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• People With Arthritis Need Exercise but Don’t Get It
• The Internet Is Critical Information Source
• NIAID Study Finds Higher Dose of Flu Vaccine Improves Immune Response in the Elderly

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People With Arthritis Need Exercise but Don’t Get It 

Physical activity provides many positive effects for people with arthritis. Yet according to a data review of the 2002 National Health Interview Survey, people with arthritis are “significantly less likely than adults without arthritis to engage in recommended levels of moderate or vigorous physical activity.” The survey included 6,829 people with diagnosed arthritis and 20,676 people without arthritis. Only 37% of adults with arthritis met the least stringent physical activity guidelines established in 2001 (a percentage similar to people without arthritis).

Inactivity was associated with older age, less education, and functional limitations. People least likely to be physically active had difficulty walking up 10 stairs, grasping small objects, bending or kneeling, lifting 10 pounds, or standing for 2 hours. The authors noted that fear of pain and the misconception that exercise can harm joints are obstacles to getting people with arthritis to exercise.

A second analysis used data from 17,763 respondents who completed the Arthritis Burden Module of the 2004 Behavioral Risk Factor Surveillance Survey. Researchers searched for people who had arthritis diagnosed by a physician or other health professional and assessed exercise and physical activity from the question, “During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise?”

Of the 34.7% who reported having arthritis, 67% of those aged 55 to 64 and 64.2% of those ages 65 and older reported engaging in exercise/physical activity. Those who reported recent activity were more likely to be men, have higher levels of education, have been advised by a health professional that exercise/physical activity might benefit their arthritis, or have taken an arthritis education course. People who did not report recent physical activity tended to be in poorer health, older (65+), African American, overweight or obese, or have limitations due to joint symptoms.

Coauthor Steffany Haaz, MFA, told ICAA Research Review that “it is possible to regain a certain amount of mobility by slowly increasing activity again. Especially for those with arthritis, staying active is an important part of disease management to retain muscle, range of motion, and joint stability.”

The authors concluded that health professionals can play an important role in encouraging exercise. “Clinicians don’t realize how important their advice still is in today’s changing face of medicine,” said Haaz. “Those who receive advice to exercise from their doctors are much more likely to start an activity program than those who don’t.”

SOURCES: American Journal of Preventive Medicine 2006;30:385; Journal of Clinical Rheumatology 2006;12:66.

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The Internet Is Critical Information Source 

As the older population increases in number, so does the number of older adults who use the Internet. The Pew Internet and American Life Project found that 34% of Americans aged 65 and older go online. That number has increased—and will continue to increase—because of the aging baby boomers who are beginning to fill the older age groups. In the meantime, people under 60 are more likely to use the Internet: 72% of 51 to 59 year olds and 54% of 60 to 69 year olds go online.

Older “wired seniors” typically do not try as many online activities as younger people, perhaps because they have no need to or because they are more cautious. However, most adults (45% of Internet users, or about 60 million Americans) use the Internet to get information about illness or other major events.

According to a new analysis, the Internet played a major role for 54% of adults helping another person or themselves (40%) cope with a major illness. It also played a major role for 50% seeking training for their careers, 45% making major investment or financial decisions, and 43% looking for a new place to live.

Older adults may be more vulnerable to unwanted software. Only 27% of Internet users aged 51 to 59 used a spyware program, although 29% stopped downloading software and 43% stopped visiting certain sites.

SOURCE: Pew Internet and American Life Project (April 11 and April 19, 2006).

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NIAID Study Finds Higher Dose of Flu Vaccine Improves Immune Response in the Elderly 

There may be a simple way to provide elderly Americans with extra protection against the annual flu virus: give them a higher dose of seasonal flu vaccine. This idea is suggested by the results of a newly reported clinical trial supported by the National Institute of Allergy and Infectious Diseases (NIAID), a component of the National Institutes of Health (NIH).

The trial, described in the latest issue of the Archives of Internal Medicine, was conducted by a team of researchers from Baylor College of Medicine in Houston, Texas, and Sanofi Pasteur, the vaccines business of the Sanofi-Aventis Group in Paris. Led by Wendy Keitel, MD, the team conducted the trial at the Baylor Vaccine and Treatment Evaluation Unit, 1 of a network of NIAID-supported sites at university research hospitals across the United States that conduct Phase I and II clinical trials to test and evaluate candidate vaccines for infectious diseases.

NIH director Elias A. Zerhouni, MD, notes, “The study results reported by Dr. Keitel and her colleagues are important because they suggest that a higher dose of seasonal influenza vaccine can safely and significantly increase the immune responses of older people.”

“Elderly Americans are among the most vulnerable to serious complications of influenza because they generally have more underlying diseases and weaker immune systems than younger people,” says NIAID director Anthony S. Fauci, MD. “These findings are an important first step in developing new strategies to better protect the elderly against influenza-associated hospitalizations and mortality.”

“If you look at people who are dying and going into the hospital during an outbreak of seasonal influenza,” says Dr. Keitel, “the majority of those people are older individuals.”

Influenza accounts for some 36,000 deaths and more than 200,000 hospitalizations every year in the United States. It is among the most lethal killers in the United States simply because the virus infects so many people—some 5% to 20% of the U.S. population every year.

In other influenza vaccine studies, higher antibody levels resulted in better protection against infection. Conversely, decreased antibody production in the elderly can leave them more susceptible to infection and the severe complications of influenza. Helping elderly people increase antibody production should help them fight off influenza infections, and this is exactly what Dr. Keitel and her colleagues set out to test when they began the clinical trial. They hypothesized that elderly people could be given higher doses of vaccine safely and that these higher doses would increase the antibody response and confer increased protection without increasing side effects.

In the study, the investigators randomly assigned 202 adults aged 65 years or older into 4 equal-sized groups: those receiving the normal dose of vaccine (15 micrograms); twice the normal dose (30 micrograms); 4 times the normal dose (60 micrograms); or a placebo. The average age of the volunteers was 72.4 years. All study participants were followed for a month postvaccination to look for any vaccine-related side effects and to collect blood to evaluate antibody responses.

Dr. Keitel and her colleagues found that participants in the high-dose group (60 μg) had 44% to 79% higher levels of antibody than did those who received the normal dose of vaccine. Higher doses also increased the number of elderly volunteers achieving levels of antibody that have been associated with protection against influenza. Moreover, the vaccine was well tolerated at all dosage levels. Although the higher doses of vaccine caused more mild side effects at the injection site, there were no significant differences in systemic symptoms such as fever or body aches among the groups.

The successful achievement of higher levels of antibodies in this study suggests that larger doses of vaccine may be a safe and viable way of enhancing protection against influenza among elderly persons. These promising results provide a basis for further evaluation of enhanced potency vaccines in the elderly, says Dr. Keitel.

For more information on influenza see www.niaid.nih.gov/news/focuson/flu. Also visit www.PandemicFlu.gov for 1-stop access to U.S. government information on avian and pandemic flu.