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INTRODUCTION:Physical activity guidelines recommend minimum thresholds. This study sought to identify evidence-based thresholds to maintain disability-free status over 4years among adults with lower extremity joint symptoms. METHODS:Prospective multisite Osteoarthritis Initiative accelerometer monitoring cohort data from September 2008 through December 2014 were analyzed. Adults (n=1,564) aged ≥49years at elevated disability risk because of lower extremity joint symptoms were analyzed for biennial assessments of disability-free status from gait speed ≥1meter/second (mobility disability-free) and self-report of no limitations in activities of daily living (activities of daily living disability-free). Classification tree analyses conducted in 2017-2018 identified optimal thresholds across candidate activity intensities (sedentary, light, moderate-vigorous, total light and moderate-vigorous activity, and moderate-vigorous accrued in bouts lasting ≥10 minutes). RESULTS:Minimal thresholds of 56 and 55 moderate-vigorous minutes/week best predicted disability-free status over 4years from mobility and activities of daily living disabilities, respectively, across the candidate measures. Thresholds were consistent across sex, BMI, age, and knee osteoarthritis presence. Mobility disability onset was one eighth as frequent (3% vs 24%, RR=0.14, 95% CI=0.09, 0.20) and activities of daily living disability onset was almost half (12% vs 23%, RR=0.55, 95% CI=0.44, 0.70) among people above versus below the minimum threshold. CONCLUSIONS:Attaining an evidence-based threshold of approximately 1-hour moderate-vigorous activity/week significantly increased the likelihood of maintaining disability-free status over 4years. This minimum threshold tied to maintaining independent living abilities has value as an intermediate goal to motivate adults to take action towards the many health benefits of a physically active lifestyle.

INTRODUCTION:While OA literature indicates greater pain is related to less time being physically active, it is not known if time curtailment occurs primarily for moderate intensity activities or for light activities or in both. We examine the cross-sectional association of knee pain with physical activity using data from 1874 Osteoarthritis Initiative participants. METHODS:Knee pain characteristics of constant and intermittent pain were each scored by the Intermittent and Constant Osteoarthritis Pain instrument and categorized into four pain levels (no pain, intermittent pain below and above median level, and constant pain). The relationships between knee pain levels and objectively measured physical activity (average weekly moderate or light intensity minutes) were assessed by quantile regression adjusted for socio-demographics and health factors. RESULTS:Knee pain levels had a strong negative relationship with moderate intensity physical activities (p-value for trend =0.029). Compared to the no pain group, persons with more severe knee pain, particularly those reporting higher intermittent or constant pain spent less time in moderate activity. In contrast, there was no notable trend related to pain with time spent in light intensity activity. These patterns remained when restricted to persons with clinical evidence (symptoms and/or radiographic) of knee OA and among persons not using medications for knee symptoms. CONCLUSION:Greater knee pain levels were strongly related to less moderate intensity activity time, but not time spent in light intensity physical activity. This relationship suggests that light activity may be a more acceptable way to increase physical activity than moderate activity for people with symptomatic knee pain.

ObjectiveTo investigate the public health impact of obesity and other modifiable risk factors related to physical inactivity in adults with knee osteoarthritis (OA).MethodsThe frequency of inactivity as defined by the US Department of Health and Human Services was assessed from objective accelerometer monitoring of 1,089 participants (ages 49-84 years) with radiographic knee OA during the Osteoarthritis Initiative 48-month visit (2008-2010). The relationship between modifiable factors (weight status, dietary fat, fiber, smoking, depressive symptoms, knee function, knee pain, and knee confidence) with inactivity was assessed using odds ratios (ORs) and attributable fractions (AFs), controlling for descriptive factors (age, sex, race, education, lives alone, employment, frequent knee symptoms, and comorbidity).ResultsAlmost half (48.9%) of participants with knee OA were inactive. Being overweight (OR 1.8, 95% confidence interval [95% CI] 1.2-2.5) or obese (OR 3.9, 95% CI 2.6-5.7), having inadequate dietary fiber intake (OR 1.6, 95% CI 1.2-2.2), severe knee dysfunction (OR 1.9, 95% CI 1.3-2.8), and severe pain (OR 1.7, 95% CI 1.1-2.5) were significantly related to inactivity, controlling for descriptive factors. Modifiable factors with significant average AFs were being overweight or obese (AF 23.8%, 95% CI 10.5-38.6%) and inadequate dietary fiber (AF 12.1%, 95% CI 0.1-24.5%), controlling for all factors.ConclusionBeing obese or overweight, the quality of the diet, severe pain, and severe dysfunction are significantly associated with physical inactivity in adults with knee OA. All components should be considered in designing physical activity interventions that target arthritis populations with low activity levels.

Objective: To identify modifiable physical and behavioural factors associated with widespread pain (WSP) in older adults with radiographic evidence of knee osteoarthritis (OA). Methods: Cross‐sectional initial visit data of participants with radiographic knee OA (Kellgren‐Lawrence grade of ≥2) from the Osteoarthritis Initiative Study were analysed. WSP was defined as pain on both sides of the body, above and below the waist, and in the axial skeleton. Time (hrs/d) spent participating in sitting and moderate‐strenuous physical activities were calculated from the Physical Activity Scale for the Elderly questionnaire. Physical function was quantified using gait speed and the chair stand test. Restless sleep was assessed using an item on the CES‐D Scale. Logistic regression models were constructed to examine the strength of the associations between primary exposures and WSP in unadjusted and adjusted analyses. Results: Among the 2637 participants (mean age 62.6 years, 58.6% female), 16.8% met the criteria for WSP. All primary measures of interest were related to WSP in unadjusted analyses. In adjusted multivariable analysis, slow gait speed (adjusted odds ratio [aOR] 1.43; 95% CI 1.01, 2.02), lower chair stand rate (aOR 0.98; 95% CI 0.97–0.99), and restless sleep (aOR 1.61; 95% CI 1.25–2.08) maintained significant associations with WSP. Conclusion: Poor sleep behaviours and low physical function capacity are associated with WSP in adults with radiographic knee OA. These findings highlight the importance of assessing sleep, physical function, and pain distribution in this population. Interventions to improve physical function and sleep behaviours should be investigated as potential strategies to mitigate WSP. [ABSTRACT FROM AUTHOR]

Objective: Patient‐Reported Outcomes Measurement Information System (PROMIS) measures can be administered via computerized adaptive testing (CAT) or fixed short forms (FSFs), but the empirical benefits of CAT versus FSFs are unknown in juvenile myositis (JM). The present study was undertaken to assess whether PROMIS CAT is feasible, precise, correlated with FSFs, and less prone to respondent burden and floor/ceiling effects than FSFs in JM. Methods: Patients 8–17 years of age (self‐report and parent proxy) and parents of patients 5–7 years of age (only parent proxy) completed PROMIS fatigue, pain interference, upper extremity function, mobility, anxiety, and depressive symptoms measures. Pearson correlations, paired t‐tests, and Cohen's d were calculated between PROMIS CAT and FSFs. McNemar's test assessed floor/ceiling effects between CAT and FSFs. Precision and respondent burden were examined across the T score range. Results: Data from 67 patient–parent dyads were analyzed. CAT and FSF mean scores did not significantly differ except in parent proxy anxiety and fatigue (effect size 0.23 and 0.19, respectively). CAT had less pronounced floor/ceiling effects at the less symptomatic extreme in all domains except self‐report anxiety. Increased item burden and higher SEs were seen in less symptomatic scorers for CAT. Modified stopping rules limiting CAT item administration did not decrease precision. Conclusion: PROMIS CAT appears to be feasible and correlated with FSFs. CAT had less pronounced floor/ceiling effects, allowing detection of individual differences in less symptomatic patients. Modified stopping rules for CAT may decrease respondent burden. CAT can be considered for long‐term follow‐up of JM patients. [ABSTRACT FROM AUTHOR]

Objectives. We analyzed factors associated with improvement in walking ability among respondents to the nationally representative Health and Retirement Study. Methods. We analyzed data from 6574 respondents aged 53 years or older who reported difficulty walking several blocks, 1 block, or across the room in 2000 or 2002. We examined associations between improvement (versus no change, deterioration, or death) and baseline health status, chronic conditions, baseline walking difficulty, demographic characteristics, socioeconomic status, and behavioral risk factors. Results. Among the 25% of the study population with baseline walking limitations, 29% experienced improved walking ability, 40% experienced no change in walking ability, and 31% experienced deteriorated walking ability or died. In a multivariate analysis, we found positive associations between walking improvement and more recent onset and more severe walking difficulty, being overweight, and engaging in vigorous physical activity. A history of diabetes, having any difficulty with activities of daily living, and being a current smoker were all negatively associated with improvement in walking ability. After we controlled for baseline health, improvement in walking ability was equally likely among racial and ethnic minorities and those with lower socioeconomic status. Conclusions. Interventions to reduce smoking and to increase physical activity may help improve walking ability in older Americans. (doi:10.2105/AJPH.2008.142927)

Objectives. We investigated differences in the development of disability in activities of daily living among non-Hispanic Whites, African Americans, Hispanics interviewed in Spanish, and Hispanics interviewed in English. Methods. We estimated 6-year risk for disability development among 8161 participants 65 years or older and free of baseline disability. We evaluated mediating factors amenable to clinical and public health intervention on racial/ethnic difference. Results. The risk for developing disability among Hispanics interviewed in English was similar to that among Whites (hazard ratio [HR] = 0.99; 95% confidence interval [CI] = 0.6, 1.4) but was substantially higher among African Americans (HR = 1.6; 95% CI = 1.3, 1.9) and Hispanics interviewed in Spanish (HR = 1.8; 95% CI = 1.4, 2.1). Adjustment for demographics, health, and socioeconomic status reduced a large portion of those disparities (African American adjusted HR = 1.1, Spanish-interviewed Hispanic adjusted HR = 1.2). Conclusions. Higher risks for developing disability among older African Americans, and Hispanics interviewed in Spanish compared with Whites were largely attenuated by health and socioeconomic differences. Language- and culture-specific programs to increase physical activity and promote weight maintenance may reduce rates of disability in activities of daily living and reduce racial/ethnic disparities in disability.

Objectives. We evaluated the effect of depression on risk, on the basis of standardized assessment, for developing activities of daily living (ADL) disability. Methods. Depression-related risk on 2-year ADL disability is estimated from 6871 participants in a population-based national sample aged 54-65 years and free of baseline ADL disability. We evaluated the effects of factors amenable to clinical and public health intervention that may explain the relationship between depression and incident disability. Results. The odds of ADL disability were 4.3 times greater for depressed adults than their non-depressed peers (95% confidence interval=3.1, 6.0). Among depressed adults, 18.7% of African Americans, 8.0% of Whites, and 7.8% of Hispanics developed disability within 2 years. The attributable population fraction because of depression is 17.3% (95% confidence interval=11%, 24%). Concurrent health factors moderated depression-associated risk. Conclusions. Elevated risk of ADL disability onset because of depression, in a co-hort whose medical costs will imminently be covered via Medicare, is attenuated by factors amenable to public health intervention. Prevention and/or public health/ policy programs that lead to more accessible and effective mental health and medical care could reduce the development of ADL disability among depressed adults. (Am J Public Health. 2005;95:2003-2008. doi: 10.2105/AJ PH.2004.050948)

Objectives. We estimated racial/ethnic differences in rates of major depression and investigated possible mediators. Methods. Depression prevalence rates among African American, Hispanic, and White adults were estimated from a population-based national sample and adjusted for potential confounders. Results. African Americans (odds ratio [OR]-1.16, 95% confidence interval [CI]=0.93, 1.44) and Hispanics (OR=1.44, 95% CI-1.02, 2.04) exhibited elevated rates of major depression relative to Whites. After control for confounders, Hispanics and Whites exhibited similar rates, and African Americans exhibited significantly lower rates than Whites. Conclusions. Major depression and factors associated with depression were more frequent among members of minority groups than among Whites. Elevated depression rates among minority individuals are largely associated with greater health burdens and lack of health insurance, factors amenable to public policy intervention.

Objective. We examine the role of economic access in gender and ethnic/racial disparities in the use of health services among older adults. Methods. Data from the 1993-1995 study on the Asset of Health Dynamics Among the Oldest Old (AHEAD) were used to investigate differences in the 2-year use of health services by gender and among non-Hispanic White versus minority (Hispanic and African American) ethnic/racial groups. Analyses account for predisposing factors, health needs, and economic access. Results. African American men had fewer physician contacts; minority and non-Hispanic White women used fewer hospital or outpatient surgery services; minority men used less outpatient surgery; and Hispanic women were less likely to use nursing home care, compared with non-Hispanic White men, controlling for predisposing factors and measures of need. Although economic access was related to some medical utilization, it had little effect on gender/ethnic disparities for services covered by Medicare. However, economic access accounted for minority disparities in dental care, which is not covered by Medicare. Discussion. Medicare plays a significant role in providing older women and minorities access to medical services. Significant gender and ethnic/racial disparities in use of medical services covered by Medicare were not accounted for by economic access among older adults with similar levels of health needs. Other cultural and attitudinal factors merit investigation to explain these gender/ethnic disparities.