Session Title: Orthopedics, Low Back Pain and Rehabilitation - ARHP Poster
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose : Behavioral theories suggest psychological distress reduces physical activity (PA) engagement via behavioral inhibition. Community factors such as neighborhood cohesion are also associated with PA. This study examined the association between emotional distress and PA in adults with persistent knee pain and identified whether neighborhood social cohesion moderates this relationship.
Methods : Data from 601 African American and White adults > 45 years with persistent knee pain (defined as pain, aching, stiffness on most days) enrolled in the Johnston Osteoarthritis Project (2006-2011) were analyzed. Moderate/vigorous intensity PA (MVPA), measured using the Behavioral Risk Factor Surveillance Survey (BRFSS) PA scale, was categorized into a 3-level variable according to 2008 US PA Guidelines (0-9, 10-<150, ³150 MVPA minutes/week). The Arthritis Impact Measurement Scales (AIMS 2) – Anxiety scale measured anxiety (higher scores indicate more anxiety) and SampsonÕs Neighborhood Cohesion Scale assessed social cohesion (higher scores indicate greater cohesion). Covariates included: demographics (age, gender, race, education, body mass index (BMI), employment), medical history (comorbidities, symptomatic KOA), depression (CES-D), community factors (poverty level, neighborhood walkability, safety, aesthetics), perceived helplessness, and WOMAC physical function, stiffness and pain. A generalized logit model examined associations between MVPA levels and anxiety and the interaction between perceived social cohesion and anxiety, adjusting for covariates (Table).
Results : ParticipantsÕ mean age was 68.9 years (SD=9), 407(67%) were Caucasian, 431 (72%) were female. 403 (67%) adults had knee pain for ³ 5 years and mean AIMS-2 anxiety score was 3.36 (SD=1.9). 222 (37%) adults engaged in < 10 minutes of MVPA/week, 138 (23%) in 10-149 minutes/week and 241 (40%) met DHHS requirements of ³ 150 min of MVPA/week. Three hundred fourteen individuals (52%) reported positive neighborhood social cohesion. Factors associated with engagement in some MVPA and meeting recommended MVPA levels were: younger age, female gender, better knee function, fewer comorbidities, less depression, longer duration of knee pain, and positive neighborhood social cohesion and aesthetics. A two-unit increase in the AIMS anxiety subscale, among individuals who perceived positive cohesion, was associated with increased odds of engaging in MVPA.
Conclusion : Neighborhood social cohesion appears to moderate the relationship between anxiety and participation in weekly MVPA. Specifically, social cohesion did not affect those engaged in high PA levels but did promote more PA among those who were anxious/tense. Recognizing the positive affect of social cohesion on anxiety and MVPA may inform counseling strategies for adults with persistent knee pain to adopt PA to manage their pain.
|Table: Correlates of Weekly Physical Activity Participation in Adults with Persistent Knee Pain From Multivariate Generalized Logit Model|
|Explanatory Variable||10 – <150 min MVPA/week||>= 150 min MVPA/week||Type III p-value|
|2-point increase Anxiety/Tension with no neighborhood social cohesion||OR = 0.87 95%CI = 0.58-1.3||OR = 1.01 95%CI = 0.69-1.48||0.06|
|2- point increase Anxiety/Tension with neighborhood social cohesion||OR = 1.49 95%CI = 0.98-2.27||OR = 1.01 95%CI = 0.70-1.47|
|Race||OR = 0.77 95%CI = 0.46-1.32||OR = 0.65 95%CI = 0.41-1.05||0.29|
|Duration of Knee Pain (years)||OR = 1.85 95%CI = 1.04-3.27||OR = 1.28 95%CI = 0.77-2.13||0.07|
|Has > 2 Comorbidities||OR = 0.45 95%CI = 0.26-0.78||OR = 0.69 95%CI = 0.43-1.12||0.015|
|Female||OR = 2.11 95%CI = 1.18-3.78||OR = 1.07 95%CI = 0.67-1.73||0.025|
|Age (years)||OR = 0.95 95%CI = 0.92-0.98||OR = 0.98 95%CI = 0.95-1.00||0.003|
|Depressed (CES-D)||OR = 0.68 95%CI = 0.32-1.40||OR = 0.35 95%CI = 0.16-0.73||0.02|
|Aesthetically Nice Neighborhood||OR = 0.64 95%CI = 0.36-1.12||OR = 0.56 95%CI = 0.34-0.94||0.07|
|Knee Function (WOMAC)||OR = 0.98 95%CI = 0.96-0.99||OR = 0.97 95%CI = 0.95-0.98||0.0006|
|Diagnosed with knee osteoarthritis (KOA)||OR = 0.61 95%CI = 0.34-1.05||OR = 0.66 95%CI = 0.41-1.06||0.13|
* reference category for MVPA is 0-9 minutes of MVPA per week
To cite this abstract in AMA style:Iversen MD, Alvarez C, Cleveland RJ, Jordan JM, Callahan LF. The Relationship Between Anxiety and Physical Activity Participation in Adults with Persistent Knee Pain and the Moderating Effect of Neighborhood Social Cohesion [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/the-relationship-between-anxiety-and-physical-activity-participation-in-adults-with-persistent-knee-pain-and-the-moderating-effect-of-neighborhood-social-cohesion/. Accessed November 14, 2019.
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