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Cornwall N, Swaithes L, Woodcock C, Healey EL, Hider SL. Implementation of physical activity interventions for people with inflammatory arthritis: an overview and future recommendations. Rheumatol Adv Pract 2023; 7:rkac094. [PMID: 36699546 PMCID: PMC9870707 DOI: 10.1093/rap/rkac094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 04/29/2022] [Indexed: 01/25/2023] Open
Abstract
Regular physical activity is important for both physical and mental health. This is particularly important for people with inflammatory arthritis, because of the benefits on both disease-specific and systemic outcomes and the increased risk of comorbidities such as cardiovascular disease. Despite a wealth of evidence supporting physical activity interventions, there remains a significant gap in implementation into routine care. This overview describes what implementation is, examines why it is important to consider implementation approaches to improve uptake of physical activity, highlights factors that influence successful implementation using exemplars from both osteoarthritis and inflammatory arthritis and recommends where future research is needed.
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Affiliation(s)
| | | | | | | | - Samantha L Hider
- Correspondence to: Samantha L. Hider, School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, UK. E-mail:
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Quirk H, Haake S. Engaging people with long-term health conditions in a community-based physical activity initiative: a qualitative follow-up study evaluating the parkrun PROVE project. BMC Sports Sci Med Rehabil 2021; 13:123. [PMID: 34629089 PMCID: PMC8504078 DOI: 10.1186/s13102-021-00351-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/21/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND The "parkrun: running or volunteering for everyone" (PROVE) project was an example of a community-based physical activity and volunteering initiative for people living with long-term health conditions in England. The 3 year project involved appointing volunteer Outreach Ambassadors whose role was to promote parkrun to people living with long-term health conditions through various outreach activities. This qualitative study aimed to understand the experience of delivering the project from the perspective of volunteer Outreach Ambassadors and the PROVE Project Manager. METHODS The PROVE Project Manager and ten PROVE Outreach Ambassadors across nine health condition groups were interviewed by the researcher (asthma, blood pressure, deaf and hard of hearing, dementia, diabetes, endometriosis, heart conditions, learning disabilities and/or autism, and obesity). Interview transcripts were analysed using thematic analysis. RESULTS Four themes and nine sub-themes were generated. The participants highlighted challenges in measuring the project's success and bringing about meaningful and lasting change, and reflected on the value of the project as a learning opportunity. Despite some successes, it was thought that the project had limited reach outside of the existing parkrun community. The Outreach Ambassadors reflected on their experiences in the role and the skills required, finding it rewarding and highlighting the importance of networking and forming connections with key stakeholders. The findings are discussed in comparison to interviews conducted with the Outreach Ambassadors 12 months earlier. CONCLUSIONS This study provides evidence to support the public health potential of parkrun though targeted initiatives such as the PROVE project and provides a critical reflection on what worked and what did not work when delivering the project. The findings have relevance for organisations wishing to implement similar outreach initiatives using a volunteer workforce, including recommendations for resource management, communication, leadership, fostering volunteer autonomy and defining and capturing success.
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Affiliation(s)
- Helen Quirk
- School of Health and Related Research (ScHARR), The University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Steve Haake
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, UK
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Smit E, Leenaars K, Wagemakers A, van der Velden K, Molleman G. How to recruit inactive residents for lifestyle interventions: participants' characteristics based on various recruitment strategies. Health Promot Int 2021; 36:989-999. [PMID: 33270846 PMCID: PMC8521843 DOI: 10.1093/heapro/daaa134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Care Sport Connectors (CSCs) have been appointed to create a connection between primary care and physical activity (PA) sectors to stimulate inactive residents into becoming physically active. Adequate recruitment strategies are necessary to reach the intended target group in order to foster the sustainability of lifestyle interventions. The objective of this study is to explore PA behavior and health characteristics of the target group reached by CSCs and if these characteristics differ between participants when grouped based on how they were recruited. Participants from lifestyle interventions were included between September 2014 and April 2016 using a purposive sampling method. Participants were recruited through CSCs via public relations (n = 135), a personal letter (n = 136), or a referral (n = 98) and compared based on their PA level, health-related quality of life, motivation, self-efficacy, morbidity and health-related fitness. Scores were analyzed with a multi-level (mixed model) analysis measured before the intervention. The three groups were different in PA level (p = 0.002). The outcomes regarding health-related quality of life, motivation, and number of somatic disorders were also significantly different for the three groups, except for the categories of mental health (p = 0.145) and self-efficacy (p = 0.464). For all dimensions, the referral group scored the least favorable. The investment in time and money for an active recruitment strategy like referrals is worthwhile because it provides CSCs the opportunity to reach people who are inactive and at risk of chronic disease. Future studies are necessary to reveal the effect on PA levels and health in the long-term.
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Affiliation(s)
- Eva Smit
- Department of Primary and Community Care, Radboud
University Medical Center, Radboud Institute for Health Sciences,
Nijmegen, P.O. Box 9101 6500 HB. The
Netherlands
| | - Karlijn Leenaars
- Department of Healthy Living, RIVM,
Bilthoven, P.O Box 1, 3720 BA, The Netherlands
| | - Annemarie Wagemakers
- Social Sciences, Group Health & Society,
Wageningen University, Wageningen, P.O. Box 8130, 6700 EW,
The Netherlands
| | - Koos van der Velden
- Department of Primary and Community Care, Radboud
University Medical Center, Radboud Institute for Health Sciences,
Nijmegen, P.O. Box 9101 6500 HB. The
Netherlands
| | - Gerard Molleman
- Department of Primary and Community Care, Radboud
University Medical Center, Radboud Institute for Health Sciences,
Nijmegen, P.O. Box 9101 6500 HB. The
Netherlands
- Research Department, GGD Gelderland
Zuid, Nijmegen, P.O. Box 1120, 6501 BC, The
Netherlands
- Corresponding author: E-mail:
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Mays AM, Kim S, Rosales K, Au T, Rosen S. The Leveraging Exercise to Age in Place (LEAP) Study: Engaging Older Adults in Community-Based Exercise Classes to Impact Loneliness and Social Isolation. Am J Geriatr Psychiatry 2020; 29:777-788. [PMID: 33268235 PMCID: PMC7563028 DOI: 10.1016/j.jagp.2020.10.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/07/2020] [Accepted: 10/12/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Social isolation and loneliness are associated with morbidity and mortality in older adults. Limited evidence exists regarding which interventions improve connectedness in this population. DESIGN/SETTING/PARTICIPANTS In this pre-post study we assessed community-based group health class participants' (age ≥50) loneliness and social isolation. Participants (n = 382) were referred by a Cedars-Sinai Medical Network (Los Angeles, California) healthcare provider or self-referred from the community (July 2017-March 2020). INTERVENTION Participants met with a program coordinator and selected Arthritis Exercise, Tai Chi for Arthritis, EnhanceFitness, or the Healthier Living Workshop. MEASUREMENTS We measured social isolation using the Duke Social Support Index (DSSI) and loneliness using the UCLA 3-item Loneliness Scale at baseline, class completion, and 6 months. RESULTS Mean age was 76.8 years (standard deviation, SD = 9.1); 315 (83.1%) were female; 173 (45.9%) were Non-Hispanic white; 143 (37.9%) were Non-Hispanic Black; 173 (46.1%) lived alone; mean baseline DSSI score was 26.9 (SD = 4.0) and mean baseline UCLA score was 4.8 (SD = 1.8). On multivariable analysis adjusted for gender, race/ethnicity, income, self-rated health, and household size, DSSI improved by 2.4% at 6-week compared to baseline (estimated ratio, ER: 1.024; 95% confidence interval [CI]: 1.010-1.038; p-value = 0.001), and 3.3% at 6-month (ER: 1.033; 95% CI: 1.016-1.050; p-value <0.001). UCLA score after adjusting for age, gender, race/ethnicity, live alone, number of chronic conditions, income, and self-rated health, did not change at 6-week (ER: 0.994; 95% CI: 0.962-1.027; p-value = 0.713), but decreased by 6.9% at 6-months (ER: 0.931; 95% CI: 0.895-0.968; p-value <0.001). CONCLUSION Community-based group health class participants reported decreased loneliness and social isolation at 6-month follow-up.
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Affiliation(s)
- Allison Moser Mays
- Cedars-Sinai Medical Center, Section of Geriatric Medicine (AMM, KR, SR), Division of Internal Medicine, Department of Medicine, Los Angeles, CA; UCLA David Geffen School of Medicine (AMM, TA, SR), Los Angeles, CA.
| | - Sungjin Kim
- Cedars-Sinai Medical Center (SK), Biostatistics and Bioinformatics Research Center; Samuel Oschin Comprehensive Cancer Institute; Cedars-Sinai Medical Center, Los Angeles, CA
| | - Katrina Rosales
- Cedars-Sinai Medical Center, Section of Geriatric Medicine (AMM, KR, SR), Division of Internal Medicine, Department of Medicine, Los Angeles, CA
| | - Tam Au
- UCLA David Geffen School of Medicine (AMM, TA, SR), Los Angeles, CA
| | - Sonja Rosen
- Cedars-Sinai Medical Center, Section of Geriatric Medicine (AMM, KR, SR), Division of Internal Medicine, Department of Medicine, Los Angeles, CA; UCLA David Geffen School of Medicine (AMM, TA, SR), Los Angeles, CA
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Fishleder S, Petrescu-Prahova M, Harris JR, Leroux B, Bennett K, Helfrich CD, Kohn M, Hannon P. Predictors of Improvement in Physical Function in Older Adults in an Evidence-Based Physical Activity Program (EnhanceFitness). J Geriatr Phys Ther 2020; 42:230-242. [PMID: 29979352 PMCID: PMC6318072 DOI: 10.1519/jpt.0000000000000202] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Declines in strength, flexibility, and balance in older adults can lead to injuries and loss of independence and are particularly common in those of greater age and in worse health. EnhanceFitness (EF) is a nationally disseminated, evidence-based group exercise program for older adults that has been shown to improve function through cardiovascular, strength, flexibility, and balance exercises. This article examines changes in, and predictors of, participant physical function from baseline through 2 program cycles of EF as measured by 3 physical function tests: arm curls, chair stands, and 8-foot up-and-go. METHODS We analyzed data on participants who attended at least 2 consecutive 16-week program cycles between January 2005 and June 2016. We ran 3 random-effects linear regression models, 1 for each physical function test, and accounted for missing data and clustering by class site. Independent variables included attendance, demographics, and health status. RESULTS AND DISCUSSION A total of 7483 participants completed baseline and 2 sets of follow-up physical function tests. For all 3 physical function tests, participants showed some degree of improved physical function at each follow-up, and greater program attendance predicted clinically significant improvements. Some participants had less improvement: females, those less active at baseline, older than 75 years, not married or partnered, or in fair or poor health, those who had experienced at least 1 fall, and those with a disability. CONCLUSION EnhanceFitness program providers may need to implement additional measures to support the participants who could benefit most from EF, such as targeting messaging, coordinating with referring providers to emphasize attendance and general activity in specific participants, and offering additional support to groups who show less improvement during classes. The evidence presented here may inform clinical decision making for older adult patients and increase health care provider confidence in EF and similar exercise programs, thereby providing a mechanism to maintain and continue functional gains made in clinical or rehabilitation settings.
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Affiliation(s)
- Sarah Fishleder
- Health Promotion Research Center, University of Washington, Seattle, WA
- Department of Health Services, University of Washington, Seattle, WA
| | - Miruna Petrescu-Prahova
- Health Promotion Research Center, University of Washington, Seattle, WA
- Department of Health Services, University of Washington, Seattle, WA
| | - Jeffrey R. Harris
- Health Promotion Research Center, University of Washington, Seattle, WA
- Department of Health Services, University of Washington, Seattle, WA
| | - Brian Leroux
- Department of Biostatistics, University of Washington, Seattle, WA
- Department of Oral Health Sciences, University of Washington, Seattle, WA
| | - Kimberly Bennett
- Department of Rehabilitative Medicine, University of Washington, Seattle, WA
| | | | - Marlana Kohn
- Health Promotion Research Center, University of Washington, Seattle, WA
| | - Peggy Hannon
- Health Promotion Research Center, University of Washington, Seattle, WA
- Department of Health Services, University of Washington, Seattle, WA
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Thompson AR, Christopherson Z, Marshall LM, Carlson HL, Carlson NL. A Pilot Randomized Controlled Trial for Aerobic and Strengthening Exercises on Physical Function and Pain for Hip Osteoarthritis. PM R 2019; 12:229-237. [PMID: 31600429 DOI: 10.1002/pmrj.12262] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 09/20/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND Hip osteoarthritis (OA) limits lower extremity physical function. Exercise therapy may improve physical function and reduce pain in patients with hip OA. OBJECTIVE To evaluate the feasibility of a randomized controlled trial (RCT) to measure the effect of a structured hip-specific resistance and aerobic exercise program on physical function and self-reported pain in adults with hip OA. DESIGN Pilot RCT. SETTING Academic medical center. PARTICIPANTS Thirty one adults with radiographic hip OA. INTERVENTIONS Participants were randomly allocated in a 2:1 ratio to a 3-month structured exercise intervention (n = 21) or a 3-month waitlist control (n = 10). MAIN OUTCOME MEASURES The 6-minute walk test was the primary outcome measure. Self-reported physical function was assessed with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical function subscale and pain visual analog scale (VAS). Measures of feasibility were assessed as secondary outcomes. RESULTS From baseline to 3 months, the median change from baseline in distance covered during the 6-minute walk test in the intervention group (49 m) was double that of the control group (22 m), but the difference was not statistically significant (P = .13). Likewise, the WOMAC physical function subscale score median changes in the intervention group (5 points) were double that of the controls (2 points), although the difference was not statistically significant (P = .06). Median change in pain scores was slightly reduced in each group but not significantly different between groups (P = .53). CONCLUSION Although no statistically significant between-group differences were found in this pilot RCT, improvements were seen in measures of physical function compared to controls. A larger RCT of this structured exercise program may be warranted.
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Affiliation(s)
- Austin R Thompson
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR
| | - Zach Christopherson
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR.,Department of Physical and Occupational Therapy, Duke University, Durham, NC
| | - Lynn M Marshall
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR
| | - Hans L Carlson
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR
| | - Nels L Carlson
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR
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Sharpe PA, Wilcox S, Schoffman DE, Baruth M. "Participation, satisfaction, perceived benefits, and maintenance of behavioral self-management strategies in a self-directed exercise program for adults with arthritis". EVALUATION AND PROGRAM PLANNING 2017; 60:143-150. [PMID: 27863325 PMCID: PMC6252271 DOI: 10.1016/j.evalprogplan.2016.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 09/26/2016] [Accepted: 11/01/2016] [Indexed: 06/06/2023]
Abstract
A process evaluation was conducted in conjunction with a controlled trial of a self-directed exercise program among people with arthritis to describe the program's reach; self-management behaviors, exposure to materials, program perceptions, satisfaction, and perceived benefits; compatibility with targeted participants' needs; and maintenance. Participants (n=197) were predominantly white, middle-aged, college-educated women. At 12 weeks, 73.2% had read ≥90% of the program materials (at nine months>70% had "occasionally" or "often" looked back over each of the five parts of the materials); 63.3% had set goals (52.5% at nine months), and 83.9% had "some" or "a lot" of success following their plan (64.2% at nine months), while 90.4% rated the program "good" or "excellent" (87.5% at nine months). At 12 weeks, the majority (89.3%) used written logs to self-monitor (mean=9.3 logs); by nine months, >70% never kept logs. Most (>80%) rated twelve of thirteen program components as helpful, and 98.6% would recommend the program. From 38% to 62.4% endorsed each of eight program benefits, with small declines of ≤9% at nine months. Qualitative response identified ways the program met and did not meet expectations. The main program compatibility issue was targeting all adults with arthritis, while featuring older adults in materials.
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Affiliation(s)
- Patricia A Sharpe
- Prevention Research Center, Arnold School of Public Health, 921 Assembly Street, University of South Carolina, Columbia, SC 29208, United States.
| | - Sara Wilcox
- Prevention Research Center, Arnold School of Public Health, 921 Assembly Street, University of South Carolina, Columbia, SC 29208, United States; Department of Exercise, Arnold School of Public Health, 921 Assembly Street, University of South Carolina, Columbia, SC 29208, United States.
| | - Danielle E Schoffman
- Prevention Research Center, Arnold School of Public Health, 921 Assembly Street, University of South Carolina, Columbia, SC 29208, United States; Department of Health Promotion, Education and Behavior, Arnold School of Public Health, 915 Greene Street, University of South Carolina, Columbia, SC 29208, United States.
| | - Meghan Baruth
- Prevention Research Center, Arnold School of Public Health, 921 Assembly Street, University of South Carolina, Columbia, SC 29208, United States.
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Applying the Evidence for Exercise Prescription in Older Adults with Knee Osteoarthritis. CURRENT GERIATRICS REPORTS 2016. [DOI: 10.1007/s13670-016-0178-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Marconcin P, Espanha M, Yázigi F, Campos P. The PLE(2)NO self-management and exercise program for knee osteoarthritis: Study Protocol for a Randomized Controlled Trial. BMC Musculoskelet Disord 2016; 17:250. [PMID: 27267755 PMCID: PMC4896008 DOI: 10.1186/s12891-016-1115-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 06/02/2016] [Indexed: 11/21/2022] Open
Abstract
Background International recommendations suggest exercise and self-management programs, including non-pharmacological treatments, for knee osteoarthritis (KOA) because they can benefit pain relief and improve function and exercise adherence. The implementation of a combined self-management and exercise program termed PLE2NO may be a good method for controlling KOA symptoms because it encourages the development of self-efficacy to manage the pathology. This study will assess the effects of a self-management and exercise program in comparison to an educational intervention (control program) on symptoms, physical fitness, health-related quality of life, self-management behaviors, self-efficacy, physical activity level and coping strategies. Methods/Design This PLE2NO study is a single-blinded, randomized controlled trial of elderly (aged above 60 yrs old) patients with clinical and radiographic KOA. The patients will be allocated into either an educational group (control) or a self-management and exercise group (experimental). All participants will receive a supplement of chondroitin and glucosamine sulfates. This paper describes the protocol that will be used in the PLE2NO program. Discussion This program has several strengths. First, it involves a combination of self-management and exercise approaches, is available in close proximity to the patients and occurs over a short period of time. The latter two characteristics are crucial for maintaining participant adherence. Exercise components will be implemented using low-cost resources that permit their widespread application. Moreover, the program will provide guidance regarding the effectiveness of using a self-management and exercise program to control KOA symptoms and improve self-efficacy and health-related quality of life. Trial registration NCT02562833 (09/23/2015)
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Affiliation(s)
- Priscila Marconcin
- Universidade de Lisboa, Faculdade de Motricidade Humana, CIPER, LBMF, P-1499-002, Estrada da Costa, 1499-002 Cruz Quebrada, Dafundo, Portugal. .,CAPES Foundation, Ministry of Education of Brazil, Brasília, DF, 70040-020, Brazil.
| | - Margarida Espanha
- Universidade de Lisboa, Faculdade de Motricidade Humana, CIPER, LBMF, P-1499-002, Estrada da Costa, 1499-002 Cruz Quebrada, Dafundo, Portugal
| | - Flávia Yázigi
- Universidade de Lisboa, Faculdade de Motricidade Humana, CIPER, Laboratório de Fisiologia eBioquímica do Exercício, P-1499-002, Estrada da Costa 1499-002 Cruz Quebrada, Dafundo, Portugal
| | - Pedro Campos
- Universidade de Lisboa, Faculdade de Motricidade Humana, CIPER, LBMF, P-1499-002, Estrada da Costa, 1499-002 Cruz Quebrada, Dafundo, Portugal
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Zgibor JC, Schlenk EA, Vater L, Kola S, Vander Bilt J, Woody S, Jacob ME, Lo-Ciganic WH, Brenckle A, Brandenstein J, Kwoh CK, Boudreau R, Albert S, Conroy M, Rodgers E, Newman AB. Partnership Building and Implementation of an Integrated Healthy-Aging Program. Prog Community Health Partnersh 2016; 10:123-32. [PMID: 27018361 DOI: 10.1353/cpr.2016.0001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Evidence-based interventions exist for prevention of chronic disease in older adults. Partnering with community organizations may provide a mechanism for disseminating these interventions. OBJECTIVE To describe the partnership and program implementation by the Arthritis Foundation (AF) and the University of Pittsburgh. METHODS The AF Exercise Program (AFEP; an existing evidence-based program) was enhanced with the "10 Keys"™ to Healthy Aging (a prevention-focused program bundling the most common risk factors for chronic disease and disability in older adults and applies behavior change strategies to enhance prevention). The program was delivered in 20 sessions over 10 weeks by community health workers in a cluster-randomized trial. LESSONS LEARNED Partnering with an organization having an existing infrastructure supports program delivery at the community level. This partnership provided programming in 54 sites across Pittsburgh and surrounding communities. CONCLUSIONS This collaborative partnership created a productive synergy maximizing strengths in both research and program delivery.
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The steps to health randomized trial for arthritis: a self-directed exercise versus nutrition control program. Am J Prev Med 2015; 48:1-12. [PMID: 25441237 PMCID: PMC4732708 DOI: 10.1016/j.amepre.2014.08.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 07/22/2014] [Accepted: 08/08/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND Despite the established benefits of exercise for adults with arthritis, participation is low. Safe, evidence-based, self-directed programs, which have the potential for high reach at a low cost, are needed. PURPOSE To test a 12-week, self-directed, multicomponent exercise program for adults with arthritis. DESIGN Randomized controlled trial. Data were collected from 2010 to 2012. Data were analyzed in 2013 and 2014. SETTING/PARTICIPANTS Adults with arthritis (N=401, aged 56.3 [10.7] years, 85.8% women, 63.8% white, 35.2% African American, BMI of 33.0 [8.2]) completed measures at a university research center and participated in a self-directed exercise intervention (First Step to Active Health(®)) or nutrition control program (Steps to Healthy Eating). INTERVENTION Intervention participants received a self-directed multicomponent exercise program and returned self-monitoring logs for 12 weeks. MAIN OUTCOME MEASURES Self-reported physical activity, functional performance measures, and disease-specific outcomes (arthritis symptoms and self-efficacy) assessed at baseline, 12 weeks, and 9 months. RESULTS Participants in the exercise condition showed greater increases in physical activity than those in the nutrition control group (p=0.01). Significant improvements, irrespective of condition, were seen in lower body strength, functional exercise capacity, lower body flexibility, pain, fatigue, stiffness, and arthritis management self-efficacy (p values<0.0001). More adverse events occurred in the exercise than nutrition control condition, but only one was severe and most were expected with increased physical activity. CONCLUSIONS The exercise program improves physical activity, and both programs improve functional and psychosocial outcomes. Potential reasons for improvements in the nutrition control condition are discussed. These interventions have the potential for large-scale dissemination. This study is registered at Clinicaltrials.gov NCT01172327.
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Crowley L. The effectiveness of home exercise programmes for patients with rheumatoid arthritis: a review of the literature. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/174328809x435277] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Baruth M, Wilcox S, Schoffman DE, Becofsky K. Factors associated with disability in a sample of adults with arthritis. Disabil Health J 2013; 6:377-84. [PMID: 24060261 DOI: 10.1016/j.dhjo.2013.04.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 03/27/2013] [Accepted: 04/23/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Arthritis is the most common cause of disability among US adults. Few studies have comprehensively examined factors associated with disability in this population. OBJECTIVE To investigate the relationship between a number of disease and non-disease related factors and disability in sample of adults with self-reported doctor-diagnosed arthritis. METHODS Participants (n = 396) taking part in a randomized controlled trial of arthritis self-management completed a comprehensive survey assessing a number of demographic, arthritis-specific, health-related, behavioral, and psychological variables at baseline. Disability, as measured by the Health Assessment Questionnaire (HAQ), was also measured. Hierarchical regression models examined the independent associations between blocks of variables and disability. RESULTS Demographic variables (R(2) = 0.13), arthritis-specific demographics (i.e., type, medication use; ΔR(2) = 0.16), physical health-related variables (ΔR(2) = 0.06), arthritis-specific symptoms (ΔR(2) = 0.12), health behaviors (ΔR(2) = 0.00), and psychological variables (ΔR(2) = 0.03) explained 50% of the variance in disability score (R(2) = 0.50). With the exception of health behaviors, the addition of each block of variables significantly improved the model, explaining additional variance in HAQ scores (p < 0.0001). In the final model, older age, less than a high school education, rheumatoid arthritis, greater arthritis duration, taking steroids, taking narcotics, greater pain, greater stiffness, greater depressive symptoms, and lower arthritis self-efficacy were associated with greater disability whereas male gender, fibromyalgia, and excellent/very good health were associated with less disability. CONCLUSIONS A number of disease and non-disease related variables were associated with disability. These findings suggest that disability in adults with arthritis may be a complicated phenomenon; such complexity may make decreasing disability in this population challenging.
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Brosseau L, Wells GA, Kenny GP, Reid R, Maetzel A, Tugwell P, Huijbregts M, McCullough C, De Angelis G, Chen L. The implementation of a community-based aerobic walking program for mild to moderate knee osteoarthritis (OA): a knowledge translation (KT) randomized controlled trial (RCT): Part I: The Uptake of the Ottawa Panel clinical practice guidelines (CPGs). BMC Public Health 2012; 12:871. [PMID: 23061875 PMCID: PMC3491047 DOI: 10.1186/1471-2458-12-871] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 10/02/2012] [Indexed: 11/23/2022] Open
Abstract
Background The implementation of evidence based clinical practice guidelines on self-management interventions to patients with chronic diseases is a complex process. A multifaceted strategy may offer an effective knowledge translation (KT) intervention to promote knowledge uptake and improve adherence in an effective walking program based on the Ottawa Panel Evidence Based Clinical Practice Guidelines among individuals with moderate osteoarthritis (OA). Methods A single-blind, randomized control trial was conducted. Patients with mild to moderate (OA) of the knee (n=222) were randomized to one of three KT groups: 1) Walking and Behavioural intervention (WB) (18 males, 57 females) which included the supervised community-based aerobic walking program combined with a behavioural intervention and an educational pamphlet on the benefits of walking for OA; 2) Walking intervention (W) (24 males, 57 females) wherein participants only received the supervised community-based aerobic walking program intervention and the educational pamphlet; 3) Self-directed control (C) (32 males, 52 females) wherein participants only received the educational pamphlet. One-way analyses of variance were used to test for differences in quality of life, adherence, confidence, and clinical outcomes among the study groups at each 3 month assessment during the 12-month intervention period and 6-month follow-up period. Results Short-term program adherence was greater in WB compared to C (p<0.012) after 3 months. No statistical significance (p> 0.05) was observed for long-term adherence (6 to 12 months), and total adherence between the three groups. The three knowledge translation strategies demonstrated equivalent long-term results for the implementation of a walking program for older individuals with moderate OA. Lower dropout rates as well as higher retention rates were observed for WB at 12 and 18 months. Conclusion The additional knowledge translation behavioural component facilitated the implementation of clinical practice guidelines on walking over a short-term period. More studies are needed to improve the long-term walking adherence or longer guidelines uptake on walking among participants with OA. Particular attention should be taken into account related to patient’s characteristic and preference. OA can be managed through the implementation of a walking program based on clinical practice guidelines in existing community-based walking clubs as well as at home with the minimal support of an exercise therapist or a trained volunteer. Trial Registration Current Controlled Trials IRSCTNO9193542
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Affiliation(s)
- Lucie Brosseau
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada.
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Evaluation of a multi-component group exercise program for adults with arthritis: Fitness and Exercise for People with Arthritis (FEPA). Disabil Health J 2012; 5:305-11. [PMID: 23021743 DOI: 10.1016/j.dhjo.2012.07.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 06/22/2012] [Accepted: 07/25/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND Research supports the favorable effects of exercise on physical and psychosocial outcomes in those with arthritis. Few easily disseminated, multi-component, arthritis-specific programs have been evaluated using both physical function and psychosocial measures. Fitness and Exercise for People with Arthritis (FEPA) is a new community-based, 3-month, instructor supervised multi-component exercise program for individuals with arthritis designed to increase strength, flexibility, balance, and aerobic conditioning, while emphasizing joint-protection and proper biomechanics. PURPOSE To conduct a preliminary evaluation of the effects of the FEPA program on physical function and arthritis-related outcomes in individuals with arthritis. METHOD Middle-aged (n = 31, M(age) = 54.8 ± 7.2) and older (n = 79, M(age) = 76.0 ± 6.6) adults with arthritis completed the instructor led FEPA program in community senior centers, churches, and adult education settings. Changes in physical function, measured using the arm curl, back-scratch test, 8-foot up-and-go, and 6 min walk and self-reported arthritis-related pain, perceived physical function, affect, and self-efficacy for symptom management were assessed using RM ANOVA. RESULTS Significant improvements (ps < .05) in all physical function measures were found in the older group. In the middle-aged group, significant improvements (ps < .05) were found in the 8-foot up-and-go and 6 min walk. Self-reported physical function, pain perceptions, and self-efficacy for pain management significantly improved (ps < .05) in middle-aged participants, while only self-reported pain perceptions significantly improved in the older group. CONCLUSIONS FEPA shows promise for improving health-related outcomes in those with arthritis, and has potential for sustainability in community settings.
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Bhat AA, DeWalt DA, Zimmer CR, Fried BJ, Rangachari P, Seol YH, Callahan LF. Associations between low literacy and health status measures: cross-sectional analyses of two physical activity trials. JOURNAL OF HEALTH COMMUNICATION 2011; 17:230-245. [PMID: 22059652 DOI: 10.1080/10810730.2011.585688] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Arthritis researchers have thoroughly documented a powerful relationship between years of education and health outcomes, but they have not documented the role of literacy. The authors examined the associations between literacy and arthritis health status measures. Participants were recruited from southeastern urban and rural areas. Rapid Estimate of Adult Literacy in Medicine, which provides an estimate of reading level in less than 3 minutes, was administered to 447 participants at baseline in 2 community-based randomized controlled trials of lifestyle interventions designed for aging sedentary adults with arthritis. Those who read below ninth grade were considered to have low literacy. Among the 447 study participants, the median sample age was 69 years. A majority of the participants were women (86%), Caucasian (80%), overweight or obese (72%). Of all participants, 20% had low literacy. Significantly more African Americans (54%) than Caucasians (12%) had low literacy levels (p < .001). Individuals with low literacy did not have significantly worse disability or arthritis symptoms than individuals with adequate literacy (all ps > .05). Among our study participants, 1 in 5 had low literacy, but literacy was not associated with health status in this population.
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Affiliation(s)
- Anita A Bhat
- Medical College of Georgia, 1120 15th Street, EB 1011, Augusta, GA 30912, USA.
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Jones DL. A public health perspective on physical activity after total hip or knee arthroplasty for osteoarthritis. PHYSICIAN SPORTSMED 2011; 39:70-9. [PMID: 22293770 DOI: 10.3810/psm.2011.11.1941] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are common treatments for osteoarthritis (OA) with good-to-excellent outcomes. As the US population ages, rates of OA and THA/TKA will continue to rise. People with OA and THA/TKA are less active than those without arthritis or arthrosplasty, respectively. With the numerous documented health benefits obtained from physical activity, it is imperative from a public health perspective that patients are sufficiently active to maintain health after surgery. Increasing moderate-intensity physical activity is a safe, efficacious, and cost-effective mechanism for improving health and reducing health care costs in this population. The return to leisure/sporting activities after THA/TKA is not as well studied as other aspects of functional recovery. In particular, no evidence-based guidelines for physical activity after THA/TKA are available. Most recommendations have been derived from cross-sectional surveys of orthopedic surgeons. Based on the literature, the general consensus for recommendations appears to be to: 1) return to low- to moderate-intensity activities and no-, low-, or intermediate-impact activities within 3 to 6 months postoperatively, 2) discourage high-impact activities, 3) avoid high-contact athletic activities, and 4) educate rather than dissuade patients from resuming leisure/sporting activities. Sports medicine physicians are in an ideal position to counsel patients in regard to leading active lifestyles. The physician can evaluate and treat any remaining functional limitations postoperatively, as well as prescribe the appropriate dose (ie, type, intensity, frequency, and duration) of physical activity. The 2008 Physical Activity Guidelines for Americans can help guide physicians in prescribing the appropriate dose of activity. Finally, physicians can refer patients to evidence-based, community-delivered group exercise and/or behavioral change interventions that are approved by the Centers for Disease Control and Prevention for people with arthritis.
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Affiliation(s)
- Dina L Jones
- West Virginia University, School of Medicine, Department of Orthopaedics, Morgantown, WV, USA.
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Baruth M, Wilcox S. Effectiveness of two evidence-based programs in participants with arthritis: findings from the active for life initiative. Arthritis Care Res (Hoboken) 2011; 63:1038-47. [PMID: 21425245 DOI: 10.1002/acr.20463] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Arthritis is the leading cause of disability in the US. Strong evidence suggests that physical activity (PA) is beneficial to those with arthritis. This study examined whether changes in PA and PA-related outcomes from two general evidence-based PA programs (Active Choices [AC] and Active Living Every Day [ALED]) differed in participants with and without arthritis. METHODS Active for Life was a 4-year, multicenter, translational initiative that evaluated the effects of AC and ALED on PA and PA-related outcomes. Participants self-reported arthritis, PA, depressive symptoms, perceived stress, and satisfaction with body appearance and function. A subset of participants completed functional fitness tests. RESULTS Participants (n = 2,413 AC, n = 3,191 ALED) completed at least one outcome measure; 619 ALED participants completed at least one functional fitness test. Significant improvements in all PA and PA-related outcomes were seen for people with and without arthritis with the exception of depressive symptoms and perceived stress, which only improved in ALED participants. In general, effect sizes were similar for those with and without arthritis. CONCLUSION ALED and AC, both general behavioral PA programs, produced positive and meaningful changes in PA and a number of PA-related behaviors in participants with and without arthritis, pointing to the potential appropriateness of these evidence-based programs for people with arthritis.
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Altpeter M, Houenou LO, Martin KR, Schoster B, Callahan LF. Recruiting and retaining hard-to-reach populations: Lessons learned and targeted strategies from arthritis physical activity intervention studies. Arthritis Care Res (Hoboken) 2011; 63:927-8. [DOI: 10.1002/acr.20474] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Rosenberg DE, Bombardier CH, Hoffman JM, Belza B. Physical activity among persons aging with mobility disabilities: shaping a research agenda. J Aging Res 2011; 2011:708510. [PMID: 21748010 PMCID: PMC3124953 DOI: 10.4061/2011/708510] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 04/17/2011] [Indexed: 11/20/2022] Open
Abstract
With the aging of the baby boomer population and their accompanying burden of disease, future disability rates are expected to increase. This paper summarizes the state of the evidence regarding physical activity and aging for individuals with mobility disability and proposes a healthy aging research agenda for this population. Using a previously published framework, we present evidence in order to compile research recommendations in four areas focusing on older adults with mobility disability: (1) prevalence of physical activity, (2) health benefits of physical activity, (3) correlates of physical activity participation, and, (4) promising physical activity intervention strategies. Overall, findings show a dearth of research examining physical activity health benefits, correlates (demographic, psychological, social, and built environment), and interventions among persons aging with mobility disability. Further research is warranted.
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Affiliation(s)
- Dori E. Rosenberg
- Harborview Medical Center, Department of Rehabilitation Medicine, University of Washington, 325 Ninth Avenue, Seattle, WA 98104, USA
| | - Charles H. Bombardier
- Harborview Medical Center, Department of Rehabilitation Medicine, University of Washington, 325 Ninth Avenue, Seattle, WA 98104, USA
| | - Jeanne M. Hoffman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA
| | - Basia Belza
- School of Nursing, University of Washington, Seattle, WA 98195, USA
- School of Public Health, University of Washington, Seattle, WA 98195, USA
- Coordinating Center, CDC Healthy Aging Research Network, University of Washington, Seattle, WA 98195, USA
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Brittain DR, Gyurcsik NC, McElroy M, Hillard SA. General and Arthritis-Specific Barriers to Moderate Physical Activity in Women With Arthritis. Womens Health Issues 2011; 21:57-63. [DOI: 10.1016/j.whi.2010.07.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Revised: 07/23/2010] [Accepted: 07/26/2010] [Indexed: 10/19/2022]
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Chard SE, Stuart M. An Ecological Perspective on the Community Translation of Exercise Research for Older Adults. J Appl Gerontol 2010. [DOI: 10.1177/0733464810385814] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Regular exercise lowers the risk of disease progression for many chronic illnesses, but older adults experience relatively low rates of exercise. Although multiple intervention studies indicate that community-based programs can facilitate exercise participation, whether this research has resulted in widespread targeted exercise programs within communities is unknown. This study seeks to understand the ecological context of exercise for older adults through a cross-sectional survey of community exercise facilities within a mid-Atlantic city. The findings highlight the limited nature of the existing exercise infrastructure and reveal gaps in the community translation of research evidence regarding exercise adherence. An expansion in the availability of community exercise programs for older adults and more uniform policies to support older adult exercise are needed.
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Wu G, Keyes L, Callas P, Ren X, Bookchin B. Comparison of telecommunication, community, and home-based Tai Chi exercise programs on compliance and effectiveness in elders at risk for falls. Arch Phys Med Rehabil 2010; 91:849-56. [PMID: 20510973 DOI: 10.1016/j.apmr.2010.01.024] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Revised: 01/18/2010] [Accepted: 01/23/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare the adherence to and effectiveness of Tai Chi exercise program through a live, interactive, telecommunication-based exercise (Tele-ex) with that of a similar program through a community center-based exercise (Comm-ex) and a home video-based exercise (Home-ex) among community-dwelling elders who are at risk for falls. DESIGN Three groups randomized controlled trial with pretests and posttests. SETTING Exercise programs were community-based, and the outcome measures were laboratory-based. PARTICIPANTS Adults (N=64) age 65+ years with positive fall history in the previous year and/or significant fear of falling. INTERVENTION A 24-form, Yang-style Tai Chi for 15 weeks, 3 hours a week. MAIN OUTCOME MEASURES Exercise compliance, number of falls, fear of falling (Activities-specific Balance Confidence [ABC] score), self-perceived health (Medical Outcomes Study 36-Item Short Form Health Survey [SF-36]), Timed Up & Go (TUG), single leg stance (SLS), and body sway during quiet stance (medial-lateral foot center of pressure [ML-COP]). RESULTS Tele-ex and Comm-ex groups demonstrated significantly higher exercise attendance and in-class practice time than the Home-ex group (P<.01) and significant reductions in the mean number of falls and injurious falls (P<.01). There were significant improvements posttraining in SLS, ABC, ML-COP, and Physical Health subscore of the SF-36 (P<.05). Both Tele-ex and Comm-ex groups demonstrated larger improvements than the Home-ex group in TUG, ML-COP, and the Social Function, Mental Health, and Physical Health subscores of the MOS SF-36. CONCLUSION Compared with the Home-ex, the Tele-ex and Comm-ex groups are better in exercise compliance, fall reduction and balance and health improvements. Tele-ex is an effective, affordable, and acceptable choice of exercise for elders.
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Affiliation(s)
- Ge Wu
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT 05405, USA.
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Brittain DR, Gyurcsik NC. Perceptions of Trained Leaders on Improving the Public Health Impact of Three Arthritis Foundation Programs. Health Promot Pract 2010; 11:572-9. [DOI: 10.1177/1524839908328997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Arthritis Foundation (AF) offers effective community-based programs to help manage arthritis, including aquatic, exercise, and self-help programs. Trained leaders can facilitate the adoption, maintenance, and reach of these programs and thus the impact on public health. This study identifies reasons for becoming AF aquatic, exercise, and/or self-help program leaders, AF program reach, and adoption and maintenance challenges encountered by individuals after being trained. Researchers interviewed by telephone 72 participants who attended an AF leader training workshop. Participants reported various reasons for becoming program leaders (e.g., a wish to help others). AF programs were mainly adopted and maintained in urban communities and in fitness/ health clubs, medical centers, or senior centers. Aquatics programs were the most frequently offered, and all programs had low reach (with a mean number of participants of 14.41, 12.50, and 11.00 for aquatic programs, exercise programs, and self-help programs, respectively. Challenges to adopting and maintaining programs include the time of year (e.g., winter, holidays) and lack of a facility to offer the program.
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Affiliation(s)
- Danielle R. Brittain
- Department of Health and Exercise Science at the University of Oklahoma in Norman, Oklahoma,
| | - Nancy C. Gyurcsik
- College of Kinesiology at the University of Saskatchewan in Saskatoon, Saskatchewan, Canada
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Brady TJ, Jernick SL, Hootman JM, Sniezek JE. Public health interventions for arthritis: expanding the toolbox of evidence-based interventions. J Womens Health (Larchmt) 2010; 18:1905-17. [PMID: 20044851 DOI: 10.1089/jwh.2009.1571] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Since 1999, the Centers for Disease Control and Prevention's (CDC) Arthritis Program has worked to improve the quality of life for people with arthritis, in part by funding state health departments to disseminate physical activity (PA) and self-management education (SME) interventions. Initially, only one SME and two PA interventions were considered evidence-based and appropriate for people with arthritis. The purposes of this article are to describe the processes and criteria used to screen new or existing intervention programs and report the results of that screening, including an updated list of recommended intervention programs. METHODS A series of three sets of screening criteria was created in consultation with subject matter experts: arthritis appropriateness, adequacy of the evidence base, and implementability as a public health intervention. Screening interventions were categorized as Recommended, Promising Practices, Watch List, Future Possibility, or Unlikely to Meet criteria based on how well the intervention met the screening criteria. RESULTS A total of 15 packaged PA interventions and six SME interventions were screened. Three PA and three SME interventions met all three sets of criteria and were added to the list of recommended public health interventions for use by CDC-funded state arthritis programs. An additional two SME interventions are developing the infrastructure for public health dissemination and were categorized as Promising Practices, and six PA interventions have evaluations underway and are on the Watch List. CONCLUSIONS The CDC Arthritis Program identified arthritis-appropriate interventions that can be used effectively and efficiently in public health settings to improve the quality of life of people with arthritis. The screening criteria used offer a guide to intervention developers on necessary characteristics of interventions for use in public health settings. The expanded menu of interventions is beneficial to clinical care and public health professionals and, ultimately, to people with arthritis.
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Affiliation(s)
- Teresa J Brady
- Arthritis Program, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
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van der Giesen FJ, van Lankveld W, Hopman-Rock M, de Jong Z, Munneke M, Hazes JMW, van Riel PLCM, Peeters AJ, Ronday HK, Vlieland TPMV. Exploring the public health impact of an intensive exercise program for patients with rheumatoid arthritis: A dissemination and implementation study. Arthritis Care Res (Hoboken) 2010; 62:865-72. [DOI: 10.1002/acr.20138] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Layne JE, Arabelovic S, Wilson LB, Cloutier GJ, Pindrus MA, Mallio CJ, Roubenoff R, Castaneda-Sceppa C. Community-Based Strength Training Improves Physical Function in Older Women With Arthritis. Am J Lifestyle Med 2009. [DOI: 10.1177/1559827609342061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Exercise is recognized as a mainstay treatment of arthritis, yet more than 40% of adults with arthritis report no leisure time physical activity participation. The Centers for Disease Control and Prevention is working to identify and promote evidence-based physical activity programs to improve physical function among adults with arthritis. The authors conducted a multisite, pilot randomized controlled trial to examine the effects of community-based strength training versus usual activity in women (n = 33) 55 years of age and older with arthritis. The moderate-intensity, progressive strength training intervention included balance and flexibility exercises. Classes met 2 times per week for 12 weeks. Outcome measures included muscle strength, performance-based physical function (mobility, flexibility, and balance), and arthritis symptoms. Lower body strength improved from baseline to 12 weeks in the strength training versus control group (32.2%-7.3%, respectively; P = .004). Physical function improved in the strength training group over 12 weeks (range, 7%-50%; P < .05), with no change in control group. Adherence to the intervention was 82% ± 16%. There were no adverse effects on arthritis symptoms. These results demonstrate the efficacy of this program and its potential to be disseminated as an evidence-based strength training intervention to improve physical function and strength among older women with arthritis and other major comorbidities.
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Affiliation(s)
- Jennifer E. Layne
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center at Tufts University, Boston, Massachusetts, , People Exercising, Inc, Boston, MA, Foundation for Informed Medical Decision Making, Boston, Massachusetts
| | - Senada Arabelovic
- Division of Rheumatology/Immunology, Arthritis Treatment Center, Tufts Center, Boston, Massachusetts
| | - Lynn Bairos Wilson
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center at Tufts University, Boston, Massachusetts
| | - Gregory J. Cloutier
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center at Tufts University, Boston, Massachusetts
| | - Mariya A. Pindrus
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center at Tufts University, Boston, Massachusetts
| | - Charlotte J. Mallio
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center at Tufts University, Boston, Massachusetts
| | - Ronenn Roubenoff
- Division of Rheumatology/Immunology, Arthritis Treatment Center, Tufts Center, Boston, Massachusetts
| | - Carmen Castaneda-Sceppa
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, Northeastern University Bouve College of Health Sciences, Boston, Massachusetts
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van den Berg MH, van der Giesen FJ, van Zeben D, van Groenendael JHLM, Seys PEH, Vliet Vlieland TPM. Implementation of a physical activity intervention for people with rheumatoid arthritis: a case study. Musculoskeletal Care 2008; 6:69-85. [PMID: 18302159 DOI: 10.1002/msc.128] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To investigate the potential facilitators and barriers regarding the implementation on a larger scale of an internet-based physical activity intervention which had previously proved to be effective in a randomized, controlled trial concerning sedentary patients with rheumatoid arthritis (RA). METHODS Assuming a central delivery of the intervention by two trained physical therapists in four regions in the Netherlands, the following activities were employed: the recruitment of potential participants (RA patients), the acquisition of cooperation from referring rheumatologists and the acquisition of reimbursement from regional health insurance companies. Evaluation was done by means of the Reach, Evaluation, Adoption, Implementation and Maintenance framework, of which the following three dimensions were considered relevant: Reach (the number of potential participants), Adoption (readiness for adopting the programme in real life among rheumatologists) and Implementation (the extent to which the intervention could be delivered as intended). Evaluation measures comprised a postal survey among 927 patients with RA in two regions, a telephone survey among rheumatology centres in four regions and consultations with five regional health insurance companies. RESULTS Seventy-six out of 461 responding RA patients (20%) met the original study inclusion criteria (being sedentary and having access to the internet) and were interested in participation. However, the potential costs of the purchase of a bicycle ergometer and the interference with patients' current physical therapy were obstacles for eligible patients actually to participate. Rheumatologists in four out of five rheumatology centres were willing to participate. All five health insurance companies were willing to reimburse the guidance and feedback by the physical therapist, and the costs of the internet site (estimated costs 271 euro [203 pound] per patient per year), but not the bicycle ergometer (estimated costs 350 euro [262 pound]), provided that current physical therapy would be discontinued. CONCLUSIONS Facilitators for the implementation of an internet-based physical activity intervention were: (i) a considerable proportion of RA patients were eligible and interested in the programme; (ii) the majority of rheumatologists were willing to refer patients; and (iii) health insurance companies were willing partially to reimburse the intervention. Barriers were the additional costs for patients and their unwillingness to discontinue current physical therapy. These findings underscore the need for additional research into barriers to participation in physical activity interventions among patients with RA, and in reimbursement strategies in particular.
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Affiliation(s)
- M H van den Berg
- Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands.
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Reid MC, Papaleontiou M, Ong A, Breckman R, Wethington E, Pillemer K. Self-management strategies to reduce pain and improve function among older adults in community settings: a review of the evidence. PAIN MEDICINE 2008; 9:409-24. [PMID: 18346056 DOI: 10.1111/j.1526-4637.2008.00428.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
CONTEXT Self-management strategies for pain hold substantial promise as a means of reducing pain and improving function among older adults with chronic pain, but their use in this age group has not been well defined. OBJECTIVE To review the evidence regarding self-management interventions for pain due to musculoskeletal disorders among older adults. DESIGN We searched the Medline and Cumulative Index to Nursing and Allied Health Literature databases to identify relevant articles for review and analyzed English-language articles that presented outcome data on pain, function, and/or other relevant endpoints and evaluated programs/strategies that could be feasibly implemented in the community. Abstracted information included study sample characteristics, estimates of treatment effect, and other relevant outcomes when present. RESULTS Retained articles (N = 27) included those that evaluated programs sponsored by the Arthritis Foundation and other programs/strategies including yoga, massage therapy, Tai Chi, and music therapy. Positive outcomes were found in 96% of the studies. Proportionate change in pain scores ranged from an increase of 18% to a reduction of 85% (median = 23% reduction), whereas change in disability scores ranged from an increase of 2% to a reduction of 70% (median = 19% reduction). Generalizability issues identified included limited enrollment of ethnic minority elders, as well as non-ethnic elders aged 80 and above. CONCLUSIONS Our results suggest that a broad range of self-management programs may provide benefits for older adults with chronic pain. Research is needed to establish the efficacy of the programs in diverse age and ethnic groups of older adults and identify strategies that maximize program reach, retention, and methods to ensure continued use of the strategies over time.
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Affiliation(s)
- M Carrington Reid
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA.
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van den Berg MH, Ronday HK, Peeters AJ, le Cessie S, van der Giesen FJ, Breedveld FC, Vliet Vlieland TPM. Using internet technology to deliver a home-based physical activity intervention for patients with rheumatoid arthritis: A randomized controlled trial. ACTA ACUST UNITED AC 2007; 55:935-45. [PMID: 17139640 DOI: 10.1002/art.22339] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To compare the effectiveness of 2 Internet-based physical activity interventions for patients with rheumatoid arthritis (RA). METHODS A total of 160 physically inactive patients with RA who had a computer with Internet access were randomly assigned to an Internet-based physical activity program with individual guidance, a bicycle ergometer, and group contacts (individualized training [IT] group; n = 82) or to an Internet-based program providing only general information on exercises and physical activity (general training [GT] group; n = 78). Outcome measures included quantity of physical activity (questionnaire and activity monitor), functional ability, quality of life, and disease activity (baseline, 3, 6, 9, and 12 months). RESULTS The proportion of physically active patients was significantly greater in the IT than in the GT group at 6 (38% versus 22%) and 9 months (35% versus 11%; both P < 0.05) regarding a moderate intensity level for 30 minutes in succession on at least 5 days a week, and at 6 (35% versus 13%), 9 (40% versus 14%), and 12 months (34% versus 10%; all P < 0.005) regarding a vigorous intensity level for 20 minutes in succession on at least 3 days a week. In general, there were no statistically significant differences regarding changes in physical activity as measured with an activity monitor, functional ability, quality of life, or disease activity. CONCLUSION An Internet-based physical activity intervention with individually tailored supervision, exercise equipment, and group contacts is more effective with respect to the proportion of patients who report meeting physical activity recommendations than an Internet-based program without these additional elements in patients with RA. No differences were found regarding the total amount of physical activity measured with an activity monitor.
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Affiliation(s)
- M H van den Berg
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
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van den Berg MH, de Boer IG, le Cessie S, Breedveld FC, Vliet Vlieland TPM. Most people with rheumatoid arthritis undertake leisure-time physical activity and exercise in the Netherlands: an observational study. ACTA ACUST UNITED AC 2007; 53:113-8. [PMID: 17535147 DOI: 10.1016/s0004-9514(07)70044-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
QUESTION What type of physical activity or exercise is undertaken by people with rheumatoid arthritis? What type of physical activity or exercise do they prefer? What is their attitude towards physical activity or exercise? What are the perceived barriers to undertaking physical activity or exercise? DESIGN Survey of a random sample of people with rheumatoid arthritis. PARTICIPANTS Four hundred people with rheumatoid arthritis in the Netherlands. RESULTS Of the 252 people who returned the questionnaire (63% response) 201 (80%) people participated in some type of physical activity or exercise. Significantly more inactive people were male, less educated, and older than the active people. Of the active people, 45 (22%) participated exclusively in supervised activities, 72 (36%) in unsupervised activities, and 84 people (42%) combined supervised and unsupervised activities. Cycling and walking were the two unsupervised activities people performed most often. Supervised group exercise and unsupervised individual physical activity were reported as the favourite activities. Further, more people preferred being physically active under expert supervision than without supervision and preferred water-based over land-based activities. The most frequently-mentioned barriers were lack of energy, presence of pain, lack of motivation, lack of information, and fear of joint damage. CONCLUSION The majority of people with rheumatoid arthritis participated in some physical activity or exercise, mostly under supervision. Preferences for types of activity varied, underpinning the need for a variety of options for people with rheumatoid arthritis.
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Gyurcsik NC, Brittain DR. Partial Examination of the Public Health Impact of the People with Arthritis Can Exercise (PACE�) Program: Reach, Adoption, and Maintenance. Public Health Nurs 2006; 23:516-22. [PMID: 17096776 DOI: 10.1111/j.1525-1446.2006.00591.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To partially evaluate the public health impact (i.e., reach, adoption, maintenance) of People with Arthritis Can Exercise (PACE) programs, which were initiated as a result of two PACE instructor-training workshops. DESIGN The study design involved a one-time only, cross-sectional assessment of reach, adoption, and maintenance, conducted 6 months after the workshops. SAMPLE Participants were 11 adults (n(females)=10) trained to be PACE instructors at one of the workshops. MEASUREMENTS One-on-one phone interviews, developed using the RE-AIM framework, assessed reach, adoption, and maintenance. RESULTS Eight of the 11 individuals trained as instructors subsequently began PACE in one of 10 organizations across various communities, indicating high program adoption. However, on average, only 7 individuals with arthritis participated in each PACE program, indicating a low program reach. Within 6 months of beginning PACE, only 3 organizations continued to offer PACE, indicating low program maintenance. Two primary challenges to initiating PACE included recruiting a sufficient number of people to participate in the program and in finding a convenient time to offer it so more individuals could join. CONCLUSION The public health impact, as assessed by reach, adoption, and maintenance, of PACE programs initiated as a result of 2 instructor-training workshops was low.
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Affiliation(s)
- Nancy C Gyurcsik
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
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Brady TJ, Sniezek JE. Implementing the National Arthritis Action Plan: new population-based approaches to increasing physical activity among people with arthritis. ARTHRITIS AND RHEUMATISM 2003; 49:471-6. [PMID: 12794806 DOI: 10.1002/art.11052] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Teresa J Brady
- Arthritis Program, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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Affiliation(s)
- Patricia A Sharpe
- Prevention Research Center, Norman J. Arnold School of Public Health, University of South Carolina, Columbia 29208, USA.
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