Baseline Knee Osteoarthritis and Chronic Obstructive Pulmonary Disease as Predictors of Physical Activity Decline: A Five-Year Longitudinal Study in U.S. Adults Using the Disablement Process Framework
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design and Setting
2.2. Study Participants
2.3. Diagnosis of Knee OA and COPD
2.4. Outcome Measure: Physical Activity
2.5. Covariates
2.6. Statistical Analysis
3. Results
3.1. Summary of Participant Groups
3.2. Physical Activity Trajectories over Time
3.3. Subgroup and Interaction Analyses
3.4. Model Diagnostics and Sensitivity Checks
4. Discussion
4.1. Study Limitations
4.2. Public Health Relevance
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
COPD | Chronic obstructive pulmonary disease |
OA | Osteoarthritis |
PASE | Physical Activity Scale for the Elderly |
BMI | Body mass index |
PA | Physical activity |
References
- Veronese, N.; Honvo, G.; Bruyere, O.; Rizzoli, R.; Barbagallo, M.; Maggi, S.; Smith, L.; Sabico, S.; Al-Daghri, N.; Cooper, C.; et al. Knee osteoarthritis and adverse health outcomes: An umbrella review of meta-analyses of observational studies. Aging Clin. Exp. Res. 2023, 35, 245–252. [Google Scholar] [CrossRef]
- Cross, M.; Smith, E.; Hoy, D.; Nolte, S.; Ackerman, I.; Fransen, M.; Bridgett, L.; Williams, S.; Guillemin, F.; Hill, C.L.; et al. The global burden of hip and knee osteoarthritis: Estimates from the global burden of disease 2010 study. Ann. Rheum. Dis. 2014, 73, 1323–1330. [Google Scholar] [CrossRef]
- Ciapponi, A.; Alison, L.; Agustina, M.; Demian, G.; Silvana, C.; Edgardo, S. The epidemiology and burden of COPD in Latin America and the Caribbean: Systematic review and meta-analysis. COPD 2014, 11, 339–350. [Google Scholar] [CrossRef]
- Wshah, A.; Guilcher, S.J.; Goldstein, R.; Brooks, D. Prevalence of osteoarthritis in individuals with COPD: A systematic review. Int. J. Chronic Obstr. Pulm. Dis. 2018, 13, 1207–1216. [Google Scholar] [CrossRef]
- Vorensky, M.; Orstad, S.L.; Squires, A.; Parraga, S.; Byrne, K.; Merriwether, E.N. Relationships Between Socioecological Factors and Self-Efficacy to Participate in Physical Activity for Adults With Chronic Musculoskeletal Pain: An Integrative Review. Phys. Ther. 2024, 104, pzae120. [Google Scholar] [CrossRef] [PubMed]
- Nemati, D.; Keith, N.; Kaushal, N. Investigating the Relationship Between Physical Activity Disparities and Health-Related Quality of Life Among Black People With Knee Osteoarthritis. Prev. Chronic Dis. 2023, 20, E56. [Google Scholar] [CrossRef] [PubMed]
- Verbrugge, L.M.; Jette, A.M. The disablement process. Soc. Sci. Med. 1994, 38, 1–14. [Google Scholar] [CrossRef]
- Zmerly, H.; Milanese, C.; El Ghoch, M.; Itani, L.; Tannir, H.; Kreidieh, D.; Yumuk, V.; Pellegrini, M. Personalized Physical Activity Programs for the Management of Knee Osteoarthritis in Individuals with Obesity: A Patient-Centered Approach. Diseases 2023, 11, 182. [Google Scholar] [CrossRef] [PubMed]
- Wallis, J.A.; Webster, K.E.; Levinger, P.; Taylor, N.F. What proportion of people with hip and knee osteoarthritis meet physical activity guidelines? A systematic review and meta-analysis. Osteoarthr. Cartil. 2013, 21, 1648–1659. [Google Scholar] [CrossRef]
- Aldosari, A.A.; Majadah, S.; Amer, K.A.; Alamri, H.H.; Althomali, R.N.; Alqahtani, R.F.; Alamer, R.A.; Alshehri, S.Z.; Alhayyani, R.M.; Aleman, S.Y.; et al. The Association Between Physical Activity Level and Severity of Knee Osteoarthritis: A Single Centre Study in Saudi Arabia. Cureus 2022, 14, e24377. [Google Scholar] [CrossRef]
- Santos, P.; Alves, A.; Aily, J.; Selistre, L. Challenges To Implementing Physical Activity in Patients with Knee Osteoarthritis during the COVID-19 Pandemic: A Qualitative Study. Osteoarthr. Cartil. 2023, 31, S408. [Google Scholar] [CrossRef]
- Hanania, N.A.; O’Donnell, D.E. Activity-related dyspnea in chronic obstructive pulmonary disease: Physical and psychological consequences, unmet needs, and future directions. Int. J. Chronic Obstr. Pulm. Dis. 2019, 14, 1127–1138. [Google Scholar] [CrossRef] [PubMed]
- Marcus, B.S.; McAvay, G.; Gill, T.M.; Vaz Fragoso, C.A. Respiratory symptoms, spirometric respiratory impairment, and respiratory disease in middle-aged and older persons. J. Am. Geriatr. Soc. 2015, 63, 251–257. [Google Scholar] [CrossRef]
- Yu, T.; Frei, A.; Ter Riet, G.; Puhan, M.A. Determinants of Physical Activity in Patients with Chronic Obstructive Pulmonary Disease: A 5-Year Prospective Follow-Up Study. Respiration 2016, 92, 72–79. [Google Scholar] [CrossRef]
- Zhao, M.; Veeranki, S.P.; Magnussen, C.G.; Xi, B. Recommended physical activity and all cause and cause specific mortality in US adults: Prospective cohort study. BMJ 2020, 370, m2031. [Google Scholar] [CrossRef]
- Ding, D.; Lawson, K.D.; Kolbe-Alexander, T.L.; Finkelstein, E.A.; Katzmarzyk, P.T.; van Mechelen, W.; Pratt, M.; Lancet Physical Activity Series 2 Executive Committee. The economic burden of physical inactivity: A global analysis of major non-communicable diseases. Lancet 2016, 388, 1311–1324. [Google Scholar] [CrossRef] [PubMed]
- Burke, J.F.; Sussman, J.B.; Kent, D.M.; Hayward, R.A. Three simple rules to ensure reasonably credible subgroup analyses. BMJ 2015, 351, h5651. [Google Scholar] [CrossRef]
- Charlson, M.E.; Carrozzino, D.; Guidi, J.; Patierno, C. Charlson Comorbidity Index: A Critical Review of Clinimetric Properties. Psychother. Psychosom. 2022, 91, 8–35. [Google Scholar] [CrossRef]
- Barbour, K.E.; Helmick, C.G.; Boring, M.; Brady, T.J. Vital Signs: Prevalence of Doctor-Diagnosed Arthritis and Arthritis-Attributable Activity Limitation—United States, 2013–2015. MMWR Morb. Mortal. Wkly. Rep. 2017, 66, 246–253. [Google Scholar] [CrossRef] [PubMed]
- Peat, G.; Thomas, E.; Duncan, R.; Wood, L.; Hay, E.; Croft, P. Clinical classification criteria for knee osteoarthritis: Performance in the general population and primary care. Ann. Rheum. Dis. 2006, 65, 1363–1367. [Google Scholar] [CrossRef]
- Bolszak, S.; Casartelli, N.C.; Impellizzeri, F.M.; Maffiuletti, N.A. Validity and reproducibility of the Physical Activity Scale for the Elderly (PASE) questionnaire for the measurement of the physical activity level in patients after total knee arthroplasty. BMC Musculoskelet. Disord. 2014, 15, 46. [Google Scholar] [CrossRef]
- Tao, Y.X.; Wang, L.; Dong, X.Y.; Zheng, H.; Zheng, Y.S.; Tang, X.Y.; Zhao, Y.; Zhang, Q. Psychometric properties of the Physical Activity Scale for the Elderly in Chinese patients with COPD. Int. J. Chronic Obstr. Pulm. Dis. 2017, 12, 105–114. [Google Scholar] [CrossRef]
- Christensen, J.C.; Jakiela, J.T.; White, D.K. Factors Associated with Trajectories of Physical Activity Over 8 Years in Knee Osteoarthritis. Eur. J. Rheumatol. 2023, 10, 1–7. [Google Scholar] [CrossRef]
- Lee, Y.H.; Huang, Y.P.; Pan, S.L. Physical activity and the risk of chronic obstructive pulmonary disease: A longitudinal follow-up study in Taiwan. Am. J. Med. Sci. 2024, 368, 55–60. [Google Scholar] [CrossRef]
- Gay, C.; Guiguet-Auclair, C.; Mourgues, C.; Gerbaud, L.; Coudeyre, E. Physical activity level and association with behavioral factors in knee osteoarthritis. Ann. Phys. Rehabil. Med. 2019, 62, 14–20. [Google Scholar] [CrossRef]
- Troosters, T.; van der Molen, T.; Polkey, M.; Rabinovich, R.A.; Vogiatzis, I.; Weisman, I.; Kulich, K. Improving physical activity in COPD: Towards a new paradigm. Respir. Res. 2013, 14, 115. [Google Scholar] [CrossRef]
- Waschki, B.; Kirsten, A.; Holz, O.; Muller, K.C.; Meyer, T.; Watz, H.; Magnussen, H. Physical activity is the strongest predictor of all-cause mortality in patients with COPD: A prospective cohort study. Chest 2011, 140, 331–342. [Google Scholar] [CrossRef]
- Garcia-Aymerich, J.; Lange, P.; Benet, M.; Schnohr, P.; Anto, J.M. Regular physical activity modifies smoking-related lung function decline and reduces risk of chronic obstructive pulmonary disease: A population-based cohort study. Am. J. Respir. Crit. Care Med. 2007, 175, 458–463. [Google Scholar] [CrossRef]
- Spruit, M.A.; Singh, S.J.; Garvey, C.; ZuWallack, R.; Nici, L.; Rochester, C.; Hill, K.; Holland, A.E.; Lareau, S.C.; Man, W.D.; et al. An official American Thoracic Society/European Respiratory Society statement: Key concepts and advances in pulmonary rehabilitation. Am. J. Respir. Crit. Care Med. 2013, 188, e13–e64. [Google Scholar] [CrossRef]
- McCarthy, B.; Casey, D.; Devane, D.; Murphy, K.; Murphy, E.; Lacasse, Y. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst. Rev. 2015, 2015, CD003793. [Google Scholar] [CrossRef]
- Activity, M.P.; Team, W. WHO Guidelines on Physical Activity and Sedentary Behaviour; World Health Organization: Geneva, Switzerland, 2020. [Google Scholar]
- Cheng, S.W.M.; Alison, J.A.; Stamatakis, E.; Dennis, S.M.; McKeough, Z.J. Validity and Accuracy of Step Count as an Indicator of a Sedentary Lifestyle in People With Chronic Obstructive Pulmonary Disease. Arch. Phys. Med. Rehabil. 2023, 104, 1243–1252. [Google Scholar] [CrossRef] [PubMed]
- Martin, L.M.; Leff, M.; Calonge, N.; Garrett, C.; Nelson, D.E. Validation of self-reported chronic conditions and health services in a managed care population. Am. J. Prev. Med. 2000, 18, 215–218. [Google Scholar] [CrossRef] [PubMed]
- Washburn, R.A.; Smith, K.W.; Jette, A.M.; Janney, C.A. The Physical Activity Scale for the Elderly (PASE): Development and evaluation. J. Clin. Epidemiol. 1993, 46, 153–162. [Google Scholar] [CrossRef] [PubMed]
Characteristics | Groups | p | ||
---|---|---|---|---|
Control n = 122 (14.3%) | Knee OA n = 646 (75.5%) | COPD n = 87 (10.2%) | ||
Age in a year, mean (SD) | 55.0 (7.6) | 61.1 (8.4) | 65.1 (8.7) | <0.001 *** |
Age group, n (%) | <0.001 * | |||
<65 years | 40 (46) | 407 (63) | 105 (86.1) | |
≥65 years | 47 (54) | 239 (37) | 17 (13.9) | |
Sex, n (%) | 0.032 * | |||
Male | 47 (38.5) | 311 (48.1) | 32 (36.8) | |
Female | 75 (61.5) | 335 (51.9) | 55 (63.2) | |
Race, n (%) | 0.001 * | |||
White or Caucasians | 113 (92.6) | 487 (75.4) | 68 (78.2) | |
Black or African American | 9 (7.4) | 159 (24.6) | 19 (21.8) | |
Marital status, n (%) | 0.002 * | |||
Married | 100 (82) | 426 (65.9) | 56 (64.4) | |
Unmarried/divorced/widowed | 22 (18) | 220 (34.1) | 31 (35.6) | |
Educational status, n (%) | <0.001 * | |||
Primary school or less | 5 (4.1) | 534 (82.7) | 60 (68.9) | |
High school or more | 117 (95.9) | 112 (17.3) | 27 (31.1) | |
Employment status, n (%) | <0.001 * | |||
Employed | 106 (86.9) | 379 (58.7) | 33 (37.9) | |
Unemployed | 16 (13.1) | 267 (41.3) | 54 (62.1) | |
Annual income, n (%) | <0.001 * | |||
<USD 50,000 | 18 (14.7) | 224 (34.7) | 48 (55.2) | |
≥USD 50,000 | 104 (85.3) | 422 (65.3) | 39 (44.8) | |
Smoking status, n (%) | <0.001 ** | |||
Nonsmoker | 81 (66.9) | 309 (48.7) | 27 (31.4) | |
Current smoker | 7 (5.8) | 279 (44) | 13 (15.1) | |
Former smoker | 33 (27.3) | 46 (7.3) | 46 (53.5) | |
Comorbidity, n (%) | <0.001 ** | |||
0 | 112 (92.6) | 465 (73.8) | 27 (31) | |
1 | 5 (4.1) | 110 (17.5) | 40 (46) | |
≥2 | 4 (3.3) | 55 (8.7) | 20 (23) | |
BMI (kg/m2), n (%) | <0.001 ** | |||
Normal weight | 70 (58.3) | 155 (24.1) | 12 (13.8) | |
Overweight | 44 (36.7) | 264 (35) | 32 (36.8) | |
Obese | 6 (5) | 226 (40.9) | 43 (49.4) | |
PASE, mean (SD) | 178.6 (75.9) | 158.4 (80.1) | 130.7 (68.7) | <0.001 *** |
Variable | Model 1 a | Model 2 b | ||||
---|---|---|---|---|---|---|
β | 95% CI | p | β | 95% CI | p | |
Intercept | 211.4 | 203.1, 219.7 | <0.001 | 214.6 | 204.8, 224.4 | <0.001 |
Time | −0.11 | −1.45, 0.67 | 0.708 | −0.10 | −0.52, 0.60 | 0.895 |
Knee OA versus control | −9.44 | −17.7, −1.09 | 0.027 | −6.62 | −15.4, −2.19 | 0.014 |
COPD versus knee OA | −16.9 | −26.7, −7.17 | 0.007 | −11.2 | −21.7, −0.67 | 0.037 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Alhammad, S.A.; Vennu, V. Baseline Knee Osteoarthritis and Chronic Obstructive Pulmonary Disease as Predictors of Physical Activity Decline: A Five-Year Longitudinal Study in U.S. Adults Using the Disablement Process Framework. Healthcare 2025, 13, 1902. https://doi.org/10.3390/healthcare13151902
Alhammad SA, Vennu V. Baseline Knee Osteoarthritis and Chronic Obstructive Pulmonary Disease as Predictors of Physical Activity Decline: A Five-Year Longitudinal Study in U.S. Adults Using the Disablement Process Framework. Healthcare. 2025; 13(15):1902. https://doi.org/10.3390/healthcare13151902
Chicago/Turabian StyleAlhammad, Saad A., and Vishal Vennu. 2025. "Baseline Knee Osteoarthritis and Chronic Obstructive Pulmonary Disease as Predictors of Physical Activity Decline: A Five-Year Longitudinal Study in U.S. Adults Using the Disablement Process Framework" Healthcare 13, no. 15: 1902. https://doi.org/10.3390/healthcare13151902
APA StyleAlhammad, S. A., & Vennu, V. (2025). Baseline Knee Osteoarthritis and Chronic Obstructive Pulmonary Disease as Predictors of Physical Activity Decline: A Five-Year Longitudinal Study in U.S. Adults Using the Disablement Process Framework. Healthcare, 13(15), 1902. https://doi.org/10.3390/healthcare13151902