BOOST/Project 2: Can Computer-based Telephone Counseling Improve Long-term Adherence to Strength Training in Elders with Knee Osteoarthritis?

Specific Aims

1.  To conduct a randomized trial to determine if, compared to a control group, knee OA participants randomized to TLC will have greater adherence to and participation in exercise over 2 years.

2.  To determine the association of function and pain at 1 year and 2 years with adherence to the exercise program at the same time points.

Significance

KRBaker-cropIf this intervention proves positive, since it is based in recorded scripts and software programs already, it may be disseminated easily and inexpensively to a large population.  Exercise leaders could be trained to lead the initial strength training class throughout communities and then participants could use the TLC system or other similar ones.  Significant effects may provide the evidence health insurers require to cover program costs.  If this program is proven effective over the long term, the impact on disability associated with OA could be tremendous.  Since exercise, including strengthening, has proven benefits in other rheumatic diseases, heart disease, and other chronic diseases, this project has implications for exercise treatment broadly in chronic disease.

Description

A multitude of studies have now shown that strength training is an effective treatment to improve pain and function in knee osteoarthritis (OA).  The 2008 OARSI guidelines recommend strength training for the management of knee OA and the CDC’s physical activity guidelines for 2008 recommend muscle strengthening exercises to be done 2 times per week in older individuals. Even with these recommendations less than 15% of individuals over the age of 65 report doing any strength training. In addition, poor adherence has been observed in long-term strength training trials.  We need to provide programs to motivate people first to engage and second to adhere to a strength training program.  In our project we will engage participants in strength training and motivate them to adhere over the long term using state of the art technology, telephone linked communication (TLC), which has been shown to improve adherence in other health behaviors.

We will examine the effects of a 2-year TLC strength training program on exercise adherence.  Participants in the study will start with a 1-month exercise class and will then be followed for 2 years from the end of the exercise class to assess how people follow the exercise regime.