Kaushal Navin, Nemati Donya, Kholodovsky Eric, Jahn Jacob, Best Thomas M
Department of Health Sciences, School of Health & Human Sciences, Indiana University, Indianapolis, IN, USA.
College of Nursing, The Ohio State University, Columbus, Ohio, USA; Kirwan Institute for the Study of Race and Ethnicity, Columbus, Ohio, USA.
Soc Sci Med. 2025 Feb;366:117610. doi: 10.1016/j.socscimed.2024.117610. Epub 2024 Dec 6.
Engaging in regular exercise is essential for managing knee osteoarthritis (KOA) symptoms. Despite the established findings, sustained exercise adoption remains a challenge for KOA patients, with notable disparities among Hispanic patients, warranting a need to identify determinants that explain the racial discrepancy in exercise participation. The purpose of this study was to employ a biopsychosocial model to identify determinants of exercise participation and highlight racial disparities. Patients (n = 163) from a university hospital clinic were medically examined to be considered eligible for the study based on radiographs. Eligible participants completed validated survey measures that assessed exercise participation over the past two weeks, along with measures from biological, psychological and social domains to predict future intention exercise. Structural equation modelling tested hypothesized the paths. Past exercise behavior predicted attitudes, self-efficacy, and future exercise intentions. Pain catastrophizing correlated with exercise participation, but the competing effects of physician and (personal) social support on exercise nullified the significance of pain catastrophizing to exercise participation. Significant ethnicity comparisons found non-Hispanic white patients to have higher education, income, lower BMI, stronger scores on attitudes and self-efficacy, and greater exercise participation time. Non-significant effects between the two ethnicities include intention, physician support, and social support. Designing an intervention that helps foster support from the patient's physician and proximal friends/family members can play a vital role in exercise participation for both ethnicities. Additional focus on developing attitudes and self-efficacy among Hispanics can address some disparities. Further notes on promoting exercise equity using a biopsychosocial approach are provided.
进行规律运动对于控制膝关节骨关节炎（KOA）症状至关重要。尽管已有既定的研究结果，但持续采用运动疗法对KOA患者来说仍是一项挑战，西班牙裔患者之间存在显著差异，因此有必要确定能够解释运动参与方面种族差异的决定因素。本研究的目的是采用生物心理社会模型来确定运动参与的决定因素，并突出种族差异。来自大学医院诊所的患者（n = 163）接受了医学检查，根据X光片确定符合研究条件。符合条件的参与者完成了经过验证的调查量表，这些量表评估了过去两周的运动参与情况，以及生物、心理和社会领域的量表，以预测未来的运动意向。结构方程模型检验了假设路径。过去的运动行为预测了态度、自我效能感和未来的运动意向。疼痛灾难化与运动参与相关，但医生和（个人）社会支持对运动的竞争效应抵消了疼痛灾难化对运动参与的显著影响。显著的种族比较发现，非西班牙裔白人患者的教育程度更高、收入更高、体重指数更低、态度和自我效能感得分更强，运动参与时间更长。两个种族之间不显著的影响包括意向、医生支持和社会支持。设计一种有助于促进患者医生和亲密朋友/家庭成员支持的干预措施，对于两个种族的运动参与都可以发挥至关重要的作用。额外关注培养西班牙裔的态度和自我效能感可以解决一些差异。还提供了关于使用生物心理社会方法促进运动公平性的进一步说明。
