Health Notes

Paving a Way to Better Health

By Connie Mitchell “Walk more.” Primary care physicians say it all the time for many reasons. Walking is one of the best ways to work physical activity into a daily routine, which is why it’s commonly recommended for weight loss, cardiovascular conditioning, musculoskeletal rehabilitation and other health benefits. It’s supposed to be free and easy.

But that’s not the case for some people. Neighborhoods might not be easily or safely walkable due to many reasons, and a Saint Louis University researcher is hoping to pinpoint where those areas are and what needs to change.

With a five-year grant of more than $750,000 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, Dr. Sarah Gebauer, an assistant professor of family and community medicine, is drawing on technology to learn more about how neighborhood walking can impact osteoarthritis of the knee and how barriers to walking impact patients.

Osteoarthritis causes pain and stiffness in joints as protective cartilage at the ends of bones degenerates due to age, injury, genetics, obesity and other factors. Walking is a low-impact exercise that can help maintain muscle strength, which supports joints. It also increases blood flow and improves production of joint fluid, helping to reduce pain.

“Walking around your own neighborhood is the easiest and most low-cost option for patients,” Gebauer says. “But there are so many things that stand in the way of that for many of the patients I see. If the infrastructure isn’t well-maintained, or if the patient fears for their safety, they likely won’t get in enough exercise to help manage their symptoms.”

Gebauer is bringing two types of data together to help determine where geographical “hot spots” are and what can be done to improve the situation for individuals and communities. She’ll use Geospatial Information Science and data from a Veterans Affairs Electronic Medical Record to explore the influence of neighborhood on walking and osteoarthritis. The geospatial modeling, identifying varying measures of walkability, will follow veterans retrospectively across the country for 11 years. At the same time, Gebauer will interview primary-care physicians and patients to help determine how knowledge of neighborhood barriers and resources can enhance shared decision-making.

“This work will be a multidisciplinary approach to understanding just how place plays a role in knee osteoarthritis,” she says. “We’ll use big data (administrative health record data) to understand the big picture, but then we’ll dig into the real-life experiences of people who live in these neighborhoods and suffer with knee osteoarthritis pain and disability every day.”

Gebauer adds that physicians often know very little about where their patients live. “The more we can understand about the physical and social circumstances of our patients’ neighborhoods, the more we can support individuals in meeting their health care goals. We can also advocate for them, empowering, amplifying and echoing their voices to ensure they are heard as policy decisions are made about their communities.” ln ln Saint Louis University, 1 N. Grand Blvd., St. Louis, 1-800-758-3678, slu.edu