Ross E. Andersen

Race/ethnicity, social class and their relation to physical inactivity during leisure time: results from the Third National Health and Nutrition Examination Survey, 1988–1994

BACKGROUND Physical inactivity is more prevalent among racial and ethnic minorities than among Caucasians. It is not known if differences in participation in leisure time physical activity are due to differences in social class. Thus, this paper provides estimates of the prevalence of physical inactivity during leisure time and its relationship to race/ethnicity and social class. METHODS This was a national representative cross-sectional survey with an in-person interview and medical examination. Between 1988 and 1994, 18,885 adults aged 20 or older responded to the household adult and family questionnaires as part of the Third National Health and Nutrition Examination Survey . Mexican-Americans and African-Americans were over-sampled to produce reliable estimates for these groups. Multiple assessment of social class included education, family income, occupation, poverty status, employment status, and marital status. RESULTS The age-adjusted prevalence (per 100) of adults reporting leisure time inactivity is lower among Caucasians (18%) than among African-Americans (35%) and Mexican-Americans (40%). African-American and Mexican-American men and women reported higher prevalence of leisure time inactivity than their Caucasian counterparts across almost every variable, including education, family income, occupation, employment, poverty and marital status. CONCLUSIONS Current indicators of social class do not seem to explain the higher prevalence of physical inactivity during leisure time among African-American and Mexican-American. More research is needed to examine the effect of other constructs of social class such as acculturation, safety, social support and environmental barriers in promoting successful interventions to increase physical activity in these populations.

Lifestyle physical activity interventions: History, short- and long-term effects, and recommendations

INTRODUCTION Lifestyle physical activity interventions have resulted in response to the public health problem of promoting regular amounts of physical activity to the majority of U.S. adults who remain inadequately or completely inactive. These lifestyle interventions allow a person to individualize his/her physical activity programs to include a wide variety of activities that are at least of moderate intensity and to accumulate bouts of these activities in a manner befitting his/her life circumstances. METHODS We reviewed the history of lifestyle physical activity interventions and defined lifestyle physical activity based on this review. We located 14 studies that met this definition. RESULTS Lifestyle physical activity interventions are effective at increasing and maintaining levels of physical activity that meet or exceed public health guidelines for physical activity in representative samples of previously sedentary adults and obese children. The majority of these interventions have been delivered by face-to-face contact in small groups, which limits their public health impact. However, a small number of studies demonstrate that these interventions can be delivered by mail and telephone, which may enhance their generalizability. Most of these studies utilized behavior change theories such as Social Cognitive Theory, the Transtheoretical Model, and Behavior Learning to shape the interventions. Lifestyle interventions aimed at modifying the environment, such as signs posted to increase stair climbing, also have been shown to be effective over the short term. CONCLUSIONS The major issues concerning lifestyle physical activity interventions are: (1) testing their ability to be implemented on a large scale; (2) examining cost-effectiveness for different modes of delivery; and (3) researching the efficacy in populations such as the elderly, minorities, economically disadvantaged, and individuals with concurrent disease. More studies aimed at manipulating the environment to increase physical activity need to be tested over periods of one year or longer. It is possible that lifestyle interventions could be integrated and delivered by new technologies such as interactive computer-mediated programs, telephone, or computer web-based formats. All of these recommended approaches should utilize valid and reliable measures of physical activity and should examine the health effects, particularly on a longitudinal basis. Basic dose-response studies in controlled settings also are needed to help us understand the health effects of accumulated moderate intensity activity.

Acculturation and leisure-time physical inactivity in Mexican American adults: results from NHANES III, 1988-1994.

OBJECTIVES This study examined the relationship between acculturation and leisure-time physical inactivity among Mexican American adults. METHODS Using data from the Third National Health and Nutrition Examination Survey, we estimated the prevalence of physical inactivity according to place of birth and language used at home. RESULTS Spanish-speaking Mexican Americans had a higher prevalence of physical inactivity during leisure time than those who spoke mostly English, independent of place of birth. CONCLUSIONS Acculturation seems to be positively associated with participation in leisure-time physical activity.

Exercise in the Treatment of Obesity Effects of Four Interventions on Body Composition, Resting Energy Expenditure, Appetite, and Mood

This study investigated changes in body composition, resting energy expenditure (REE), appetite, and mood in 128 obese women who were randomly assigned to 1 of 4 treatment conditions: diet alone, diet plus aerobic training, diet plus strength training, or diet combined with aerobic and strength training (i.e., combined training). All women received the same 48-week group behavioral program and were prescribed the same diet. Exercising participants were provided 3 supervised exercise sessions per week for the first 28 weeks and 2 sessions weekly thereafter. Participants across the 4 conditions achieved a mean weight loss of 16.5 +/- 6.8 kg at Week 24, which decreased to 15.1 +/- 8.4 kg at Week 48. There were no significant differences among conditions at any time in changes in weight or body composition. Women who received aerobic training displayed significantly smaller reductions in REE at Week 24 than did those who received strength training. There were no other significant differences among conditions at any time on this variable or in changes in appetite and mood.

Serum levels of insulin-like growth factor-I (IGF-I) and dehydroepiandrosterone sulfate (DHEA-S), and their relationships with serum interleukin-6, in the geriatric syndrome of frailty

Background and aims: The geriatric syndrome of frailty has been conceptualized as a loss of physiologic reserve associated with endocrine dysregulation and immune dysfunction. Our prior studies suggest that the frailty syndrome is associated with elevated serum IL-6 levels. In the present study, our aim is to evaluate the possible role of endocrine dysregulation and its relationship with serum IL-6 in the pathogenesis of this syndrome. Methods: Using a recently validated screening algorithm for frailty, we identified 18 frail and 33 non-frail community-dwelling older adults for inclusion in this study. Serum levels of insulin-like growth factor-I (IGF-I), DHEA-S, and IL-6 were measured by im-munoassays. The inter-relationships among serum levels of IL-6, DHEA-S, and IGF-I were determined by linear regression analysis. Results: Age-adjusted serum levels of IGF-I (88±49 vs 122±47 [ng/mL], p<0.023) and DHEA-S (0.30±0.21 vs 0.53±0.25 [ug/mL], p=0.016) were significantly lower in frail vs non-frail individuals, respectively. There was a trend for IL-6 to be inversely correlated with IGF-1 in the frail (r= −0.42; p=0.082) but not the non-frail group (r=0.12, p=0.521). Conclusions: Frail subjects have lower levels of serum IGF-I and DHEA-S and higher levels of IL-6 than do non-frail, age-matched individuals. The trend toward an inverse correlation between IGF-I and IL-6 in the frail, but not the non-frail group, suggests potential interaction between endocrine and immune/cytokine dysregulation that requires further study in larger cohorts.

Can inexpensive signs encourage the use of stairs? Results from a community intervention.

The American Heart Association recently added a sedentary lifestyle to its list of modifiable risk factors [1]. Reports suggest that only 22% of the U.S. adult population are active enough to derive health benefits from their physical activity and that one in four Americans are completely sedentary [2]. This finding may parallel the sharp increase in the prevalence of overweight persons over the past 12 years, from 25% in the National Health and Nutrition Examination Survey (NHANES II) in 1976-1980 to 33% in phase I of NHANES III in 1988-1991 [3]. The Centers for Disease Control and Prevention and the American College of Sports Medicine recently revised their recommendation regarding exercise to suggest that all Americans should accumulate 30 minutes or more of moderate-intensity physical activity on most or all days of the week [4]. Inactive people who increase their levels of physical activity are less likely to die of all causes and of cardiovascular disease than those who remain sedentary [5, 6]. Walking and taking the stairs instead of escalators or elevators may be two easy ways for seemingly healthy sedentary adults to become more moderately active [7-10]. In 1980, Brownell and associates [11] examined the effects of placing a sign that encouraged stair use for health benefits at the base of an escalator that was adjacent to a flight of stairs in a mall, train station, and bus terminal in Philadelphia. They reported that the sign resulted in statistically significant increases in stair use among 45 694 commuters. They also noted that overweight persons did not use the stairs as often as leaner persons before or after the sign was erected. Blamey and colleagues [12] recently examined the effects of encouraging stair use for health benefits in a Scottish train station and also found that a low-cost sign could result in statistically significantly increases in stair use by adults. We examined the trends among shoppers of different ages, ethnicities, sexes, and body weights in a shopping mall in which escalators and stairs were adjacent. We also observed the differential effects of adding signs at the base of the escalator that promoted stair use for health benefits or weight control. Methods Participants We observed 17 901 adult patrons of a mall located in a Baltimore suburb while they used the stairs or escalators. Because of the potential for artifactual influence on the decision process, persons carrying items larger than a briefcase were excluded. We also excluded persons carrying a baby or child and those judged to be younger than 18 years of age. Participants were unaware that they were part of a study investigating physical activity patterns. Design This observational study involved an initial baseline phase and two subsequent intervention phases that incorporated motivational signs displayed at the base of the escalator and stairs. Each of the three phases lasted 1 month. During the baseline phase, the frequency of stair use compared with use of the adjacent escalator was recorded. During the first interventional phase (health benefits), a 22 28 sign was placed on an easel beside the escalator and stairs. The sign featured a caricature of a heart at the top of a flight of stairs and the statement, Your heart needs exercise, use the stairs. During the second interventional phase (weight control), a similar-sized sign was placed on an easel. The sign featured a caricature of a woman at the top of a flight of stairs; she had a thin waistline and was wearing pants with a waist that was too large. The caption on the sign read, Improve your waistline, use the stairs. Setting In this suburban Baltimore mall, participants could use the escalator or the stairs to get to the second floor. A stairway was adjacent to ascending and descending escalators. The stairway consisted of 10 stairs, a 6-foot landing, and 10 more stairs. Observations were made during June, July, and August between 10:30 a.m. and 9:00 p.m. on all days of the week. Procedures Observations were made by one of the authors. A previous physical activity study [11] used many observers to ensure valid observation of all persons. However, the volume of mall traffic was never so heavy that more than one observer was needed to code the characteristics and choice of each person. Before the study began, the observer and the senior author spent one full day in the mall classifying shoppers by age and weight status to be sure that observations were as accurate as possible. The observer sat in an inconspicuous spot at the foot of the steps that allowed for clear observation. Frequency of stair use was recorded in the same way during each of the three phases. Each persons sex and ethnicity (black, white, or other) was recorded. In addition, persons were judged to be 40 years of age or older or younger than 40 years of age. Finally, the observer noted whether the person appeared overweight. Statistical Analysis The change in proportions of persons using the stairs from the baseline to the intervention phases of the study was analyzed by using the chi-square test and by computing 95% CIs around the differences in proportions between the comparison groups. The same procedure was used to examine intergroup differences (normal weight or overweight) within a given phase of the study. We also computed the number needed to treat (NNT), the number of shoppers who needed to be exposed to the sign to get one shopper to use the stairs, as 1/RD, where RD is expressed as the difference in proportions between the two comparison groups. Results are presented as the proportion of persons who opted to use the stairs rather than the escalator; 95% CIs are presented with associated P values and the NNT. Data were analyzed by using the SPSS for Windows (version 8.0) statistical package [13]. Results A total of 17 901 observations were made. Overall, the use of stairs at baseline was 4.8%. During the intervention period when the health benefits sign was displayed, stair use increased significantly to 6.9% (difference, 2.1 percentage points [CI, 1.3 to 2.8 percentage points]; NNT, 48). Compared with the baseline value, stair use also increased significantly to 7.2% when the weight-control sign was displayed (difference, 2.4 percentage points [CI, 1.5 to 3.2 percentage points]; NNT, 42). Stair use did not differ between the health benefits (6.9%) and the weight-control (7.2%) signs (difference, 0.3 percentage points [CI, 0.5 to 1.2 percentage points]; NNT, 333). Sex Table 1 and Table 3 shows the percentage of persons who used the stairs during the studys three phases as a function of age, sex, race, and body weight. Table 2 shows the change in stair use with the two signs and the change from the health benefits sign to the weight-control sign. A similar pattern emerged among men and women: Compared with baseline levels of stair use, both the health benefits sign and the weight-control sign increased stair use from 4.9% to 7.2% and 7.4%, respectively, among women and from 4.8% to 6.4% and 7.0%, respectively, among men). No sex-related differences were found when no sign or either type of sign was present. Table 1. Stair Use before and during Placement of Two Different Motivational Signs Table 3. Table 1 Continued Table 2. Changes in Stair Use among Groups of Shoppers in Response to Signs Promoting Stair Use Age At baseline, 4.6% of persons judged to be younger than 40 years of age used the stairs. Six percent took the stairs with the display of the health benefits sign (difference, 1.4 percentage points [CI, 0.3 to 2.4 percentage points]; NNT, 71), and 6.1% took the stairs in response to the weight-control sign (difference, 1.5 percentage points [CI, 0.3 to 2.7 percentage points]; NNT, 66), significantly increasing stair use relative to the baseline value (P = 0.015). No statistically significant difference in stair use was found between the health benefits sign and weight-control sign (difference, 0.1 percentage points [CI, 3.4 to 3.6 percentage points]). A similar pattern emerged among persons judged to be 40 years of age or older. At baseline, 5.1% of persons took the stairs; when the health benefits sign was erected, 8.1% chose to climb the stairs (difference, 3.0 percentage points [CI, 1.7 to 4.3 percentage points]; NNT, 33), and the weight-control sign increased stair use to 8.7% (difference, 3.6 percentage points [CI, 2.1 to 5.1 percentage points]; NNT, 28). Stair use did not significantly differ between the two signs (difference, 0.6 percentage points [CI, 0.8 to 2.1 percentage points]). Older shoppers were more likely than younger shoppers to take the stairs in response to both the health benefits sign (difference, 2.1 percentage points [CI, 0.9 to 3.2 percentage points]) and the weight-control sign (difference, 2.6 percentage points [CI, 1.1 to 4.1 percentage points]) (Figure 1). Figure 1. Patterns of stair use among shoppers judged to be younger than 40 years of age (white bars) or 40 years of age or older (striped bars). Body Weight Persons were stratified by body weight (not overweight or overweight). At baseline, 5.4% of shoppers judged to be not overweight used the stairs. The health benefits sign increased stair use to 7.2% (difference, 1.8 percentage points [CI, 1.2 to 4.7 percentage points]; NNT, 55), and the weight-control sign increased stair use to 6.9% (difference, 1.5 percentage points [CI, 0.3 to 2.6 percentage points]; NNT, 66). The same pattern emerged among persons judged to overweight: The health benefits sign significantly increased stair use from 3.8% to 6.3% [difference, 2.5 percentage points (CI, 1.2 to 3.7 percentage points); NNT, 40], and the weight-control sign increased stair use from 3.8% to 7.7% (difference, 3.9 percentage points [CI, 1.2 to 7.0 percentage points]; NNT, 40). In persons judged not to be overweight, stair use did not differ significantly between the health benefits sign (7.2%) and the weight-control sign (6.9%) (difference

Impact of weight loss on Health-Related Quality of Life

To examine the effect of treatment-induced weight loss on Health-Related Quality of Life (HRQL), 38 mildly-to-moderately overweight persons recruited to participate in a study to examine the efficacy of a lifestyle modification treatment program completed a sociodemographic questionnaire, the Beck Depression Inventory (BDI), the Medical Outcomes Study Short-Form Health Survey (SF-36, as an assessment of HRQL), and underwent a series of clinical evaluations prior to treatment. After baseline evaluations, participants were randomly assigned to either a program of lifestyle physical activity or a program of traditional aerobic activity. Participants again completed the SF-36 and BDI after the 13-week treatment program had ended. Weight loss averaged 8.6 ± 2.8 kg over the 13-week study. We found that weight loss was associated with significantly higher scores (enhanced HRQL), relative to baseline, on the physical functioning, role-physical, general health, vitality and mental health domains of the SF-36. The largest improvements were with respect to the vitality, general health perception and role-physical domains. There were no significant differences between the lifestyle and aerobic activity groups on any of the study measures. These data indicate that, at least in the short-term, weight loss appears to profoundly enhance HRQL.

Abnormal body composition phenotypes in older rheumatoid arthritis patients: association with disease characteristics and pharmacotherapies.

OBJECTIVE To compare measures of body fat and lean mass and the prevalence of abnormal body composition phenotypes (sarcopenia, overfat, and sarcopenic obesity) in men and women with rheumatoid arthritis (RA) versus matched controls, and to explore the disease-related predictors of abnormal body composition in patients with RA. METHODS A total of 189 men and women with RA and 189 age-, sex-, and race-matched non-RA controls underwent dual-energy x-ray absorptiometry for measurement of total and regional body fat and lean mass. Continuous and categorical measures of body composition were compared between RA and control subjects by sex and according to categories of body mass index (BMI). Within the group of RA patients, demographic, lifestyle, and RA disease and treatment characteristics were compared for RA patients with healthy body composition versus those with abnormal body composition phenotypes. RESULTS Compared with non-RA controls, RA status was significantly associated with greater odds of sarcopenia, overfat, and sarcopenic obesity in women, but not in men. Relative differences in body composition phenotypes between RA and control subjects were greatest for patients in the normal weight BMI category (<25 kg/m(2)). Among RA characteristics, increasing joint deformity, self-reported disability scores, C-reactive protein levels, rheumatoid factor seropositivity, and a lack of current treatment with disease-modifying antirheumatic drugs were significantly associated with abnormal body composition. CONCLUSION Abnormal body composition phenotypes are overrepresented in patients with RA, particularly in those in the normal weight BMI range. RA-associated disease and treatment characteristics contribute to this increase in abnormal body composition.

Encouraging Patients To Become More Physically Active: The Physician's Role

The healthful effects of regular exercise are recognized by most physicians and many adults. Physical activity decreases the incidence of coronary artery disease, serum lipid abnormalities, hypertension, and type 2 diabetes mellitus and increases longevity. Unfortunately, awareness of these facts by both the public and health care professionals has not translated into a more active population. Of adults in the United States, only 22% are currently active enough to derive health benefits from their physical activity, 53% are somewhat active but not active enough to derive health benefits, and 25% are completely sedentary [1]. The American Heart Association [2] recently added sedentary lifestyle to its list of controllable risk factors. The American College of Sports Medicine and the Centers for Disease Control and Prevention (CDC) suggest that all Americans should accumulate 30 minutes or more of moderate-intensity physical activity on most, preferably all, days of the week [3]. The National Institutes of Health (NIH) recently issued similar recommendations [4]. However, the NIH stressed that persons currently meeting this standard can derive additional health and fitness benefits by becoming more physically active or participating in more vigorous activities. Getting Patients Moving Getting patients moving is always a challenge. The subject of physical activity should be broached with sedentary patients at the first office visit. Say, for example, It must be hard to stay physically active with all the time you need to spend at a desk job. This beginning can lead easily to information on the patients attitudes and beliefs about exercise and whether he or she wants to begin an exercise program. Many sedentary patients would like to become more active but do not know how to begin. Obtain a history of exercise habits and sports participation over a lifetime. This can help identify the type of activity to suggest. For example, a former varsity athlete who enjoyed regular exercise and training may feel comfortable with a traditional prescription for structured exercise in a health club. Conversely, a program of increased lifestyle activity may initially be more appropriate for a sedentary, middle-aged patient with no formal exercise history. It is also helpful to identify the persons current exercise pattern (that is, the exercise pattern over the past 3 to 6 months) and barriers to participation (Table 1). Characterizing social preferences may also help tailor the exercise prescription. For example, some enjoy the solitude of walking or jogging; others enjoy the camaraderie of an exercise class. Table 1. Principles of Exercise Prescription for the Apparently Healthy Adult, Based on Current Levels of Physical Activity It is common for the press to emphasize stories about the exercise-related tragedies of elite athletes who succumb to sudden cardiac death. Thus, it is important to address patient fears related to exercise [5]. Patients should understand that, in reality, regular physical activity is associated with a decreased risk for heart disease. Furthermore, the risk for sudden death with moderate-intensity activity is considerably less than the risk with more intense vigorous exercise [1]. It is important for physicians to state clearly the medical importance of physical activity. Patients may perceive that physicians who do not address the need to exercise are condoning a sedentary lifestyle. On the other hand, a clear statement that addresses the health benefits and importance of increasing physical activity conveys the message that sedentary habits are bad habits. Once the stage is set, it is best to establish small, attainable initial goals with the patient. For example, after establishing baseline levels of physical activity, a first step is to recommend increased lifestyle activity. The prescription should be very specific, achievable, and realistic (for example, walk five blocks and walk up three extra flights of stairs each day) and should be developed in discussion with the patient. Writing the recommendation on a prescription pad may increase the likelihood that the recommendation will be followed. At follow-up visits, ask patients if they have successfully met their goals. Any increase is a step in the right direction and should be praised. With time and encouragement, many persons find that what they were initially doing largely to please others (such as the physician) becomes rewarding and self-reinforcing as they perceive improvements in physical fitness, energy level, mood, and health. Effects of Physician Advice Helping patients change modifiable risk factors is a difficult task for health care providers [6-8]. Because patients respect their physicians advice, a succinct message from a physician can be a potent catalyst in motivating change [9, 10]. Fully 80% of Americans cite their physician as their primary source of information about health [11], and the average adult makes 2.7 visits to a physician per year; thus, the physician has multiple opportunities to intervene and encourage patients to adopt healthier lifestyles [12]. The U.S. Preventive Services Task Force [9] recommends that physicians advise patients to engage in a program of regular physical activity tailored to their individual health status and lifestyle [9]. Although the conviction that physician counseling to increase physical activity may have a significant effect on public health is widespread, only limited empirical evidence supports it [9]. One major study, the PACE (Physician-Based Assessment and Counseling for Exercise) program, was developed to provide specific counseling protocols matched to the patients level of activity and readiness to change. Long and colleagues [13] found that 3- to 5-minute counseling sessions increased physical activity among patients treated in the primary care setting. Eighty percent of providers in the PACE trial reported that their patients were receptive or very receptive to activity counseling. More than 50% of providers perceived that their patients became more active after the intervention. In one randomized trial [10], increases in the duration (but not the frequency) of physical activity were reported a month after physician activity counseling [10]. Patients in this trial were also asked to report their level of agreement with the following statement: If my doctor advised me to exercise, I would follow his/her advice. Thirty-five percent of patients strongly agreed and 58% agreed with this statement, whereas only 7% disagreed and less than 1% strongly disagreed. Investigators in a multicenter cohort study assessed changes in several health-related behaviors 1 year after a preventive intervention by primary care physicians. Surveys conducted before and after the intervention showed that study patients with behavioral risks who had the intervention were more likely than matched controls to report positive changes with regard to exercise adoption, use of seatbelts, weight loss, and reduction of alcohol intake [14]. Although physicians generally believe that most patients should exercise, many of those who counsel their patients about health-habit modifications address smoking and body weight more frequently than they address inactivity [15]. For example, Rosen and coworkers [16] reported that although 64% of primary care physicians prescribed exercise for their high-risk patients, only 29% regularly counseled all patients about the importance of regular activity. Patients often interpret a lack of advice to become more active as an endorsement of the view that physical activity is not important. Recommendations about Physical Activity Early guidelines specified that aerobic exercise would offer little benefit if it were not done at moderate to high intensity in a steady state for 20 to 60 minutes three or more times per week [17]. These rigorous recommendations were designed to achieve optimal improvements in physical fitness. Persons currently exercising at this level should be encouraged to continue because this activity is likely to maximize both health and fitness benefits. However, the current low rate of volitional participation in exercise may be due in part to the misunderstanding that exercise must be vigorous and uninterrupted in order to provide health benefits [3]. Physical activity is defined as any bodily movement produced by skeletal muscles that results in energy expenditure [18]. Physical fitness is related to, but distinct from, physical activity. It is defined as a set of attributes that people have or achieve that relates the ability to perform physical activity [18]. Fit persons have a lower risk for cardiovascular disease [19, 20]. In 1989, Blair and colleagues [19] demonstrated that adults with low cardiorespiratory fitness had much higher rates of all-cause and cardiovascular mortality than did those who were moderately fit. Smaller but additional reductions in death rates were seen in persons who were the most fit. Thus, physical activity need not be vigorous or extensive to produce substantial health benefits. Recent reports document that the health benefits of increasing activity can be accrued at exercise intensities significantly lower than previously thought [18-20]. These findings prompted the NIH [4], the CDC and the American College of Sports Medicine [3], and the Surgeon General [1] to revise exercise guidelines. It is now suggested that sedentary persons who wish to become more physically active should accumulate 30 minutes or more of moderate-intensity physical activity each day as an alternative to traditional programmed exercise. In 1993, Paffenbarger and colleagues [21] reported the effects of changes in physical activity and other lifestyle characteristics on mortality in 10 269 Harvard University alumni. Men who were initially sedentary but had started to participate in moderately vigorous sports by 1977 had a 23% lower risk for death than di

Association of Body Composition With Disability in Rheumatoid Arthritis: Impact of Appendicular Fat and Lean Tissue Mass

OBJECTIVE To explore the association of measures of body composition with disability in patients with rheumatoid arthritis (RA). METHODS Patients with RA underwent total body dual-energy x-ray absorptiometry for measurement of total and regional body fat and lean mass. The associations of measures of fat and lean mass with disability, measured with the Health Assessment Questionnaire (HAQ), were explored for the total cohort and by sex, controlling for pertinent demographic, lifestyle, and RA disease and treatment covariates. RESULTS We studied 197 subjects (118 women, 79 men). Median (interquartile range) HAQ score was 0.625 (0.125-1.25) and was significantly higher, indicating worse physical function, in women than in men. HAQ score was strongly correlated with depression, pain, RA duration, duration of morning stiffness, Disease Activity Score in 28 joints, radiographic damage scores, levels of physical and sedentary activities, and body composition, with increasing fat and decreasing lean mass associated with higher HAQ scores. Appendicular fat and lean mass demonstrated the strongest association per kilogram with HAQ. Mean HAQ score was 0.52 units higher for subjects in the highest versus the lowest quartile of appendicular fat mass (P<0.001), and 0.81 units higher for subjects in the lowest versus the highest quartile of appendicular lean mass (P<0.001). Adjusting for demographic and RA characteristics partially attenuated these associations. The joint associations of appendicular fat and lean mass on HAQ were additive without significant interaction. CONCLUSION Body composition, particularly the amount of fat and lean mass located in the arms and legs, is strongly associated with disability in RA patients.