Background/Purpose: Exercise is a central component in treatment and rehabilitation for chronic musculoskeletal conditions. Current literature supports the use of therapeutic exercise to reduce pain, improve function, and enhance quality of life in people with arthritis. Due to an estimated 30-60% of patients not following prescribed exercises, studies have investigated barriers and predictors of exercise adherence, as well as interventions that aim to increase it. The objective of this best evidence synthesis was to determine the effectiveness of interventions aiming to increase exercise adherence to prescribed exercise programs in adults living with arthritis.

Methods: This study is part of a larger systematic review on the effectiveness of exericse adherence in people with a variety of chronic diseases. A literature search was conducted from 1947 to December 2010 using MEDLINE, EMBASE, PubMed, CINAHL, Academic Search Complete, IS Web of Science, PSYCInfo, SPORTDiscus, and Cochrane Database of Systematic Reviews using search terms related to chronic diseases and exercise adherence. Eligible studies for the current review included: participants 18 years and older with a diagnosis of arthritis; intervention(s) that aimed to improve adherence to a prescribed exercise regimen; a control or comparison group; and, measured exercise adherence as an outcome. Four independent assessors scanned titles and abstracts, performed data extraction and assessed study quality using the Pedro scale. The relative difference of exercise adherence was calculated for each study.

 

Results: The search strategy revealed 12,085 articles. Of the 68 eligible articles on exercise adherence interventions in chronic diseases, 13 articles from 12 studies involved patients with arthritis. Interventions varied from knowledge-based programs (ie. educational brochure) to motivational-based strategies (ie. social cognitive model). Of the 12 studies, 7 had a Pedro score >6, indicating high quality. Of the 4 studies in rheumatoid arthritis (RA), 3 were of high quality reporting a statistically significant difference in exercise adherence between the intervention and control groups (relative difference = 20.9%-66.7%). Six studies involved patients with osteoarthritis (OA), 4 of which were rated high quality, with only 1 reporting a statistically significant difference between groups (relative difference = 32.2%-106.3%). Two low quality studies included a mix of patients with OA and inflammatory arthritis; one reported a statistically significant result while the other did not provide sufficient data to determine statistical significance (relative difference = 42.1%-104.8%).

Conclusion:   Based on three high quality studies in RA, there is strong evidence supporting the effectiveness of exercise adherence interventions in this population. The evidence for OA neither supports nor disproves the effectiveness of interventions for this population as results among 4 high quality studies were mixed. The evidence was also unclear in mixed types of arthritis due to poor quality of the studies. Our results suggest that future research efforts on exercise adherence interventions should target those with OA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/effects-of-interventions-that-aim-to-increase-exercise-adherence-in-people-with-arthritis-a-best-evidence-synthesis/