NEW YORK (Reuters Health)—”Booster sessions” with a physiotherapist help older adults with osteoarthritis keep doing their exercises, a new systematic review and meta-analysis suggests.
“There is strong evidence for the benefits of exercise for people with osteoarthritis or chronic low back pain. However, multiple studies have shown adherence to exercise declines over time, and the benefits of exercise are not maintained long term. Identifying interventions that are successful in improving and maintaining adherence to exercise is crucial so that clinicians can help their patients achieve the full benefit of exercise,” says senior study author Dr. Rana Hinman, professor and physiotherapist at the University of Melbourne in Australia.
“For exercise to be effective, it is vital that patients with chronic musculoskeletal conditions adhere to exercise recommendations. But getting patients to adhere to exercise over the longer term is challenging for most clinicians. We were surprised to find there is relatively little research investigating this important clinical problem,” she tells Reuters Health.
“Clinicians may consider including ‘booster sessions’—having follow-up consultations or supervised exercise sessions with their patients after they have been exercising on their own for a period of time. This allows clinicians to monitor progress, adjust exercise programs, re-motivate patients and help troubleshoot any difficulties they may be experiencing while independently adhering to their exercise program,” Dr. Hinman adds.
Dr. Hinman and her colleagues searched the major databases for randomized controlled trials that examined the effects of interventions aimed at increasing adherence to therapeutic exercise among adults 45 years of age and above with chronic low back pain with or without osteoarthritis of the hip, knee or both.
Of the 3,899 studies identified, nine studies including 1,045 participants were eligible for their study.
In the four studies that assessed strategies to increase motivation or that used behavioral graded exercise, exercise adherence was significantly higher (d=0.26–1.23). But behavioral counseling, action coping plans that included audio, video, or both, did have a significant effect, the researchers reported in the British Journal of Sports Medicine, online Jan. 13.
The two studies that assessed “booster sessions” with a physiotherapist showed a small to moderate pooled effect in favor of the sessions (standardized mean difference 0.39, 95% confidence interval 0.05 to 0.72, z=2.26, p=0.02, I2=35%).
Dr. Hinman says she and her group are planning randomized controlled trials to examine the effects of different strategies to boost exercise adherence in people with osteoarthritis.
“One of the strategies we will evaluate is using targeted Short Message Service [SMS] messages in response to patient feedback about how they are managing with their exercise program. We are also exploring the validity of patient-reported measures of exercise adherence,” she says.
Reference
- Nicolson PJ, Bennell KL, Dobson FL, et al. Interventions to increase adherence to therapeutic exercise in older adults with low back pain and/or hip/knee osteoarthritis: a systematic review and meta-analysis. Br J Sports Med. 2017 Jan 13. pii: bjsports-2016-096458. doi: 10.1136/bjsports-2016-096458. [Epub ahead of print]
