Physical Activity Types and Programs Recommended by Primary Care Providers Treating Adults With Arthritis, DocStyles 2018

Primary care providers (PCPs) can offer counseling to adults with arthritis on physical activity, which can reduce pain and improve physical function, mental health, and numerous other health outcomes. We analyzed cross-sectional 2018 DocStyles data for 1,366 PCPs who reported they always or sometimes recommend physical activity to adults with arthritis. Most PCPs sampled (88.2%) recommended walking, swimming, or cycling; 65.5% did not recommend any evidence-based, arthritis-appropriate physical activity programs recognized by the Centers for Disease Control and Prevention. Opportunities exist for public health awareness campaigns to educate PCPs about evidence-based physical activity programs proven to optimize health for adults with arthritis when more than counseling is needed. Objective Physical activity is recommended for adults with all types of arthritis because it can reduce pain and improve physical functioning, mood, and quality of life (1,2). Professional organizations encourage health care professionals to counsel adults with arthritis on physical activity and recommend supervised programs when needed (3,4). Primary care providers (PCPs) frequently treat arthritis (5) and are instrumental in promoting physical activity. Although we previously found that 98.4% of PCPs always or sometimes recommend physical activity to adults with arthritis (6), the content of physical activity counseling may affect its effectiveness (3). Addressing patient concerns (eg, arthritis-specific physical activity barriers such as pain) warrants specific guidance and referrals to safe, supervised programs (3). To build on a previous study, we examined physical activity types and programs recommended among PCPs recommending physical activity to adults with any type of arthritis and compared distributions of characteristics of PCPs recommending programs versus PCPs unaware of them. Methods We analyzed cross-sectional data from 2018 Porter Novelli Doc Styles (https://styles.porternovelli.com/docstyles), an online national market research survey assessing PCP attitudes, patient en counters, and use of medical information resources. Eligible Doc-Styles participants were family practitioners, internists, obstetri-cian/gynecologists, and nurse practitioners aged 21 or older, liv-ing and practicing in the US, practicing for at least 3 years, treat-ing at least 10 patients weekly, and working at an individual, group, or inpatient practice. From June through August 2018, Porter Novelli invited participants by email to complete the sur-vey from the Sermo Global Medical Panel (www.sermo.com), SurveyHealthcareGlobus (www.surveyhealthcareglobus.com), and WebMD (www.webmd.com). Target quotas (1,000 PCPs, 250 ob-stetricians/gynecologists, and 250 nurse practitioners) were met by inviting highly responsive participants (defined as completing >75% of any kind of survey [not only DocStyles] in which they had been invited to participate) first from among those not parti-cipating in DocStyles 2017. Of 2,582 invited persons, 1,505 com-pleted the survey (response rate, 58.3%) and were compensated $55 to $77 based on number of questions asked. We excluded 116 PCPs not treating adults with arthritis and 23 never recommend-ing physical activity, which resulted in an analytic sample of 1,366. Additional survey details are available elsewhere (6). Al-though analyses were not subject to Centers for Disease Control and Prevention's (CDC's) institutional review board, we followed all Council of American Survey Research Organizations guidelines, and the data set was deidentified. The 2018 DocStyles Survey included a module with questions about recommendations for CDC-recognized arthritis-appropriate physical activity programs (hereafter "programs") (7), which have an evidence base for addressing physical activity barriers (8). PCPs treating an average of at least 1 adult with arthritis weekly completed multiple choice questions about physical activity coun-seling for adults with arthritis, including physical activity types, programs recommended, and reasons for not recommending pro-grams. We calculated percentages for physical activity type and program variables overall (N = 1,366) and reasons for not recommending programs among PCPs not recommending programs (n = 895). To identify opportunities for promoting program awareness, we gen-erated distributions of PCP characteristics overall (N = 1,366) and for those recommending programs (n = 471) and unaware of pro-grams (n = 710). We generated percentages using SAS version 9.4 (SAS Institute Inc); we performed chi 2 tests in Excel version 2008 (Microsoft Corp) to assess differences (significant at alpha = .05) between PCP groups. Results PCPs were commonly aged 50 or older (46.2%; 95% CI, 43.5%-48.8%), men (57.5%; 95% CI, 54.8%-60.1%), non-Hispanic White (67.1%; 95% CI, 64.6%-69.6%), and working in a group outpatient practice (67.5%; 95% CI, 65.0%-70.0%) (Ta-ble). Most PCPs recommended walking, swimming, or cycling (88.2%; 95% CI, 86.5%-89.9%), stretching (63.8%; 95% CI, 61.3%-66.4%), and physical therapy (60.8%; 95% CI, 58.2%-63.4%) (Figure). Programs were recommended less fre-quently than physical activity: 34.5% (n = 471) of PCPs recom-mended 1 or more programs. The most commonly recommended programs were the Arthritis Foundation's Aquatic Program (18.0%; 95% CI, 16.0%-20.0%), the Arthritis Foundation's Exer-cise Program (14.4%; 95% CI, 12.6%-16.3%), and Walk With Ease (13.8%; 95% CI, 12.0%-15.7%) (Figure). Most PCPs did not recommend any programs (65.5%; 95% CI, 63.0%-68.0%); among this group (n = 895), the most commonly reported reasons were being unaware of them (n = 710; 79.3%; 95% CI, 76.7%-82.0%); programs were unavailable in their area (22.5%; 95% CI, 19.7%-25.2%), unaffordable for patients (12.5%; 95% CI, 10.3%-14.7%), or inaccessible to patients (12.2%; 95% CI, 10.0%-14.3%); and believing patients would not attend (10.5%; 95% CI, 8.5%-12.5%).