Managing Arthritis in Rural Areas

Woman presenting a list of tasks

Instructor reviews self-management tasks with participants during an in-person self-management education workshop.

Ease arthritis pain with physical activity and self-management education. Learn how programs in your area can help you take back control of your health.

Nearly one-third of US adults in the most rural areas have arthritis, which includes more than 100 conditions that affect the joints, tissues around the joint, and other connective tissues. Symptoms vary depending on the type of arthritis, but usually include joint pain and stiffness. More than half of adults with arthritis in the most rural areas are limited in their everyday activities by the condition.

Adults with arthritis can reduce or better manage their symptoms, including pain, by being physically active and participating in self-management education workshops like the Chronic Disease Self-Management Program (CDSMP). Other recognized, effective community-based programs for adults with arthritis include physical activity programs that can reduce arthritis pain. These programs can help improve function, movement, mood, and general quality of life. They are available throughout the United States, through partners like The Y external icon (YMCAs) and the National Recreation and Park Association (NRPA)external icon.

Physical Activity Programs

Physical activity is a simple and effective, drug-free way to relieve pain from arthritis. Most people with arthritis can be physically active on their own by walking or doing other kinds of activity. For those who are concerned about how to be physically active safely and without making their arthritis worse, physical activity community programs—like Enhance Fitnessexternal icon, Walk With Easeexternal icon, and Fit & Strong!—have been tested among adults with arthritis and proved to help them reduce or better manage arthritis symptoms and  be healthier. They are often held in parks, recreation centers, Ys, and other community venues.

Regular physical activity can have many benefits for people with arthritis without making symptoms worse. The second edition of Physical Activity Guidelines for Americansexternal icon recommends that adults, including those with arthritis, get at least 150 minutes of moderate-intensity physical activity per week. However, any amount of physical activity has health benefits. In addition to walking, other recommended physical activities for people with arthritis are swimming, dancing, biking, and water aerobics.

Community-based physical activity programs offer ways for adults with arthritis to be physically active safely in group settings or on their own. These programs can provide a structured and enjoyable way to manage arthritis pain and can help people take control of their health.

Programs for Adults in Rural Areas

Offering physical activity programs in rural areas can be challenging because the population is more spread out, and transportation options can be limited. Some CDC-supported state programs and national partners are overcoming the challenges by starting workshops and programs in rural areas and improving the health and hope of people with arthritis who participate.


In Oregon, CDC’s partners have made great strides toward reaching rural communities. Since 2018, Newport Parks and Recreation’s 60+ Activity Center with NRPA support has been implementing the Walk With Ease (WWE) group program–a 6-week low-impact walking program that teaches adults with arthritis or chronic pain how to safely and comfortably incorporate physical activity into their daily lives. The 60+ Activity Center has engaged over 170 older adults in its group WWE program. Participants have reported increased strength, balance, and physical function, as well as decreased stress, chronic pain, and fatigue.

The Newport 60+ Activity Center has also partnered with a local hospital, Samaritan Health Services, to implement an electronic health record referral process. Through this process, people aged 60 and older with arthritis are referred to WWE at the 60+ Activity Center via a mailed letter from Samaritan Health Services. From the launch of the referral pilot in August 2019 until October 2019, nearly 50 additional participants mostly have been referred from Samaritan Health Services.

Beyond offering the group WWE program to Oregon residents, the Oregon Health Authority’s Arthritis Programexternal icon is partnering with Oregon State University (OSU) Extension Service to bring the self-directed version of WWE to rural communities in Oregon. The OSU Extension has developed tools to enhance the self-directed WWE program, such as weekly emails from a trained leader and links to additional resources, including videos. Each participant commits to self-directed walking sessions three times a week. For people in rural areas, the classes break down barriers to in-person WWE classes, including time and travel. Both the self-directed and group WWE programs allow participants to go at their own pace, on their own time, to improve their arthritis symptoms.


The Missouri Arthritis Program works directly with the University of Missouri Extension program. Extension staff across the state have been trained by master trainers in the Chronic Disease Self-Management Education Program (CDSMP) and WWE, as well as the Diabetes Self-Management Program (DSMP), and the Chronic Pain Self-Management Program (CPSMP). The Missouri Arthritis Program also uses cross-referrals, referring participants in self-management education programs such as CPSMP and DSMP to physical activity programs like WWE and vice-versa, to ensure participants stay engaged in self-management education and physical activity programs to manage their conditions.

Extension specialist Liz Harrison covers one rural county in Central Missouri and offers CDSMP, DSMP, and WWE in her coverage area. “These programs are especially valuable as worksite wellness programs because it not only provides an opportunity for employees to feel valued by their employer, but it provides opportunity for physical activity during the workday and camaraderie between employees that may not otherwise know each other.” A participant from the program stated, “I am so proud of myself for walking 4 days last week. Holding me accountable is a good thing!”

North Dakota

In North Dakota, Williston Park and Recreation District with NRPA support offers WWE to older adults with arthritis, diabetes, and heart disease. The agency has partnered with their local hospital, independent medical practices, and nursing homes to engage older adults in their program. Many participants have reported improvements in their balance, walking pace, and walking distance. To further engage older adults who have lower extremity pain and mobility issues, Williston will be offering the Fit & Strong! program, a multicomponent physical activity and behavior-change program that teaches sedentary adults with joint pain, stiffness, and mobility issues how to engage in safe and effective exercise.

These programs show how self-management education workshops and physical activity programs can improve the health of those with arthritis living in rural areas.