| Abbott etal,29 2013; New Zealand. | 2 × two-arm RCT; knee or hip osteoarthritis; n = 206; 67y; 55% women. | Each intervention group participant attended 9 treatment sessions of 50min (7 sessions in the initial 9wk, 2 booster sessions at week 16) held by trained physiotherapists. IG1: manual physiotherapy to modify the quality and RoM of target joints and associated soft tissue; prescription of a home program to be completed 3 times/wk. IG2: exercise physiotherapy: supervised program of warm-up/aerobic, muscle strengthening, stretching, neuromuscular control; prescription of a home program to be completed 3 times/wk. IG3: combination therapy: combination of manual and exercise therapy. CG: usual care. Measurements: baseline, 9wk, 6mo, 1y. | Primary: WOMAC index. Secondary: pain, physical function (timed up and go test, 30-s sit to stand test, 40-m self-paced walk test), patient global assessment. | Individualized manual physiotherapy program, multimodal individualized supervised exercise physiotherapy program, and combination of both programs. Logbooks for home program. | Attendance of scheduled intervention visits. No logbook data for home program. | The intention to treat factorial analysis for all participants indicated a statistically significant difference between WOMAC scores at 1y for manual therapy vs no manual therapy, in addition to usual care (P = .030 adjusted, 0.027 unadjusted), but did not reach significance for exercise therapy vs no exercise therapy (P = .061 adjusted, 0.079 unadjusted). Secondary outcomes also showed consistent benefits favoring all 3 physiotherapy interventions in addition to usual care. Of the participants randomized to the 3 active intervention groups, 88.3% attended of at least 80% of scheduled intervention visits. |
| Aily etal,30 2023; Brazil. | Two-arm RCT; knee osteoarthritis; n = 100; 55y; 60% women. | CG: periodized circuit training delivered face-to-face by a single physiotherapist, in groups with up to 5 participants, 3 times a week, for 14wk; videos and exercise booklet to guide their continued independent exercise. IG: telerehabilitation; same periodized circuit training as CG, but remotely in an asynchronous model through video recordings via DVD, website, YouTube, or mobile app (WhatsApp). Logbook, provided materials for exercises, exercise booklet as in CG. Periodic 20-min phone calls by another physiotherapist (and investigator) in weeks 2, 3, 4, 6, 8, 11, and 14. Measurements: at weeks 0, 14, and 26. | Primary: pain and disability. Secondary: physical function, knee extensor strength, thigh composition, body composition, muscle architecture, and pain catastrophizing, adherence. | Telerehabilitation with remote exercises, videos; logbook; phone calls to motivate and instruct; identify possible difficulties; monitor progress; and check symptoms and functional capacity. | Number of sessions reportedly completed. | There was a marked reduction in pain severity and improvement of physical function by week 14 in both groups. The estimate of the between-group difference for pain was –3mm (95% CI, –12 to 5); for physical function − 1 point (95% CI, − 2 to 0). The telerehabilitation format was not inferior to the face-to-face format. At 26wk, the marked difference of pain severity and physical function were maintained. At baseline pain severity measured in means (SD) on the VAS (mm) as 67 (SD 17) in IG and 68 (19) in CG; at week 26, pain severity was 12 (15) in IG and 21 (24) in CG. The mean number of sessions performed per week at week 26 was 3.6 (SD 1.3) in IG and 2.9 (SD 0.8) in CG. |
| Allen etal,78 2018; United States. | Three-arm RCT; knee osteoarthritis; n = 350; 65.3y; 71.7% women. | IG1: IBET, encouragement to complete strengthening and stretching exercises 3 times/wk, aerobic exercises daily, for 12mo. IG2: PT with home exercise program and PT visits 0–8× 1-h sessions. CG: wait list for 12mo. | Primary: pain, stiffness, function (WOMAC) at 4mo. Secondary: pain, physical function, self-reported PA (PASE), self-reported minutes per week of stretching, strengthening and aerobic exercise, and participants’ global assessment of change at 4 and 12mo. Intervention delivery: number of days logged into the website and number of PT visits. | IBET with tailored exercises on OA, exercise progression recommendations, automated reminders, progress tracking; comparison to supervised exercise-based PT; monetary compensation in all groups at each time point. | PASE, weekly minutes of exercise. | No significant difference between groups at 4 or 12mo for WOMAC total: −3.36 (95% CI, −6.84 to 0.12), P = .06 in IG2, −2.70 (95% CI, −6.24 to 0.85), P = .14 in IG1 (difference in baseline to 4mo vs CG). Intervention delivery: 80% logged into the website between baseline and 4mo, 81% logged in between 4 and 12mo; number of PT visits was 5.7. No significant differences in PASE scores between groups (difference in baseline to 12-mo IG2 vs CG: 7.11 [95% CI, 9.69 to 23.91], P = .41; IG1 vs CG: 7.02 [95% CI, 10.31 to 24.35, P = .43]; PASE in CG: 1.17, IG1: 8.19, IG2: 8.28). Weekly minutes of aerobic activity: difference in baseline to 4 mo vs CG: 1.09 [95% CI, −0.61 to 2.8), P = .21 in IG2; 1.89 (95% CI, 0.15 to 3.62), P = .03 in IG1. Weekly minutes of stretching and strengthening significantly different. |
| Ang etal,79 2013; United States. | Two-arm RCT; fibromyalgia; n = 216; 45.9y; 95.5% women. | Two individualized supervised exercise sessions and instruction for home exercises: initially 10–12min/session, 2–3d/wk, then gradually increase to 28–30min/session, 3–4d/wk. IG: additional 6 sessions of telephone-delivered MI over a 12-wk period. CG: additional 6 sessions of telephone-delivered FM-relevant education over a 12-wk period. | Primary: frequency and duration of PA, physical impairment. Secondary: functioning, FM-related symptoms, pain, MVPA, and depression. | Individualized supervised exercise sessions, MI according to an MI handbook and evaluated by the MITI method. | Hours per week of PA (CHAMPS survey questionnaire); FIQ and FIQ-PI; accelerometer; and 6-min distance walk test. | Primary outcome: at the 6-mo follow-up, there were no significant differences in the percent of IG and CG participants who reported an increase of ≥30min/wk in MVPA (IG 54% vs CG 53%, P = .89). Secondary outcomes: 6-mo follow-up: more self-reported h/wk of PA in IG vs CG (2.2 [0.2] vs 1.3 [0.2], P = .01); no significant differences of accelometry-based PA (min/wk); IG walked 43.9 (6.3) m farther from baseline compared with 24.8 (6.3) m for CG (P = .03) in the 6MWT. No significant results for other clinical outcomes. |
| Bagg etal,31 2022; Australia. | Two-arm RCT; chronic low back pain; n = 276; 45.9y; 50% women. | IG: Graded sensorimotor retraining; 12 individual 1-h treatment sessions by physiotherapists within 12–18wk; participants were encouraged to complete a home treatment component 30min 5 times/wk during treatment period. CG: sham procedure by physiotherapist, 12 1-h sessions within 12–18wk, no advice or education, sham low-intensity laser therapy; home training component with a sham cranial electrical stimulation device to be used for 30min 5 times a week; diary. Measurements at baseline, 18, 26, and 52wk. | Primary: pain intensity. Secondary: disability, quality of life, depressive symptoms, sleep quality, beliefs about low back pain, kinesiophobia, catastrophizing, pain self-efficacy, and treatment rational credibility. | Intention of graded sensorimotor retraining was to help people in pain understand that it was safe and helpful to move (step 1: pain education using graphical media, video, metaphor, narrative), feel safe to move (step 2: graded movement treatments, sensory precision training, mental rehearsal of movement), and experience that it was safe to move (step 3: graded movement training toward more complex exercises). | Attendance of participants at each treatment session. | Between baseline and 18-wk follow-up, mean pain intensity decreased from 5.6 to 3.1 in IG and from 5.8 to 4.0 in CG (estimated mean difference, −1.0; 95% CI, −1.5 to − 0.4; P = .001). Compared with participants in the control group over 18wk, participants in IG had significantly improved disability, quality of life dimensions questionnaire, health thermometer, back beliefs, kinesiophobia, pain catastrophizing, and pain self-efficacy scores. The median (IQR) number of sessions attended was 12 (12–12). In total, 119 participants (86.2%) attended at least 9 sessions of the test intervention and 121 (87.7%) attended at least 9 sessions of the control. |
| Baker etal,24 2020; United States | Two-arm RCT; knee osteoarthritis; n = 104; 65y; 81% women. | Initial 6-wk group exercise, twice/week, booklet: BOOST home exercise program, ankle weights, exercise logs. IG: TLC phone calls, weekly (first 6mo) then monthly (remaining 18mo). IG and CG: monthly automated phone messages as reminder for training and completing exercise logs, for 24mo. | Primary: exercise adherence. Secondary: pain, physical function (functional performance assessments, quadriceps and hamstring strength). | Motivational TLC (assessment of exercise behavior, goal setting, messages to overcome barriers, information on lapsing, alerts to study team in case of exercise lapse > 4wk) based on social cognitive theory, self-efficacy, TTM; exercise logs; and booklet. | Adherence scale 0–10 on a questionnaire (0–3 no adherence, 4–10 adherence). | No significant difference between groups at 24mo, adherence scale IG: 3.63 (95% CI, 2.70–4.56), CG: 4.01 (95% CI, 3.03–4.99), P = .57. |
| Bendrik etal,32 2021; Sweden. | Two-arm RCT; hip or knee osteoarthritis; n = 141; 60y; 73% women. | IG: advice and prescription group; advice: 1-h session of information (oral and printed) about osteoarthritis, PA and weight control; individually tailored advice about PA: aerobic exercises 3 times/wk (walking or cycling) for at least 30min, muscle strengthening activities daily (eg,use stairs). Written PA prescription (individual patient-centered dialog; type, form, frequency and dose of PA) and 4 follow-up appointments (at 3wk and 3mo: by phone or in-person visit; also at 3mo: 1-h group booster session about OA and PA; at 6mo: individual 1-h follow-up visit) CG: advice-only group. Measurements at baseline and 6mo. | Activity minutes per week, leisure-time PA, sitting time, 6MWT, pain, disability (HOOS) and KOOS, quality of life, 30-s chair-stand test, maximal step-up test, 1-leg rise test, accelerometer (PA, sedentary time), and diary (form, duration, and intensity of PA). | Advice sessions with behavior change techniques of information and goal-setting discussion. Prescription of PA based on individual patient-centered dialog. Goal setting (behavior goal), action planning of PA (home-based or supervised as preferred), self-monitoring (diary), review of behavior goals, and graded tasks. Accelerometer. Individual follow-up visits (by phone or in-person) and booster sessions. | Activity minutes/week, light and MVPA (minutes per day), steps per day. | Self-reported activity minutes and leisure-time PA in both groups had improved at 6mo, whereas accelerometer assessed PA remained stable in both groups. There were no significant differences between groups in the 6MWT, in the 30-s chair stand test, maximal step-up test, or 1-leg rise test from baseline to 6mo. Pain intensity (VAS) after the 6MWT decreased significantly in the prescription group. Pain, other symptoms, ADL, sports/recreation function, and quality of life assessed with HOOS/KOOS, did not show any between-group differences from baseline to 6mo, but showed significant within-group improvements. Quality of life, assessed with EQ-5D, did not show any significant difference between groups from baseline to 6mo, but met the standard for clinical improvement in EQ-5D (value ≥ 0.08) in both groups. |
| Bennell etal,33 2016; Australia. | Three-arm RCT; knee osteoarthritis; n = 222; 63.4y; 60% women. | Ten individual PT sessions over 12wk, phone calls after intervention at weeks 22, 38, and 46. IG1: PCST, 45-min sessions, plus daily training at home, after 12wk as needed; IG2: combination PCST/exercise, 70-min sessions; IG3: exercise, 25-min sessions, 4 times/wk at home, after 12wk 3 times/wk. | Primary: knee pain, physical function; secondary: pain, quality of life, PASE, self-efficacy, pain catastrophizing, coping strategies, depression, anxiety, stress, global change, quadriceps strength, physical function, walking velocity, and cost-effectiveness. | Pain education and training in cognitive and behavioral PCST; combination of PCST with exercise; and logbooks and phone calls to discuss progression and adherence (all participants). | Participant’s treatment-session attendance, logbook. | Postintervention at 12wk: no significant difference between groups concerning pain intensity (VAS overall pain in IG3 31.8 [22.3], IG1 33.2 [22.3], IG2 26.4 [18.4]) or WOMAC function (IG3 19.2 [10.1], IG1 23.5 [10.6], IG2 15.4 [9.2]), but proportion of participants with improved pain is increased in IG2 (IG1: 62%, IG2: 83%, CG: 62%), significant improvement of WOMAC function in IG2 vs IG1 or IG3. At week 32 (not 52): IG1 significant greater improvement compared to IG2 (PASE 39.6 [72.4; 6.9] difference change between groups, P < .05). Home exercise adherence was significant higher in IG3 vs IG2 at 12wk (84% [23%] vs 76% [29%], P = .03), no significant differences between groups at follow-ups. |
| Bennell etal,34 2017; Australia. | Two-arm RCT; knee pain; n = 168; mean age 62y; 63% women. | IG1and IG2: 6mo with 5 × 30-min PT sessions including home exercises 3×/wk according to usual care standards. IG1 only: additionally 6–12 telephone coaching sessions over 6mo using the HealthChange (behavior change) methodology. | Primary: knee pain intensity, physical function. Secondary: pain when walking, quality of life, PA, and adherence measures. | HealthChange methodology used in IG1: parallel to PT sessions, participants received telephone calls based on MI, solution-focused counseling, and cognitive behavioral therapy. It includes effective information exchange, individualized goal setting and support converting intention into action and maintenance. Accelerometer. | (1) Number of attended PT and telephone coaching sessions and (2) number of completed home exercise sessions (self-report). | Primary outcome NRS at 6mo: 3.1 (2.2) (IG1), 3.8 (2.3) (IG2), WOMAC function at 6mo: 14.7 (10.6) (IG1), 18.2 (11.7) (IG2). Adherence to PT sessions was significantly better in IG1 compared to IG2 group sessions (IG: mean 4.4, SD 1.2; IG2: mean 4.3, SD 1.4, P < .05). Mean adherence to telephone coaching sessions in IG1 was 5.4 (SD 2.0). Adherence to home exercise sessions was significantly better in IG1 compared to IG2 (69% vs 55%) during 6-mo intervention (mean difference 14%; 95% CI, 4 to 24), but was not significantly different during months 6–12 or months 12–18. Self-rated home exercise adherence using NRS was 7.4 in IG1 vs 5.7 in IG2 (95% CI) during intervention, but was not different during months 6–12 (IG1 4.1; 95% CI, 3.3 to 4.9 vs IG2 3.9; 95% CI, 3.1 to 4.7; mean difference 0.2; 95% CI, 20.8 to 1.3), or months 12–18 (IG1 3.8; 95% CI, 3.1 to 4.6 vs IG2 3.6; 95% CI, 2.9 to 4.4; mean difference 0.2; 95% CI, 20.8 to 1.2). |
| Bennell etal,35 2017; Australia. | Two-arm RCT; knee osteoarthritis; n = 148; 61.2y; 56% women. | IG: 3 internet-delivered treatments: (1) educational material, no time schedule; (2) PCST (PainCOACH) in eight 35- to 45-min sessions once per week and daily practice of PCST; and (3) seven 30- to 45-min Skype sessions with a physiotherapist in weeks 2, 3, 4, 6, 8, 10, and 12, to prescribe home exercises 3 times/wk. CG: educational internet-delivered material only (same as in IG). Intervention for 3mo, follow-up at 9mo (6mo after intervention). | Primary: overall pain, physical function. Secondary: knee pain, global change, quality of life, self-efficacy, pain catastrophizing, use of coping skills to manage pain, number of attended PCST and exercise sessions, logbooks for adverse events. | Internet-delivered educational material; internet-delivered PCST (PainCOACH), weekly generic email reminder for 8wk, then monthly; internet-delivered home exercises; Skype sessions with PT; pedometer (optional); and monetary compensation (all participants). | Number of sessions attended (PainCOACH, Skype); self-reported number of home exercises and daily PCST sessions (percentage of total prescribed sessions); and self-reported adherence to home exercise on NRS scale. IG only. | Home exercise adherence and exercise sessions completed measured in IG (95% CI): mean self-rated home exercise adherence during treatment 7.9 (7.4–8.5), during follow-up 4.7 (3.9–5.5). Mean home exercise sessions completed during treatment (3mo) 68% (60–75), during follow-up (9mo) 47% (39–56). Online education during treatment: 78% IG vs 88% CG, during follow-up: 42% IG vs 57% CG. Primary outcome: pain during walking (NRS) in IG vs CG, means (SD), at baseline 6.1 (1.4) vs 6.2 (1.3), at 3mo 3.3 (2.2) vs 5.1 (2.0), at 9mo 3.6 (2.2) vs 4.7 (2.5). Pain (change between groups baseline to 3mo; baseline to 9mo): 1.6 (0.9 to 2.3), P < .001; 1.1 (0.4 to 1.8), P = .003. Physical function (change between groups baseline to 3mo; baseline to 9mo): 9.3 (5.9 to 12.7), P < .001; 7.0 (3.4 to 10.5), P < .001. |
| Bennell etal,36 2020; Australia. | Two-arm RCT; knee osteoarthritis; n = 110; 62.3y; 67.2% women. | Participants who completed the TARGET trial (5 PT sessions in 12wk) were included in the ADHERE trial: unsupervised home exercise program for 24wk, 3 times/wk. IG: automated semiinteractive SMS messaging, up to 5 SMS/wk, for 24wk. CG: no SMS messaging. | Primary: adherence to home exercises (EARS), number of days home exercises. Secondary: adherence to home exercises 3 times/wk, knee pain, other symptoms, function, quality of life, self-efficacy, kinesiophobia, pain catastrophizing, PASE, and global overall change. | Face-to-face meeting with PT, paper-based instructions for exercise, optional logbook, and text-messages based on Behavior Change Wheel. | EARS, number of days home exercises/week. | Significant results at 24wk (IG vs CG) for adherence to home exercises: EARS 16.5 (SD 6.5) vs 13.3 (SD 7.0), mean difference 3.1 (95% CI, 0.8 to 5.5), P = .01; exercise days per week 1.8 (SD 1.2) vs 1.3 (SD 1.2), mean difference 0.6 (95% CI, 0.2 to 1.0), P = .01. Participants that did not perform home exercises in the past week: 23% (IG) vs 35% (CG); home exercises on 1d: 8% vs 20%; home exercises on 2d: 29% vs 22%; home exercises on 3d: 40% vs 24%. |
| Bentsen etal,80 1997; Sweden. | Two-arm RCT; chronic low back pain; n = 74; 57y; 100% women. | IG: dynamic strength back exercise at fitness center (30min, twice a week) together with home training program for 3mo, then home training for 9mo (3 exercises, 10 times, daily). CG: home training program for 12mo. | Disability, sick leave, use of analgesics, physical condition, use of health care service, adherence. | Fitness center training before home exercises. | Fitness center and home training program adherence. | IG vs CG: 70% vs 38% completed the home training for 1y. Significant improvement of disability at 3mo (P < .02) and 12mo (P < .02) in IG, CG only at 3mo (P < .02). Significant improvement of disability between groups only at 12-mo follow-up (P < .05), but not at 3mo. |
| Berdal etal,81 2018; Norway. | Two-arm RCT; rheumatic diseases; n = 389; 57.5y; 70.5% women. | IG: traditional rehabilitation program; self-management booklet; goal setting conservation before and after rehabilitation, and during follow-up telephone calls; 4 telephone calls after rehabilitation and after 1, 3, and 5mo. CG: only traditional rehabilitation program for 1–4wk. | Primary: health-related quality of life. Secondary: quality of life, health status, self-efficacy, pain, fatigue, global disease activity, and motivation for change. | Self-management booklet based on cognitive behavioral theory, goal setting conversations and telephone follow-up using motivational interviewing. | Adherence to rehabilitative treatment. | Quality of life was significantly better after rehabilitation at discharge in the IG vs CG (95% CI): 53.4 (50.9 to 55.9) vs 50.1 (47.7 to 52.5); effect 3.32 (0.27 to 6.37); P = .03. No significant differences between groups at 6 and 12mo. Adherence was not related to improved outcomes after rehabilitation. No significant differences for motivation for change (CG 8.0; 7.7 to 8.2 vs IG 8.1; 7.9 to 8.4, P = .37) and self-efficacy (CG 59.1; 56.5 to 61.8 vs IG 57.1; 54.3 to 59.9, P = .29) at discharge (or any other time point). |
| Bossen etal,82 2013; The Netherlands. | Two-arm RCT; knee or hip osteoarthritis; n = 199; 62y; 66% women. | IG: web-based program “Join2move,” BGA program, tailored weekly modules, self-paced 9wk in total, weekly personal messages, information about OA, lifestyle and videos, intervention months 0–3, and follow-up at 12mo. CG: waiting list for 12mo. | Primary: PA, physical function, self-perceived effect. Secondary: pain, fatigue, OA-related symptoms, quality of life, anxiety, depression, self-efficacy, pain coping, locus of control. | Web-based behavior graded activity, favorite recreational activity, goal setting, time-contingent PA objectives, tailored automated text messages or emails, accelerometer, activity diary. | Self-reported activity (PASE), number of weekly modules completed, daily average time spent in total activity. | Significant results for total PA (PASE) at 12mo IG vs CG (means, 95% CI): 174 (150 to 198) vs 153 (125 to 181); difference between groups 21.2 (3.6 to 38.9); ES 0.18; P = .02. Significant results for total PA (accelerometer min/d) at 12mo, IG vs CG (95% CI): 361 (317 to 406) vs 338 (291 to 384); difference between groups 24 (0.5 to 46.8); ES 0.19; P = .045. No significant differences in PASE between participants with or without accelerometer. Physical functioning and self-perceived effect: significant difference only at 3mo. |
| Brosseau etal,84 2012; Canada. | Three-arm RCT; knee osteoarthritis; n = 222; 63y; 68.9% women. | The RCT included 2 walking group IG and a CG. IG1 (WB) and IG2 (W) comprised a supervised walking group (3×/wk with 45-min aerobic phase), IG1 (WB) also included a behavioral intervention component (short- and long-term goal setting, educational component, monthly face-to-face counseling to support adherence), and an educational pamphlet; IG2 (W) included with supervised walking and educational pamphlet but not the behavioral component. CG: educational pamphlet only and self-directed walking. Measurements: at 3, 6, 9, 12, 15, and 18mo. | Primary outcome: quality of life. Secondary outcomes: clinical outcomes (mobility, pain, endurance), adherence, confidence, and self-efficacy. | All groups received pedometers and a log book. The IGs also received monetary compensation for walking sessions and completing assessments and the log book, the CG only for assessments and log book. IG1 (WB) also completed the behavioral component. | Number of walking sessions (in WB and W groups recorded by walking supervisor and self-reported in log book, in CG self-recorded in log book). Data were collected every 3mo. | There was no significant difference in number of walking sessions attended between the walking (IG1 and IG2) groups at any 3-mo time interval. There was a significant difference between the IG1 group (80.2% of sessions attended) and the CG (65.2% attended) (P < .012) at 3mo but not between the groups at months 3–12 (63.6% vs 53.5% 3–6mo, 53.4% vs 52.8% 6–9mo, 44.5% vs 49.0% 9–12mo). |
| Brus etal,85 1998; The Netherlands. | Two-arm RCT; rheumatoid arthritis; n = 55; 59.2y; 81% women. | IG: education program: four 2-h meetings in first month, reinforcement meetings at months 4 and 8, one training to proper execute physical exercises, encouragement to plan own regimen; measurements at 0, 3, 6, and 12mo. CG: brochure about RA. | Medication compliance, PA compliance, disease activity, physical function, psychological function, pain, social activities, and RoM. | Education program (compliance to medication and PA) with short PA training, planning of own exercise regimen including discussion and feedback from training instructor. | PA times/wk, minutes per session. | Medication compliance (sulfasalazine) was not significantly different at following time points (means [SD]): 91% (12) in IG vs 87% (22) in CG at 3mo, 82% (22) vs 82% (28) at 6mo. After 12 mo, compliance rates were 89% (16) in IG and 84% (21) in CG. Time spent on PA was significantly greater at 3mo (change between 0 and 3mo) in IG (30 [45]min/wk) vs CG (4 [56]min/wk), P < .05; no significant differences between 0–6mo (27 [81] vs 32 [119]) and 0–12mo (20 [79] vs −7 [33]) for time spent on PA. |
| Chen etal,25 2020; China. | Two-arm RCT; knee osteoarthritis; n = 161; 68.9y; 92.5% women. | IG: TTM-based exercise program, three 2-h group activities with education and exercise over 2wk, printed home exercise guidance. Then individualized and reversible distribution into 2 subgroups (preaction stage and action stage) with group activities every 4wk, until week 12; 2 review sessions at weeks 4 and 12; follow-up at 24wk. CG: 3 home exercise guidance sessions at weeks 0, 1, 2 and 2 review sessions (same as IG) at weeks 4 and 12; printed home exercise guidance; recommendations: 30- to40-min exercises on at least 3d/wk. Follow-up at 24wk. | Primary: exercise adherence. Secondary: self-efficacy, decisional balance, OA symptoms, physical function. | TTM-based exercise program, printed education manuals, phone calls, and WeChat. | Self-rated adherence to the prescribed home exercise program. | No significant difference in exercise adherence score in IG vs CG at weeks 4 and 12, but significantly better at week 16 (IG vs CG, means [SD]) (7.07 [1.70] vs 5.26 [3.10]), week 20 (6.74 [1.68] vs 5.07 [2.70]), and week 24 (7.58 [1.29] vs 5.0 [1.53]); P < .001. The intragroup comparison at different time points showed that the adherence scores of both the intervention group (F = 9.877, P < .001, partial η2 = .370) and control group (F = 29.858, P < .001, partial η2 = .690) were statistically different over 24wk. Significant differences also in exercise self-efficacy, decisional balance scores, pain intensity, joint stiffness, lower limb muscle strength at 24wk. |
| Christensen etal,37 2015; Denmark. | Three-arm RCT; knee osteoarthritis; n = 192; 62.5y; 81% women. | CAROT study (Influence of WL or Exercise on Cartilage in Obese Knee Osteoarthritis Patients Trial). All participants entered an initial 16-wk intensive dietary therapy to induce major WL before randomization. IG1: dietary maintenance program for 1y, weekly 1-h sessions (52 sessions in total), weekly weighing and provision of free formula product to consume once daily. IG2: exercise program, 3-d/wk, consisting of a warm-up phase (10min), a circuit-training phase (45min) and a cooldown/stretching phase (5min); 4 periods of 12wk, and 1 period of 4wk (52wk in total). Gradually translation from supervised facility-based exercises to unsupervised home-based exercises. CG: usual care, no additional attention after first 16wk of dietary therapy. After 52 wk optional active intervention program. Measurements at baseline, 16wk, and 68wk. | Primary: pain (VAS), number of patients responding (OMERACT-OARSI responder). Secondary: KOOS subscales (pain, other symptoms, function in daily living, function in sport and recreation, knee-related quality of life), health-related quality of life (SF-36), radiographs, anthropometry, physical function (6MWT). | Gradually translation from supervised facility-based exercises to unsupervised home-based exercises over a 1-y period. | OMERACT-OARSI responder. | All 3 randomized groups, but especially the dietary group, succeeded in maintaining WL after 1y of maintenance therapy, statistically significant interaction between group and time (P < .0001). After 68wk, the dietary maintenance program was more effective in maintaining lower body weight than both the exercise group (difference − 4.7kg; −7.4 to −2.1kg; P = .0005) and the control group (difference − 2.7kg; −5.4 to −0.1kg; P = .043). Across groups, all patients had a reduction in VAS pain after 68wk (P = .03; within-group analyses). The observed OMERACT-OARSI success rates were 50% (38%–62%) for the diet group, 41% (29%–53%) for the exercise group and 52% (39%–64%) for the control group. |
| Crossley etal,38 2015; Australia. | Two-arm RCT; PFJ osteoarthritis; n = 92; 55y; 50% women. | All participants: 8 treatments with a trained project physiotherapist, 60-min sessions, once weekly for 4wk, then once every 2 wk for 8wk. Encouragement for regular PA, logbooks. IG: PFJ-targeted exercise, education, manual therapy and taping program; tailored on strength, pain, swelling, and co-morbidities (goal was to keep pain ≤2 on VAS10); prescription of home exercise program, to be performed 4 times/wk, exercise manual. CG: OA-education intervention (based on Arthritis Victoria patient information sheets), control for the patient–therapist interaction and psychosocial context, discussion only. Measurements at baseline, 3, and 9mo. | Primary: global rating of change, pain (VAS), ADL (KOOS subscale = physical function WOMAC subscale). Secondary: pain, symptoms, sport and recreation, quality of life (all KOOS), and adherence. | Physiotherapy tailored on each participant’s clinical presentation and the presence of co-morbidities. | Completion of home exercises (adherent participants completed at least 3 home exercises/week, 75%). | The intervention program in IG resulted in more people being much improved (20/44) than the OA-education control group (5/48) at 3-mo (relative risk 4.31; 95% CI, 1.79 to 10.36). IG participants reported significantly greater reductions in pain (VAS) than those in CG (mean difference: −15.2mm; 95% CI, −27.0 to − 3.4). However, there were no significant effects on physical function as measured using the KOOS-ADL (5.8; −0.6 to 12.1). IG participants reported significantly greater reductions in KOOS-pain than those in the OA-education group (6.0; 95% CI, 0.1 to 12.6). At 9mo, results were no longer statistically significant. Adherence with home exercises was recorded by 24 (77%) participants. |
| de Rooij etal,39 2017; The Netherlands. | Two-arm RCT; knee osteoarthritis; n = 126; 64y; 75% women. | IG: exercise therapy, 20-wk individualized (tailored) knee OA exercise program, 2 sessions of 30–60min/wk, under physiotherapist supervision, muscle ST of lower extremity, aerobic training, training of daily activities. Diagnostic phase: extensive 1-h procedure, comorbidity-related adaptations to exercise therapy. Exercises were adapted by changing frequency, intensity, timing, type, and adding educational or coaching strategies. Monitoring of comorbidity-related symptoms and clinical parameters. Encouragement to perform exercises at home at least 5 times a week. CG: usual care. Waiting list for 32wk, then exercise intervention was offered. Measurements at baseline, 10, 20, and 32wk. | Primary: physical function (WOMAC), 6MWT. Secondary: serious adverse events, pain (NRS, WOMAC), physical function (SF-36, patient-specific functioning scale, walking questionnaire, climbing stairs questionnaire, rising and sitting down questionnaire, and physical performance), moderate-intensity PA (LAPAQ), fatigue, muscle strength, psychological functioning, frailty, global perceived effect, and knee-specific variables. | Exercise therapy program tailored to comorbidities. | Completion of home exercises. | On average, participants performed their home exercises 4 times/wk (SD 1.1) during the trial. Significant differences over time between groups were found for WOMAC-physical function (B = −7.43; 95% CI, − 9.99 to −4.87; P < .001) and the 6MWT (B = 34.16; 95% CI, 17.68 to 50.64; P < .001) in favor of the intervention group. There was a significant difference over time between groups, in favor of the intervention group for pain and the majority of physical functioning measures, as well as for fatigue, muscle strength, PA, and frailty. |
| Friedrich etal,40 1998, Friedrich etal,41 2005; Austria. | Two-arm RCT; low back pain; n = 93; 44.1y; 51% women. | IG: exercise program with 10 prescribed 25-min exercise sessions, 2–3 sessions per week, recommendation to exercise daily at home and after program; motivation program in 5 interventions. CG: exercise program (same as in IG). Follow-ups at 4 and 12mo (Friedrich etal40) and 5y (Friedrich etal41). | Primary: disability, working ability, and pain intensity. Secondary: physical impairment, motivation, and compliance. | Motivation program with counseling and information, reinforcement techniques, treatment contract, and exercise diary. | Number of treatment sessions attended, training frequency and duration. | Significant differences between groups regarding disability, working ability, pain intensity, improved physical impairment at 12mo and 5y; 81.8% of IG participants attended all 10 treatment sessions, 51% of CG participants. At 4mo, home exercise adherence was not significantly different, but weekly training frequency was significantly increased in IG at 12mo (4.0 [1.9] vs 3.1 [2.2]d/wk); no significant difference between groups at 5y regarding regularly performed exercises: number of years exercises were performed regularly in IG: 3.5 (SD 2.0) and CG: 4.4 (SD 2.2), P = .134. |
| Gialanella etal,86 2017; Italy. | Two-arm RCT; neck pain; n = 94; 58y; 89% women. | Stretching exercise program consisting of 10 individual sessions with a physiotherapist, spread over a 2-wk period (5d/wk), encouragement to exercise regularly at home, written and illustrated material. IG: home-based telemedicine program for 6mo: fortnightly scheduled phone calls and unscheduled phone calls as needed. CG: only recommendation to continue exercising at home. Measurements at baseline, 15d, and 6mo after exercise program. | Pain severity, NDI, neck RoM, comorbidity, and adherence. | Phone calls (physician-directed, nurse-managed telemedicine program) for data collection, advice on solutions for persistent pain and symptoms of exacerbation, postural education, number of prescribed exercises, specific exercises to focus on, use of an orthopedic neck collar, pharmacological interventions, and encouragement. | Self-reported exercise session per week. | At 6mo, pain VAS score was 3.9 in IG (1.8; 95% CI, 3.4 to 4.4) and 5.1 (1.9; 95% CI, 4.6 to 5.7) in CG; NDI score was 12.6 (6.5; 95% CI, 10.6 to 14.5) in IG and 17.1 (6.8; 95% CI, 15.1 to 19.1) in CG. Significant compared to baseline (P < .001) and between groups at 6mo (P = .001) for pain and NDI. 15d after initial exercise program, 94% of patients of both groups performed 2–7 exercise sessions at home. Percentage of patients performing 2–7 exercise sessions at home was 87.2% in IG vs 65.9% in CG at 6mo. Adherence to home exercises (≥5 sessions per week) at 15d was 48.9% in IG vs 46.9% in CG, at 6mo 42.6% in IG, 29.8% in CG. Percentage of patients not performing any exercise sessions at home was 2.1% in IG vs 25.6% in CG at 6mo. Adherence to home exercises had a significant but weak relationship to phone surveillance, pain score, NDI, and patient’s opinion on the home exercise program. |
| Gilbert etal,42 2018; United States. | Two-arm RCT (randomization stratified by diagnosis OA/RA); knee osteoarthritis, rheumatoid arthritis; n = 340 (n = 155 for OA, n = 185 for RA); 63.1y for OA, 54.8y for RA; 60% women for OA, and 84% women for RA. | IMPAACT IG: initial visit with an index physician for PA counseling, encouragement to work toward or maintain 30min/d of moderate-intensity PA; one individual in-person counseling for 45–60min with a health care specialist (nurse or therapist), then in-person or by telephone meetings for 10–15min at months 3, 6, 12, 18, and 24; additional meetings via telephone, email, or other means were encouraged, but optional. CG: only initial visit with an index physician for brief PA counseling and encouragement. | Primary: change in self-reported physical function, analyzed separately for OA and RA, over 24mo. Secondary: self-reported pain, PA, and health status. | Individual counseling (motivational interviewing, individualized goal setting, tailored strategies for increasing PA, and monitoring progress); accelerometer. | Average daily minutes of nonsedentary PA (≥100 counts per minute) and moderate-vigorous PA (≥2020 counts per minute). | For OA participants, WOMAC function scores were significantly different in IG compared to CG: 14.39 (95% CI, 12.75 to 16.03) vs 16.60 (95% CI, 15.11 to 18.10), P = .049, over 24mo total; WOMAC pain scores were 4.80 (95% CI, 4.29 to 5.31) and 5.50 (95% CI, 5.00 to 6.00), P = .051, respectively. For RA participants, no differences were measured in HAQ function: 0.38 (95% CI, 0.30 to 0.45) in IG, 0.38 (95% CI, 0.28 to 0.47) in CG, P = .99; or in pain. Daily activity minutes were not significantly different between groups at all time points, for OA participants (IG vs CG): 494.11 (95% CI, 474.03 to 514.20) vs 480.11 (95% CI, 463.14, to 497.08), P = .288; and RA participants (IG vs CG): 482.10 (95% CI, 470.52 to 493.68) vs 483.99 (95% CI, 470.83 to 497.14), P = .832. Daily MV minutes were not significantly different for OA patients (IG vs CG): 15.85 (95% CI, 13.62 to 18.09) vs 16.41 (95% CI, 14.10 to 18.72), P = .680; RA participants: 14.16 (95% CI, 11.72 to 16.60) vs 12.25 (95% CI, 9.78 to 14.71), P = .067. |
| Häkkinen etal,43 2004; Finland. | Two-arm RCT; rheumatoid arthritis; n = 61; 49y; 62% women. | IG: minimally supervised home-based ST for 24mo: initial 3 training programs were held in the rheumatology unit; participants were instructed to exercise twice a week; intensity and technique of exercises were checked at 6, 12, 18, and 24-mo follow-up visits. CG: participants were instructed to perform range-of-motion and stretching exercises twice a week; no initial training program; and no follow-up visits. After 24-mo measurement, participants were instructed once to perform strength exercises; no follow-up visits. All participants were encouraged to perform recreational PA 2–3 times/wk. Five-year follow-up measurement. | Muscle strength, physical function, and association of training compliance with changes in physical function. | Initial training program at rheumatology unit; follow-up visits to check on exercise intensity and technique; training diaries. | Time spent on PA (minutes and number of exercise trainings per week). | ST compliance averaged 1.4–1.5 times/wk in IG within 2-y training period. The time spent with PA was 245 (115) min/wk for IG and 195 (104) for CG at 2y; 237 (147) and 223 (131) at 5y. Twenty IG participants from IG and 12 from CG reported intensive exercises at 5y. Ten IG participants and no CG participant exercised in the gym at 5y. The mean (SD) muscle strength indices at the 2-y assessment were in favor of the IG patients (287 [90] kg in IG vs 230 [93] kg in CG, P = .025). Knee extension strength increased by 59% (P < .001) and 31% (P < .001) at 2y in the IG and CG, respectively; 49% and 29% at 5y. Strength of all assessed muscle groups were in favor of the IG at 5y. Physical function, mean walking speed, and stair-climbing times are significantly improved in the IG compared to CG after 2y. At 5y, intensity of training was associated with the strength index (r = .34, P = .01), but not with time used for PA. |
| Haugmark etal,87 2021; Norway. | Two-arm RCT; fibromyalgia; n = 170; 42y; 94% women. | Three-hour patient education and oral information program for all participants. IG: VTP, 7–12 patients in each group, 10 weekly 4-h sessions plus a booster session at 6mo, held by physiotherapists and nurses. PA counseling, 12-wk program by physiotherapist. CG: treatment as usual: no organized intervention, participants were free to attend any treatment and activity at their own initiative. Measurements at baseline, 3mo (after VTP), and 12mo. | Primary: PGIC. Secondary: pain, fatigue, sleep quality, psychological distress, tendency to be mindful, PA, motivation and barriers for PA, work ability, quality of life, overall health. | VTP: various topics (eg,Who am I/My resources and potentials/Values), various creative methods (eg,music, drawing, poetry), logbooks, sharing of experiences with other participants. Mindfulness meditation, gentle yoga exercises. PA counseling based on individual motivational interviewing, individual and group PA, tailored goals, identifying and overcoming barriers, guiding through exercises. | PA was assessed by 3 questions from the Nord-Trøndelag Health Study (frequency, intensity, and duration of leisure-time PA, weekly PA). | The median PGIC score was 4 (range 1–7) in both groups at 3-mo and 12-mo follow-up. There were statistically significant differences between the groups in distribution of the PGIC scores at 3-mo follow-up (P = .01), but not at 12-mo follow-up (P = .06). There were no statistically significant differences between the groups at 12-mo follow-up in any disease-related outcomes. |
| Hinman etal,28 2020; Australia. | Two-arm RCT; knee osteoarthritis; n = 175; 63y; 63% women. | $A50 gift voucher for completing all questionnaires. IG: one phone call from the Australian Musculoskeletal Help Line. Additionally, 5–10 consultations via phone with a physiotherapist over 6mo, physiotherapists were trained in HealthChange Methodology. Action plan: 5–6 exercises were chosen from 14 to be performed 3 times/wk at home. Information folder, exercise bands, access to website for exercise videos. CG: one phone call from the Musculoskeletal Help Line. Measurements at baseline, 6, and 12mo. | Primary: pain (NRS), function (WOMAC). Secondary: pain (WOMAC), pain on walking (NRS), self-efficacy on pain and function, fear of movement, PA (PASE), behavioral determinants of exercise, benefits of PA, quality of life, global changes, and satisfaction. | Phone call from Musculoskeletal Help Line providing information about OA, treatments and self-management strategies, community resources, assistance navigating services, emotional support and care escalation when needed. Phone calls from physiotherapists who offered person-centered exercise-based care using theoretically informed behavioral change techniques (HealthChange Methodology). Action plan for exercises, information folder, exercise bands, exercise videos (website). | Participants and physiotherapists recorded adherence to PA using NRS. | Primary outcomes: At 6mo, evidence of a between-group difference in change in function favored IG (4.7 units; 95% CI, 1.0 to 8.4) but there was no evidence of a difference in pain (0.7 units ; 0.0 to 1.4). There were no between-group differences at 12mo. Between-group differences in adherent participants were evident and favored IG. Participant-rated adherence (NRS) to PA plan was 7.8 (2.6) at 6mo and 6.1 (3.29) at 12mo. Physiotherapist rating of participant adherence to overall program was 7.7 (1.8) at 6mo (not assessed on 12mo). Secondary outcomes: At 6mo, IG demonstrated a greater reduction in pain on daily activities (1.2 units; 95% CI, 0.2 to 2.1) and pain on walking (1.0, 0.1 to 1.8), and a greater increase in pain self-efficacy (−1.2, −1.8 to –0.6). At 12mo, IG participants also reported a greater increase in PA (−31, −60 to –1). |
| Hughes etal,44 2004; United States. | Two-arm RCT; osteoarthritis; n = 150; 73.6y; 84% women. | IG: Fit and strong!-PA and behavior change program, 90-min sessions 3 times/wk for 8wk (24 sessions in total), first 60-min resistance training and fitness walking, then 30-min group discussion-educational component, Book (The Arthritis Helpbook). Graduation ceremony at 8wk. Goal for maintaining exercise after program: minimum of 3d/wk for a total of 30min/d (90min/wk). CG: book as in IG, list of exercise programs in the community, self-care materials and handouts, waitlist for 24mo. Measurements at baseline, 2 and 6mo. | Self-efficacy for arthritis self-management, exercise adherence self-efficacy, adherence, functional lower extremity muscle strength, 6-min distance walk, osteoarthritis index. | Group discussion with education-behavior change component to enhance self-efficacy for exercise adherence, goal setting, feedback, Jensen and Lorish process model for patient–practitioner collaboration (therapeutic relationship with discussion and negotiation about goals and beliefs, iterative problem solving, performance records shared weekly); tapes of music, postintervention exercise contract, log diary, The Arthritis Helpbook, graduation certificate. | Attendance during intervention, self-reported daily walking distance, repetitions completed, time spent exercising (min per session), heart rates, number of times/wk of exercise. | (1) IG participants attended 18.9 (4.3) sessions of the intervention program, 70% of IG participants attended at least 75% of the sessions. (2) Number of minutes of exercise per week was 148.8 in IG vs 72.9 in CG (P = .006) at 6mo, IG participants increased their minutes from 100.2 at baseline by 48.5%. (3) Self-efficacy for exercise was significantly higher in IG vs CG at 6mo (P < .05) (means, SD): 7.9 (2.5) vs 5.9 (2.8). (4) No difference for exercise adherence efficacy. (5) No difference for timed stand. (6) Six-minute walk distance was significantly higher in IG vs CG (396.9m vs 331.8m; P = .018), IG distance increased by 13.3% compared to baseline. (7) Osteoarthritis index at 6mo between groups was significantly decreased in pain and stiffness scores, but not for physical function (improvement only within IG group). |
| Hughes etal,45 2006; United States. | Two-arm RCT; osteoarthritis; n = 215; 73.4y; 83% women. | Same as above. | Same as above; pain. | Same as above. | Same as above. | (1) Same as above. (2) Number of minutes of exercise per week was 210.5 in IG vs 115.7 in CG (P < .01) at 12mo, IG participants increased their minutes from 135.3 at baseline by 55.6%. Effect size of 0.713 at 6mo, 0.669 at 12mo for minutes of exercises per week. (3) Self-efficacy for exercise was significantly higher in IG vs CG at 6 and 12mo (P < .01), effect sizes of 0.783 at 2mo, 0.798 at 6mo, and 0.905 at 12mo. (4) Significant differences (P < .01) favoring the treatment group at 6 and 12mo on the Self-Efficacy for Adherence Over Time measure, effect sizes of 0.760 at 6mo, and 0.705 at 12mo. (5) No difference for timed stand, low effect sizes. (6) No difference for 6-min walk distance. (7) Osteoarthritis index for pain improved significantly at 6mo (P = .04); no difference at 12mo, effect size 0.20. (8) Significant difference for pain at 6mo, borderline significance at 12mo; effect sizes of 0.246 at 6mo, and 0.187 at 12mo. |
| Hughes etal,88 2010, Desai, 89 2014; United States. | 2 × two-arm RCT; osteoarthritis; n = 419; 71.1y; 87% women. | All participants: “Fit and strong!”—PA and behavior change program, 90-min sessions 3 times/wk for 8wk (24 sessions total), including 30-min group discussion; goal for follow-up PA was to maintain 20min of each flexibility, aerobic and resistance training at a minimum of 3 times/wk (180min/wk). IG1: “negotiated participants,” individualized follow-up plan for PA maintenance that reflects the participants’ preferences for type, time, and location for PA; with TR: 2 phone calls per month in months 3–6, one phone call per month between months 7 and 18, 10–20min per call. IG2: “negotiated participants,” no TR IG3: “mainstreamed participants,” follow-up existing group/facility-based best-practice program, 1h 3 times/wk; with TR IG4: mainstreamed participants, no TR Measurements: baseline, 8wk, 6, 12, and 18mo. | Primary: PA maintenance Secondary: pain, stiffness, physical function, muscle strength, functional exercise capacity, body mass index, depression Process evaluation: barriers to exercise, decisional balance, stage of change. | Group discussion: problem solving and education (to facilitate arthritis symptom management, self-efficacy for exercise, and commitment to lifestyle change), individualized PA plan; signing a maintenance contract at a graduation ceremony; TR: TTM and MI principles, monitoring PA participation, providing strategies for setting goals, solving problems, and reinforcing progress. | Caloric expenditure and frequency of all and moderate activity (self-report, CHAMPS questionnaire). | Caloric expenditure was maintained at highest level in IG1, followed by IG2 and IG3, lowest in IG4 compared to baseline; caloric expenditure for all PA in IG1 was significantly improved at all time points, 24.8% increase at 2mo, 21.2% increase at 18mo vs baseline. Frequency of all PA was significantly increased in IG1 at 6 and 12mo. WOMAC pain, stiffness and physical function improved significantly at all time points; significant improvement at muscle strength (timed stand) and functional exercise capacity (6-min walk distance) at all time points; no difference on BMI; significantly lower depression scores. Difference by TR: no significance in WOMAC scores, muscle strength, functional exercise capacity, BMI, depression Process evaluation: IG3 participants reported fewer barriers, little change for IG1 and IG4, more barriers for IG2. Decisional balance improved among IG3, little change for IG1 and IG4, scores declined for IG2. Stage of change: IG2 showed most improvement, followed by IG3, little change for IG1 and IG4. TR dose not statistically significant on barriers, decisional balance and stage of change. |
| Hurley etal,90 2015; Ireland. | Three-arm RCT; chronic back pain; n = 246; 45y; 67.9% women. | The RCT included a walking group (IG1), an exercise class group (IG2) and a CG; all treatments were delivered by PTs and all participants received a copy of “The Back Book”; principles of cognitive behavioral management were included in the PTs’ approach. IG1 (walking program): 8-wk individualized walking program and educational walking booklet plus pedometer with the aim to achieve 5 × 30-min walks per wk. Participants were also requested to complete a walking diary. IG2 (exercise class): 8 wk of weekly 1-h exercise classes based on “Back to Fitness” program. CG: usual PT (on average 5 PT sessions). | Primary outcome: change in lower back pain functional disability. Secondary outcomes: average pain over the last week, quality of life, psychosocial beliefs, PA, self-efficacy, stage of behavior change, adherence. | IG1: individualized walking program, education on back pain, pedometer, diary, self-assessment of breathlessness to guide walking intensity, weekly telephone calls. IG2: group-based exercise classes at local hospital offered once a week; short- and long-term goal setting in exercise diary. | Adherence was defined as participating in ≥4wk of walking program and achieving 70% of walking aim (IG1), attending ≥ 4 exercise classes (IG2) or attending ≥4 treatment sessions with PT. | Number of contacts with PT was significantly higher in IG1 (mean 6.4, SD 2.2) compared to the other groups (IG2: mean 4.7, SD 2.6; CG: mean 3.6, SD 1.9) but there was no significant difference in weeks of treatment. Adherence rate was highest in IG1 and lowest in CG (significantly. not reported). Adherence overall rate with the protocol was 79.9% in IG1, 62.3% in IG2, 48.0% in CG. Participants’ mean weekly walking volume increased by 31%, from 126.8min (675.9) at week 1 to 165.9 (6111.5) min at week 8 (mean difference 39.1, 95% CI, 26.6 to 104.9min); in IG1. |
| Janik etal,46 2024; France. | Two-arm RCT; chronic low back pain; n = 136; 39.5y; 45% women. | Multidisciplinary program for all patients over 4 wk, 5 d each week, 140h of care, exercise sessions by kinesiologist and physiotherapist. IG: Multidisciplinary program plus educative program, 1-h sessions (3 sessions mandatory, 2 sessions optional). CG: Multidisciplinary program only. Measurements at baseline, 3, and 6mo. | Pain, impact of pain on different activities, physical disability, muscle endurance and flexibility, motivation, level of PA. | Education program with mandatory sessions (motivation, management of daily life, PA) and optional sessions depending on anxiety/depression or sick leave/unemployment (management of stress and emotions, professional project). | Level of PA was collected through a structured interview (no PA, weak, moderate, high level). | There is no significant difference for PA motivation between groups. At the end of intervention, a significant decrease of pain intensity was measured, compared to baseline values (P < .001); at 6-mo follow-up, the 2 groups presented no significant difference. At 3mo, 91% of IG patients and 77% of CG patients participated in regular PA (high, moderate or low levels). At 6-mo follow-up, the practice of PA level was homogeneous between groups; 82% of the participants maintained regular PA. |
| Jönsson etal,91 2018; Sweden. | Intervention study with reference group; osteoarthritis; n = 264; 63y; 61% women. | Physiotherapist visit for all participants. IG: minimal intervention: informational program combined with individually adapted exercise. Optional: PT-supervised exercise class, twice a week for 6wk (12 times in total) or home exercise program, 1 or 2 daily exercises, few minutes each day. Individual PT visit at 3mo. CG: reference participants were told not to make any lifestyle changes; standard care; individual PT visit at 3mo and offer for education and supervised exercise, switch to IG. Measurements: at baseline, 3 and 12mo (12mo only intervention group). | Primary: PA and sedentary time. Secondary: pain, quality of life, arthritis self efficacy, comorbidity. | BOA: combined peer- and healthcare professional-delivered information and individually adapted exercise. Information sessions about OA and exercise, barriers, incorporation of PA in daily life, self-management strategies to reduce symptoms; optional session with person affected by OA talking about personal experience of living with OA and nonsurgical interventions. Free choice to exercise or not, to exercise at home or in supervised class. Personal visit from a PT, focus on how to incorporate PA continuously in daily life. Accelerometer, daily activity log. | Daily minutes of sedentary, low activity and moderate-vigorous activity; self-reported time spent in aquatic and cycling activities; compliance to intervention and supervised exercise. | 19% of IG participated in 10–12 supervised exercise sessions, 16% participated 7–9 times, 28% participated 1–6 times. Moderate-vigorous PA was significantly increased at 12mo compared to baseline in IG (not at 3mo in IG or CG): 34 (22–52; n = 141) daily minutes at baseline, 34 (19–52; n = 129) at 3mo, 32 (18–52; n = 110; P = .026) at 12mo; reference group no values at 12mo. No significant differences between groups at 3mo. Pain was significantly reduced at 3 and 12mo compared to baseline in IG, not in CG (no 12mo values); quality of life was significantly reduced at 3 and 12mo; self-efficacy was significantly reduced only at 3mo. Although participation in the intervention arm of this study achieved pain relief and increased self-efficacy and quality of life, it did not decrease sedentary time or increase PA time. |
| Karlsson etal,92 2014; Sweden. | Two-arm RCT; neck pain; n = 57; 41y; 100% women. | IG (STRENGTH): 3 instruction session, then at home program of progressive and periodized ST for neck and shoulder muscles, mostly with dumbbells; goal for the first 8wk was 3 sets of 20 repetitions for each exercise, then up to a year increasing dumbbell weight and adjusted repetitions. Stretching exercises same as in CG, 3 times a week. CG (STRETCH): stretching of neck, shoulder, chest, and arm muscles; 3 times a week. Follow-up at 4–6mo and 12mo. | Primary: pain intensity, function Secondary: RoM in the neck, neck strength, and shoulder strength. Main interest: adherence. | Exercise diary based on long-term and short-term goals; telephone and email support every 4–8wk. | Number of exercises per week. | Adherence was low: IG: number of exercises at 4- to 6-mo follow-up: 1.5–2.5 times a week, at 12mo 1.5 times a week or less. CG: at 4- to 6-mo follow-up: 2 times a week, at 12mo 1.5 times a week or less. Pain and function at 4–6mo and 12mo compared to baseline: no difference between groups. Within both groups significant increases in neck and shoulder strength (NDI change of +4 in both groups) and decreases in pain (NRS of 1–2 in both groups). |
| Kloek etal,47 2018; The Netherlands. | Two-arm RCT; hip or knee osteoarthritis; n = 208; 63y; 68% women. | IG: e-Exercise intervention over 12wk, 5 face-to-face sessions with trained physical therapist, online application focusing on behavioral graded activity, exercises and information, based on the Dutch OA guideline. Session 1: selection of 1 type of PA and 4 strength and stability exercises, online 3-d baseline test to assess physical load ability. Session 2: discussion of baseline test, used to formulate short- and long-term goals. Session 3 (week 6): online progress reports. Session 5 (week 12): maintenance of PA was discussed and supported. CG: usual physical therapy according to Dutch OA guideline with information, physical exercise, and strength and stability exercises. Measurements at baseline, 3 and 12mo. | Primary: physical function (HOOS, KOOS), PA (questionnaire and accelerometer ActiGraph, ActiGraph GT3x). Secondary: HOOS- and KOOS-subscales (pain, symptoms, sport/recreation function, quality of life), change in OA symptoms, pain, tiredness, self-efficacy, adherence (website usage). | e-Exercise online application with 3 modules: graded activity to meet individual short-term goals; video-supported strength and stability exercises; videos and information about OA, pain and weight management, motivation and social influences on pain. Weekly automated emails, weekly reminders to evaluate assignments, automatic tailored feedback. | Sessions attended. Percentage of adherent participants (number of participants who completed at least 8 of 12 e-Exercise modules were classified as “adherent”). PA (moderate and vigorous activity) in minutes per day. | After 3mo, no statistically significant differences were seen between e-Exercise and usual physical therapy for the primary outcome measures of physical functioning and PA and the secondary outcome measures. Within the usual physical therapy group, significant improvements were seen for physical functioning, the Timed “Up & Go” Test, subscales of the HOOS and the KOOS (pain, sport, and quality of life), the NRS for pain, and self-efficacy (subscales pain and symptoms). Within the e-Exercise group, significant improvements were seen for physical functioning, subjective PA, pain (NRS and HOOS/KOOS), tiredness, and self-efficacy (subscales pain and symptoms). At the 12-mo follow-up, no statistically significant differences were seen between groups for the primary outcome measures. For secondary outcome measures, a significant difference was seen on changes in sedentary behavior. 73 (81.1%) of IG participants completed at least 8 of 12 modules and were classified as “adherent.” |
| Knittle etal,48 2015; The Netherlands. | Two-arm RCT; rheumatoid arthritis; n = 78; 62.7y; 67% women. | IG: education session about PA with a 5-step plan to increase PA in week 1. One-to-one motivational interview for 45min in week 2. Two one-to-one self-regulating coaching session for 40–60min each in weeks 4 and 5. Follow-up phone calls for up to 20min in weeks 6, 12, and 18. Recommendation at each time point was 30min of moderate-intensity PA on 5d of the week (5 × 30 recommendation). CG: same education session as in IG in week 1, no further invention. Measurements at baseline, 6wk, and 32wk. | Primary: leisure-time PA Secondary: self-efficacy, autonomous motivation, RA disease activity, functional status, depressive symptoms, fatigue. | Motivational interview (weighing of pros and cons of engaging in PA, individual lifestyle links, long-term goals); exercise diary; 2 self-regulating coaching sessions (to enhance fidelity of intervention delivery, review and feedback of exercise diary, short-term goals, barrier identification and problem solving, activating social support, self-reward, use of reminders); phone calls (discussion of efforts in self-regulating PA). | Minutes per week of PA; days per week engaged in at least 30min of moderate-intensity PA over the past month. | Significant results with small to large effect sizes at 6mo: leisure-time PA (minutes per week): 303 (294) min in IG vs 212 (285) min in CG, effect 84 (95% CI, −2.9 to 170.9), effect size 0.29, P = .022; days per week with at least 30min of PA: 4.3 (1.6) in IG vs 3.4 (1.6) in CG, effect 1.2 (95% CI, 0.49 to 1.91), effect size 0.75, P = .016; autonomous motivation: 6.1 (0.7) in IG vs 5.1 (1.2) in CG, effect 0.5 (95% CI, 0.24 to 0.76), effect size 0.51, P = .001; self-efficacy: 95.8 (41.8) in IG vs 82.9 (38.8) in CG, effect 19.0 (95% CI, 5.8 to 32.2) effect size 0.47, P = .008. A significantly higher percentage of participants in the intervention group (67%) met the 5 × 30 recommendation for PA than in the control group (23%) at 6wk, 48% in IG and 25% in CG at 32wk. Disease activity, function, depressive symptoms, fatigue not significant with small effect sizes. |
| Knittle etal,93 2016; The Netherlands. | Same as above. | Same as above. | Difference in the use of self-regulation skills between groups; which intervention target (use of self-regulation skills, autonomous motivation, and self-efficacy for PA) leads to initiation and maintenance of leisure-time PA; prediction of PA at follow-up and posttreatment. | Same as above. | Questionnaires. | IG reported significantly higher use of self-regulation skills than the CG at 6mo. None of the intervention targets had significant effects on the initiation of PA or maintenance of PA. |
| Krein etal,49 2013; United States. | Two-arm RCT; low back pain; n = 229; 51.6y; 88% men. | Participants are veterans. IG: study enrollment session, enhanced care group with weekly pedometer data upload and weekly email reminders to upload pedometer data; access to study website and computer discussion group/internet support group. Goal for walking was average step count in the prior week with a fixed number of steps (800) added. CG: study enrollment session as IG, usual care group with monthly pedometer data upload and monthly email reminders to upload pedometer data. Outcome measurements at baseline, 6, and 12mo. | Primary: pain-related disability (RDQ score) at 12mo Secondary: pain intensity, walking, pain-related fear-avoidance, self-efficacy for exercise. | Pedometer; website with automated goal setting and feedback, targeted motivational and informational messages, educational materials about back classes, body mechanics, good posture, exercises; e-community and forum with topics like mental health concerns, strategies for walking or alternative pain management strategies. | Number of steps per day. | RDQ score at 6mo significantly reduced between groups: 7.2 for IG vs 9.2 for CG (adjusted difference of 1.6; 95% CI, 0.3 to 2.8, P = .02) for complete case analysis; at 12mo these differences were no longer significant. Pain severity was reduced at 6 and 12mo, but difference between groups of 0.5 was not significant. Step count was increased in IG by 700 steps per day at 6mo, by 100–200 steps per day at 12mo, not significant (6mo IG vs CG: 5370.0 [3180.8] vs 4682.5 [2925.0], between group difference 725.5 [95% CI, −193.6 to 1644.7], P = .12; 12mo: 4681.8 [3000.6] vs 4758.1 [2991.1], between-group difference 122.4 [95% CI, −623.9 to 868.6], P = .75). Self-efficacy at 6mo was significantly less in IG compared to CG. Intervention engagement: IG participants uploaded pedometer data once a week for a median of 32wk (62% of the recommended time). IG participants logged into the website once per week for a median of 20wk (38% of the recommended time). |
| Lang etal,50 2021; Canada. | Two-arm RCT; low back pain; n = 174; 46y; 60.1% women. | IG: standard package of education and advice (The Back Book), personalized pedometer-driven walking program for a minimum of 5 consecutive days per week during the 12-wk intervention, weekly phone calls for 12wk to discuss individually tailored goals. CG: standard package of education and advice (The Back Book), no pedometer. Measurements at baseline, 12wk, 6, and 12mo. | Primary: disability Secondary: pain, time spent being physically active over the past 7d, fear-avoidance beliefs, back beliefs, PA self-efficacy, quality of life, adherence. | The Back Book; pedometer; weekly phone call to discuss progress, document daily step count and negotiate daily step targets for the subsequent week. | Steps per day, IPAQ questionnaire. | Disability score was significantly improved at 12wk for IG and CG, but not at 6 and 12mo (means with 95% CI): 20.5 (18.4 to 22.6) at baseline, 15.1 (12.9 to 17.4) at 3mo, 13.1 (10.9 to 15.4) at 6mo, 11.9 (9.3 to 14.4) at 12mo in IG; 21.2 (18.7 to 23.8), 18.8 (15.8 to 21.8), 16.8 (13.5 to 20.1), 16.7 (11.9 to 21.4) in CG, respectively. IG participants significantly increased their daily step count by an average of 2140 (SD 2894) steps at 12wk (34% increase from baseline). 81% of participants completed the consistent weekly step count increase at 12wk. No significant between-group differences for fear-avoidance beliefs, quality of life, self-efficacy, time spent physically active and back beliefs at any time point. |
| Lemstra and Olszynski,94 2005; Canada. | Two-arm RCT; fibromyalgia; n = 79 participants; 49y; 85% women. | IG: intervention led by rheumatologist, physical therapist, psychologist, dietician, massage therapist. 18 group supervised exercise therapy sessions, 2 group pain and stress management lectures, 1 group education lecture, 1 group dietary lecture, 2 massage therapy sessions; exercise sessions (aerobic exercises, treadmill, stretching, weight training). CG: standardized medical care consisting of the waiting list. Measurements at 6wk and 15mo. | Self-perceived health status, average pain intensity, pain-related disability, depressed mood, days in pain, hours in pain, prescription and nonprescription medication usage, work status. | Group exercise sessions, educational lectures, attendance monitoring, exercise therapist was supposed to create a social, nonintimidating environment for the patients; development of own management plan, realistic short-term expectations, identifying barriers. | Attendance at intervention program, phone questionnaire at follow-up. | Attendance adherence to the entire protocol was 90.56% (SD 1.72%) at intervention completion. 51% of the intervention group self-reported that they continued with their exercise program at least 3 times a week during the 15-mo follow-up period. Significant change in average pain intensity 1.02 (0.25) (IG) and 0.22 (0.20) (CG) after intervention completion (6wk), no significant change in average pain intensity: −0.21 (−0.80 to 0.38) at 15-mo follow-up in IG. |
| Li etal,95 2020; Canada. | Two-arm RCT; rheumatoid arthritis; n = 86; 55y; 91% women. | Delayed-control design: start of 8-wk intervention either immediately or delayed at week 10. Delay group (CG) monthly emails of arthritis news unrelated to PA. All study physical therapists (n = 11) received a 2-d training in motivational interviewing. In-person session with 20min of group education and 30min of individual counseling with physical therapist; wearable device to track steps, timing and intensity of activity (Fitbit Flex 2) and web-based app (FitViz); biweekly phone calls from physical therapist. Measurements at baseline, weeks 9, 18, and 27. | Primary: MVPA. Secondary: mean daily time in purposeful activity, mean daily time in sedentary behavior, average daily steps, McGill Pain Questionnaire, Fatigue Severity Scale, Partners in Health Scale, Patient Health Questionnaire, Self-Reported Habit Index. | Group education about benefits of PA and pain management. Motivational interviewing. Individual counseling with action planning approach (set individual goals and parameters on FitViz with automated personalized feedback, develop action plan, identify barriers and solutions). Biweekly phone calls to review progress and modify activity goals. | SenseWear Mini (multisensory monitor worn 24h a day, differentiates between sedentary, light, moderate and vigorous PA): time in MVPA. Attended sessions, phone calls, Fitbit use. | At 9wk, mean (SD) time spent in MVPA was 44.7 (41.2)min/d in the immediate group and 31.6 (32.4)min/d in the delay group. For secondary outcomes, we found a statistically significant adjusted mean difference in pain McGill Pain Questionnaire (–2.45 [95% CI, –4.78 to –0.13]). A trend favoring the immediate group was found in time spent in purposeful activity (0.5min/d [95% CI, –4.6 to 5.6]), daily steps (644.1 [95% CI, –103.8 to 1,392.0]), and time spent in sedentary behaviors (–10.4min/d [95% CI, –53.4 to 32.6]). The average intervention adherence in the immediate group was 98.3% for the education session attendance, 88.1% for the physical therapist phone calls, and 83.1% for Fitbit use. In all, 78% of participants met all 3 fidelity criteria. Adherence rates were similar in the delay group when participants received the program in week 10. |
| Lonsdale etal,26 2017; Ireland. | Two-arm RCT; low back pain; n = 255 patients, n = 53 physiotherapists; 45.3y; 54% women. | Training for physiotherapists: 1h, evidence-based PT care for chronic LBP; additional training for IG: 8h, communicational skills training (CONNECT training). IG: usual PT care from physiotherapist with CONNECT training. CG: usual PT care from physiotherapist without CONNECT training. Measurements at baseline and 1, 4, 12, and 24wk after first PT appointment. | Patient self-reported adherence to PT’s recommendations; proportion of specific rehabilitation exercise completed during previous week; leisure–time PA. PT reported patients’ in-clinic adherence. | Communicational skills training CONNECT (Communication Style and Exercise Compliance in Physiotherapy) for physiotherapists. | Rating scale for adherence (ARS); sessions completed/sessions prescribed; in-clinic attendance. | CONNECT training for physiotherapists had a weak positive effect on patient’s self-reported home-based adherence, mean difference between groups for overall adherence is 0.45 (95% CI, 0.12 to 0.78) with P = .01 and Cohen d = 0.31 (at week 24: Cohen d 0.28, P = .12). All other outcomes have low effect sizes that are not statistically significant, exemption: overall perceived competence to follow recommendations (mean difference between groups) 0.44 (95% CI, 0.19 to 0.69), P = .00, d = 0.77. Home-based adherence (ARS) at week 24 was 4.86 (1.92) in CG and 4.95 (1.98) in IG. No significant effect on proportions of specific back exercises completed at home or on PA, no effect on pain, function, satisfaction with treatment, quality of life. |
| Lorig etal,51 2008; United States. | RCT; osteoarthritis, rheumatoid arthritis, and fibromyalgia; n = 855; 52.2y; 90% women. | IG: internet ASMP, web-based instructions (The Learning Center), web-based bulletin board discussion (The Discussion Center); 6-wk program, log on at least 3 times for a total of 1–2h and participation in the weekly activities. CG: usual care with no intervention. Data collection at baseline, 6mo, and 12mo. | Quality of life measures (pain, fatigue, health distress, global health, activities limitation, health assessment); health-related behaviors (stretching and strengthening, aerobic exercise, use of cognitive symptom management technique, use of techniques to improve communication with health care providers); utilization measures (self-reported outpatient visits to physicians, emergency room visits, nights in the hospital, chiropractic visits, physical therapy); arthritis self-efficacy. | Website tools (exercise log book, medication diaries, tailored exercise program); Learning Center: individualized exercise programs by using cognitive symptom management, methods for managing negative emotions, an overview of medications, aspects of physician–patient communication, healthy eating, fatigue management, action planning feedback, methods for solving arthritis-related problems; interactive teaching: peer moderators assist participants with the program, model action planning and problem solving, offer encouragement and post to the bulletin boards (Discussion Center), monitor daily posts of all participants, email reminders to encourage nonparticipants to participate; arthritis helpbook with exercises. | Intervention completer group at 12-mo follow-up. | Of all participants, 78% (CG) and 72% (IG) completed 6-mo questionnaires, 82% (CG) and 71% (IG) completed 1-y questionnaire, 67% completed all 3 questionnaires; out of the 409 participants the mean amount of log ins was 31.6 (SD 24.5) times over 6wk (participants were asked to log in at least 3 times/wk). Four of the 6 health status variables had significant time–randomization interactions (health distress, activity limitation, self-reported global health, and pain); the time–randomization interaction for self-efficacy was also significant; no significant time–randomization interactions for health behaviors or health care utilization. |
| Mattukat etal,96 2014; Germany. | Two-arm RCT; rheumatic diseases; n = 307; 46.9y; 62% women. | Intervention within exercise rehabilitation therapy. IG: RAPIT program: intensive group exercise program, 4 times a week for 2wk, 90min of cycle ergometer, circuit training, sport games, 30min each; TMBC, PA booklet, written agreement signed by physiotherapist and patient and sent to attending physician. CG: conventional rehabilitation treatment. Measurements: baseline, after discharge (3wk), 6 and 12mo. | Primary: improvement of PCS (part of SF-36). Secondary: functional capacity (HFAQ), pain (NRS), psychological improvement (SF-36, HADS), physical activity (FPAQ), exercise motivation (Exercise Self-Efficacy scale), employment, cost. All at 12mo after discharge from rehab. | RAPIT program, TMBC, booklet (barriers, goal setting), written agreement, short questionnaire 4wk after discharge as aftercare impulse. | Exercise self-efficacy, perceived benefits of and barriers to regular PA. | Significant differences for PCS (higher in CG) and for everyday PA (more PA/FPAQ in IG) at 12mo. PCS in CG significantly higher than in IG at 12mo: 37.4 (SD 10.0) vs 35.7 (SD 10.4); P < .05; Cohen d = 0.21; effect −2.30 (95% CI, −4.35 to −0.25). FPAQ kcal/wk (CG vs IG): 2098 (SD 2846) vs 3394 (5642); Cohen d = 0.36; effect 1305 (95% CI, 314 to 2296). Exercise self-efficacy at 12mo (CG vs IG): 3.05 (SD 0.78) vs 3.22 (SD 0.81) Exercise motivation: exercise self-efficacy 0.33 (95% CI, 0.26 to 0.41), P < .001 at discharge. |
| Mayoux-Benhamou etal,97 2008; France. | Two-arm RCT; rheumatoid arthritis; n = 208; 54.7y; 90% female. | IG: educational program included 8 weekly, 5-h sessions for 8–10 outpatients (information about RA and its medical management, physical program). Then split into subgroups for workshops (1h each): (1) education on joint protection, footwear, splints; (2) practice of home-based exercise and aerobic exercises such as cycling; (3) aquatic training; and (4) relaxation training. Goal for home-based exercises was to practice at least 3 exercises each day. Meeting at 6-mo follow-up to reinforce the program. CG: usual medical care (could include individual physical therapy only if considered necessary by the attending physician). Follow-up measurements at 6 and 12mo. | Primary: compliance with home-based exercise program. Secondary: physical and psychological determinants of compliance and health changes (predisposing factors like educational factors, living along at home, Steinbrocker functional class, HAQ, 50-foot walk time, Baecke questionnaire, HADS anxiety score, HADS depression score, FACIT-F score, AHI coping score, AIMS physical subscore, AIMS psychological subscore). | Multidimensional educational 5-h training; booklet with home-based exercise program and PA recommendation, and for record keeping; information on guidelines for practicing PA; group discussion to enhance positive attitudes and beliefs, tailored advice and individual approaches to overcome barriers, incorporate PA in daily life, find enjoyable activities and to modify the program; reinforcement meeting at 6mo. | Level of leisure PA: proportion of self-reported mean weekly number of exercises to total number of exercises included in home-based program (baseline follow-up, Baecke questionnaire). | Compliance to home-based exercises at 6-mo follow-up was 13.5% participants in the IG and 1.1% in the CG (P = .002), the compliance rate being 15.8% (SD 24.9%) and 4.8% (SD (18.2%), respectively (P < .001). Leisure PA compliance was 28.2% in the IG and 13.8% in the CG at 6mo. Twelve months compliance to home-based exercise was only 7.9% in the IG and 3.4% in the CG (P = .19), the 12-mo compliance rate was 11.8% (SD 25.5%) vs 4% (SD 16%) (P < .001); leisure PA compliance was not significant different between groups at 12mo. Participating in the IG (P = .02), having a low baseline level of PA (P > .001), and having good psychological status (P = .004) were related to leisure PA compliance. |
| McCarthy etal,22 2004; United Kingdom. | Two-arm RCT; knee osteoarthritis; n = 214 participants; 64.9y; 60.2% women. | IG: home exercises program aimed at increasing lower limb strength and endurance and improving balance, plus 8wk of twice-weekly knee classes run by a physiotherapist (45-min circuit training). CG: home exercises program aimed at increasing lower limb strength and endurance and improving balance. Assessment before and after treatment and also at 6 and 12mo follow-ups. | Primary: assessment of locomotor function, using a timed score of 3 locomotor activities (walking, transferring, and stair time). Secondary: pain, self-reported disability, general health, lower limb strength, RoM and compliance with exercise; QALYs. | Group sessions, face-to-face interview for the assessments, compliance questionnaire. | Compliance questionnaire. | At 12mo, 41.6% of CG participants and 32.2% of IG participants did not perform any home exercises; 35.1% of CG and 41.4% of IG participants did home exercises between 1 and 3 times a week and 23.4% of CG and 26.7% of IG participants exercised 4–7 times a week. |
| Mikesky etal,98 2006; United States. | Two-arm RCT; knee osteoarthritis; n = 221; 69y; 58% women. | IG: ST; first 3mo participants were asked to train twice a week at NIFS and once at home, during the following 3mo, at least once per week at NIFS and twice at home, during months 7–9 two training sessions per month at NIFS and 3 workouts per week at home, in months 10–12, to train at NIFS only once each month and the remainder of workout sessions at home; after the first year, subjects returned to NIFS for strength testing and assessment of pain and function every 6mo. Basic workout structure (at NIFS and at home): general warm-up of walking for 5min, resistance training session, 5-min cooldown; 3 sets of each exercise with progression to greater resistance levels. Exercises booklets and videotape for home ST workouts. CG: RoM exercises, no external loading, each workout session (45min) had the same structure as the ST sessions: warm-up by walking for 5min, followed by flexibility exercises and a 5-min cooldown, the RoM group also began training at NIFS and gradually made the transition to home-based exercise on the same schedule as the ST group; exercise booklets. Measurements at baseline, 12, 18, 24, and 30-mo. | Pain, function, overall health status, level of depressive symptoms, radiographic outcomes, isokinetic strength. | Supervised training session by fitness trainer; computerized attendance check in for each session; contact by fitness trainer after missed workouts to resolve barriers; exercise booklets and a videotape for guidance; study newsletter, study T-shirt, buddy system, social gatherings on holidays; self-reporting of exercises at home. | Attendance recording with online check-in system during group sessions; self-reported exercise adherence for the home-based exercises. | Subjects in both IG and CG treatment groups only attended approximately half of the 24 exercise sessions scheduled during the 12wk of the study (49% in IG vs 46% in CG, P = .453), with renewed effort by the fitness trainer, adherence rates increased in both groups over the initial 12-mo interval during which facility-based workouts were scheduled (59% in IG and 64% in CG, P = .397); self-reported adherence to home-based exercise workouts over months 13–30 was similar in frequency to that measured during months 1–12 by the electronic surveillance system (56% IG and 62% CG). ST did not have a significant effect on changes in knee pain. By month 30, both treatment groups still had higher mean WOMAC functional limitation scores than at the onset of the study, indicating poorer function. However, a trend toward better function in the ST group than in the RoM group was observed (P = .088). |
| Moseng etal,52 2020; Norway. | Two-arm RCT; hip and knee osteoarthritis; n = 393; 63y; 71% women. | IG: SAMBA (Norwegian study title, “Collaboration for improved OA care”): group-based patient education program for 3h (education on OA and recommended treatments), PTs prescribed individually tailored exercise programs, the exercise period lasted 8–12wk, with 2 supervised weekly sessions, exercise doses were gradually increased toward 2–4 sets with 8–12 repetitions of 60%–70% of 1-repetition maximum to increase the resistance when the patient could perform 2 extra repetitions with the last set (“the 2+ principle”); the patients were encouraged to add a third home-based session consisting of 30- to 60-min cardiorespiratory exercise like brisk walking, running, or bicycling. CG: usual care. | Pain, physical function, stiffness, disease activity, hip/knee pain-related quality of life, knee injury and osteoarthritis outcome score, quality of life, daily hours spent in sitting position. | SAMBA model (patient education about OA, risk factors, symptoms, treatment, exercise, healthy eating/weight management, PA in daily living, self-management, to live with OA); reassessment/feedback with general practitioner after group sessions/individual sessions; group sessions; exercise diaries by participants; monitoring of the individual patients’ performance and adjusting exercise dose and degree of difficulty to facilitate progression. | (1) Attendance (exercising for >2 times/wk for >8wk). (2) exercise diaries by participants. | IG: 65% exercised >2 times/wk for >8wk, 43% self-reported having received physiotherapy once or more between baseline and 6mo; at both 3 and 6mo the intervention group reported marginally less pain (4.4 [SD 2.0] in IG, 4.7 [SD 2.2] in CG; P = .002) and disease activity and improved function compared to the CG, similar results were also seen for H/KOOS quality of life subscale, with marginally higher scores in the intervention group and slightly less time spent in sitting position at 3 and 6mo. |
| Munukka etal,99 2020; Finland. | RCT; knee osteoarthritis; n = 87; 64y; 100% women. | IG: small group sessions in PT-supervised lower limb aquatic resistance training lasting 1h, 3 times a week for 4mo (with a total of 48 training sessions), 3 resistance levels (barefoot, small fins, and large resistance boots), training intensity was set at “as hard and fast as possible” and was monitored using heart rate monitors. After intervention, participants were offered the possibility of participating in 2 sessions consisting of 1h of light stretching and relaxation during the 4-mo intervention period; CG: usual care. Follow-up: after intervention, participants kept a diary each day for 12mo (duration, type, and intensity of the activity) to determine MET-hours. Measurements at baseline, 4, and 12mo. | Pain, stiffness, physical functional, quality of life, role limitations due to physical problems, bodily pain, general health perception, vitality, social functioning, role limitations due to emotional problems and mental health. | Therapeutic aquatic exercises: (1) regular group sessions (with attendance recording), (2) activity monitor tracking and wearing, and (3) diary keeping. | (1) Group attendance; (2) training intensity measured using heart rate monitors, the rate of perceived exertion and repetitions completed per set; and (3) training diary for follow-up. | After 4mo of aquatic resistance training, there was a significant decrease in the stiffness dimension of WOMAC −8.5mm (95% CI, −14.9 to −2.0, P = .006) in the training group compared to the controls. After the cessation of the training, this benefit was no longer observed during the 12-mo follow-up. No between-group differences were observed in any of the SF-36 dimensions. |
| Murphy etal,100 2016; United States. | Three-arm RCT; hip or knee osteoarthritis; n = 193; 65y; 62% women. | All participants: home monitoring period before randomization, 7d, with accelerometer Actiwatch (Philiphs Respironics) and logbook for pain, fatigue, stiffness, wake, and bedtime. Tailored and General Activity Pacing intervention: 3 individual in-person sessions with occupational therapist, first session about 1h, second and third 30–45min each, 7–10d between sessions, learning module with objectives, exercises, homework activities. Monthly calls to assess health status (also all participants). IG1: Tailored Activity Pacing, individualized summary report from home monitoring period: personalized pacing schedule and recommendations, graphics, activity periods, comparison values relative to a sample of individuals with the same condition. IG2: General Activity Pacing, no information about home monitoring period. CG: usual care. Measurements at baseline, 10wk, and 6mo. | Primary: fatigue Secondary: physical function (6MWT, WOMAC disability and WOMAC pain), self-efficacy, activity pacing. | Tailored activity pacing, personalized pacing schedule based on home monitoring period. | Activity pacing subscale of the CPCI. | Of all primary and secondary outcomes, the only significant group difference between groups was for WOMAC pain in the model adjusted for covariates. Participants of the general activity pacing intervention had a significant decrease in their pain from baseline to 10wk; however, participants of the usual care group had decreased pain from baseline to 6mo. At 10wk and 6mo, participants of the pacing interventions had significantly higher reported usage of activity pacing compared to usual care. Average activity pacing (CPCI Pacing Score) for each treatment group at 6mo was 4.27 (1.60) in IG1, 4.17 (1.57) in IG2, and 3.43 (1.87) in CG. |
| Nelligan etal,53 2021; Australia. | Two-arm RCT; osteoarthritis; n = 206; 59.7y; 63% women. | IG: “My Knee Exercise Website” with information, specific strengthening exercise regimen and PA guidance, 24-wk strengthening plan, goal: 3 times/wk. “My Exercise messages” smartphone app with 24-wk automated messages. CG: “My Knee Education Website” with information on knee pain, knee OA, importance of exercise, and PA. | Primary: pain, physical function. Secondary: KOOS pain, function in sport and recreation, and knee-related quality-of-life subscales. | Website (education, 24-wk knee strength exercise plan (only IG), logbook), smartphone app with automated text messages (weekly exercise session diary, messages for reinforcement, barrier identification and behavior change, facilitator behavior change techniques, reminders, opt-out, special occasions, eg,birthdays, holidays). | Participant-reported number of days that knee exercises were performed during the previous week; Exercise Adherence Rating Scale. | Number of days participated in exercise for the knee in the past week (0–7d) at 24-wk follow-up: IG: 3.3 (1.9); CG: 3.1 (2.3). EARS (section B): IG: 15.3 (6.3); CG: 12.7 (6.0). Overall average knee pain (NRS) at baseline: IG: 6.3 (1.5); CG: 6.2 (1.5) and at 24wk: IG: 3.5 (2.2); CG: 5.0 (2.4). Physical function (WOMAC) at baseline: IG: 26.7 (11.8); CG: 25.0 (12.2) and at 24wk: IG: 16.6 (13.0); CG: 20.7 (13.9). Also: pain (KOOS, ASES). |
| Nour etal,101 2006; Canada. | Two-arm RCT; osteoarthritis and rheumatoid arthritis; n = 113; 77.7y; 90% women. | IG: 1-h weekly home visits by a practitioner for 6 consecutive weeks. CG: 1-y waiting list. Measurements: baseline, 8wk, and postintervention. | Pain intensity, fatigue and stiffness, optimism, mastery and self-efficacy, exercise, relaxation, leisure activities, everyday coping behaviors, accessibility of social networks (physical characteristics). | Cognitive-behavioral principles; weekly visits by healthcare practitioner to discuss goals and developing an action plan, education, information about exercises, strategies for positive attitude, better symptom control and energy saving. Each visit included a review of the previous visits and contract (ie,setting a weekly goal and developing an action plan), an exploration of a new topic (eg,stiffness and pain) and the formulation of a new personal contract. | Interview at 3 points in time: participants were asked to estimate the number of time per week they performed each activity (from 0 times/wk to 7 times/ wk). | Ninety-seven people completed postintervention measures (58 people in the IG and 39 in CG), this number represents 77.6% of the 125 participants in the initial sample; for weekly occurrence of exercise observed means indicated that control participants changed their weekly occurrence of exercise from 4.79 (SD 5.11) times/wk at preintervention to 5.64 (SD 5.81) times at postintervention whereas IG increased from 6.48 (SD 6.37) times/wk to 10.02 (SD 6.65); from preintervention to postintervention IG changed their weekly stretching frequently from 2.56 (SD 2.92) to 4.57 (SD 2.94) times a week whereas CG changed it from 2.06 (SD 2.80) to 2.30 (SD 3.00) times a week; between preintervention and postintervention a 3% decrease for CG and a 25% increase among CG for walking frequency; for weekly occurrence of relaxation activities, CG decreased from 6.23 times/wk (SD 6.86) at preintervention to 6.02 (SD 6.63) at postintervention whereas CG changed from 5.92 (SD 7.23) times/wk at preintervention to 6.66 (SD 8.03) at postintervention. |
| O’Dwyer etal,54 2017; Ireland. | Two-arm RCT; rheumatic ankylosing spondylitis; n = 40; 42y; 35% women. | IG: individually tailored, semistructured consultations with a physiotherapist, 30min, over 3mo, 3 areas were addressed: education (AS information booklet, PA guidelines: recommendation ≥150min of moderate-intensity aerobic PA per week), resources (programs, classes), goal setting (individual PA goals and action plans). Follow-up sessions in person or telephone to review PA behavior, progress, goals and to provide support were individually set. Weekly reminders of PA goals by text messages or email. Accelerometer ActiGraph over 7d at months 0, 3, and 6. CG: usual care. Measurements: baseline, 3, and 6mo. | Primary: PA (accelerometer) Secondary: physical fitness and anthropometry (body measurements and mobility), global well-being, disease activity, activities of daily living and functional ability, quality of life, self-efficacy, exercise benefits and barriers scale. | Motivational interviewing, partnership, and cooperation between physiotherapist and participant, behavior change techniques (goal setting, problem solving, action planning, self-monitoring, social support, information, behavior substitution). Weekly reminders (text messages, email). | MVPA (minutes/week). Proportion of participants who met PA guideline recommendation at 6mo. | There were large, statistically significant time-by-group effects for MVPA. In the intervention group, there were statistically significant differences in MVPA between baseline and postintervention at 3mo (P = .027), and between baseline and follow-up at 6mo (P = .029). At the end of the follow-up phase, there were significantly more participants in the intervention group meeting the PA guidelines than in the control group (IG = 14, CG = 3; P < .001). In the intervention group, there was a statistically significant difference in the quality of life score over time. There were no statistically significant time-by-group interaction effects for the other questionnaire outcomes. |
| Olsen etal,102 2022; Norway. | Two-arm RCT; hip osteoarthritis; n = 101; 63y; 79% women. | PE, inspired by national educational program (AktivA), monthly 3.5-h seminar by an orthopedic surgeon and a physiotherapist. IG: PE and BBAT. BBAT: 12 sessions in an open-group setting once a week, led by physiotherapist, 70min of guided movements, 20min of reflective talk regarding movement experiences. CG: PE only. Standard care. | Primary: pain, HOOS. Secondary: physical capacity, movement quality, self-reported health and function, self-efficacy. | PE: dialog with the participant, describing OA disease, treatment options, advice on benefits, weight regulation, and PA. BBAT: insight into movement habits, increase awareness of more varied and dynamically adjustable ways of moving, and provide tools to integrate purposeful movement strategies into daily life setting. | Compliance of BBAT (persons who attended at least 10 sessions). | The intervention participants attended a mean of 10 (SD = 2.1) BBAT sessions, ranging from 4 to 12. About 30 persons were found to be compliers of BBAT: No effect of the treatment was shown on NRS pain during walking and HOOS. In intention‐to‐treat analysis, effect of treatment was found only in movement quality, with a large effect size. This effect was somewhat stronger in per‐protocol analysis, in which we found effects in health (EQ-5D-5L VAS, P = .037), function (HHS, P = .029), and self‐efficacy (ASES pain, P = .049) with moderate effect sizes. |
| Pastor-Mira etal,103 2021; Spain. | Three-arm RCT; fibromyalgia; n = 157; 54.1y; 100% women. | IG1: MIIC: group motivational training session for 30min and postmotivational intervention session for 30min. IG2: IIC: information session about postural hygiene (as in CG) and postmotivational intervention session for 30min as in IG1. CG: Two sessions about postural hygiene: (1) information and (2) practice. Goal: MWP: for at least 30min in bouts of 15min, twice a week, over 6wk; SWP: at least 60min in bouts of 20min, 4 times a week, over 6wk. Measurements: university labs for baseline assessment (T1), 15-min group information session and 75-min intervention, follow-up measurement at 7wk (T2), 12wk (T3), and 36wk (T4). | Primary: self-reported adherence to minimum and standard walking program; walking behavior. Secondary: fibromyalgia impact, pain intensity, distress, physical function, participant’s expectations and satisfaction. | Motivational group training session: goal strengthening (IG1 and IG2); if-then plans (IG2); logbooks; pedometer. | Intention to walk (theory of planned behavior recommendations score); self-reported days and minutes of walking, duration of rests during activity; average steps per walking day. | MWP is explained by time (F3 = 8.47, P < .001), by IG1 (F1 = 3.72, P < .001) and by their interaction (F3 = 5.95, P < .001) as fixed effects, and by time as a random effect. Tukey post hoc contrasts showed significant differences (T = −2.24, P < .001). SWP was explained by time (F3 = 6.10, P < .001), by IG1 (F1 = 5.54, P < .001) and by their interaction (F3 = 3.48, P < .001) as fixed effects. Tukey post hoc contrasts showed significant differences (T = −2.29, P < .001) in time 2 (between the CG and the IG1). No significant effects for FM impact, pain intensity, distress. |
| Penninx etal,104 2001; United States. | Three-arm RCT; osteoarthritis; n = 250; 69.1y; 41.2% women. | IG1 (aerobic exercise program): 3-mo facility based walking program and a 15-mo home-based walking program, 3 times/wk for 1h (10-min walking and flexibility stretches and a 40-min period of walking). Six phone calls and 4 visits by exercise leader during months 4 and 6 to develop a walking exercise program in their home environment, additional phone calls (reminders) every 3wk (months 7–9) or monthly (months 10–18) IG2 (resistance exercise program): 3-mo supervised facility-based program with 3 one-h sessions per week, and a 15-mo home-based program (10-min warm-up and a cooldown phase and a 40-min phase consisting of 2 sets of 12 repetitions of 9 exercises: leg extensions, leg curl, step up, heel raise, chest fly, upright row, military press, biceps curl, and pelvic tilt, with dumbbells or cuff weights. CG: monthly group sessions during the first 3mo on education related to arthritis management including time for discussions and social gathering, later participants were called bimonthly (months 4–6) or monthly (months 7–18) to maintain updated and provide support. Data collection visits at 3, 9, and 18mo, telephone interviews at 6, 12, and 15mo. | Primary outcome: ADL disability measurements (self-reported disability assessed every 3mo during the 18-mo follow-up, at 3, 9, and 18mo posttrandomization, participants were invited for data collection visits. | Attendance registered by exercise leaders, regular phone calls, record keeping diary. | Exercise class attendance, exercise log book. | The cumulative incidence of ADL disability was lower in the exercise groups (37.1%) than in the attention control group (52.5%) (P = .02). Compliance with exercise declined over time, with an average of 85% compliance during the first 3mo, 61% for months 4–9, and 54% for months 10–18, with no statistical significant difference between exercise groups (resistance/aerobic exercise). The lowest ADL disability risks were found for participants with the highest compliance to exercise: those in the highest aerobic exercise compliance tertile (>78%) had the lowest risk of incident ADL disability of 0.38 (0.17–0.82), compared to the lowest compliance tertile (<30%) with risk of ADL disability of 0.77 (0.41–1.46). |
| Pignato etal,105 2018; United States. | Two-arm RCT; knee osteoarthritis, n = 259; 64.9y; 70.7% women. | IG1 (PT): intervention was modeled after standard care for patient with knee OA with an emphasis on active interventions and a home exercise program; the intervention was delivered by physical therapists in multiple clinics, based on typical range of outpatient PT visits for knee OA, participants could receive up to 8 one-h sessions during the initial 4mo of the study. IG2 (IBET): access to the IBET website with set program; assessment after 4mo. | Primary outcome: exercise adherence, secondary outcome: HCQs (WOMAC, exercise self-efficacy, social support for exercises, comfort with internet use), 2-min step test. | IBET: website with personalized and tailored exercise training, videos, email reminders. | Number of days logged onto the website, self-reported PA for home-based activity (PASE). | During the first 4mo, the mean number of days participants of the intervention group logged onto the IBET website was 20.7 (SD 24.6), median 9.5, during the 12-mo period, the mean number of days participants logged on was 40.5 (SD 59.8, median 10.5). In bivariate analyses for the IBET group, the following characteristics were associated (P < .15) with greater activity on the PASE Leisure Activity subscale: lower BMI, better scores on the WOMAC function subscale, better performance on the 2-min step test, higher social support for exercise, and higher SEE. |
| Pisters etal,23 2010; The Netherlands. | Two-arm RCT; hip and/or knee osteoarthritis; n = 200 patients; 65y; 77% women. | IG: 18 sessions of behavioral graded activity over 12wk and up to 7 booster sessions over the next year (weeks 18, 25, 34, 42, and 55 and 2 additional sessions in weeks 18 and 25); individually tailored exercises; recommendation for PA is moderate-intensity aerobic PA for a minimum of 30min on at least 5 d/wk or vigorous-intensity aerobic PA for a minimum of 20min on 3 d/wk or some combination of moderate- and vigorous-intensity activities (at least 450 MET-min/wk). CG: 18 sessions of usual care over 12wk; sessions were discontinued if according to physiotherapists all goals had been achieved, at week 12 advice to continue exercises. | Exercise adherence and PA (short questionnaire to assess health enhancing PA, SQUASH) at baseline, 13, and 65wk. | Behavioral exercise program (behavioral graded activity) with individually tailored exercises from a physiotherapist, education messages, activity diaries, performance charts during consultations. | Self-reported adherence to recommendations for home exercises and activities on a 5-point scale; PA (SQUASH): days per week, average time per day, effort for PA. | Number of adherent participants for exercises was 75% at week 13 and 59% at week 65 in IG and 44% at week 13 and 34% at week 65 in CG. Total PA (days per week with at least 30min of moderate to vigorous PA, means [SD]) was 5.6 (2.2) in IG and 4.2 (2.8) in CG at 13wk; 5.0 (2.6) in IG and 3.6 (2.9) in CG at 65wk. Adherence to recommended exercises was significantly higher in IG vs CG at 13wk and 65wk (4.3, 2.1–9.0 vs 3.0, 1.5–6.0), adherence to recommended home activities were significantly higher in IG at week 13 (3.1, 1.4–6.9) but no difference at week 65, IG performed at least 30min of walking on 1.6d (0.8–2.4) more than the CG at 13wk and on 0.7d (0.1–1.5) more at 65wk. |
| Ravaud etal,106 2009; France. | Two-arm RCT; knee osteoarthritis; n = 336; 64.3y; 74.6% women. | IG: 3 goal-oriented personal visits by a physician, first visit informing patients about the disease and treatment, second (day 15) and third (day 30) visits focused on only one component each exercise (3 sessions of 30min/wk progressively increased to 3 sessions of 60min/wk of rapid walking or cycling depending on the patient’s preference) and WL (strategy for losing and maintaining weight), also tailored counseling of patients to increase the odds achieving modification of behavior. CG: usual care with same amount of appointments. Measurements at baseline, 4, and 12mo. | Primary outcome: change in body weight and time spent on physical exercises (Baecke index) at 4mo. Secondary outcomes: evaluated during the follow-up visits to the rheumatologists (pain on movement during 48/h before the visits on a numerical scale, WOMAC, and SF-12). | Three goals-oriented visits by a physician for education, advice, information about exercise, pain, and body weight. Diary for exercise and weight. | Time spent on physical exercises (physical exercise in leisure subscale of the Baecke index; 0–5 scale). | Decrease in measured weights was greater in the IG at 4mo (mean change to baseline −1.11, SD 2.49kg) than in CG (mean change −0.37, SD 2.39kg), P = .007. Baecke index was greater in the IG (0.20 [0.56] vs 0.04 [0.78]. IG and CG did not differ in secondary outcomes apart from pain (mean −1.65 [2.32] vs −1.18 [2.58]) and global assessment of disease activity (mean −1.66 [2.26] vs 0 = −0.90 [2.48]). |
| Reilly etal,55 1989; United States. | Two-arm RCT; chronic low back pain; n = 40; no age declared; 50% women. | IG and CG: predesigned exercise programs, comprising flexibility, strength and aerobic exercises; subjects were told to adhere to the program 4 times/wk for 6mo for a total of 96 sessions, subjects were given the names of 3 comparably equipped health clubs they could attend. IG only: certified strength and conditioning specialist for 6mo (96 sessions), 4 times/wk. | Change in body measures, aerobic fitness, strength measurement, pain, pain relapses, completed sessions. | Certified strength and conditioning specialist who would monitor and work with each subject individually. | Class attendance monitored by health club staff. | Change in body measures: body weight was 162.15 (SD 26.1) in IG and 174.15 (SD 41.0) in CG; percent body fat was 24.00% (SD 5.4) in IG and 28.25% (SD 7.6) in CG, P = .05. Significant differences also in lean weight and fat weight. Aerobic fitness: resting heart rate was 70.05 (SD 3.3) in IG and 74.85 (SD 6.1) in CG, P = .01. Pain level was 33.5 (SD 11.3) in IG and 80.00 (SD 13.9) in CG. Completed sessions was 90.75 (SD 3.3) (87%) in IG and 31.95 (SD 17.2) (31%) in CG. |
| Rooks etal,56 2007; United States. | Four-arm RCT; fibromyalgia; n = 207; 49.8y; 100% women. | IG1–4: 16-wk program, 60min of activity per session; brief warm-up of walking on a treadmill (5min, then increase 2–4min weekly); final portion of each sessions for IG1 (AE) and IG2 (ST) involved flexibility for primary body movement, IG1 and IG2 met twice a week, written instructions provided to each participant. IG1: aerobic and flexibility exercise (AE), progression to a total of 45min of walking. IG2: ST, aerobic and flexibility exercises (ST), maximum of 20min of treadmill walking followed by 25min of ST movement, each participant started with 1 set of 6 repetitions at a resistance level the person could perform easily, 3 instructions sessions, resistance exercises progressed to 2 sets of 10 to 12 repetitions. IG3: arthritis foundation’s FSHC, 7 session program series of lectures (5–15min) with group discussions and supplementary readings, sessions were 120-min long every 2wk. IG4: combination of IG2 and IG3 (ST-FSH). | Primary outcome: change in physical function from baseline to completion of the intervention after 16wk (2 self-assessment instruments and 1 performance measure to quantify physical function (FIQ, change of 20% significant, SF-36, 6MWT). Secondary outcome: social and emotional function, symptoms and self-efficacy (VAS of the FIQ, bodily pain and vitality subscales of SF-36, beck depression inventory, ASES): all assessment manners were performed for all participants including upper and lower body strength tests for IG1 + 2. | Demonstrated exercises, regular supervised exercise classes, self-determined level of effort, regular group sessions with advice and discussion sessions. Self-help course. | Class attendance. | Attendance rates in all 4 intervention groups were 73% for group 1 (ST), 78% for group 2 (aerobic exercises), 77% for “FSHC”-group (self-help, CG), and 78% for “ST-FSHC” group (strength-aerobic-self-help, IG). Means (SD) after 16-wk intervention program (CG vs IG) for pain 5.9 (2.2) vs 4.9 (2.4); Physical function (SF-36) 49.3 (23.9) vs 59.1 (19.1); Bodily pain 37.9 (20.4) vs 47.4 (19.7); Self-efficacy (pain scale) 56.9 (21.2) vs 69.3 (17.9); Self-efficacy (other symptoms) 59.6 (18.3) vs 70.8 (14.9). |
| Shao etal,107 2021; Taiwan. | Two-arm RCT; rheumatoid arthritis; n = 224; 58.8y; 86% women. | IG: participation in a joint protection and PA self-management intervention for 8wk; instructions were provided in the rheumatology clinic of each participant and began with assessment of the patient’s living environment, goal setting (weeks 1–8), DVD (watch at introduction), self-monitoring and self-evaluations (weeks 1–8), peer story telling at introduction, 4 telephone calls at the end of the first, third, fifth, and seventh week of the program (discussion of problems, concerns with positive feedback). CG: standard rheumatology care only. Measurements: outcome was assessed at baseline, 2, 3, and 6mo. | DAS-28 score, self-assessments for self-efficacy (ASES), physical functioning (MHAQ), quality of life (SF-36), self-management behaviors (modified self-management scale by Hampson etal108 [1993] and Lorig etal61). | Self-management program; information about pain and other symptoms, PA and relief; goal setting; peer story telling; telephone calls (discussion of problems, positive feedback), DVD (self-management strategies) and recordkeeping booklet (goals, daily activities, symptoms, personal reactions). | Self-monitoring of PA with diary, questionnaire for daily activities (MHAQ). | When compared with the control group at 6mo, following initiation of the self-management program, participants in the IG demonstrated significantly greater improvement in physical functioning (B = 4.08), self-efficacy of pain (B = 4.89), self-management behavior (B = 4.65); IG: MHAQ (21.44; SD = 2.99), self-efficacy (41.76; SD = 6.23); self-management behavior (19.67; SD = 3.04); CG: MHAQ (24.75; SD = 8.28), self-efficacy (35.95; SD = 6.51), self-management behavior (17.45; SD = 3.97). |
| Sjöquist etal,109 2011; Sweden. | Two-arm RCT; rheumatoid arthritis; n = 228; 56y; 74% women. | IG: 1-year coaching program aiming at adopting PA of at least moderate intensity, 30min/d, ≥4d/wk. Individual sessions with physical therapists and personal coaches, lectures by a psychologist. Telephone support from the coach once monthly, 8–10 times in total. Activity logbooks. No coaching for following year. Goal: PA of at least moderate intensity, 30min/d, at least 4d/wk. CG: care as usual. Measurements: baseline, 1y, and 2y. | Primary: general health. Secondary: DAS-28, pain, activity limitation (disability), self-efficacy, outcome expectations for symptom decrease following PA, PA behavior (self-report questionnaire). | Information about benefits of PA, discussions about own body functions and possibilities for PA. Goal setting and documenting, obstacles and barriers were discussed, problem-solving strategies by personal coaches. Lectures by a psychologist about cognitive–behavioral theory and measures based on the techniques developed by Fordyce and stages of change. Monthly phone calls. Activity logbooks. | Self-report questionnaire. PA behaviour (low, intermediate: 1–3 times/wk, high: ≥4 times/wk). | Regarding the primary outcome, participants in the CG reported better general health perception (global VAS) at 2y than did participants in the IG. Analyses of the additional outcomes disease activity, activity limitation, self‐efficacy, and outcome expectations indicated no difference between IG and CG at 2y, except for pain (participants in the CG reported less pain at 2y than did participants in the IG). Analysis of PA behavior indicated no differences between the IG and the CG between baseline and 2y. |
| Skrepnik etal,110 2017; United States. | Two-arm RCT; knee osteoarthritis, n = 211; 62.6y; 50.5% women. | IG and CG: activity monitor (Jawbone UP 24) on wrist 24/7; 5 visits by the study team (screening and baseline; days −7 and 1), with follow-up visits at days 7, 30, and 90 (last visit). IG: regular follow-ups per standard of care (information about benefits of walking in a brochure available from the arthritis foundation) plus an unblinded wearable activity monitor and a mobile app called OA (daily and monthly activity trends available to participants); post adherence check at day 180. CG: regular follow-up plus blinded activity tracker (no access of data to the patient about activity tracking), standard of care instructions. | Primary outcome: mobility (steps per day). Secondary outcome: steps per day at each assessment visit (average of 7d period) and at day 90; 6MWT; satisfaction with treatment (PAM; questionnaires); sleep (activity tracker); VAMS assessment. | Smartphone app “OA GO” plus wearable activity monitor/pedometer; motivational messages and daily diary keeping, daily step goal (step count not concealed). | Activity monitor/pedometer. | Almost all IG patients (101/107) decided to continue using the OA GO app and entered the 90–180d adherence period; 81/101 (80.2%) of these patients completed the 180d. Significant differences between the increases in least squares mean number of steps per day (1199 vs 467) and mean percentage change (35.8% vs 11.5%) from baseline favor in IG over CG. Of the patients in IG who entered the 90–180d adherence period, 36/101 (35.6%) were 80% or more compliant with use of the OA GP app. |
| Svege etal,57 2016; Norway. | Two-arm RCT; hip osteoarthritis; n = 109; 57.8y; 54% women. | IG and CG: initial attendance of a patient education program developed for people with a hip OA and provided in the form of a “hip school” provided by 2 physical therapists educated in the method. IG: exercises specifically designed for people with hip OA (warm-up, strengthening, functional exercises, stretching exercises, performance 2 or 3 times/wk for 12wk). CG: attended 2-mo follow-up visit at a physical therapy clinic (no access to exercise therapy program during the intervention period) Measurements at baseline, 4, 10, and 29mo. | Primary outcome: pain (WOMAC; Fernandes etal58). Secondary outcomes: hip RoM, isokinetic concentric muscle strength of knee and hip flexion and extension, the Astrand test, distance and pain during 6MWT, VAS); activity assessment through Pascale for elderly (PASE). | Education program of 3 group sessions by a physical therapist; training diaries. | Training diaries. | Primary outcome published by Fernandes etal58: pain at 4mo (means [SD]) in CG was 25.3 (18.5), in IG 20.6 (17.2); at 10mo in CG 23.4 (19.6) and IG 16.8 (17.7); at 16mo in CG 22.3 (18.4) and IG 17.3 (14.5). |
| Tan etal,111 2024; Singapore. | Two-arm RCT; knee osteoarthritis; n = 110; 66y; 75% women. | IG: Collaborative Model of Care between Orthopedics and Allied Healthcare Professionals (CONNACT), 12-wk intervention, 2 educational sessions by orthopedic surgeon, 8 sessions of exercise by physiotherapist based on neuromuscular exercise (NEMEX) principles, optional psychological intervention (3 group sessions for patients with anxiety, depression, significant pain, low activation), optional dietary and nutritional intervention (3 group sessions for patients with BMI > 23.5kg/m2) CG: usual care: often referral to physiotherapist without psychological or dietary intervention. Measurements at baseline, 3, 6, and 12mo. | Primary: 4 subscales from KOOS4. Secondary: pain, physical performance, activity score, 40-m gait speed, time-up and go, chair-stand test, stair-climb test, EQ-5D, global perceived effect, patient acceptable symptom score, analgesia consumption score, food frequency psychological and BMI measures. | Promotion of PA through cohesion and peer support, individualization by physiotherapists’ guidance. | Exercise Adherence questionnaire, SIRAS (adherence/compliance results will be discussed in separate publication). | There was no significant between-group difference for KOOS4 at 12mo (difference; 95% CI: −1.86; −9.11 to 5.38). Within-group differences: for the primary outcome KOOS4, there were significant improvements in both usual care (difference; 95% CI: 19.29; 14.40 to 24.18) and CONNACT (difference; 95% CI: 17.55 (12.46 to 22.64) from baseline to 12mo. The between-group analysis at each time point (3, 6, and 12mo) showed that the CONNACT arm demonstrated superior outcomes for the physical performance measures for the stair climb test at 3mo (difference; 95% CI:−2.74; −5.43 to −0.06). The median SIRAS score for the intervention patients were high at 13.3 (11.8 to 13.8). |
| Thomas etal,112 2002; United Kingdom. | Four-arm RCT; knee osteoarthritis; n = 786; 62y; 64% women. | Two-y exercise program, self-paced but progressively more challenging, taught at home by a trained researcher, 4 visits for 30min in the first 2mo, follow-up visits at 6-mo intervals, participants were encouraged to perform exercises for 20–30min/d. Monthly phone calls, 2min per call. Placebo tablet Dolomite (with calcium, magnesium) twice a week to motivate the no intervention control group to remain in the study. IG1-a: exercise therapy plus telephone contact IG1-b: exercise therapy plus telephone contact, placebo tablet IG2: exercise therapy IG3: monthly telephone contact CG-a: no intervention, placebo tablet CG-b: no intervention Measurements at baseline 6, 12, 18, and 24mo. | Primary: pain. Secondary: stiffness, disability, general physical function, psychological score (anxiety, depression), isometric quadriceps muscle strength. | Monthly telephone calls, all by the same researcher, to monitor symptoms, offer simple advice, problems were referred to researcher who taught the program. | Self-completed diaries (categories high/medium/low). | No significant differences were found between the groups that did and did not receive the placebo intervention: no intervention vs placebo (CG-a vs CG-b), P = .66; exercise plus telephone vs exercise, telephone, and placebo (IG1-a vs IG1-b, P = .94). These subgroups were therefore merged. At 24mo, the exercise group differed significantly from the nonexercise groups in regard to knee pain at 6, 12, 18, and 24mo. Similar improvements were not observed for the telephone groups compared with the nontelephone groups. Self-reported adherence to the exercise program was graded as high (n = 128), medium (n = 32), or low (n = 307). The impact of exercise adherence on self-reported pain at 24mo suggested a dose–response effect. |
| Thomsen etal,113 2020; Denmark. | Two-armed RCT; rheumatoid arthritis; n = 150 patients; 59.6y; 81% women. | IG: 4-mo intervention consisted of 3 individual motivational counseling sessions and 0–5 individual text messages per week; initial counseling session at week 1 (set individual behavioral goals and plans for reduction of daily sitting time), 2 later counseling sessions (weeks 3 and 10) to review/change set goals or make new ones. CG: continue with usual lifestyle. Measurements at baseline, 4, 6, 18, and 22mo. | Primary outcome: daily sitting time (ActivePAL, version 7.2.32, PAL Technologies). Secondary outcome: self-reported daily sitting time at work, leisure time, number of breaks in daily sitting time, pain (VAS), fatigue, physical function, general self-efficacy, body measurements, resting blood pressure, venous blood sample. | Counseling sessions (social cognitive theory, eg,self-efficacy and Motivational Interview techniques): behavioral goals, action plans, information, reviews; individually drafted text messages. | Activity monitor (ActivPAL). | Compared to baseline, sitting time in the IG decreased 1.10h/d, whereas it increased by 1.32h/d in the CG. The IG replaced the daily sitting time with both increased standing and stepping time, with between-group differences in change of 0.93 and 0.33h/d at 18-mo follow-up. 43 IG participants (57%) had reduced their daily sitting time by at least 5min compared to 7 participants (9%) in the CG. For most secondary outcome, between-group differences favored the IG: eg,pain (VAS) −15.51mm (–23.42 to –7.6), P = .0001. |
| van den Berg etal,114 2006; Netherlands. | Two-arm RCT; rheumatoid arthritis; n = 160; 49.7y; 77% women. | IG (individual training intervention): weekly detailed personal PA program consisting of muscle strengthening exercises, RoM exercises and cycling on a bicycle ergometer (10–30min/d), 5 times a week; goal to meet the Dutch public health recommendations for PA (at least 30min/d for at least 5 d/wk). CG (general training): access to web pages containing general information about aerobic, muscle strengthening, RoM, promotion of PA, advice to perform activities on at least 5d/wk to reach the goal 30min of moderate PA on at least 5d/wk; free copy of Beweegwijzer 2002. Measurements at baseline, 3, 6, 9, and 12mo. | Primary outcome: proportion of patients meeting the PA recommendations. Secondary outcomes: total number of days per week during which patients reported being moderate active for 30min accumulated throughout the day or vigorously active for 20min in succession, heart rate monitor measurements, functional ability, quality of life, and disease activity (MACTAR score, RAQoL, DAS-28). | Personal internet page with individual weekly updated exercise plan; ergometer/heart rate monitor; supervision by physical therapists per email; group meetings every 3mo (new exercises, information, contact to group members and exchange of experience, self-management strategies). | Logging onto internet page; activity diary; activity monitor. | After 3mo, 63 patients (86%) in the IG group and 9 (16%) in the CG group logged onto the web site at least once a week. Proportion of physically active patients was significantly greater in the IG than in the CG group at 6mo (38% vs 22%) and 9mo (35% vs 11%) regarding a moderate-intensity level for 30min in succession on at least 5d/wk. Regarding a vigorous-intensity level for 20min in succession on at least 3d/wk at 6 (35% vs 13%), 9 (40% vs 14%), and 12mo (34% vs 10%). |
| van Gool etal,115 2006; United States. | Four-arm RCT; osteoarthritis; n = 392; 68.3y; 74.3% female. | IG1 (WL): maintain an average WL of 5% during 18mo through health education (0–4mo: 16 weekly individual and group, 5–18mo: biweekly individual and group session for 8wk, then monthly meetings and telephone calls). IG2 (EX): 3d/wk exercise program (facility- or home-based) consisted of 15-min aerobics phases; 15-min resistance-training phase which consisted of 2 sets 12 repetitions of the following exercises: leg extension, leg curl, heel raise, and step up; 15-min cooling down. IG3 (WL + EX): exact combination of the separate WL and EX interventions. CG: healthy life style education. Measurements at baseline, 4, and 18mo. | Primary outcome: diet sessions attendance; exercise session attendance; differentiation between initiation phase and maintenance phase in analysis; self-reported medical history at baseline, WOMAC (function, pain, stiffness), MMSE to assess cognitive function at baseline, SF-36, medical outcome study social survey. | Choice of facility-based or home-based exercise program or both; dietary program; regular telephone appointments (reminders, after sessions missed); log book for home-based exercise program; provided transport to program sessions if needed. | Exercise diary; attendance rate for dietary and exercise sessions. | Mean percentage attendance to diet sessions over 18mo was 60.7% (SD 28.5), mean percentage attendance to exercise sessions was 53.2% (SD 29.0). WOMAC pain score (mean [SD]) in initiation phase (months 1–4) was 7.0 (3.2) in participants with low attendance vs 6.9 (3.5) in participants with high attendance. In maintenance phase (months 5–18), pain score was 7.3 (3.4) vs 6.5 (3.3). |
| Veenhof etal,116 2006; The Netherlands. | Two-arm RCT; hip and/or knee osteoarthritis, n = 200; 64.8y; 77% women. | IG: maximum of 18 sessions within a period of 12wk; starting phase (educational messages, selection of problematic activities and treatment goals, determination of baseline value), treatment phase (increase of selected activities, gradually and in a time contingent way by means of an exercise program), integration phase (support and reinforcement of behavioral change and integration of the increased level of activities in the daily living of the patient max of 7 sessions in 5 determined booster sessions in weeks 18, 25, 34, 42, and 55). CG: general Dutch PT guidelines for hip and/or knee OA providing information and advice, exercise therapy and encouragement of positive coping with their symptoms, max of 18 sessions within a period of 12wk. | Primary outcome: pain (VAS) and WOMAC, physical function WOMAC, patient global assessment. Secondary outcome tiredness (VAS), patient-oriented physical function, MACTAR (disability questionnaire), 5-m walking time, muscle strength, RoM. | BGA program with goal setting, feedback and positive reinforcement; regular physiotherapy sessions over a long-term period (55wk); psychological encouragement. | Self-reported exercise adherence (questionnaire). | After 13wk, IG showed improvement in pain and physical function of 25.8% and 20.8% compared with baseline, respectively. Differences between the groups in improvement for pain, physical function, and PGA at all assessments were in favor of IG but differences were small and not statistically significant. |
| van Veldhuijzen Zanten etal,117 2021; United Kingdom. | Two-arm RCT; rheumatoid arthritis; n = 115; 55y; 66% women. | Three-month exercise program for all participants in the gym, each session: warm-up, main session (30min at 60%–75% of maximum heart rate), and cooldown. One induction session at the gym. Participants were advised to complete 2 sessions per week in the gym and one session at home. IG: gym program plus face-to-face consultations with behavior change counselor at the start and 3mo, telephone consultations at 1, 2, and 5mo. CG: gym program only, at different gym. Measurements: baseline, 3, 6, and 12mo. | Primary: CRF. Secondary: CVD factors: blood pressure and serological risk factors, PA (IPAQ), gym attendance, serological disease characteristics, well-being (subjective vitality, quality of life, anxiety and depression). | Behaviour change techniques grounded in SDT: discussion of exercise history, perceived benefits and risks, encouragement, life goals, goal-setting, review of goals, behavior change, problem solving to overcome barriers and enhance self-efficacy, PA maintenance plans. | Gym attendance. | CRF did not change over time in either group, but being younger and male was associated with higher CRF. There were no significant group × time interactions. DBP was significantly reduced at 3, 6, and 12mo compared to preintervention baseline in both groups. In the control group only, moderate to vigorous PA was lower at 3, 6, and 12mo compared to baseline. The mean number (range) of sessions attended did not significantly differ between arms (control group: 7.6 [1–24]/n = 19, experimental group: 12.1 [1–35]/n = 34). The intervention did not influence subjective vitality, quality of life, fatigue, depression or anxiety. Autonomous motivation was higher and controlled motivation lower at 3, 6, and 12mo compared to baseline in both groups. |
| Villafaina etal,59 2019; Spain. | Two-arm RCT; fibromyalgia; 54y; n = 55; 100% women. | IG: 24-wk exercise intervention with two 1-h sessions per week, warm-up, aerobic exercises, postural control and coordination games, walking training with an exergame (virtual reality rehabilitation tool, VirtualEx-FM), intervention led by kinesiologist, dance teacher, technician. The following 24wk were called “detraining” with no intervention. CG: care as usual, no intervention. Measurements at baseline, 24, and 48wk. | Primary: lower limb strength, agility, CRF. Secondary: impact of the disease, PA, and inactivity. | Exergame VirtualEx-FM: increase attendance and motivation while taking into account preferences and needs of participants. | MET-minutes per week (IPAQ questionnaire). | Repeated-measures ANOVA showed significant effects on the lower limb strength (chair stand test, P = .017) and CRF (6MWT, P = .011), no significant effect was found for agility (10-step stair test, P = .666) (IG vs CG at 48wk). Performance of lower limb strength in the exergame group significantly increased after intervention at 24wk (P = .030) while performance significantly decreased in the control group (P = .046). MET-minutes per week did not differ significantly between groups postintervention at 24wk: IG preintervention 2667.35 (3704.18), postintervention 2990.17 (3090.58); CG preintervention 4422.71 (4291.30), postintervention 3406.94 (6315.86). |
| Wagenaar etal,118 2024; The Netherlands. | Two-arm RCT; rheumatoid arthritis; n = 83; 55y; 92% women. osteoarthritis; n = 66; 64y; 84% women. | PFJ lifestyle intervention, theoretical and practical education about whole food plant-based diet, PA (goal: 150min/wk moderate intense PA and 2d/wk MSK strengthening), sleep and stress management, 10 group meetings of 6–12 participants over 4mo, led by dietitian and physical therapist. After 4-mo intervention: extension study (encouragement to adhere to PFJ intervention). CG: usual care for 4mo, then PFJ intervention and extension study. Measurements at baseline, 2, 4, 6, and 12mo. | Primary: DAS-28 (28-joint Disease Activity Score) for RA, WOMAC total score for OA after intervention. Secondary: DAS-28 and WOMAC in extension study, body weight, waist circumference, body composition and bone density, fasted blood samples, blood pressure, depression, fatigue, pain, physical function, dietary intake (diary), minutes of stress-reducing and PA. Adherence. | PFJ lifestyle intervention with individual intakes from dietitian and physical therapist, videos for exercises at home, elaborated weekly menus and supplementation with methylcobalamin and cholecalciferol. After active intervention period: extension study with monthly newsletters with recipes, articles, podcasts, 6 adherence-promoting webinars presented by PFJ dieticians and physical therapists on topics like WL, unprocessed food, gut microbiome, and guided (mindfulness) exercises. Digital food diary. | PA (minutes per week) with digital questionnaire. | RA participants who completed the extension study had a lower DAS-28 at the end of the intervention and a trend toward greater change during the intervention compared with dropouts. There was no significant difference between change in WOMAC total score during the intervention for OA participants who completed the extension study compared with dropouts. Time spent on PA was in the recommended range at the start of the intervention for both RA and OA. At the end of the intervention, time spent per week on both physical and stress-relieving activities was increased as compared with the start, and these changes were sustained throughout the extension study. |
| Wang etal,27 2020; China. | Two-arm RCT; osteoarthritis; n = 189; 67.4y; 92.6% women. | IG (weeks 0–2): 3 times 2h group activities by physiotherapist over 2wk (1-h group health education, 1-h exercise); (weeks 3–24): subdivision of preaction group and action group with 6 separate sessions at weeks 4, 8, 12, 16, 20, and 24 for 2h; assessment through Questionnaire of Stage of Exercise Change; 2 review sessions at weeks 4 and 12. CG: usual exercise guidance without adherence interventions; at baseline, weeks 1 and 2 physiotherapists carried out 3 home exercise guidance sessions, at weeks 4 and 12 review classes same as IG. | Primary outcome: exercise adherence measurement using 11-point numeric rating scale. Secondary outcome KOA symptoms including pain intensity and joint stiffness, knee function collected at baseline and weeks 24 and 48. | TTM; scheduled physiotherapy group sessions with exercises and health education. | Group activity attendance; self-reported exercise adherence on a numeric rating scale. | Exercise adherence score in IG at week 4 was 7.59 (SD 1.64) at week 4, 6.27 (SD 1.86) at week 12, 7.58 (SD 1.29) at week 24, 6.55 (SD 1.28) at week 36, and 5.56 (SD 1.00) at week 48. Adherence rates were only significantly different from control group at weeks 24, 36, and 48. Pain intensity in the intervention group was significantly lower than that in the control group at week 24 (P = .006) with 16.18 (15.94) vs 23.47 (17.11) and at week 48 (P = .012) with 13.62 (11.28) vs 19.64 (16.83). |
