Effects of activity strategy training on pain and physical activity in older adults with knee or hip osteoarthritis: a pilot study

Abstract

Objective: To examine effects of activity strategy training (AST), a structured rehabilitation program taught by occupational therapists and designed to teach adaptive strategies for symptom control and engagement in physical activity (PA).

Methods: A randomized controlled pilot trial was conducted at 4 sites (3 senior housing facilities and 1 senior center) in southeastern, lower Michigan. Fifty-four older adults with hip or knee osteoarthritis (mean +/- SD age 75.3+/-7.1 years) participated. At each site, older adults were randomly assigned to 1 of 2 programs: exercise plus AST (Ex + AST) or exercise plus health education (Ex + Ed). The programs involved 8 sessions over 4 weeks with 2 followup sessions over a 6-month period, and were conducted concurrently within each site. Pain, total PA and PA intensity (measured objectively by actigraphy and subjectively by the Community Healthy Activities Model Program for Seniors questionnaire), arthritis self-efficacy, and physical function were assessed at baseline and posttest.

Results: At posttest, participants who received Ex + AST had significantly higher levels of objective peak PA (P=0.02) compared with participants who received Ex + Ed. Although not statistically significant, participants in Ex + AST tended to have larger pain decreases, increased total objective and subjective PA, and increased physical function. No effects were found for arthritis self-efficacy.

Conclusion: Although participants were involved in identical exercise programs, participants who received AST tended to have larger increases in PA at posttest compared with participants who received health education. Future studies will be needed to examine larger samples and long-term effects of AST.

Trial registration: ClinicalTrials.gov NCT00613678.

Figure 1

Adherence flow chart. ACR = American College of Rheumatology; OA = osteoarthritis; Ex + AST = exercise plus activity strategy training; Ex + Ed = exercise plus health education.

Figure 2

Comparison of baseline and posttest pain levels by treatment group using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Solid bars show baseline; stippled bars show posttest. Error bars show the mean and SEM. EX+ED = exercise plus health education; EX+AST = exercise plus activity strategy training.

Figure 3

Comparisons of baseline and posttest objective and subjective physical activity (PA) scores by treatment group. A, Objective total PA and B, Objective peak PA (P = 0.02), both measured by actigraph accelerometer (activity counts). C, Community Healthy Activities Model Program for Seniors (CHAMPS) total PA (kcal/week). D, CHAMPS moderate PA is the percentage of people who participate in moderate- or greater-intensity activities. Solid bars show baseline; stippled bars show posttest. Error bars show the mean and SEM. EX+ED = exercise plus health education; EX+AST = exercise plus activity strategy training.