Health Care Provider Toolkit: Physical Activity Counseling for Adults with Arthritis

Health care providers play an important role in helping patients with arthritis become physically active to reduce their pain. Yet, two out of five patients with arthritis are not receiving counseling from their health care provider.

This toolkit provides physical activity counseling resources to help you improve your patients' pain and quality of life. We hope the tools and resources can accelerate efforts to improve the health and well-being of adults with arthritis.

It was developed for primary care providers, specialists, physical therapists, physician assistants, nurses, pharmacists, and other medical professionals. Providers like you care for patients, prescribe medications, and/or counsel or refer patients to behavioral interventions for chronic illnesses, such as arthritis.

An estimated 3.5 million adult New Yorkers (22.7%) have been diagnosed with arthritis. To improve the quality of life for these adults, the New York State Department of Health (NYSDOH) Arthritis Program seeks to increase their self-management behaviors. These behaviors include participation in self-management education workshops and physical activity.

What You Can Do To Help Your Patients With Arthritis

The Centers for Disease Control and Prevention (CDC) and NYSDOH recommend that health care providers counsel patients with arthritis about physical activity as an option to ease their pain.

In the NYSDOH's Commissioner's Monthly Letter of June 2019, the Commissioner highlighted the important role of health care providers in counseling patients with arthritis about becoming physically active to improve and manage their symptoms.

For each of the actions recommended below, click on the links to access resources, such as counseling tools, patient handouts, and decision aids.

1) Learn more about physical activity guidelines and counseling considerations for adults with arthritis and disabilities. The Physical Activity Guidelines for Americans recommend 150 minutes of moderate intensity activity per week for adults, including adults with arthritis.

• Physical Activity Guidelines
• Physical Activity Counseling Considerations for People with Disabilities and Arthritis

2) Identify patients with arthritis who would benefit from physical activity counseling. Creating an arthritis registry using your electronic health record system can help you identify patients with osteoarthritis and rheumatoid arthritis who would benefit from physical activity counseling, chronic disease support, and referrals to evidence-based programs. If you use HealtheConnections' myData platform, registries are available in the myData Arthritis Dashboard with data from the Health Information Exchange.

• Arthritis Registry Specifications

3) Counsel patients with arthritis about the benefits of physical activity to ease arthritis pain and improve function. Promote joint-friendly exercises like walking. You have an influential role in your patients' decision to include regular physical activity in their life. Tools such as the Exercise is Medicine® (EIM) Rx for Health series from the American College of Sports Medicine can help you assess your patients' current physical activity levels and prescribe physical activity based on these levels and their health status.

• Public Health Live! Prescribing Physical Activity to Improve Arthritis Management
• Physical Activity Counseling Resources
• Patient Education Materials

4) Refer patients with arthritis to Centers for Disease Control and Prevention (CDC)-recommended physical activity programs for arthritis. These programs have been shown to reduce pain and disability related to arthritis and improve movement and mood.

• Summary of the Evidence
• Patient Education Materials

Self-Management Education Programs

You can also refer patients with arthritis to evidence-based, self-management education programs like the Chronic Disease Self-Management Program (CDSMP). This group-based program focuses on establishing healthy behaviors to help manage chronic disease.

Facts: Arthritis and Physical Activity in New York State

• The prevalence of arthritis for adults in New York State is 22.7%.¹
• Most people with arthritis in New York State are women 65 and older.¹
• Low-impact and joint-friendly physical activity has many benefits for patients with arthritis, including:
  • Decreasing pain by about 40%.²
  • Improving quality of life.²
  • Preventing other chronic diseases,² including diabetes,³ heart disease,⁴ and obesity.⁵
• Also, participating in an evidence-based intervention can help reduce health care expenses⁶ and improve function, self-efficacy, perceived control, balance, and strength among patients with arthritis.⁷
• Although the Centers for Disease Control and Prevention (CDC) recommends that health care providers counsel people with arthritis to engage in physical activity,² two out of five people are not receiving health care provider counseling.⁸

For more facts about arthritis in New York State, go to the New York State Arthritis Fact Sheet.

Go to References

Action 1 Tools

Physical Activity Guidelines

Title	Description
Centers for Disease Control and Prevention (CDC) Exercise to Ease Arthritis Pain	This resource includes physical activity guidelines and recommended physical activity options for people with arthritis.
Centers for Disease Control and Prevention (CDC) Increasing Physical Activity Among Adults with Disabilities	This resource includes physical activity guidelines and recommended physical activity options for people with disabilities.
Exercise is Medicine (EIM) Summary Sheet	This handout provides an overview of EIM and how you can activate it in your practice. It gives a basic overview of physical activity guidelines and allows you to complete physical activity assessments.
U.S. Department of Health and Human Services (HHS) Physical Activity Guidelines for Americans	These guidelines discuss evidence-based physical activity interventions, including physical activity guidelines for all age ranges, disability statuses, and considerations to keep in mind when prescribing physical activity to patients with arthritis.

Physical Activity Counseling Considerations for People with Disabilities and Arthritis

Nearly 1 in 4 adults in New York State has a disability. Arthritis is one of the leading causes of disability in the nation and in New York State. In addition to being a major cause of disability, arthritis is also more common among adults with disability. In fact, adults with disability are more than three times as likely (50.5%) to have arthritis than adults without disability (16.4%).

Most adults with disability are able to participate in physical activity, yet nearly half of them do not get any aerobic physical activity. As a health care provider, you can:

• Recommend moderate physical activity, such as rolling, walking, and biking, to boost mood and help reduce arthritis pain and stiffness.
• Refer patients to evidence-based programs, like Enhance®Fitness, that are proven, safe ways to get active. Programs are often led by Certified Inclusive Fitness Trainers and can be adapted to all abilities, making them accessible and inclusive for adults with disability.

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Action 2 Tools

Arthritis Registry Specifications

This document provides a code set to define an arthritis registry for diagnosed osteoarthritis (OA) or rheumatoid arthritis (RA) in the electronic health record (EHR) system, including the specifications and description of approach. The New York State Department of Health Arthritis Program developed this resource to help your practice create an arthritis registry in your EHR system. The registry will identify patients with arthritis who would benefit from physical activity counseling and referral to physical activity programs, such as the Enhance®Fitness and Walk With Ease programs.

Arthritis Registry Specifications

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Action 3 Tools

Public Health Live! Prescribing Physical Activity to Improve Arthritis Management

The NYS Arthritis Program partnered with the University at Albany School of Public Health to produce this free, 1-hour webcast and provide continuing education credits. This webcast describes the prevalence and burden of arthritis in NYS and addresses the need for health care providers to counsel and refer patients with arthritis to physical activity, including walking and arthritis-appropriate evidence-based interventions.

• View the webcast

Physical Activity Counseling Resources

These resources can help you integrate physical activity counseling into your practice and recommend physical activity options for adults with arthritis and disabilities.

Source/Title	Description
Centers for Disease Control and Prevention (CDC) Clinician-Targeted Intervention and Patient-Reported Counseling on Physical Activity Journal Article	This journal article in Preventing Chronic Disease examines the effectiveness of a clinician-targeted intervention that used the 5As approach (Ask, Advise, Agree, Assist, Arrange) to physical activity counseling in a medically underserved patient population.
Exercise is Medicine (EIM) Coding and Billing Tips	These tips guide you through selecting appropriate diagnostic and billing codes for physical activity assessments, prescriptions, and counseling. This resource can also be used by a health care organization's billing department to allow billing for and tracking of physical activity counseling.
Exercise is Medicine (EIM) COVID-19 and Exercise webpage	This webpage provides resources and support for keeping patients active during the COVID-19 pandemic.
Exercise is Medicine (EIM) HCP Action Guide	This guide describes how health care providers can (1) integrate physical activity counseling into their practice, (2) assess physical activity levels, (3) determine patient physical activity readiness, (4) prescribe physical activity, (5) refer patients to programs, (6) promote physical activity within your health care organization, (7) involve staff throughout these processes, and (8) become a champion for this cause.
National Center on Health, Physical Activity, and Disability (NCHPAD) Find a Certified Inclusive Fitness Trainer	This website allows you to search for exercise professionals including Certified Inclusive Fitness Trainers (CIFT). CIFTs are uniquely qualified to work with people who have health risks and/or physical limitations.
National Recreation and Park Association (NRPA) Increasing Referrals to Community-Based Programs and Services: An Electronic Health Record Referral Process	This guide describes implementation of EHR referral processes for you to identify and refer patients with arthritis to evidence-based interventions offered through local parks and recreation.
Osteoarthritis Action Alliance (OAAA) Pharmacy Toolkit	The OAAA Pharmacy Toolkit guides pharmacists in assuming an active role in detecting, preventing, and treating osteoarthritis.

Patient Education Materials

These handouts are designed to support your physical activity recommendations to patients/clients. Each handout can be printed and given to a patient or scanned into the electronic health record (EHR) to be added to the after-visit summary.

Source/Title	Description
Centers for Disease Control and Prevention (CDC) Physical Activity. The Arthritis Pain Reliever brochure.	This co-branded brochure from the CDC and NYSDOH promotes physical activity as a method to manage arthritis pain and increase function. To order copies of the brochure, please email your request to OGS.SM.GDC@OGS.NY.GOV. Make sure to provide your complete mailing address and the quantity being requested.
Exercise is Medicine (EIM) Physical Activity Vital Signs (PAVS)	This handout provides a snapshot of whether patients meet the physical activity guidelines and it allows you to track patients' physical activity habits over time. PAVS can be integrated within electronic health records, allowing you to "flag" noncompliant patients.
Exercise is Medicine (EIM) Exercise prescription form and pad	The prescription form and pad allow you to easily prescribe physical activity to patients.
Exercise is Medicine (EIM) Exercise Prescription for Osteoarthritis Exercise is Medicine (EIM) Exercise Prescription for Rheumatoid Arthritis	These handouts from EIM's Rx for Health series describe how patients with osteoarthritis and rheumatoid arthritis can safely exercise. They provide a website link to exercise examples and a weekly exercise plan template. A Spanish version of the osteoarthritis handout is provided here. A Spanish version of rheumatoid arthritis handout is provided here.
Exercise is Medicine (EIM) Physical activity promotional fliers	These fliers promote physical activity in general. You can display these to start a conversation with patients about physical activity.
Exercise is Medicine (EIM) Sit Less, Move More	This two-page form describes how patients can integrate physical activity into their daily routine (e.g., at work, home) and helps patients set a weekly goal for improving their physical activity habits. A Spanish version of this resource is provided here.
Exercise is Medicine (EIM) Staying Active During the Coronavirus Pandemic (for adults)	This two-page handout describes how patients can safely exercise during the pandemic. It includes frequently asked questions about physical activity and COVID-19. Arabic, Croatian, Farsi, French,Greek, Hebrew, Italian, Mandarin, Polish, Portugese, Spanish, Spanish (España) translations of this resource are provided here.
Monday Mile walking routes Onondaga County & Madson County	The Monday Mile is a community-based walking program. Several New York State counties have created one-mile walking routes and maps to help people find routes in their area.
NYS State Parks Golden Park Program Access Pass	This handout describes a New York State Parks program that allows residents free or discounted use of state parks, and more. Residents must be 62 or older and/or have a disability. The program allows use of not only state parks, but also boat launch sites, arboretums, state historic sites, and state-operated golf courses.

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Action 4 Tools

Summary of the Evidence

Multiple study results demonstrate the effectiveness of evidence-based interventions.

Source/Title	Description
American Physical Therapy Association (APTA) Evidence-Based Community Programs: WWE Group and Self-Directed EnhanceFitness	These handouts summarize evidence supporting the programs' benefits (see page 2).
Centers for Disease Control and Prevention (CDC) Physical Activity Programs	This website describes the CDC-recognized and promising physical activity programs for adults with arthritis.

Patient Education Materials

Source/Title	Description
American Physical Therapy Association (APTA) Learn About handouts: WWE Group and Self-Directed EnhanceFitness	These patient-centered handouts describe WWE (both group and self-directed) and EF. They include a description of the program, its benefits, and links to where patients can sign up for a class -- or learn more.

References

1. New York State Department of Health. 2018 NYS Behavioral Risk Factor Surveillance System
2. U.S. Centers for Disease Control and Prevention. Arthritis and Physical Activity Fact Sheet. Retrieved from www.cdc.gov/arthritis/pa_factsheet.htm on July 1, 2013.
3. Bolen J, Hootman J, Helmick C, Murphy L, Langmaid G, Caspersen C. Arthritis as a potential barrier to physical activity among adults with diabetes— United States, 2005 and 2007. Morbidity and Mortality Weekly Report. 2008;57(18):486-489.
4. Bolen J, Murphy L, Greenlund K, et al. Arthritis as a potential barrier to physical activity among adults with heart disease-United States, 2005 and 2007. Morbidity and Mortality Weekly Report. 2009;58(7):165-169
5. Hootman J, Murphy L, Helmick C, Barbour K. Arthritis as a potential barrier to physical activity among adults with obesity—United States, 2007 and 2009. Morbidity and Mortality Weekly Report. 2011;60(19):614-618.
6. Ackermann, R. T., Williams, B., Nguyen, H. Q., Berke, E. M., Maciejewski, M. L., & LoGerfo, J. P. (2008). Healthcare cost differences with participation in a community-based group physical activity benefit for medicare managed care health plan members. Journal of the American Geriatrics Society, 56(8), 1459–1465. doi:10.1111/j.15325415.2008.01804.x
7. Callahan, L.F., Shreffler, J.H., Altpeter, M., Schoster, B., Hootman, J., Houenou, L.O., Martin, K.R., Schwartz, T.A. (2011). Evaluation of group and self-directed formats of the Arthritis Foundation's Walk With Ease Program. Arthritis Care Res (Hoboken). 63(8), 1098-107. doi: 10.1002/acr.20490.
8. Hootman JM ML, Omura JD, et al. Health Care Provider Counseling for Physical Activity or Exercise Among Adults with Arthritis — United States, 2002 and 2014. MMWR Morbidity and Mortality Weekly Report 2018. 2018;66(5152):1398-1401.