was projected to increase in the upcoming years (2002). Due to the prevalence of obesity and lack of PA researches concluded that participants were almost twice as likely to experience a functional decline in comparison to those physically active. Physical activity had a more significant impact on the health systems by decreasing pain, improving function, delaying disability, promoting mental well-being and reducing the risk of comorbid diseases.

## Practical advice

Arthritis is most prevalent in individuals with signs of obesity, lack of PA and limited range of movement. Health professionals recommend regular PA due to it benefiting a decreased morbidity and mortality from cardiovascular disease, cancer and diabetes and leads to increased durability and flexibility surrounding joints.

## Further information/resources

For further information regarding arthritis resources below provide additional information;
* Arthritis Australia
* Physical Activity Levels Among the General US Adult Population and in Adults with and Without Arthritis
* Prevalence of self-reported arthritis or chronic joint symptoms among adults

## References

* 1 2 Shih M, Hootman JM, Kruger J, Helmick CG. Physical activity in men and women with arthritis: National Health Interview Survey, 2002. American journal of preventive medicine. 2006 May 1;30(5):385-93.
* ↑ https://www.arthritis.org/health-wellness/about-arthritis/understanding-arthritis/what-is-arthritis
* ↑ https://www.mayoclinic.org/diseases-conditions/osteoarthritis/symptoms-causes/syc-20351925#:~:text=Osteoarthritis%20is%20the%20most%20common,%2C%20knees%2C%20hips%20and%20spine.
* ↑ https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/symptoms-causes/syc-20353648#:~:text=Rheumatoid%20arthritis%20is%20a%20chronic,lungs%2C%20heart%20and%20blood%20vessels.