Exercise therapy is a key intervention in the management of patients with knee OA1. However, comorbidity is present in 68 to 85% of patients with OA (e.g. cardiac disease, diabetes type 2, obesity)2,3. Comorbidity interferes with exercise therapy. In clinical practice, comorbidity is a frequent reason to exclude patients from exercise therapy. If accepted into an exercise program, both therapists and patients tend to reduce exercise intensity to a level unlikely to be effective, because of fear of aggravating symptoms of the comorbid disease. Further, the effect of exercise therapy in patients with knee OA and severe comorbidity is not known. Patients with unstable medical conditions, precluding safe participation in an exercise program, are excluded from clinical trials. In view of the effectiveness of exercise therapy in knee OA and the high prevalence of comorbidity, there is a great need for comorbidity-related adaptations to exercise therapy. In this lecture a strategy (i3-S strategy) will be presented on how to develop comorbidity-related adaptations to exercise therapy in an index disease (e.g osteoarthritis)4. According this strategy we have developed a tailored exercise program for patients with knee OA and comorbidity. Subsequently, to evaluate the efficacy of the tailored exercise program for patients with knee OA and comorbidity (cardiac disease, diabetes type 2, COPD and obesity (body mass index ≥30kg/m2) a randomized controlled trial (n=126) was performed in a secondary care setting. The results showed that tailored exercise therapy greatly improved physical functioning, reduced pain and was also safe for patients with knee OA and (severe) comorbidity5. At present we are implementing and evaluating the protocol in primary care.
Fransen M, McConnell S, Harmer AR, Van der Esch M, Simic M, Bennell KL. Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev 2015; 1:CD004376.
Tuominen U, Blom M, Hirvonen J, Seitsalo S, Lehto M, Paavolainen P et al. The effect of co-morbidities on health-related quality of life in patients placed on the waiting list for total joint replacement. Health Qual Life Outcomes 2007; 5:16.
van Dijk GM, Veenhof C, Schellevis F, Hulsmans H, Bakker JP, Arwert H et al. Comorbidity, limitations in activities and pain in patients with osteoarthritis of the hip or knee. BMC Musculoskelet Disord 2008; 9:95.
Dekker J, de Rooij M, van der Leeden M. The i3-S strategy for developing comorbidity-related adaptations to exercise therapy. Disability and Rehabilitation 2016; 38:905–9.
de Rooij M, van der Leeden M, van der Esch M, Cheung J, Häkkinen A, Haverkamp D, Roorda LD, Twisk J, Vollebregt J, Lems WF, Dekker J. Efficacy of tailored exercise therapy in patients with knee osteoarthritis and comorbidity: a randomized controlled trial. Accepted for publication in Arthritis Care & Research (Hoboken), 2016.
Disclosure of Interest None declared