Association between different types of physical activities and arthritis among Chinese elderly: evidence from the China health and retirement longitudinal study

doi:10.21203/rs.3.rs-3890440/v1

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Association between different types of physical activities and arthritis among Chinese elderly: evidence from the China health and retirement longitudinal study

https://doi.org/10.21203/rs.3.rs-3890440/v1

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Background

The association between physical activities and arthritis has gained considerable attention. However, current research on the correlation between different types of physical activity and arthritis in middle-aged and elderly individuals remains relatively limited. Gaining a deeper understanding of the impact of exercise behavior on arthritis in this population holds significant importance in comprehending joint health and disease management. This study aims to investigate the relationship between various types of physical activity and arthritis in middle-aged and elderly individuals in China.

Methods

This cross-sectional study utilized the first wave data from the China Health and Retirement Longitudinal Study (CHARLS), where participants were categorized into either arthritis or non-arthritis groups. Meanwhile, based on the survey questionnaire, physical activity levels were classified into three categories of light, moderate, and vigorous. A logistic regression model was employed to evaluate the association between exercise and arthritis, with odds ratios (OR) reported to indicate the degree of correlation between the two factors.

Results

The cross-sectional analysis included a total of 5334 participants, among whom the overall prevalence of arthritis was 35.0%. After adjusting for all potential risk factors, there was an independent association between types of physical activity and arthritis (vigorous compared to light or moderate activity: OR = 1.473, 95%CI 1.276–1.701, p < 0.001; moderate compared to light activity: OR = 1.182, 95%CI 1.015–1.377, p = 0.032). In subgroup analysis, the association of types of physical activities with arthritis was also significant in participants over 55 years of age, male, BMI ≥ 24, as well as in individuals with hyperlipidemia or hypertension (p < 0.05). However, no significant associations were found in individuals with diabetes or hyperglycemia, gastrointestinal or digestive system disorders, BMI < 24, aged 45–55, or in the female population (p > 0.05).

Conclusion

Exercise intensity is an independent risk factor for arthritis in middle-aged and elderly Chinese individuals. The relationship between exercise and arthritis may be influenced by factors such as gender, age, BMI, and the presence of chronic diseases.

arthritis

physical activities

China health and retirement longitudinal study

cross-sectional study

Arthritis, a prevalent chronic painful condition, predominantly manifests in middle-aged and elderly cohorts [1, 2]. The escalating pace of global aging has elevated arthritis into an ever more pressing public health concern [3]. According to statistics, nearly 400 million people are expected to suffer from osteoarthritis by 2030, imposing substantial burdens upon both individual well-being and societal economics [4]. Therefore, there is an imperative to undertake comprehensive investigations into the occurrence and intervention methodologies for arthritis in middle-aged and elderly populations.

The relationship between exercise and arthritis has attracted considerable interest [5–9]. On one hand, exercise, as a non-pharmacological intervention, is widely acknowledged as a beneficial and effective treatment for arthritis [10]. By engaging in appropriate exercise, individuals can enhance their muscle strength and flexibility and improve joint stability and function, resulting in the reduction of pain and discomfort associated with arthritis [11, 12]. On the other hand, excessive or inappropriate exercise may have detrimental effects on joints, potentially worsening or triggering the development of arthritis [13]. Consequently, investigating the connection between exercise intensity and arthritis in middle-aged and elderly populations assumes great importance in formulating tailored exercise interventions and strategies for arthritis prevention.

However, current research tends to focus primarily on the therapeutic effects of specific types of exercise on arthritis, while there is relatively limited research on the correlation between exercise intensity and arthritis, particularly among middle-aged and elderly individuals in China [14–16]. Long-term, large-scale cross-sectional studies are lacking in this regard. There is currently a lack of clinically guiding research on whether to exercise, exercise intensity, and how to exercise in the presence of underlying medical conditions. Particularly in countries like China, where the aging population is high, it is crucial to deepen our understanding of the impact of physical activity on arthritis in middle-aged and elderly individuals to alleviate the occurrence of arthritis and improve the quality of life of older adults[17]. Therefore, there is an urgent need to conduct research on the correlation between physical activity and arthritis in middle-aged and elderly individuals based on the Chinese population to fill this research gap.

In summary, this study aims to conduct a cross-sectional research and analysis utilizing large sample data collected from the China health and retirement longitudinal study to explore the correlation between different exercise intensities and arthritis among middle-aged and elderly individuals in China, while also uncovering potential influencing factors. The results of this research will provide more targeted exercise recommendations for this population, enhancing their joint health and improving their quality of life, while also providing significant references for public health policies and health management.

Design and study population

The China Health and Retirement Longitudinal Study (CHARLS) is an internationally representative research project that has gathered high-quality micro-level data from individuals aged 45 and above[18]. The data encompasses a wide range of information on population characteristics, lifestyle behaviors, retirement, and health status. To conduct this cross-sectional study, the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were employed, utilizing data from the CHARLS Wave 1 survey [19, 20]. This survey involved a comprehensive sample of 17,603 participants. Exclusion criteria were implemented to facilitate the study process, which included age under 45, missing physical activity and arthritis data, as well as a lack of demographic features, lifestyle behaviors, and health status information. Ultimately, 12,269 participants were excluded based on these criteria, while 5,334 participants were included in the study (Fig. 1). The Ethics Committee of Peking University (IRB00001052-11015) approved the CHARLS study, and all participants provided informed consent.

Dependent variable

In order to ascertain arthritis status, participants were queried as to their medical history with regard to a diagnosis of arthritis (i.e., "Have you ever been diagnosed with arthritis by a physician?"). An affirmative response was taken to denote the condition of arthritis.

Independent variable

Physical activity intensity was determined through a self-reported questionnaire. Based on the level of exertion, the activities were classified into three categories: vigorous, moderate, and light. The time spent engaging in each level of activity was recorded on a weekly and daily basis. Vigorous activities included tasks that made one breathe heavily, such as lifting heavy objects, digging, farming, aerobic exercises, fast cycling, and carrying loads while cycling. Moderate-intensity activities resulted in slightly faster breathing than usual, such as lifting light objects, regular-speed cycling, mopping the floor, practicing tai chi, or brisk walking. Light activities predominantly involved walking, including moving from one place to another during work or at home, as well as walking for leisure, exercise, or entertainment purposes.

Control variable

The confounding factors in this study mainly include demographic characteristics, lifestyle factors, health conditions, and vital signs. (1) Demographic characteristics: age, gender, marital status; (2) Lifestyle factors: smoking, alcohol consumption, physical activity; (3) Health conditions: obtained through self-reporting, including history of falls, fractures, physical disabilities, and chronic diseases (such as hypertension, dyslipidemia, etc.); (4) Vital signs: blood pressure (systolic and diastolic), pulse rate, height, weight, and body mass index (BMI). According to the Chinese standard, BMI was categorized into three groups: underweight (< 18.5 kg/m²), normal weight (18.5–23.9 kg/m²), and overweight/obesity (≥ 24 kg/m²).

Statistical analysis

Continuous variables were expressed as mean ± standard deviation. Count and percentage (%) were used to represent categorical variables. Student's t-test and chi-square test were used to compare baseline characteristics between the two groups (non-arthritis group and arthritis group). A binary logistic regression model was established to evaluate the relationship between exercise intensity and arthritis. Two models were evaluated in this study: Model 1 adjusted for age, gender, and body mass index; Model 2 adjusted for age, gender, body mass index, smoking, alcohol consumption, marital status, physical disabilities, chronic diseases, history of falls, and hip fractures. The strength of correlation was expressed in terms of odds ratio (OR) and 95% confidence interval (CI). Statistical analysis was performed using IBM SPSS 25.0. A two-tailed P-value less than 0.05 was considered statistically significant.

Characteristics of the participants

Baseline characteristics of the arthritis and non-arthritis groups were presented in Table 1. Among the 5,334 participants, the overall prevalence of arthritis was 35%. Compared to participants without arthritis, those with arthritis were more likely to have higher exercise intensity, be female, older in age, or smoke (p < 0.05).

In terms of health characteristics, there were statistically significant differences between the two groups in terms of physical disabilities, history of falls, and chronic diseases (such as diabetes or hyperglycemia, stomach or other digestive disease, hypertension, cancer or malignant tumor, chronic lung diseases, heart diseases, liver diseases, stroke, kidney diseases, asthma, emotional, nervous or psychiatric problems, and memory-related disease) (p < 0.05).

Logistic regression analysis of exercise intensity and arthritis

Univariate logistic regression analysis was performed to identify potential risk factors. In Model 1, adjustment was made for age, gender, and body mass index. The results showed a significant association between exercise intensity and arthritis (vigorous exercise versus light-moderate exercise: OR = 1.473, 95%CI 1.276–1.701, p < 0.001; moderate exercise versus light exercise: OR = 1.183, 95%CI 1.024–1.366, p = 0.022) (Fig. 2). In Model 2, after adjusting for all potential risk factors, exercise intensity remained an independent risk factor for arthritis (vigorous exercise versus light-moderate exercise: OR = 1.436, 95%CI 1.230–1.677, p < 0.001; moderate exercise versus light exercise: OR = 1.182, 95%CI 1.015–1.377, p = 0.032). In addition, older age, physical disabilities, stomach or other digestive disease, hypertension, chronic lung diseases, liver diseases, kidney diseases, heart diseases, and history of falls were also independent risk factors for arthritis (p < 0.05) (Fig. 3).

Subgroup analysis of arthritis incidence according to different exercise intensities

We conducted subgroup analyses on specific populations based on different demographic characteristics. The subgroup analyses showed significant differences in gender, age, chronic diseases, and BMI (Table 2). Only participants who were male, aged over 55, had a BMI > 24, had hyperlipidemia, or hypertension had a significantly increased risk of developing arthritis with increased exercise intensity. However, no significant association was found for participants with diabetes or hyperglycemia, gastrointestinal disorders, BMI < 24, ages 45–55, or female gender.

In this study, we found a significant association between high-intensity exercise and arthritis, consistent with previous research. Excessive exercise may subject joints to sustained high loads, potentially resulting in joint injury, inflammation, and pain [21, 22]. Moreover, we found that age, gender, smoking, physical disabilities, falls, and a history of chronic diseases such as diabetes or hyperglycemia, limb disabilities, gastrointestinal disorders, hypertension, malignancies, chronic lung disease, heart disease, liver disease, stroke, kidney disease, asthma, and emotional or memory disorders were also independent risk factors for arthritis. These findings suggest that when considering the impact of exercise intensity on the risk of arthritis, other possible risk factors should also be taken into account.

However, it should be noted that the effect of exercise intensity on arthritis is not the same for everyone. Our subgroup analysis indicated that gender, age, BMI, and the presence of chronic diseases might influence the relationship between exercise and arthritis. For example, increased exercise intensity only significantly increases the risk of developing arthritis in populations that are male, aged over 55, overweight or obese, or have hyperlipidemia or hypertension. On the other hand, the relationship between exercise and arthritis is not significant in populations that are female or have a history of other chronic diseases such as diabetes or hyperglycemia, or gastrointestinal disorders. These findings contribute to a more accurate assessment of the impact of exercise intensity on arthritis, enabling the development of more personalized exercise plans and providing more precise exercise recommendations for specific populations. This helps to avoid unnecessary risks of arthritis and adapt to the variations in different populations and chronic disease conditions. For instance, for women with a normal or slightly underweight BMI, under the age of 55, and with diabetes or hyperglycemia, or gastrointestinal disorders, exercise intensity should not be a concern in terms of arthritis burden.

This is a study investigating the correlation between exercise intensity and arthritis in the elderly population in China. The study has a large sample size and national representativeness, which allows for some degree of generalization. Furthermore, the richness of the CHARLS questionnaire enables us to adjust for various confounding factors, enhancing the robustness of the results. In conclusion, the findings of this study provide important evidence for the development of personalized exercise programs for arthritis patients. Moderate exercise can help alleviate symptoms of arthritis, improve joint function and flexibility, and enhance quality of life. However, it is important to develop a reasonable exercise plan based on individual characteristics and chronic disease conditions, and to consult with a doctor or professional health consultant before engaging in physical activity.

Although the results of this study are of great significance, there are limitations that should be acknowledged. Firstly, this study is a cross-sectional study, which makes it difficult to establish causality. Therefore, follow-up studies are needed to further investigate the causal relationship between exercise intensity and arthritis. Secondly, our study relies on self-reported data on exercise levels, which may be susceptible to memory bias and subjective errors. It is therefore necessary to utilize more objective methods of exercise monitoring. Lastly, it is important to consider other potential confounding factors during the data analysis process to avoid biases in the study.

When examining the correlation between exercise intensity and arthritis in the elderly population, there are other crucial aspects that warrant consideration and discussion. Firstly, it is imperative to investigate whether the impact of exercise on arthritis is consistent across various joint sites. There may exist variations in the response to exercise interventions among different joints within the same cohort, such as the knee and hip joints. Previous studies have suggested that exercise interventions may exert greater benefits on knee arthritis compared to hip arthritis [23]. These discrepancies might be attributed to variations in nutritional factors, structural composition, and biomechanical characteristics among different joint sites. Consequently, future investigations should concentrate more precisely on the effects of exercise interventions on distinct joint sites and develop tailored exercise regimens accordingly. Secondly, it is crucial to evaluate exercise intervention strategies for different stages of arthritis. In the early stages of arthritis development, moderate exercise can enhance the supportive structures of the joints, alleviate pain, and slow down disease progression by improving muscle strength and balance, thereby reducing joint load [24]. However, in the later stages of disease progression, the type and dosage of exercise may need corresponding adjustments to prevent diminished benefits and further injuries. In future research, these stage-specific differences should be taken into account, and more specific intervention strategies should be developed. Furthermore, a deeper understanding of the response to exercise in different types of arthritis is necessary. Arthritis is a broad concept encompassing various types of inflammatory and non-inflammatory joint diseases. Different types of arthritis may have distinct pathological mechanisms and clinical presentations. Therefore, further research is needed to investigate the differences in exercise interventions among patients with different types of arthritis and develop personalized exercise prescriptions accordingly. Moreover, the relationship between exercise and other chronic diseases needs to be considered. Chronic diseases such as obesity, hypertension, and diabetes, like arthritis, are common health issues in the elderly population. Through appropriate exercise interventions, these chronic diseases can be controlled, thereby further reducing the incidence and severity of arthritis. Therefore, future research should consider comprehensive interventions among multiple chronic diseases. Lastly, future research can focus more on specific types and dosages of exercise and their effects on arthritis, in order to develop more individualized and effective exercise prescriptions to help middle-aged and elderly people prevent and treat arthritis. Furthermore, various healthcare strategies to alleviate arthritis in middle-aged and elderly individuals, including appropriate intervention methods and new treatment options, need to be evaluated more systematically.

This cross-sectional study suggested that exercise intensity was an independent risk factor for arthritis in middle-aged and elderly Chinese individuals, particularly among male participants, those aged 55 years or older, those with a BMI ≥ 24, and those with hyperlipidemia or hypertension, as an increase in physical activity was closely associated with the incidence of arthritis.

Ethics approval and consent to participate

The studies involving human participants were reviewed and approved by Biomedical Ethics Review Committee of Peking University. The patients/participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.

Consent for publication

Not applicable.

Funding

This study was supported by grants through State Administration of Traditional Chinese Medicine High-level Key Discipline of Traditional Chinese Medicine - Tuina (zyyzdxk-2023061)

Authors' contributions

ZZQ and SWQ designed this study; ZZQ and LJ analysed the data and drafted the manuscript; LJS, CJT, ZS, SYM helped to interpret the results and modified the manuscript; All authors read and approved the final manuscript.

Competing interest

The authors declare that they have no competing interests.

Availability of data and materials

The datasets for this study can be found in the China Health and Retirement Longitudinal Study (CHARLS). The original datasets of CHARLS is accessible on http://charls.pku.edu.cn/en.

Acknowledgments

We would like to thank the CHARLS research team, the field team, and every respondent for their time and efforts that they have devoted to the CHARLS project.

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Tables 1-2 is available in the Supplementary Files section.

No competing interests reported.

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Version 1

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You are reading this latest preprint version

Association between different types of physical activities and arthritis among Chinese elderly: evidence from the China health and retirement longitudinal study

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Version 1

Abstract

Background

Methods

Results

Conclusion

Figures

Background

Method

Design and study population

Dependent variable

Independent variable

Control variable

Statistical analysis

Results

Characteristics of the participants

Logistic regression analysis of exercise intensity and arthritis

Subgroup analysis of arthritis incidence according to different exercise intensities

Discussion

Conclusion

Declarations

References

Tables

Additional Declarations

Supplementary Files

Status:

Version 1