In “Stepping Forward: A Scoping Review of Physical Activity in Osteoarthritis,” White and colleagues¹ aimed to help patients, policymakers, investigators, and healthcare providers (HCPs) better understand how physical activity (PA) is defined and measured, the benefits of PA for knee osteoarthritis (KOA), the potential role of PA in the development and/or progression of KOA, and the PA Guidelines for Americans. This correspondence aims to: reinforce the importance of PA for adults with arthritis; clarify definitions for “inactive” and “insufficiently active” from the PA Guidelines for Americans; and supplement White and colleagues’ scoping review by (1) highlighting arthritis-appropriate evidence-based interventions (AAEBIs) for PA and self-management education, and (2) providing resources to facilitate HCP screening, counseling, and referral to evidence-based PA interventions for adults with arthritis.

Because PA is strongly recommended for management of hand, hip, and knee osteoarthritis,² it is a public health priority to increase the proportion of adults with arthritis who receive HCP counseling for PA.^3–4 For overall health, the PA Guidelines for Americans (2nd edition) recommends all older adults (≥ 65 years), including those with any form of arthritis, engage in at least 150 minutes per week of moderate-intensity (or: 75 minutes vigorous-intensity; or an equivalent combination of moderate- to vigorous-intensity) aerobic PA, and 2 days per week of muscle-strengthening PA. Older adults also need multicomponent PA comprising balance training and aerobic and muscle-strengthening activities.⁵ White and colleagues¹ defined “inactive” individuals as those engaging in 1–149 minutes/week of moderate-to-vigorous PA. However, the PA Guidelines for Americans⁵ uses the following terms: “inactive” to describe individuals doing no (0 min/week) moderate- or vigorous-intensity PA beyond basic movement from daily life activities; and “insufficiently active” to describe individuals doing some moderate- or vigorous-intensity PA (1–149 min/week), but not meeting aerobic PA guidelines. This clarification is important for several reasons. Electronic health records may soon be standardized to assess the number of days/week and minutes/day of moderate-to-vigorous aerobic PA and the number of days/week of strength-based PA. These metrics provide a quick assessment of patients who are inactive, insufficiently active, or meeting guidelines—to help HCPs tailor their counseling and referral accordingly. Additionally, the terms inactive and insufficiently active discourage “all-or-nothing” messaging by acknowledging and positively reinforcing small increases in PA that are likely to produce health benefits, even if persons don’t meet recommendations. Finally, encouraging adults with arthritis to gradually include PA into everyday activities (eg, occupational, transportation, household), and promote leisure-time activities that they enjoy or can safely do at home (eg, walking, gardening) increases confidence, motivation, and success in reducing sedentary behavior and increasing PA.^5–8

Adults with arthritis and comorbid chronic diseases have great need for evidence-based PA interventions to help them begin and maintain PA. The Centers for Disease Control and Prevention (CDC) partners with the Osteoarthritis Action Alliance (OAAA) to recognize effective interventions such as AAEBIs for PA and self-management education, demonstrating positive impact on at least 2 arthritis-related health outcomes (eg, pain, balance, function, weight) maintained for at least 3 months post-intervention. Currently, 13 community-based PA AAEBIs are promoted across the United States by state and national partners.⁹ These AAEBIs can be matched with patients’ functional ability, pain, and preferences by considering program length, delivery format (online, in person), level of social interaction (self-directed, group-based), and PA type (walking, combined aerobic and muscle-strengthening, aquatic, tai chi, etc.). Many PA AAEBIs are free/low cost, many include health education and/or behavior change strategies (eg, goal setting, self-monitoring),^8,10 and some are offered in multiple languages. While every community may not offer in-person PA AAEBIs, virtual options are available (Table 1 is an OAAA quick reference of AAEBIs). Importantly, PA AAEBIs are effective without requiring PA-tracking wearable monitors, but persons may use these devices based on interest and affordability.

For adults with arthritis who are not ready for PA due to physical limitations or low interest, HCPs can refer such patients to physical therapy or a CDC/OAAA- recognized self-management education intervention that includes information about PA and other chronic disease self-management behaviors (eg, medication adherence, healthy diet). As a person’s confidence increases for arthritis self-management, HCPs can follow up at a later appointment to reassess readiness for PA.

In closing, HCPs can play a significant role in helping adults with arthritis assess their PA level, understand the PA Guidelines, understand how PA can benefit overall health and arthritis symptoms, and access arthritis resources and CDC/OAAA-recognized AAEBIs to meet their needs and preferences. Though implementing HCP screening, counseling, and referrals for PA can be challenging, resources can facilitate this process. Tables 1 and 2 include information for implementing standardized PA measures into electronic health records, tips for patient-provider communication, HCP continuing education opportunities, resources for patients, and a list of billing codes for various types of providers.