Regular Physical Activity in Patients with Osteoarthritis Can Improve Health, Save Money

VBCR - December 2013, Volume 2, No 6 - Osteoarthritis

By Phoebe Starr

San Diego, CA—Regular physical activity has the potential to improve physical health and to reduce healthcare costs for patients with osteoarthritis (OA), based on a study presented at the 2013 American College of Rheumatology meeting.

Interventions to increase the level of physical activity to a moderate or vigorous level were estimated to cost $1450 per quality-adjusted life-year (QALY), which is cost-effective and falls considerably below the current ceiling of $50,000 per QALY that is deemed cost-effective for other common medical interventions.

“We wanted to see if meeting the US Department of Health and Human Services [HHS] guidelines for regular physical activity translated into better QALYs for adults with OA or those at risk for OA. We also wanted to postulate whether interventions that increase physical activity were cost-e­f­fec­tive,” ex­plained lead investigator Kai Sun, MD, Medical Resident and Re­search Trainee, Northwestern Univer­sity Feinberg School of Medicine, Chicago, IL.
The HHS guidelines define regular physical activity as 150 minutes of moderate-to-vigorous activity weekly in bouts of ≥10 minutes.

Study Parameters
The investigators used results from the Osteoarthritis Initiative (OAI), a National Institutes of Health–sponsored study that included questionnaires, laboratory tests, and imaging test results for more than 4700 adults who have or who are at risk for knee OA.

Participants were divided into 3 groups based on their level of physical activity and were measured for 1 week with accelerometers (N = 2127): those who met the HHS physical activity guidelines, those who were insufficiently physically active (ie, <150 minutes weekly of physical activity), and those who were inactive (no bouts of physical activity lasting >10 minutes weekly).

Levels of physical activity were monitored at the beginning of the study (the 4-month visit for those participating in the OAI), and then again 2 years later (the OAI 72-month follow-up visit). At both visits, health-related utility scores were used to calculate QALYs; 1794 patients completed baseline and 2-year visits.

Increased Activity Improves Quality of Life in OA
Results showed a graded relationship between higher levels of physical activity and QALYs. In an analysis adjusted for socioeconomic and health factors, over the 2-year study, participants who met the HHS guidelines for physical activity had QALYs that were 0.11 higher than the inactive group, which was statistically significant (P <.001). Even some physical activity seems to pay off, Dr Sun emphasized, because the group with insufficient physical activity had QALYs that were 0.058 higher than the inactive group.

The inactive group tended to be older, female, nonwhite, have lower education levels, lower income, and to live alone.

“These QALYs represent about 10 to 20 additional days of perfect health over 1 year. Interventions to encourage adults to increase their physical activity could potentially translate to better quality of life, adding years of healthy life, and thereby lower overall healthcare costs,” Dr Sun said.
She noted that although it is clear that regular physical activity improves health, reduces mortality in the general population, and has arthritis-specific health benefits and improvement in symptoms, functioning, and psychosocial well-being, as well as reduced disability, the majority of adults in the United States do not attain the recommended levels of physical activity.

“The costs associated with treatment of inactivity-related diseases and injuries, lost productivity, and diminished quality of life pose an economic burden. Promoting physical activity is an important component of promoting overall health, addressing the epidemic of obesity, chronic illnesses like OA, and reducing healthcare costs over the long-term,” Dr Sun stated.

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