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Address correspondence to: Louise B. Murphy, PhD, Arthritis Program, Division of Population Health, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mailstop F-78, Atlanta GA 30341
Arthritis Program, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Arthritis Program, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Physical Activity and Health Branch, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Arthritis Program, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Arthritis Program, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Arthritis Program, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
In 2016, leisure time physical activity among U.S. adults aged ≥18 years with and without arthritis was studied to provide estimates using contemporary guidelines (2008 Physical Activity Guidelines for Americans) and population-based data (U.S. National Health Interview Survey).
Methods
Estimated prevalence of: (1) meeting aerobic, muscle strengthening, and both aerobic and muscle strengthening guidelines, by arthritis status, from 2008 to 2015; and (2) meeting guidelines across selected sociodemographic characteristics and health status and behaviors, among adults with arthritis, in 2015.
Results
In 2015, 36.2%, 17.9%, and 13.7% of adults with arthritis met aerobic, muscle strengthening, and both guidelines, respectively; age-standardized prevalence of meeting each guideline was significantly lower among those with arthritis versus those without (e.g., 41.9% [95% CI=39.5%, 44.3%] and 52.2% [95% CI=51.2%, 53.2%] met the aerobic guideline, respectively; p<0.001). From 2008 to 2015, meeting aerobic guideline rose modestly (3 percentage points) among those with arthritis compared with larger gains (7 percentage points) among those without arthritis; the percentage of adults with arthritis meeting muscle strengthening and both guidelines remained the same in contrast to modest (statistically significant) increases among those without arthritis. Among adults with arthritis, age-standardized percentage meeting each guideline was highest among those with at least a university degree.
Conclusions
Percentage meeting each guideline was persistently low among adults with arthritis. The lower prevalence among adults with arthritis versus those without suggests that adults with arthritis need additional strategies to address potential barriers (e.g., pain, psychological distress, inadequate medical support) to physical activity.
Introduction
Regular physical activity can improve the health of people living with chronic disease and is a recommended non-pharmacologic intervention for many chronic conditions, including arthritis.
Current physical activity levels among U.S. adults with arthritis are unknown. The most recent population-based national estimates were calculated from 2002 National Health Interview Survey (NHIS) data and based on now outdated recommendations (Healthy People 2010, released in 2000
Work Group recommendations: 2002 Exercise and Physical Activity Conference, St. Louis, Missouri Session V: evidence of benefit of exercise and physical activity in arthritis.
). Healthy People 2010 aerobic activity recommendations for all adults, including those with arthritis, were participation in either moderate-intensity activity ≥30 minutes per day, ≥5 days per week, or vigorous-intensity activity ≥20 minutes per day, ≥3 days per week
Work Group recommendations: 2002 Exercise and Physical Activity Conference, St. Louis, Missouri Session V: evidence of benefit of exercise and physical activity in arthritis.
The current physical activity guidelines, 2008 Physical Activity Guidelines for Americans (2008 Guidelines), contain recommendations for the general population and for people with specific chronic conditions, including arthritis.
They recommend that for substantial health benefits, adults should participate weekly in ≥150 minutes of moderate-intensity aerobic activity, 75 minutes of vigorous-intensity aerobic activity, or an equivalent combination (i.e., equivalent of ≥150 minutes of moderate aerobic physical activity). Furthermore, for more extensive health benefits (e.g., decreased all-cause mortality),
The 2008 Guidelines also recommend that adults engage in muscle strengthening activities involving all seven major muscle groups ≥2 days per week to increase bone strength and muscular fitness. Adults meeting both the aerobic and muscle strengthening guidelines fully meet 2008 Guidelines. To the authors’ knowledge, the percentage of U.S. adults with arthritis engaging in muscle strengthening activities and fully meeting the 2008 Guidelines is unknown.
Contemporary nationally representative population-based physical activity estimates among U.S. adults with arthritis were calculated using NHIS data and the 2008 Guidelines. First, for 2015, the prevalence of each aerobic physical activity level (i.e., active, insufficiently active, inactive) among U.S. adults with arthritis overall and across selected characteristics was estimated. Second, muscle strengthening prevalence overall and across selected characteristics among U.S. adults with arthritis in 2015 was estimated. Third, distribution of physical activity levels (aerobic, muscle strengthening, and both aerobic and muscle strengthening) by arthritis status was examined for 2015. Last, the percentage of adults with and without arthritis meeting each physical activity guideline type (aerobic, muscle strengthening, and both aerobic and muscle strengthening) from 2008 through 2015 was studied.
Methods
Data Sample
In 2016, NHIS data for U.S. adults aged ≥18 years were analyzed. NHIS is an ongoing, in-person, population-based cross-sectional survey that is designed to be representative of the civilian, non-institutionalized population. Final sample adult response rates from 2008 to 2015, accounting for NHIS’ household and family component response rates, ranged from 55.2% in 2015 (lowest) to 66.3% in 2011 (highest).
CDC. NHIS Survey Description: 2015 National Health Interview Survey (NHIS). ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2015/srvydesc.pdf. Published June 2016. Accessed July 1, 2016.
CDC. NHIS Survey Description: 2015 National Health Interview Survey (NHIS). ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2015/srvydesc.pdf. Published June 2016. Accessed July 1, 2016.
Respondents answering yes to Have you EVER been told by a doctor or other health professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus or fibromyalgia? were classified as having arthritis.
Three leisure time physical activity measures were examined (leisure time physical activity questions are in Appendix 1, available online):
1.
Aerobic activity: Respondents reported frequency and duration of leisure time moderate and vigorous aerobic activity during a usual week. Weekly moderate equivalent minutes were calculated by summing moderate- and vigorous-intensity minutes, where 1 minute of vigorous activity equaled 2 minutes of moderate activity. Respondents were classified as active if they engaged in ≥150 minutes of moderate-intensity equivalent activity (i.e., meets aerobic physical activity guideline),
insufficiently active if they engaged in some moderate-intensity equivalent activity but did not meet the active definition, and inactive if they reported no moderate-intensity equivalent activity that lasted ≥10 minutes. Those engaging in >300 minutes of moderate-intensity equivalent activity each week were classified as highly active.
2.
Muscle strengthening: Respondents reporting participation in leisure time physical activities specifically designed to strengthen their muscles (e.g., lifting weights, doing calisthenics) two or more times weekly were classified as meeting the muscle strengthening guideline.
3.
Fully meeting guidelines was meeting both aerobic activity and muscle strengthening guidelines.
Statistical Analysis
Four series of analyses were conducted. First, overall number and percentage (unadjusted and age standardized) of U.S. adults with arthritis in each aerobic activity category (inactive, insufficiently active, and active) were estimated. Then, for each aerobic activity level, age-standardized percentage was calculated across selected sociodemographic characteristics and health status and behaviors (Appendix 2, available online). Second, this analysis was repeated for muscle strengthening. Third, age-standardized prevalence of meeting aerobic activity, muscle strengthening, and both guidelines from 2008 to 2015, by arthritis status, was examined. Last, age-standardized distribution of physical activity levels, by arthritis status, was examined for 2015.
Analyses, conducted using SAS, version 9.3 and SUDAAN, version 11, accounted for NHIS’ complex design. Estimates were standardized to the 2000 projected U.S. population (age groups were 18–44, 45–64, and ≥65 years).
Differences in estimates were interpreted as statistically significant when 95% CIs did not overlap. Differences were formally tested with t-tests, by arthritis status, in age-standardized prevalence of physical activity levels. Time trends in age-standardized prevalence were tested using orthogonal linear polynomial contrasts at α=0.05.
Respondents with missing arthritis status were excluded from all analyses; in 2015, this represented 0.2% (weighted percentage) of adults in the U.S. civilian non-institutionalized population. For each physical activity measure, analyses were limited to those providing complete information for this measure; in 2015, missing responses (weighted percentage) across measures ranged from 0.8% (muscle strengthening) to 1.9% (meeting both guidelines).
Results
All estimates are based on self-reported information. In 2015, approximately one in five U.S. adults had arthritis (prevalence, 22.9%; age-standardized prevalence, 21.0%).
In 2015, 36.2% (19.8 million) of all U.S. adults with arthritis were active (i.e., met aerobic physical activity guideline), 22.6% (12.3 million) were insufficiently active, and 41.2% (22.5 million) were inactive (Table 1). Twenty-three percent (12.5 million) of all U.S. adults with arthritis were highly active (data not shown).
Table 1Prevalence (Weighted) of Aerobic Activity Levels
Based on the 2008 Physical Activity Guidelines for Americans. Active was ≥150 minutes of moderate-intensity aerobic activity, 75 minutes of vigorous-intensity aerobic activity, or an equivalent combination per week (i.e., met aerobic physical activity guideline). Insufficiently active was some aerobic activity but not enough to meet the active definition. Inactive was no moderate or vigorous-intensity aerobic activity for at least 10 minutes.
Among U.S. Adults With Arthritis Aged ≥18 Years, 2015
Derived from 2015 National Health Interview Survey data. There were 8,562 respondents with arthritis who provided complete information on aerobic activity. Participants with unknown values for the characteristics of interest were excluded; across characteristics examined, the percentage (weighted) of missing information ranged from 0.02% for arthritis-attributable activity limitations to 4.6% for psychological distress.
Includes non-Hispanic American Indians and Alaska Natives. There was insufficient sample size to report estimate for this race/ethnicity group separately.
Functional limitations in this measure are: walk a quarter mile, walk up 10 steps, stand for 2 hours, sit for 2 hours, stoop/bend/kneel, reach overhead, grasp small objects, lift/carry up to 10 pounds, and push/pull large objects.
Standardized to 2000 U.S. projected population (age groups were 18–44, 45–64, and ≥65 years).
Underweight/normal weight (<25.0)
925
33.1 (28.9, 37.5)
425
20.2 (16.4, 24.6)
856
46.8 (42.3, 51.2)
Overweight (25.0 to <30.0)
1,042
35.8 (31.7, 40.1)
603
19.5 (16.5, 22.8)
1,042
44.7 (40.7, 48.9)
Obese (≥30.0)
1,596
37.1 (33.8, 40.5)
788
25.8 (22.7, 29.1)
993
37.1 (33.7, 40.7)
a Based on the 2008 Physical Activity Guidelines for Americans. Active was ≥150 minutes of moderate-intensity aerobic activity, 75 minutes of vigorous-intensity aerobic activity, or an equivalent combination per week (i.e., met aerobic physical activity guideline). Insufficiently active was some aerobic activity but not enough to meet the active definition. Inactive was no moderate or vigorous-intensity aerobic activity for at least 10 minutes.
b Derived from 2015 National Health Interview Survey data. There were 8,562 respondents with arthritis who provided complete information on aerobic activity. Participants with unknown values for the characteristics of interest were excluded; across characteristics examined, the percentage (weighted) of missing information ranged from 0.02% for arthritis-attributable activity limitations to 4.6% for psychological distress.
c Number of respondents with arthritis at this aerobic activity level.
d All estimates ≥50.0% are boldface.
e Standardized to 2000 U.S. projected population (age groups were 18–44, 45–64, and ≥65 years).
f Estimate not reported because relative SE ≥30 and/or denominator contained less than 50 respondents.
g Includes non-Hispanic American Indians and Alaska Natives. There was insufficient sample size to report estimate for this race/ethnicity group separately.
h Comprises unemployed, retired, students, and homemakers.
i Functional limitations in this measure are: walk a quarter mile, walk up 10 steps, stand for 2 hours, sit for 2 hours, stoop/bend/kneel, reach overhead, grasp small objects, lift/carry up to 10 pounds, and push/pull large objects.
The age-specific percentage of adults with arthritis who were active was highest among younger adults (aged 18–44 years) and declined with increasing age. The age-standardized percentage of adults with arthritis who were active rose with increasing levels of education and self-rated health and declined with increasing number of comorbidities, severity of psychological distress, number of functional limitations, and BMI (Table 1). At least half (age-standardized percentage, 50.0%) of adults with arthritis in the following five groups were active: had at least a university degree (58.3%), excellent or very good general self-rated health (55.1%), no functional limitations (52.6%), were currently working (50.6%), and had no arthritis-attributable activity limitations (50.5%).
Across studied characteristics, the age-standardized percentage who were insufficiently active ranged from 13.2% to 27.0%. Finally, patterns across characteristics of those who were inactive were generally the reverse of patterns for being active (e.g., percentage who were inactive was lowest and highest among younger and older adults, respectively).
An estimated 17.9% (9.9 million) of U.S. adults with arthritis engaged in muscle strengthening at least twice a week (age-standardized prevalence, 19.5%) (Table 2). The percentage meeting muscle strengthening guideline was ≥25.0% for only two groups: those with at least a university degree (31.3%) and those with excellent or very good self-rated health (26.6%) (Table 2).
Table 2Prevalence (Weighted) of Muscle Strengthening Activities
Based on the 2008 Physical Activity Guidelines for Americans. Muscle strengthening guideline was defined as performing muscle strengthening activities two or more times per week.
Among U.S. Adults With Arthritis Aged ≥18 Years, 2015
Derived from 2015 National Health Interview Survey data. There were 8,630 respondents with arthritis who provided complete information on muscle strengthening activity; across characteristics examined. Participants with unknown values for the characteristics of interest were excluded; across characteristics, the percentage (weighted) of missing information ranged from 0.02% for arthritis-attributable activity limitations to 4.6% for psychological distress.
Functional limitations in this measure are: walk a quarter mile, walk up 10 steps, stand for 2 hours, sit for 2 hours, stoop/bend/kneel, reach overhead, grasp small objects, lift/carry up to 10 pounds, and push/pull large objects.
Standardized to 2000 U.S. projected population (age groups were 18 to 44, 45 to 64, and ≥65 years).
Underweight /normal weight (<25.0)
1,728
76.2 (72.2, 79.8)
495
23.8 (20.2, 27.8)
Overweight (25.0−<30.0)
2,201
80.9 (77.8, 83.7)
515
19.1 (16.3, 22.2)
Obese (≥30.0)
2,940
82.9 (80.3, 85.2)
460
17.1 (14.8, 19.7)
a Based on the 2008 Physical Activity Guidelines for Americans. Muscle strengthening guideline was defined as performing muscle strengthening activities two or more times per week.
b Derived from 2015 National Health Interview Survey data. There were 8,630 respondents with arthritis who provided complete information on muscle strengthening activity; across characteristics examined. Participants with unknown values for the characteristics of interest were excluded; across characteristics, the percentage (weighted) of missing information ranged from 0.02% for arthritis-attributable activity limitations to 4.6% for psychological distress.
c Number of respondents with arthritis at this muscle strengthening activity level.
d All estimates ≥25.0% are boldface.
e Standardized to 2000 U.S. projected population (age groups were 18 to 44, 45 to 64, and ≥65 years).
f Estimate not reported because relative SE ≥30 and/or denominator contained less than 50 respondents.
g Comprises unemployed, retired, students, and homemakers.
h Functional limitations in this measure are: walk a quarter mile, walk up 10 steps, stand for 2 hours, sit for 2 hours, stoop/bend/kneel, reach overhead, grasp small objects, lift/carry up to 10 pounds, and push/pull large objects.
An estimated 13.7% (7.5 million) of U.S. adults with arthritis (age-standardized percentage, 15.8%) met both aerobic and muscle strengthening guidelines (Appendix 3, available online). Across characteristics, the prevalence of meeting both guidelines was ≥25.0% in only one group: those with at least a university degree (26.6%).
From 2008 through 2015, the age-standardized percentage of U.S. adults with arthritis who were active (i.e., met aerobic physical activity guideline) increased by almost 3 percentage points (39.2% [95% CI=36.4%, 42.1%] in 2008 and 41.9% [95% CI=39.5%, 44.3%] in 2015; test for trend, p=0.02). The increase was larger (7 percentage points) among those without arthritis (45.0% [95% CI=43.9%, 46.2%] in 2008 and 52.2% [95% CI=51.2%, 53.2%] in 2015; test for trend, p<0.001) (Figure 1).
Figure 1Age-standardizeda percentage who met each type of guideline, by arthritis status, 2008–2015 National Health Interview Survey.
From 2008 through 2015, the prevalence of meeting muscle strengthening guideline among adults with arthritis remained statistically identical (test for trend, p=0.69). Although the prevalence for those with and without arthritis in 2008 was statistically the same, there was a modest (3 percentage point) and statistically significant increase in the percentage of adults without arthritis meeting the muscle strengthening guideline in subsequent years (test for trend, p<0.001). For those with and without arthritis, the pattern of fully meeting guidelines over time was largely similar to the patterns in muscle strengthening prevalence (test for trend among those with and without arthritis was p=0.63 and p<0.001, respectively).
In 2015, the age-standardized percentage of adults with arthritis who were aerobically active was 10 percentage points lower than those without arthritis (p<0.001) (Figure 1, Figure 2). Likewise, the percentage of adults without arthritis who were highly active was also higher than those with arthritis (35.6% [95% CI=34.6%, 36.6%] and 27.7% [95% CI=25.6%, 29.9%], respectively; p<0.001). Correspondingly, relative to those without arthritis, a higher percentage of adults with arthritis was inactive (35.8% [95% CI=33.4%, 38.3%] and 28.5% [95% CI=27.6%, 29.5%]; p<0.001) and insufficiently active (22.3% [95% CI=20.4%, 24.4%] and 19.2% [95% CI=18.5%, 20.0%]; p<0.01).
Figure 2Age-standardizeda prevalence of physical activity levels, by arthritis status, 2015 National Health Interview Survey.
The age-standardized percentage of adults meeting muscle strengthening guideline was 6 percentage points lower among those with arthritis compared with those without (19.5% [95% CI=17.8%, 21.3%] and 25.9% [95% CI=25.1%, 26.7%]; p<0.001) (Figure 1, Figure 2). Similarly, the percentage of adults with arthritis who fully met guidelines (both aerobic and muscle strengthening) was almost 7 percentage points lower among those with arthritis (15.8%, 95% CI=14.2%, 17.6%) than those without (22.6%, 95% CI=21.9%, 23.4%) (p<0.001) (Figure 1, Figure 2).
Discussion
In 2015, 36.2% (19.8 million) of U.S. adults with arthritis met the aerobic physical activity guideline, 17.9% (9.9 million) met the muscle strengthening guideline, and 13.7% (7.5 million) met both guidelines. Although based on different guidelines, the characteristics of adults with arthritis with the highest prevalence of aerobic inactivity in this study were generally similar to those with arthritis in the 2002 NHIS: being older, less educated, and having poorer physical and psychosocial health (e.g., functional limitations, comorbidities, serious psychological distress, social participation restrictions).
Patterns in meeting aerobic activity guideline across age, sex, highest educational attainment, and BMI in this study were similar to those for U.S. adults overall in the 2008 NHIS.
Across all years, only one in five adults with arthritis met the muscle strengthening guideline. Muscle strengthening has many overall (e.g., decreased all-cause mortality and bone mineral density loss)
One can participate in muscle strengthening with limited space and equipment (dumbbells, stretch bands, using own weight) and therefore it may be more accessible for those who cannot leave their home because of limited mobility or problematic weather. Although engaging in both aerobic and strengthening activities is optimal for maximizing physical activity’s benefits, having a choice between aerobic and muscle strengthening exercises may increase adherence to physical activity.
Thus, increasing awareness about muscle strengthening’s benefits, convenience, and safety may be an important strategy for increasing physical activity.
In 2015, the percentage meeting each guideline was considerably lower among adults with arthritis compared with those without; this difference has been reported previously.
Across the 8 years studied here, the percentage of adults with arthritis meeting aerobic guideline increased slightly (3 percentage points and statistically significant test for trend), whereas the percentage meeting muscle strengthening and full guidelines remained the same. By contrast, adults without arthritis experienced larger and statistically significant increases for each guideline. Adults with arthritis report both generic and arthritis-specific barriers to physical activity (e.g., functional limitations, fear that physical activity will worsen pain).
Multiple evidence-based strategies for promoting and supporting physical activity among adults with arthritis exist, but the minimal increase in this study suggests that these approaches are underused. Although there is currently no evidence that specific medical interventions increase physical activity (e.g., a recent meta-analysis of people with osteoarthritis found no increase in physical activity after total knee or hip arthroplasty
), healthcare providers may increase physical activity among adults with arthritis through medical management of physical activity barriers (e.g., pain), counseling all patients with arthritis to engage in physical activity to manage their arthritis symptoms,
and referring patients to community, evidence-based physical activity programs. Though the percentage of healthcare providers who recommend physical activity to their patients with arthritis is rising, currently two in five do not receive this recommendation.
which is consistent with primary care providers’ and rheumatologists’ reports that they do not discuss physical activity with their patients for multiple reasons, including limited appointment time.
Exercise Is Medicine® guidelines, developed to help healthcare providers address barriers and increase physical activity among their patients, include the recommendation that healthcare providers refer their patients to exercise professionals or local community programs.
designed to address arthritis-specific barriers, are available in many communities throughout the U.S. Public health professionals can support healthcare providers by ensuring that people with arthritis and healthcare providers are aware of these programs and striving to ensure complete geographic coverage of these programs in the U.S.
In 2015, one in four U.S. adults with arthritis were highly aerobically active compared with approximately one in three without arthritis. Currently, there is no evidence that adults with arthritis who are highly active (i.e., >300 moderate equivalent minutes) experience greater arthritis-specific benefits than those who are sufficiently active. However, being highly active confers other benefits, including reduced condition-specific mortality (e.g., cardiovascular disease, specific types of cancer [e.g., breast]
In this study, approximately three quarters of those with arthritis had at least one comorbidity and the prevalence of meeting aerobic and muscle strengthening guidelines decreased with increasing number of comorbidities. Thus, although many adults with arthritis may have a higher need for the benefits of being highly active, they are less likely to experience these effects than those without arthritis.
Limitations
This study’s limitations include the following. First, NHIS data are cross-sectional and therefore causal relationships cannot be inferred. Second, physical activity was self-reported and may be overestimated.
In two studies comprising middle-aged and older adults with osteoarthritis, the percentage meeting aerobic physical activity guideline, when human movement was measured with an accelerometer, was 7.3%−12.9% and 6.3%−7.7% among men and women, respectively.
These percentages are considerably smaller than the 41.9% meeting aerobic guideline in this study. Another possible source of overestimation: Whereas 2008 Guidelines do not include “light-intensity” activities, moderate activity in the NHIS uses a single question to measure both “light-intensity” and “moderate-intensity” activity. Third, NHIS data do not reflect whether reported muscle strengthening activities involved the seven major muscle groups specified in the 2008 Guidelines and may overestimate the prevalence of meeting muscle strengthening guideline.
Fourth, the physical activity measure captures leisure time activity only, which does not account for physical activity during work or transportation. Last, arthritis was self-reported. A clinic-based validation study of this question reported 77%−84% sensitivity and 59%−71% specificity, indicating likely misclassification of arthritis. Although the effect of this misclassification on this study’s estimates is unclear, the study conclusion would likely be similar in the absence of misclassification: A high percentage of adults with arthritis do not meet current aerobic or muscle strengthening guidelines.
A strength of this study was the data source, a population-based survey that measures numerous health status and behavior characteristics, including physical activity. The large sample size generated statistically precise estimates. The NHIS’ ongoing nature allowed study of 8 consecutive years. These are presumptively the first population physical activity estimates among U.S. adults with arthritis based on the 2008 Guidelines.
Conclusions
Overall, the results indicate that although approximately one in three and one in five U.S. adults with arthritis are meeting aerobic and muscle strengthening guidelines, respectively, a substantial percentage of U.S. adults with arthritis engage in no leisure time physical activity each week. Public health professionals and healthcare providers have an important role in helping people with arthritis increase physical activity levels, thus ensuring that they experience physical activity’s numerous generic and arthritis-specific benefits.
Acknowledgments
The authors thank Jeffrey Sacks, MD, MPH for his thoughtful review of the manuscript.
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
No financial disclosures were reported by the authors of this paper.
CDC. NHIS Survey Description: 2015 National Health Interview Survey (NHIS). ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2015/srvydesc.pdf. Published June 2016. Accessed July 1, 2016.
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