Implementing the National Arthritis Action Plan: New population‐based approaches to increasing physical activity among people with arthritis

For the past 2 decades, community-based, person-focused intervention programs have provided opportunities for people with arthritis to increase their levels of physical activity, but true population-based approaches are just beginning to emerge. Although many authors appear to use the terms communityand population-based interchangeably, these terms actually reflect different dimensions of an intervention. Sharpe has provided a heuristic framework for conceptualizing community-based interventions (1). Community-based can be used to describe the setting or context of an intervention (the where of the intervention), whereas population-based can refer to the body of potential participants, which may be the entire population or a defined subgroup (the who of the intervention). As Sharpe described, community-based interventions may be population-based or more individually focused. Green and Kreuter clarify that a population-based approach must go beyond people who appear for treatment or turn out for an educational event (2). For the purpose of our discussion, we define a population-based intervention as one designed to reach out to most members of a defined population. Interest in population-based approaches for arthritis has been fueled by the publication of the National Arthritis Action Plan: A Public Health Strategy (NAAP), which catalyzed the public health system’s interest in arthritis and emphasized population-based approaches (3), and the recognition that person-focused, community-based programs, such as many of those reviewed by Boutaugh (4), are unlikely to reach large portions of the 70 million Americans with arthritis (5). Minor et al have shown that people with arthritis benefit from both structured exercise and the more broadly defined physical activity (which includes daily activities of moderate intensity such as walking, raking leaves, or washing the car); and person-focused, community-based programs have been developed by the Arthritis Foundation and others (6,7). However, little is know about effective population-based approaches to increase physical activity among persons with arthritis (PWA). The NAAP calls for the development of such population-based efforts (3). We will briefly review the NAAP and the Centers for Disease Control and Prevention (CDC) Arthritis Program that emerged from Congressional support of NAAP. We also will highlight physical activity initiatives being developed by the CDC and state health departments.