Eyecare Tips

Arthritis Unnecessarily Stops Many US Diabetics Taking Needed Exercise

April 12, 2017

About half of US adults with diabetes also have arthritis, which appears to be a barrier, in addition to lack of time and being too busy with other things, because they are not sure what exercise is appropriate and they are concerned about aggravating joint pain and causing further damage. The researchers suggest health care providers pay special attention to arthritis-related barriers among diabetics who are not physically active. There is no reason why diabetics with arthritis should not enjoy the many health benefits of appropriate exercise.

The study is the work of scientists based at the US Centers for Disease Control and Prevention, Atlanta, and is published in the May 9th issue of Morbidity and Mortality Weekly Report (MMWR).

Physical activity is a recommended self-management strategy for diabetics, of which there are around 20 million in the US, and arthritis sufferers, of which there are over 45 million in the US. Research that investigates the potential barriers to increasing health-enhancing physical activity among people who have both conditions is likely to benefit many, hence the object of the study.

Increasing physical activity is good for people with diabetes because it reduces blood glucose and risk factors for complications, such as obesity and high blood pressure, and brings other benefits such as reducing risk of cardiovascular problems, according to the American Diabetes Association and the American College of Sports Medicine, wrote the researchers.

The researchers analyzed data collected in 2005 and 2007 in the Behavioral Risk Factor Surveillance System (BRFSS). This is a random, nationwide telephone survey of non-institutionalized US civilians aged 18 and over that asks if you have ever been told by a doctor that you have diabetes, or 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.

Respondents are also asked a range of questions about non-occupational physical activity, and also to give their height and weight (from which their BMI is calculated).

The results showed that: Arthritis affects diabetics more than the general population (52 per cent of US adults with diabetes have arthritis compared with 27 per cent of all adults).
This trend was true across all age groups: ie 18 to 44, 45 to 64, and over 65 years, although the percentages were different (28 versus 11 per cent, 52 versus 36 per cent, and 62 versus 56 per cent, respectively).
Diabetics with arthritis were less physically active than non-arthritic diabetics.
This was still the case after adjusting for other factors such as age, gender and BMI (body mass index). The researchers concluded that:

"The higher prevalence of physical inactivity among adults who have both diabetes and arthritis suggests arthritis might be an extra barrier to increasing physical activity."

They recommended that:

"Health-care providers and public health agencies should consider addressing this barrier with arthritis-specific or general evidence-based self-management and exercise programs."

An editorial note accompanying the report cautioned that because the survey was cross-sectional, you can't draw conclusions that are time-dependent, such as which condition came first, the diabetes or the arthritis.

However, there is room to speculate. The report suggests arthritis might be a barrier over and above the usual reasons for lack of physical activity, such as lack of time, other priorities, lack of motivation, and difficulty finding something enjoyable that requires physical exertion.

People with arthritis may be concerned that exercise will make the pain worse, cause further joint damage, or they might be unsure about the type and amount of physical activity that will help rather than worsen their condition. Hence the recommendation to health care professionals to pay special attention to diabetics with arthritis incase they have these particular concerns.

The CDC report suggests a number of resourcers, such as self-tailored self-management education programs: the Chronic Disease Self Management Program and the arthritis-specific Arthritis Foundation Self-Help Program, and several exercise programs, including EnhanceFitness, the Arthritis Foundation Exercise Program, and the Arthritis Foundation Aquatics Program, many of which are available in the community.

Adults with diabetes and arthritis may also benefit from joint friendly activities such as walking, swimming and bike riding, said the researchers.

From a research perspective, the study is limited by a number of factors, including the fact the data was obtained through self-report rather than a clinical confirmation, excluded people who did not have a landline, people in the military, and people living in institutions, and people with undiagnosed diabetes.

"Arthritis as a Potential Barrier to Physical Activity Among Adults with Diabetes --- United States, 2005 and 2007."
J Bolen, J Hootman, CG Helmick, L Murphy, G Langmaid, CJ Caspersen.
CDC MMWR, May 9, 2008, 57(18); 486-489.

Click to read the full report, including state by state results.

Sources: CDC MMWR.

: Catharine Paddock, PhD