By James Bayliss MPH
Health Promotions Officer, Arthritis Queensland
The importance of physical activity (PA) for the management of arthritis is well established. Despite this, sedentary behaviours (SB) are growing increasingly prevalent amongst those with arthritic conditions, to the detriment of cardio-metabolic health.
Facilitated by the convenience of non-active forms of transport and the prevalence of behaviours involving prolonged sitting, SB’s are now an endemic feature throughout contemporary society1.
Due to the activity-inhibiting nature of many forms of arthritis, persons with an arthritic condition tend to engage in SB at a higher rate than the general population2-4. This trend is common across both non-inflammatory and inflammatory forms of arthritis, particularly in their advanced stages. Studies have shown that persons with rheumatoid arthritis spend up to 90% of their day (~14 hours) in a sedentary state, a rate over one and a half times that of the general population3. Osteoarthritis (OA), particularly OA of the knee and lower limbs, is also associated with an increased susceptibility to SB, primarily due to symptom-induced decreases to exercise self-efficacy 2,4.
The health risks associated with SB are independent to the protective factors of PA1.
Functional decline and conditions including obesity, metabolic syndrome, cardiovascular disease and diabetes are all adversely associated with SB1-6. Most important to note is that these health risks are independent to the beneficial contributions of PA1,5. Initial research into the arthritis-specific impacts of SB suggest that the presence of an arthritic condition can increase a person’s vulnerability to these health risks and exacerbate their impact2,3,6. The causative nature of this association is not completely understood, however the increased risk of cardio-metabolic disease, all-cause mortality, and low exercise self-efficacy intrinsic to many arthritic conditions is often sighted in this regard 2-8.
Peak health bodies in Australia and around the world have responded to the growing public health risk associated with SB. A recent review of Australia’s Physical Activity Guidelines resulted in the development of Australia’s National Guidelines for Sedentary Behaviour9. However, despite this population level action, there is still a great opportunity for health practitioners, particularly those practicing at a primary care level, to address the burden of SB.
Health Professionals may consider moving beyond strategies aimed solely at increasing PA levels to approaches which both uphold PA guidelines and interrupt instances of SB1,5,9.
As the health risks associated with SB are independent to the protective factors of PA1, any PA intervention should both promote the importance of exercise as well as focus on disrupting instances of SB5,9. Studies have identified that SB occurs most regularly in work place (prolonged occupational sitting) home (prolonged sitting/lying down during leisure time) and travel (sitting whilst traveling) settings1. Health professionals could potentially target these settings for midstream (behaviour change) level intervention. Midstream level approaches allow for health professionals to work with clients on identifying factors which influence their engagement in/ avoidance of PA or SB10. Simple changes such as moving printers away from desks and identifying more active forms of travel and leisure time are examples of midstream interventions. Education on the risks associated with SB and the benefits of PA should also form part of this process11.
With predicted increases in both the burden of SB and the prevalence of musculoskeletal conditions (including arthritis)12, it is important that both health professionals and persons with arthritis are aware of the health risks associated with SB. Focusing interventions on both disrupting instances of SB and promoting PA guidelines, will help assist in mitigating this growing public health issue.
1 – Gilson, N., Burton, N., Van Uffelen,J., & Brown, W. (2011). Occupational sitting time: employee’ perceptions of health risks and intervention strategies. Health Promotion Journal of Australia, 22(1), 38 – 43.
2 – Lee, J., Chang, R., Ehrlich-Jones, L., Kwoh, K., Nevitt,M., Semanik, P., Sharma, L., Sohn, M., Song, J., & Dunlop, D. (2015). Sedentary behaviour and physical function: objective evidence from the osteoarthritis initiative. Arthritis Care and Research, 67(3),366 – 373. doi: 10.1002/acr.22432
3 - Huffman, K., Peiper, C., Hall, K., St Clair, E., & Kraus, W. (2014). Self-efficacy for exercise, more than disease-related factors, is associated with objectively assessed exercise time and sedentary behaviour in rheumatoid arthritis. Scandinavian Journal of Rheumatology, 44(2), 106-110. doi: 10.3109/03009742.2014.931456
4 – Song, J., Lindquist, L., Chang, R., Semanik,P., Ehrlich-Jones, L., Lee, J., Sohn, M., & Dunlop, D. (2015). Sedentary behaviour as a risk factor for physical frailty independent of moderate activity: results from the osteoarthritis initiative. American Journal of Public Health, 105 (7), 1439 – 1445. doi:10.1016/j.joca.2014.07.007
5 – Healy, G., Lawler, S., Thorp, A., Neuhaus, M., Robson, E., Owen, N., & Dunstan, D.Reducing Prolonged Sitting in the Workplace, an Evidence Review: Full Report.Accessed via Victoria Health from,http://www.uq.edu.au/cprc/docs/Reducing_Sitting_Workplace_Full.pdf
6 - Yu, C., Rouse, P., Veldhuijzen Van Zanten, J., Ntoumanis, N., Kitas, G., Duda, J., & Setsios, G. (2015) Subjective and objectives levels of physical activity and their association with cardiorespiratory fitness in rheumatoid arthritis patients. Arthritis Research & Therapy, 17(59), 3-7. doi: 10.1186/s13075-015-0584-7
7 - Thomsen, T., Beyer, N., Aadahl, M., Hetland, M., Loppenthin, K., Midtgaard, J, J., & Esbensen, B. (2015). Sedentary behaviour in patients with rheumatiod arthritis: a qualitative study. International Journal of Qualitative Studies on Health and Well-Being, 10 (28578). doi: 10.3420/qhwv.10.28578.
8 - Tierney, M., Fraser, A., Purtill, H., & Kennedy, N. (2015). Profile of energy expendature in people with rheumatoid arthritis. Disability and Health Journal, 8 (2015), 514 - 520.
9- Australian Department of Health (2014). Australia’s Physical Activity and Sedentary Behaviour Guidelines. Retrieved fromhttp://www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-phys-act-guidelines#apaadult
10- Fleming,M., & Parker, E. (2009).Introduction to Public Health. Sydney: Churchill Livingstone, P. 119-130.
11- Keleher,H., & Murphy, B. (2006). Understanding Health: A Determinants Approach. Melbourne: Oxford. P. 160-170.
12- Australian Institute of Health and Welfare (2014). Australia's Health 2014. www.aihw.gov.au/australias-health/.