Background Lack of regular physical activity is a risk factor for functional decline. In hip osteoarthritis, exercise therapy aims to improve patients' overall function. Systematic reviews have shown beneficial effects on pain and physical function from exercise therapy (1) but also that these positive effects are not sustained in the long term (2). The patients' self-efficacy and additional booster sessions offered after the treatment period are factors shown to positively influence physical activity maintenance (3) and beneficial posttreatment effects (2).
Objectives In an observer-blinded, randomized trial to compare the long term effects of 4 months of supervised strength training (ST), supervised Nordic Walking (NW), and unsupervised home based exercise (HBE, control group) on functional performance.
Methods 60+ years old people (n=152; 49 men, 103 women, age 70±6 years) with clinical hip osteoarthritis not on a waiting list for surgery were randomized to ST in a local fitness center (n=50), NW in a local park (n=50) or HBE (n=52). The ST- and NW-groups were offered individual counseling interviews, patient education and telephone-assisted counselling in order to improve adherence and maintenance of exercise/physical activity. Functional performance, i.e. 30s chair stand test (primary outcome), timed stair climbing and 6-minute walk test; and secondary self-reported outcomes, i.e. physical function, pain, physical activity level, self-efficacy and health related quality of life, were measured at baseline, 4- and 12 months.
Results Intention-to-treat-analyses showed equal improvements (mean (95%CI)) after intervention in number of chair stands in all three groups at 4-months (ST: 0.9 (0.2–1.6), NW: 1.9 (0.8–3.0), HBE: 1.1 (0.1–2.0)), while a between-group difference in favor for the NW-group (1.4 (0.0–2.8)) compared to ST-group were present at 12 months. Significant between-group differences (p<0.001- p<0.05) in favor of NW compared to ST and HBE were found for functional performance at all follow-up time-points. Furthermore, NW was superior (p<0.01) to HBE for improving vigorous physical activity and to both ST and HBE for improving (p<0.01) mental health at all follow-up time-points, and (p<0.05) self-efficacy at 12 months.
Conclusions Based on these results NW can be recommended compared with ST and HBE for older adults with hip osteoarthritis.
Fransen et al. Exercise for osteoarthritis of the hip. Cochrane Database Syst Rev. 2014 Apr 22;4:CD007912
Pisters et al. Long-term effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a systematic review. Arthritis Rheum. 2007 Oct 15;57(7):1245–53
Hammer et al. The impact of self-efficacy on physical activity maintenance in patients with hip osteoarthritis - a mixed methods study. Disabil Rehabil. 2015 Dec 17:1–14
Disclosure of Interest None declared
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