Physical Activity in Women With Hypothyroidism on Thyroid Hormone Therapy: Associated Factors and Perceived Barriers and Benefits

in Journal of Physical Activity and Health
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Background: The purpose of this study was to analyze factors associated with physical activity (PA) and to identify perceived barriers and benefits of PA among patients with hypothyroidism on thyroid hormone therapy. Methods: This survey-based cross-sectional study was conducted among members of the Dutch thyroid patient organization. Self-reported data on respondents’ PA levels and demographic, clinical, and physical health variables were collected. Moreover, perceived barriers and benefits to PA were identified. Respondents were categorized as physically active when meeting the recommended Dutch PA guidelines and physically inactive otherwise. To compare physically active and inactive respondents, potential confounders were entered into univariate analyses. Factors showing significant correlations (P < .20) were added to a multivariate model to determine the associated factors of PA. Results: About 1724 female respondents (mean age 53.0 [11.6] y) were included; 16.1% reported meeting the PA recommendations. Multivariate analysis showed that factors associated with PA included levothyroxine/liothyronine therapy, comorbidities, self-perceived physical fitness, and diminished physical endurance. Overall, physically related barriers to PA were rated highest. Conclusions: The vast majority of treated hypothyroid respondents are physically inactive and experience long-term exercise intolerance. Considering the health implications of physical inactivity, promotion of regular PA is of key importance in this population.

Lankhaar and Backx are with the Department of Rehabilitation, Physical Therapy Science and Sport, University Medical Center Utrecht, Utrecht, The Netherlands. Kemler is with Team Sports Injury Prevention, Dutch Consumer Safety Institute, Amsterdam, The Netherlands. Stubbe is with the Codarts, University of the Arts, Rotterdam, The Netherlands; PErforming artist and Athlete Research Lab (PEARL), Rotterdam, The Netherlands; and the Department General Practice, Erasmus MC Medical University Center Rotterdam, Rotterdam, The Netherlands.

Lankhaar (J.A.C.Lankhaar@umcutrecht.nl) is corresponding author.
  • 1.

    Duntas LH, Jonklaas J. Levothyroxine dose adjustment to optimise therapy throughout a patient’s lifetime. Adv Ther. 2019;36(suppl 2):3046. doi:10.1007/s12325-019-01078-2

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Chaker L, Bianco AC, Jonklaas J, Peeters RP. Hypothyroidism. Lancet. 2017;390(10101):15501562. doi:10.1016/S0140-6736(17)30703-1

  • 3.

    Flinterman LE, Kuiper JG, Korevaar JC, et al. Impact of a forced dose-equivalent levothyroxine brand switch on plasma TSH: a cohort study. Thyroid. 2020;30(6):821828. doi:10.1089/thy.2019.0414

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Hennessey JV, Espaillat R. Current evidence for the treatment of hypothyroidism with levothyroxine/levotriiodothyronine combination therapy versus levothyroxine monotherapy. Int J Clin Pract Suppl. 2018;72(2):e13062. doi:10.1111/ijcp.13062

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5.

    Peterson SJ, Cappola AR, Castro MR, et al. An online survey of hypothyroid patients demonstrates prominent dissatisfaction. Thyroid. 2018;28(6):707721. doi:10.1089/thy.2017.0681

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Wiersinga WM, Duntas L, Fadeyev V, Nygaard B, Vanderpump MP. 2012 ETA guidelines: the use of L-T4 + L-T3 in the treatment of hypothyroidism. Eur Thyroid J. 2012;1(2):5571. doi:10.1159/000339444

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    McAllister RM, Delp MD, Laughlin MH. Thyroid status and exercise tolerance. Cardiovascular and metabolic considerations. Sports Med. 1995;20(3):189198. doi:10.2165/00007256-199520030-00005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Lankhaar JAC, de Vries WR, Jansen JACG, Zelissen PMJ, Backx FJG. Impact of overt and subclinical hypothyroidism on exercise tolerance; a systematic review. Res Q Exerc Sport. 2014;85(3):365389. doi:10.1080/02701367.2014.930405

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Verbunt JA, Seelen HA, Vlaeyen JW, et al. Disuse and deconditioning in chronic low back pain: concepts and hypotheses on contributing mechanisms. Eur J Pain. 2003;7(1):921. doi:10.1016/S1090-3801(02)00071-X

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Lankhaar JAC, Kemler E, Hofstetter H, et al. Physical activity, sports participation and exercise-related constraints in adult women with primary hypothyroidism treated with thyroid hormone replacement therapy. J Sports Sci. 2021:110. doi:10.1080/02640414.2021.1940696

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Booth FW, Roberts CK, Laye MJ. Lack of exercise is a major cause of chronic diseases. Compr Physiol. 2012;2:11431211.

  • 12.

    World Health Organization. Global Recommendations on Physical Activity for Health. Geneva, Switzerland: WHO; 2020. https://www.who.int/news-room/fact-sheets/detail/physical-activity. Accessed October 15, 2020.

    • Search Google Scholar
    • Export Citation
  • 13.

    Weggemans RM, Backx FJG, Borghouts L, et al. The 2017 Dutch physical activity guidelines. Int J Behav Nutr Phys Act. 2018;15(1):5869. doi:10.1186/s12966-018-0661-9

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Vancampfort D, Koyanagi A, Ward PB, et al. Chronic physical conditions, multimorbidity and physical activity across 46 low- and middle-income countries. Int J Behav Nutr Phys Act. 2017;14(1):619. doi:10.1186/s12966-017-0463-5

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Forechi L, Mill JG, Griep RH, Santos I, Pitanga F, Molina MDCB. Adherence to physical activity in adults with chronic diseases: ELSA-Brasil. Rev Saude Publica. 2018;52(52):3142. doi:10.11606/S1518-8787.2018052000215

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Sharif K, Watad A, Bragazzi NL, Lichtbroun M, Amital H, Shoenfeld Y. Physical activity and autoimmune diseases: get moving and manage the disease. Autoimmun Rev. 2018;17(1):5372. doi:10.1016/j.autrev.2017.11.010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Peterson SJ, McAninch EA, Bianco AC. Is a normal TSH synonymous with “euthyroidism” in levothyroxine monotherapy? J Clin Endocrinol Metab. 2016;101(12):49644973. doi:10.1210/jc.2016-2660

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Wilcox S, Der Ananian C, Abbott J, et al. Perceived exercise barriers, enablers, and benefits among exercising and nonexercising adults with arthritis: results from a qualitative study. Arthritis Rheum. 2006;55(4):616627. doi:10.1002/art.22098

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Costello E, Kafchinski M, Vrazel J, Sullivan P. Motivators, barriers, and beliefs regarding physical activity in an older adult population. J Geriatr Phys Ther. 2011;34(3):138147. doi:10.1519/JPT.0b013e31820e0e71

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20.

    Kemler E, Blokland D, Backx F, Huisstede B. Differences in injury risk and characteristics of injuries between novice and experienced runners over a 4-year period. Phys Sportsmed. 2018;46(4):485491. doi:10.1080/00913847.2018.1507410

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21.

    Bernaards CM, Hildebrandt VH, Hendriksen IJM. Correlates of sedentary time in different age groups: results from a large cross sectional Dutch survey. BMC Public Health. 2016;16(1):1121. doi:10.1186/s12889-016-3769-3

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Nelson ME, Rejeski WJ, Blair SN, et al. Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007;39(8):14351445. doi:10.1249/mss.0b013e3180616aa2

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Sechrist KR, Walker SN, Pender NJ. Development and psychometric evaluation of the exercise benefits/barriers scale. Res Nurs Health. 1987;10(6):357365. doi:10.1002/nur.4770100603

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Melillo KM, Williams E, Futrell M, Chamberlain C. A self-assessment tool to measure older adults’ perceptions regarding physical fitness and exercise activity. J Adv Nurs. 1997;25(6):12201226. doi:10.1046/j.1365-2648.1997.19970251220.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25.

    Booth ML, Bauman A, Owen N, Gore CJ. Physical activity preferences, preferred sources of assistance, and perceived barriers to increased activity among physically inactive Australians. Prev Med. 1997;26(1):131137. doi:10.1006/pmed.1996.9982

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Netherlands Institute for Sports and Physical Activity (NISB). Pace questionnaire ‘Physician-based assessment and counseling for exercise’ (in Dutch). 2019. https://meetinstrumentenzorg.nl/wp-content/uploads/instrumenten/PACE-overige.pdf. Accessed December 19, 2020.

    • Search Google Scholar
    • Export Citation
  • 27.

    Korkiakangas EE, Alahuhta MA, Laitinen JH. Barriers to regular exercise among adults at high risk or diagnosed with type 2 diabetes: a systematic review. Health Promot Int. 2009;24(4):416427. doi:10.1093/heapro/dap031

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 28.

    Justine M, Azizan A, Hassan V, Salleh Z, Manaf H. Barriers to participation in physical activity and exercise among middle-aged and elderly individuals. Singapore Med J. 2013;54(10):581586. doi:10.11622/smedj.2013203

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Meriwether RA, Lee JA, Lafleur AS, Wiseman P. Physical activity counseling. Am Fam Physician. 2008;77(8):11291136.

  • 30.

    Malone LA, Barfield JP, Brasher JD. Perceived benefits and barriers to exercise among persons with physical disabilities or chronic health conditions within action or maintenance stages of exercise. Disabil Health J. 2012;5(4):254260. doi:10.1016/j.dhjo.2012.05.004

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 31.

    Rijksinstituut voor Volksgezondheid en Milieu (RIVM). Sport Kernindicatoren (in Dutch). 2019. www.sportenbewegenincijfers.nl/kernindicatoren/beweegrichtlijnen. Accessed December 6, 2020.

    • Search Google Scholar
    • Export Citation
  • 32.

    Droomers M, Schrijvers CT, Van de Mheen H, Mackenbach JP. Educational differences in leisure-time physical inactivity: a descriptive and explanatory study. Soc Sci Med. 1998;47(11):16651676. doi:10.1016/S0277-9536(98)00272-X

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Piirtola M, Kaprio J, Kujala UM, et al. Association between education and future leisure-time physical inactivity: a study of Finnish twins over a 35-year follow-up. BMC Public Health. 2016;16(720):111.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 34.

    Notthoff N, Reisch P, Gerstorf D. Individual characteristics and physical activity in older adults: a systematic review. Gerontology. 2017;63(5):443459. doi:10.1159/000475558

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    Dontje ML, Krijnen WP, de Greef MH, et al. Effect of diagnosis with a chronic disease on physical activity behavior in middle-aged women. Prev Med. 2016;83:5662. doi:10.1016/j.ypmed.2015.11.030

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Madan R, Celi FS. Combination therapy for hypothyroidism: rationale, therapeutic goals, and design. Front Endocrinol. 2020;11(371):111.

  • 37.

    Canaris GJ, Manowitz NR, Mayor G, Ridgway EC. The Colorado thyroid disease prevalence study. Arch Intern Med. 2000;160(4):526534. doi:10.1001/archinte.160.4.526

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38.

    Ott J, Promberger R, Kober F, et al. Hashimoto’s thyroiditis affects symptom load and quality of life unrelated to hypothyroidism: a prospective case-control study in women undergoing thyroidectomy for benign goiter. Thyroid. 2011;21(2):161167. doi:10.1089/thy.2010.0191

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39.

    Idrees T, Palmer S, Maciel RMB, Bianco AC. Liothyronine and desiccated thyroid extract in the treatment of hypothyroidism. Thyroid. 2020;30(10):13991413. doi:10.1089/thy.2020.0153

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40.

    Ettleson MD, Bianco AC. Individualized therapy for hypothyroidism: Is T4 enough for everyone? J Clin Endocrinol Metab. 2020;105(9):e3090. doi:10.1210/clinem/dgaa430

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41.

    Autenrieth CS, Kirchberger I, Heier M, et al. Physical activity is inversely associated with multimorbidity in elderly men: results from the KORA-Age Augsburg study. Prev Med. 2013;57(1):1719. doi:10.1016/j.ypmed.2013.02.014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42.

    Cimarras-Otal C, Calderón-Larrañaga A, Poblador-Plou B, et al. Association between physical activity, multimorbidity, self-rated health and functional limitation in the Spanish population. BMC Public Health. 2014;14(1):11701179. doi:10.1186/1471-2458-14-1170

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43.

    Fortin M, Haggerty J, Almirall J, Bouhali T, Sasseville M, Lemieux M. Lifestyle factors and multimorbidity: a cross sectional study. BMC Public Health. 2014;14(1):686693. doi:10.1186/1471-2458-14-686

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44.

    Hudon C, Soubhi H, Fortin M. Relationship between multimorbidity and physical activity: secondary analysis from the Quebec health survey. BMC Public Health. 2008;8(1):304311. doi:10.1186/1471-2458-8-304

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 45.

    Okano G, Miyake H, Mori M. Leisure time physical activity as a determinant of self-perceived health and fitness in middle-aged male employees. J Occup Health Psychol. 2003;45(5):286292. doi:10.1539/joh.45.286

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 46.

    Louwerens M, Appelhof BC, Verloop H, et al. Fatigue and fatigue-related symptoms in patients treated for different causes of hypothyroidism. Eur J Endocrinol. 2012;167(6):809815. doi:10.1530/EJE-12-0501

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 47.

    Filler K, Lyon D, Bennett J, et al. Association of mitochondrial dysfunction and fatigue: a review of the literature. BBA Clinical. 2014;1(1):1223. doi:10.1016/j.bbacli.2014.04.001

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 48.

    Puetz TW. Physical activity and feelings of energy and fatigue: epidemiological evidence. Sports Med. 2016;36(9):767780. doi:10.2165/00007256-200636090-00004

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 49.

    Cadmus-Bertram LA, Gorzelitz JS, Dorn DC, Malecki KMC. Understanding the physical activity needs and interests of inactive and active rural women: a cross-sectional study of barriers, opportunities, and intervention preferences. J Behav Med. 2019;43(4):638647. doi:10.1007/s10865-019-00070-z

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 50.

    Veldhuijzen van Zanten JJ, Rouse PC, Hale ED, et al. Perceived barriers, facilitators and benefits for regular physical activity and exercise in patients with rheumatoid arthritis: a review of the literature. Sports Med. 2015;45(10):14011412. doi:10.1007/s40279-015-0363-2

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 51.

    Slootmaker SM, Schuit AJ, Chinapaw MJ, Seidell JC, van Mechelen W. Disagreement in physical activity assessed by accelerometer and self-report in subgroups of age, gender, education and weight status. Int J Behav Nutr Phys Act. 2009;25:617.

    • Search Google Scholar
    • Export Citation
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