Focus Area: Physical Activity and Arthritis - Preventive Rheumatology

Physical activity ranks among the most cost-effective remedies shown to improve function and reduce pain for individuals with rheumatoid arthritis (RA) and osteoarthritis (OA). Yet many people with these conditions often don’t move their bodies enough to achieve the recommended levels of physical activity that could enhance their quality of life and decrease arthritis-related disability in this country.

Dorothy D. Dunlop, PhD: associate professor of medicine and Rowland W. Chang, MD, MPH: professor of preventive medicine, medicine, and physical medicine and rehabilitationTackling this issue with a unique multidisciplinary disease management approach, Northwestern University Feinberg School of Medicine Division of Rheumatology investigators Rowland W. Chang, MD, MPH, and Dorothy D. Dunlop, PhD, and a number of colleagues have been at the forefront of a revolutionary concept in medicine: preventive rheumatology. Drs. Chang and Dunlop lead several distinctive National Institutes of Health (NIH)-funded studies with the primary aim of intervening through physical activity in the arthritis disease process and achieving a goal of preventing the painful, disabling, and costly consequences of arthritis.

“Physical activity is one, if not the only, currently known factor that has been measured and demonstrated to show a reversible effect on arthritis-associated disability,” explains Dr. Chang, a noted expert in rehabilitative rheumatology with faculty appointments in preventive medicine, medicine, and physical medicine and rehabilitation. From a public health standpoint, physical activity could help maintain the function of the some 27 million people in the United States with OA if successfully promoted by clinicians and understood and accepted by consumers of health care. Remarks Dr. Dunlop, “Physical activity is our vaccine.”

Moving Can Do a Body Good

Encouraging physical activity via individualized intervention is at the core of the NIH-funded Increasing Motivation for Physical Activity in Arthritis Clinical Trial (IMPAACT) study. Headed by principal investigator Dr. Chang, this randomized controlled clinical trial focuses on encouraging lifestyle physical activity such as walking, cleaning, doing the laundry, and gardening rather than “formal” exercise regimes that may be impractical and unappealing to individuals affected by arthritic joint damage and pain due to RA or knee OA.

The study’s innovative intervention strategy involves using a physical activity advocate, such as a nurse or occupational therapist, to engage patients in developing an action plan to overcome barriers and incorporate physical activity into their daily routines. The IMPAACT team enrolled its first patient in 2006; study recruitment is now moving into its final phase with more than 300 participants currently enrolled. So far the findings of the study have confirmed what the IMPAACT group initially suspected: moving can do a body good and possibly prevent loss of function. Reports Dr. Chang, “We’ve estimated that with the optimal level of physical activity, arthritis-associated disability could be reduced by up to 35 percent.”

Dorothy D. Dunlop, PhD: associate professor of medicineIMPAACT has led to several companion studies, including a Multi-disciplinary Clinical Research Center (MCRC) study focusing on the cost-effectiveness of tailored physical activity intervention for persons with knee OA and RA. Dr. Dunlop, principal investigator, and health economist Larry Manheim, PhD, a research professor in the Institute for Healthcare Studies as well as physical medicine and rehabilitation at Feinberg, are tracking the health care cost usage of IMPAACT participants over the two-year period of their involvement in the trial. Through this cost-effectiveness evaluation, Dr. Dunlop’s team will provide valuable insight that will help shape the dissemination of the IMPAACT study results moving forward.

While moving might be good medicine for arthritis, it then begs the question of “how much?” Hoping to answer that question, Dr. Dunlop is also measuring physical activity on several thousand people with arthritis who are participating in the national Osteoarthritis Initiative (OAI). A novel public-private consortium funded in part by the NIH, the OAI is a multicenter, longitudinal, prospective observational study of knee OA. The work of IMPAACT team member Pamela Semanik, PhD, APN, assistant professor of physical medicine and rehabilitation, has also addressed the quantity and quality of physical activity for the clinical populations under investigation. Her clinical research is helping to validate data generated from advanced measurement tools such as accelerometry to precisely assess exercise gained from the daily activities of life in persons with arthritis. Findings from Dr. Semanik’s work as well as others throughout Feinberg make it possible for the Division of Rheumatology to advance its preventive rheumatology mission.

Important Research Provides Leadership, Earns Honors

Rowland W. Chang, MD, MPH: professor of preventive medicine, medicine, and physical medicine and rehabilitationThe IMPAACT team has forged a new path in the area of physical activity and arthritis in many ways, including leadership in the public health and rehabilitative rheumatology arenas at regional, state, and national levels. As an active volunteer for the national Arthritis Foundation as well as a representative of the Rehabilitation Institute of Chicago’s Arthritis Center, Dr. Chang was a key contributor to the state-based arthritis prevention program based in the Illinois Department of Public Health. He was the former chair of the Arthritis Foundation’s Public Health Council and of the Foundation’s Greater Chicago Chapter. He is currently a member of the Arthritis Foundation’s national board of directors and chair of its mission committee. Linda Ehrlich-Jones, PhD, RN, IMPAACT grant project manager and research assistant professor of physical medicine and rehabilitation at Feinberg, serves as 2010 president of the Association of Rheumatology Health Professionals, a division of the American College of Rheumatology.

Work in preventive rheumatology has twice earned this research group recognition from the Arthritis Foundation—the largest private, not-for-profit funder of arthritis research in the world. In both 2003 and 2005, the Foundation named their research findings among its list of annual Top 10 Arthritis Research Advances. Building on this momentum, the translational research nature of IMPAACT and its goal to provide practical advice for patients and clinicians is poised to help improve health outcomes for the 46 million Americans with arthritis.