Does Adherence Make a Difference?: Results From a Community-Based Aquatic Exercise Program

BackgroundEvidence exists demonstrating the benefits of exercise for people with osteoarthritis, but little is known about whether exercise programs are effective, that is, whether the benefits of exercise can be seen in “real life” programs for “normal” people under nonlaboratory conditions. ObjectiveTo identify characteristics of and outcomes for participants who adhere to a community-based aquatic exercise program. MethodTwo hundred and forty-nine adults with osteoarthritis were recruited from Washington State for randomization to a 20-week Arthritis Foundation aquatic exercise program (n = 125) or a wait-list control group (n = 124). Adherers were defined as those attending at least two classes per week for 16 of 20 weeks. Measures included: Quality of Well Being Scale, Health Assessment Questionnaire, Center for Epidemiological Studies-Depression Scale, and a single arthritis quality of life rating-item. ResultsBaseline to postintervention change scores revealed that treatment-group adherers (N = 35) reported improved quality of well-being, physical function, and change in arthritis quality of life compared to controls (N = 124). When comparing treatment-group adherers (N = 35) to treatment-group nonadherers (N = 67), quality of well-being and depressed mood improved for adherers, but not for nonadherers. ConclusionWhen analyzed for level of participation, exercise benefits adults with osteoarthritis. Consistent participation in exercise programs results in better outcomes. Improved methods are needed to enhance adherence, with increased attention to the role of intrinsic factors such as self-efficacy and belief systems.

[1]  C. Helmick,et al.  Cost-effectiveness of the arthritis self-help course. , 1998, Archives of internal medicine.

[2]  M. MacKay-Lyons,et al.  Therapeutic benefit of aquaerobics for individuals with rheumatoid arthritis , 1998 .

[3]  R A Oostendorp,et al.  Effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a systematic review of randomized clinical trials. , 1999, Arthritis and rheumatism.

[4]  D. Patrick,et al.  Recruiting adults with osteoarthritis into an aquatic exercise class: strategies for a statewide intervention. , 1998, Arthritis care and research : the official journal of the Arthritis Health Professions Association.

[5]  R. McNeal Aquatic therapy for patients with rheumatic disease. , 1990, Rheumatic diseases clinics of North America.

[6]  B H Marcus,et al.  Maintenance of physical activity following an individualized motivationally tailored intervention , 2001, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[7]  J E Hewett,et al.  Efficacy of physical conditioning exercise in patients with rheumatoid arthritis and osteoarthritis. , 1989, Arthritis and rheumatism.

[8]  S. Skevington,et al.  A randomized and controlled trial of hydrotherapy in rheumatoid arthritis. , 1996, Arthritis care and research : the official journal of the Arthritis Health Professions Association.

[9]  L. Berkman,et al.  Two Shorter Forms of the CES-D Depression Symptoms Index , 1993 .

[10]  D. Patrick Critical Issues and Trends : Underserved Populations Rethinking Prevention for People with Disabilities Part I : A Conceptual Model for Promoting Health , 2002 .

[11]  J. Judge,et al.  Initiation and Maintenance of Exercise Behavior in Older Women: Predictors from the Social Learning Model , 2002, Journal of Behavioral Medicine.

[12]  M. Laurant,et al.  Effectiveness of physical activity interventions for older adults: a review. , 2002, American journal of preventive medicine.

[13]  W. Applegate,et al.  A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST). , 1997, JAMA.

[14]  C. Helmick,et al.  Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. , 1998, Arthritis and rheumatism.

[15]  K. Lorig,et al.  Efficacy of psychoeducational interventions on pain, depression, and disability in people with arthritis: a meta-analysis. , 1987, The Journal of rheumatology. Supplement.

[16]  K. Harms-Ringdahl,et al.  Intensive dynamic training in water for rheumatoid arthritis functional class II--a long-term study of effects. , 1991, Scandinavian journal of rheumatology.

[17]  R M Kaplan,et al.  A general health policy model: update and applications. , 1988, Health services research.

[18]  K. Brandt,et al.  Benoxaprofen stimulates proteoglycan synthesis in normal canine knee cartilage in vitro. , 1983, Arthritis & Rheumatism.

[19]  Lori Thein Brody,et al.  Therapeutic Exercise: Moving Toward Function , 1998 .

[20]  M. Westby,et al.  A health professional's guide to exercise prescription for people with arthritis: a review of aerobic fitness activities. , 2001, Arthritis and rheumatism.

[21]  R M Kaplan,et al.  The Quality of Well-Being Scale: Applications in AIDS, Cystic Fibrosis, and Arthritis , 1989, Medical care.

[22]  K. Lorig,et al.  Arthritis patient education studies, 1987-1991: a review of the literature. , 1994, Patient education and counseling.

[23]  D. Blake,et al.  Patient non-compliance: deviance or reasoned decision-making? , 1992, Social science & medicine.

[24]  D. Patrick,et al.  Economic Evaluation of Aquatic Exercise for Persons With Osteoarthritis , 2001, Medical care.

[25]  Panush Rs,et al.  Sex and arthritis. , 2000 .

[26]  J. Fries,et al.  The dimensions of health outcomes: the health assessment questionnaire, disability and pain scales. , 1982, The Journal of rheumatology.

[27]  McNeal Rl Aquatic therapy for patients with rheumatic disease. , 1990 .

[28]  H. C. Hutchings,et al.  The cost effectiveness of auranofin: results of a randomized clinical trial. , 1988, The Journal of rheumatology.

[29]  Tom Seekins,et al.  Health promotion for people with chronic illness and physical disabilities: the connection between health psychology and disability prevention , 1998 .

[30]  H. Zeidler,et al.  Socioeconomic evaluation of rheumatoid arthritis and osteoarthritis: a literature review. , 1997, Seminars in arthritis and rheumatism.