Benefits of physical activity for those with arthritis are clear, yet physical activity is difficult to initiate and maintain. Self-efficacy is a key modifiable psychosocial determinant of physical activity. This study examined two scales for self-efficacy for exercise behavior (SEEB) to identify their strengths and weaknesses using item response theory (IRT) from community-based randomized controlled trials of physical activity programs in adults with arthritis. The 2 SEEB scales included the 9-item scale by Resnick developed with older adults and the 5-item scale by Marcus developed with employed adults. All IRT analyses were conducted using the graded-response model. IRT assumptions were assessed using both exploratory and confirmatory factor analysis. The IRT analyses indicated that these scales are precise and reliable measures for identifying people with arthritis and low SEEB. The Resnick SEEB scale is slightly more precise at lower levels of self-efficacy in older adults with arthritis.
Thelma J. Mielenz, Michael C. Edwards and Leigh F. Callahan
Leigh F. Callahan, Rebecca J. Cleveland, Mary Altpeter and Betsy Hackney
Evaluate effectiveness of the Arthritis Foundation Tai Chi Program for community participants with arthritis.
343 individuals were randomized to either the intervention or wait-list control group. Performance and self-reported outcome (SRO) measures were assessed at baseline and eight weeks. At one year, SROs only were assessed. Adjusted means were determined using regression models adjusting for covariates, and effect sizes (ES) were calculated.
Average participant age was 66 years, 87% were female, and 87% were Caucasian. Among 284 (83%) participants who returned at eight weeks, balance by reach (ES = 0.30) and helplessness, sleep, and role participation satisfaction (ES = 0.24–0.54) improved significantly; pain, fatigue, and stiffness improvement (ES = 0.15–0.23) approached significance. No change was noted in mobility, lower extremity strength, or single-leg stance balance. At one year, improvements in pain, fatigue, stiffness, helplessness, and role participation satisfaction at eight weeks were maintained; 30% continued tai chi practice.
Moderate effectiveness of the Arthritis Foundation Tai Chi Program was confirmed.
Yvonne M. Golightly, Stephen W. Marshall, Leigh F. Callahan and Kevin Guskiewicz
Injury has been identified as a potential risk factor for osteoarthritis. However, no previous study has addressed playing-career injuries and subsequent osteoarthritis in a large sample of former athletes. The purpose of this study was to describe the prevalence and determinants of arthritis and osteoarthritis in retired professional football players.
Self-reported arthritis prevalence and retrospectively-recalled injury history were examined in a cross-sectional survey of 2,538 retired football players.
Football players reported a high incidence of injury from their professional playing days (52.8% reported knee injuries, 74.1% reported ligament/tendon injuries, and 14.2% reported anterior cruciate ligament tears). For those under 60 years, 40.6% of retired NFL players reported arthritis, compared with 11.7% of U.S. males (prevalence ratio =3.5, 95%CI: 3.3 to 3.7). Within the retired NFL player cohort, osteoarthritis was more prevalent in those with a history of knee injury (prevalence ratio = 1.7, 95%CI: 1.5 to 1.9) and ligament/tendon injury (prevalence ratio = 1.6, 95%CI: 1.4 to 1.9).
In males under the age of 60, arthritis is over 3 times more prevalent in retired NFL players than in the general U.S. population. This excess of early-onset arthritis may be due to the high incidence of injury in football.
Nina Sperber, Katherine S. Hall, Kelli Allen, Brenda M. DeVellis, Megan Lewis and Leigh F. Callahan
Physical and psychological symptoms limit physical activity for people with arthritis. This study examined if self-efficacy mediated a relationship between symptom and physical activity (PA) frequency change.
This was a secondary analysis of older adults with arthritis and joint pain in a trial of a lifestyle PA program (n = 339). Measures were depressive symptoms, pain, fatigue, arthritis self-efficacy, PA self-efficacy, and PA frequency. A panel model was used to analyze relationships at baseline and changes at 20 weeks.
The mean age was 68.8 years. At baseline, depression and fatigue were associated with arthritis self-efficacy (β = –.34 and –.24) and, in turn, PA self-efficacy (β = .63); PA self-efficacy was associated with PA (β = .15). Pain and depression changes were associated with arthritis self-efficacy change (β = –.20 and –.21) and, in turn, PA self-efficacy (β = .32) change; PA self-efficacy change was associated with PA change (β = .36).
Change in symptom severity affected change in PA frequency. These relationships appeared to operate through self-efficacy. Over time, pain appeared to have a stronger relationship than fatigue with self-efficacy and PA. These findings support strategies to help people with arthritis strengthen their confidence for symptom coping and PA participation.
Nina R. Sperber, Kelli D. Allen, Brenda M. DeVellis, Robert F. DeVellis, Megan A. Lewis and Leigh F. Callahan
The authors explored whether demographic and psychosocial variables predicted differences in physical activity for participants with arthritis in a trial of Active Living Every Day (ALED).
Participants (N = 280) from 17 community sites were randomized into ALED or usual care. The authors assessed participant demographic characteristics, self-efficacy, outcome expectations, pain, fatigue, and depressive symptoms at baseline and physical activity frequency at 20-wk follow-up. They conducted linear regression with interaction terms (Baseline Characteristic × Randomization Group).
Being female (p ≤ .05), less depressed (p ≤ .05), or younger (p ≤ .10) was associated with more frequent posttest physical activity for ALED participants than for those with usual care. Higher education was associated with more physical activity for both ALED and usual-care groups.
ALED was particularly effective for female, younger, and less depressed participants. Further research should determine whether modifications could produce better outcomes in other subgroups.
Leigh F. Callahan, Rebecca J. Cleveland, Jack Shreffler, Jennifer M. Hootman, Thelma J. Mielenz, Britta Schoster, Teresa Brady and Todd Schwartz
Adults with arthritis can benefit from participation in physical activity and may be assisted by organized programs. The purpose of this study was to evaluate the effectiveness of a 20-week behavioral lifestyle intervention, Active Living Every Day (ALED), for improvements in primary outcomes (physical activity levels, aerobic endurance, function, symptoms).
A 20-week randomized controlled community trial was conducted in 354 adults. Outcomes were assessed at baseline and 20 weeks in the intervention and wait-list control groups. The intervention group was also assessed at 6 and 12 months. Mean outcomes were determined by multilevel regression models in the intervention and control groups at follow-up points.
At 20 weeks, the intervention group significantly increased participation in physical activity, and improved aerobic endurance, and select measures of function while pain, fatigue and stiffness remained status quo. In the intervention group, significant improvements in physical activity at 20 weeks were maintained at 6 and 12 months, and stiffness decreased.
ALED appears to improve participation in physical activity, aerobic endurance, and function without exacerbating disease symptoms in adults with arthritis.