Background/Purpose: EnhanceFitness® (EF) is an evidence-based, community-delivered intervention for older adults; however, its effectiveness in people with arthritis is unknown. The purpose of this pragmatic, community-based, randomized controlled trial was to determine the effectiveness of 12 weeks of EF in improving arthritis symptoms, physical and psychosocial function, and physical activity (PA) in adults with arthritis as compared to a 12-week, wait-list control group.

Methods: Community-dwelling adults, aged 18 years or older, were eligible if they were sedentary/low-active (≤ 60 minutes/week of moderate/vigorous-intensity PA), had self-reported physician-diagnosed arthritis, and were medically cleared for exercise. Participants were randomly assigned to the EF (immediate exercise) or wait-list control group. Participants exercised thrice weekly for 12 weeks (36 classes), and completed self-reported and performance-based assessments at baseline and 12 weeks. The outcomes were arthritis symptoms (pain, stiffness, fatigue on a visual analogue scale), physical and psychosocial functioning (SF-12, Self-Efficacy Questionnaire), upper/lower extremity strength (arm curl and 5 times sit-to-stand tests), aerobic endurance (2-minute step test), functional mobility (timed up-and-go test), and PA (minutes/week and kilocalories/week for all PA, CHAMPS Physical Activity Questionnaire). Analysis of Covariance was performed to determine if outcomes improved from baseline to 12 weeks after adjusting for group, age, sex, body mass index, site (northern vs. southern state county), and outcome score at baseline. The proportion of participants meeting national PA guidelines (≥ 150 minutes/week of moderate/vigorous-intensity exercise, National Health Interview Survey Questionnaire) was compared between groups at 12 weeks using a Chi-square test.

Results: Twenty-two EF classes were held at 15 community sites in 4 urban and 5 rural counties. Of the 134 participants, 68 were randomized to EF and 66 to the control group. Participants were primarily female (87%) and white (95%), with osteoarthritis (75%) and a mean ± SD age of 67 ± 11 years (range 35-89). The EF group experienced significantly lower stiffness (Effect Size [d] -0.9, p<0.001) and fatigue (d -0.8, p=0.03), and improved performance on the arm curl (d 0.9, p<0.001) and timed up-and-go (d -0.8, p=0.03) tests at 12 weeks as compared to the control group. A significantly greater proportion of the EF group were meeting PA guidelines (67%) at 12 weeks as compared to the control group (34%) (p<0.001). There were no significant differences between groups in the remaining variables.

Conclusion: A 12-week EF program was effective in improving arthritis symptoms, upper extremity strength, functional mobility, and the proportion meeting PA guidelines in adults with self-reported arthritis. This study demonstrated that an exercise program including the four key components for reducing pain and enhancing physical function (aerobic, strengthening, balance, and flexibility exercises) can substantially improve health in adults with arthritis when delivered in real-world community settings.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-randomized-controlled-effectiveness-trial-of-the-enhance-fitness-physical-activity-program-in-people-with-arthritis/