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B.R.I.D.G.E.S Background: Chronic Musculoskeletal conditions are the most common cause of long-term disability and activity limitation

Two questions emerged:  

“What are the barriers for the older adult who has begun a program of physical activity to sustain it?

What are the motivators that may help the older adult who has begun program of physical activity to sustain it?

Musculoskeletal (MSK) conditions are among the most debilitating nonfatal health diseases in older adults and significantly contribute to disability.

Chronic MSK conditions are the most common cause of long-term disability and activity limitation.1,2 In fact, one in four adults over 60 has a chronic MSK condition that limits daily activity. This has a dramatic impact on quality-of-life. Individuals with chronic MSK conditions are more likely to report poor overall health, serious psychological distress, and limited social participation.3,4 Many individuals experience a downward spiral in health due to the pain and disability associated with chronic MSK conditions (see Figure 1). Over 77% of adults with chronic MSK conditions are overweight or obese5 and more likely to have cardiovascular risk factors and excess mortality.6-8

Figure 1. Compounding Effects of Musculoskeletal Pain

Physical activity (PA) can disrupt the downward spiral resulting from chronic MSK conditions and is effective at reducing disability.9-11  Physically active individuals with chronic MSK conditions report better quality-of-life, less psychological distress and less disability.1,3,12 PA also reduces the health consequences of comorbidities, including reducing obesity13,14 and improves cardiovascular and metabolic function.15,16

Yet, people with chronic MSK conditions are significantly less likely to meet PA guidelines.17,18 Sustaining PA also remains a significant challenge for older adults with chronic MSK conditions.19 Many of these individuals are faced with concerns about the appropriateness of exercise given their condition, what to do when a new health concern arises, and how to modify their activity based on pain. Health providers often endorse PA and numerous community, state, and federal organizations have developed PA interventions for older adults. The problem is that stakeholder priorities are not aligned. The result is fragmented support for individuals with chronic MSK conditions. Additionally, many stakeholders are not trained in methods for influencing research and policy that can address this problem.

Efforts to address this challenge

In May of 2014, a three-year study began at the University of Utah Orthopaedic Center titled “Improving Function and Enhancing Wellness for Older Adults with Chronic Musculoskeletal Conditions – a new paradigm for rehabilitation.”  The goal of this study was to facilitate a Senior Health Program (SHP) and examine how a clinic-based wellness program for older adults with chronic MSK conditions affects physical function, physical activity, exercise self-efficacy, and satisfaction.

  • First, the program aimed to evaluate the impact of the SHP on physical activity levels and physical function in older adults with chronic musculoskeletal conditions.  The hypothesis was that even after a course of physical therapy, physical activity and physical function would further improve with a supportive and supervised exercise intervention.  

  • Second, the program aimed to identify the role of the SHP in improving patients’ self-efficacy with physical activity.  The hypothesize was that moving patients into a program promoting more independence and success with exercise would improve physical activity self-efficacy and the skills to manage fluctuations in symptoms wand co-morbidities beyond what is experienced in physical therapy.  

  • Third, the program aimed to assess patient satisfaction with the SHP. In order for a program to be sustainable it must also be acceptable to end-users.  

Over the three years of the study, 85 seniors 60 years of age and older, with chronic MSK conditions met personally, 2 or 3 times weekly for at least 8 weeks with trained exercise specialists to receive support and guidance in individually designed physical activity programs. Patient satisfaction with and overall perception of the program was high (Figure 2).  Patients enjoyed the socialization the program provided, the accountability the program provided, and the one-on-one care the program provided.  

Figure 2. Satisfaction with the Senior Health Program at 8-weeks. (Note: 0% reported Poor of Fair)

The clear message from the older adult patients in the SHP during individual follow-up interviews, however, was that their most salient challenge once their time with the program had ended was sustaining the physical activity. There were as many reasons for lack of sustaining physical activity as there were individuals.  

 

Two questions emerged:  “What are the barriers for the older adult who has begun a program of physical activity to sustain it?  What are the motivators that may help the older adult who has begun program of physical activity to sustain it?