Background Osteoarthritis (OA) is a very common problem with a major impact on quality of life of older people. It is expected that OA will be the fourth leading cause of disability by the year 2020. Patients with OA have a higher risk of developing comorbidities than patients without. Common comorbidities include obesity, cardiovascular disease, diabetes, and psychological conditions (e.g. depression and anxiety).
The 2008 NICE OA guidelines have made treating comorbidities in OA a research priority. They recommend exercise as a core treatment irrespective of age, comorbidity, pain severity or disability. Beneficial effects of exercise in patients with OA include improvements in pain, disability and physical performance. Exercise may be even more important in older adults with comorbidities where using NSAIDS becomes more problematic.
Objectives The overall objective was to develop a protocol and test the feasibility of a group exercise intervention with integrated self-management to help manage comorbidities in community-dwelling older adults with OA.
Methods Initial development work included: 1) a literature review identifying effective components of group exercise interventions and behaviour change strategies for older people with OA; 2) design of an intervention based on the results of the review and expert input; 3) a feasibility study to evaluate the intervention including recruitment, programme delivery and outcome assessment; 4) refining the protocol for use in a larger study which would evaluate clinical and cost-effectiveness of the intervention.
Results A group self-management package was developed, including: understanding pain and OA; self-managing OA and co-morbidities; health behaviours; personal action plans and goal setting; maintaining exercise behaviours; benefits of exercise and relaxation; coping with pain; pacing; flare ups; challenging negative thoughts.
An individualised gym-based exercise programme was designed to increase general strength, aerobic fitness and balance. The combined exercise/self-management sessions lasted ~2 hours and were conducted twice a week for 6 weeks. Participants were encouraged to progressively increase their activity levels outside of the classes.
Ten community-dwelling participants (4 M; 6 F) over the age of 75 (mean 82; range 75-92) with comorbidities were recruited. At baseline a physical assessment and questionnaire was completed. Physical testing was repeated at the last session and questionnaires at 3 months.
Overall attendance at the 12 sessions was 89%. 70% (7/10) reported some improvement in OA since starting the study, 90% (9/10) reported moderate to substantial benefit and 90% (9/10) reported some level of satisfaction with programme. Of those suffering from obesity, CVD, diabetes, anxiety or depression, 89% (16/18) reported they had felt benefit with these comorbidities and 70% (7/10) reported their overall health as better since attending the programme.
There was a 20%, increase in sit-stand performance, 4.5% in number of arm curls, 11.5% in maximum grip strength and 19.4% in 2 minute step test at follow-up assessment.
Conclusions A group intervention combining an individualised gym-based exercise programme with a self-management package was developed and tested for acceptability and feasibility in community dwelling older adults. Due to the initial success and favourable response, the protocol has since been manualised and is now ready for further testing of clinical and cost-effectiveness.
Disclosure of Interest P. Heine Grant/research support from: BUPA Foundation, S. Patel Grant/research support from: BUPA Foundation, M. Underwood: None Declared