Cdc's Great Arthritis Remedy: Exercise, Self-Management

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This is the first of two articles.

Older adults looking for arthritis pain relief should take a regular dose of physical activity-swimming, brisk walking, bicycling, gardening or raking leaves. That's because the problems that plague the health of many Americans-lack of exercise and being overweight-also contribute to the pain and disability of arthritis.

"The most important message is that there is a lot that people who have arthritis can do to help themselves," said senior behavioral scientist Teresa J. Brady of the U.S. Centers for Disease Control and Prevention (CDC) in Atlanta. Using the slogan "Physical Activity-The Arthritis Pain Reliever," CDC has directed a national educational effort at raising awareness among older Americans of nature's pain remedy.

BURDEN UNDERESTIMATED

"People underestimate the arthritis burden and tend to minimize its effects, assume it is a normal part of aging and don't go to their doctor," said Chad Helmick, a CDC medical officer and senior epidemiologist. Although arthritis is the leading cause of disability among all U.S. adults, he said that people with the condition tend to self-diagnose and fail to understand that self-management techniques can help them. "Arthritis isn't just a normal part of aging that must be endured. It is a disease," he said. He noted that 60% of people with arthritis are under age 65.

CDC estimates that in 2001, 49 million adults in the United States-including 21.4 million older people-had doctor-diagnosed arthritis. However, the number of U.S. adults with arthritis could be as high as 70 million if those reporting chronic joint symptoms but not reporting doctor-diagnosed arthritis are included. "The real story, though, is how much this number will increase," Helmick noted. CDC estimates that by 2030, the figure will jump to 41.1 million older Americans with some form of arthritis.

Approximately 16% of those over age 65 who have chronic joint symptoms have not seen their doctor, said Joe Sniezek, chief of CDC's Arthritis Program. In addition to physical activity, self-management techniques include weight control and pain management, as well as learning coping skills and how to navigate the healthcare system. The U.S. Surgeon General's 1996 report Physical Activity and Health found that regular moderate aerobic or resistance-training exercise programs reduce symptoms and improve functioning among people with rheumatoid arthritis and osteoarthritis.

Almost 60% of people age 65 or older report arthritis or chronic joint symptoms. About 20% of people with arthritis report limitations in activity, including 3 million to 4 million older adults, CDC data show.

THE HIGH COST

As the leading cause of disability among U.S. adults, arthritis and other rheumatic conditions also carry the highest cost for any disability, Helmick said. The latest data from the 1997 Medical Expenditure Panel Survey show that arthritis costs the nation $86.2 billion a year. The figure includes direct costs ($51.1 billion in medical expenditures) and indirect costs ($35.1 billion in lost wages among the working-age population), Helmick explained. Costs by state ranged from a low of $121 million in Wyoming to a high of $8.4 billion in California.

Although there is little data on whether arthritis treatment can reduce these costs, "it makes sense that if you slow the progression of the disease, you are going to save resources along the way," Sniezek said.

Past studies have demonstrated the effectiveness of community-based arthritis education in significantly reducing patients'pain, depression and disability levels. Furthermore, research by Marian A. Minor, a principal investigator with the Missouri Arthritis Rehabilitation Research and Training Center, shows that physical activity is effective in osteoarthritis treatment, leading to a decrease in pain and disability and an increase in mobility and flexibility.

Physical activity is beneficial, according to CDC, because stronger muscles help support and protect joints affected by arthritis. …