Exercise Adhrence Among Older Adults with Osteoarthritis

描述(申请人提供)：骨关节炎(OA)是当今影响老年人的最常见的疾病。它是老年人残疾的主要原因，随着美国人口老龄化，其影响预计将大幅增加(CDC，1999；CDC，2003)。到目前为止，已经在骨性关节炎患者中进行了10项运动干预的随机试验。尽管大多数人在三个月或更短的时间内报告了积极的短期结果，但只有两人报告了关于长期坚持的结果和12或18个月的相关结果的混合结果。关于骨性关节炎患者维持长期锻炼行为的数据缺乏，表明迫切需要对这一问题进行更多的研究。这项研究将使用一项具有重复措施的多地点随机对照试验来评估两种不同方法的比较效果，这些方法增强了对患有下肢骨关节炎的老年人的循证、健康和强有力的多成分运动干预的长期依从性和相关益处(Hughes等人，正在出版中)。我们将招募600人参加为期8周的健身和强壮计划。在Fit and Strong结束时，参与者将根据关节炎的严重程度进行分层，并随机分为协商维护和主流维护，前者将制定个性化定制坚持计划，后者参与者将被纳入四个参与研究地点中每个地点正在进行的基于设施的计划。此外，两个维修部门的一半参与者将被随机分配接受电话增援。我们将使用广义估计方程和随机效应模型来检验假设：与主流维持者相比，协商维持者在2、6、12、18和24个月时将经历显著更高的锻炼坚持水平，并且在锻炼自我效能感、锻炼坚持自我效能感、自我报告和观察的功能状态以及心理社会措施方面显著改善。

DESCRIPTION (provided by applicant): Osteoarthritis (OA) is the most common condition affecting older people today. It is the leading cause of disability among older people and its impact is projected to increase substantially with the aging of the U.S population (CDC, 1999; CDC, 2003). To date, 10 randomized trials of exercise interventions have been conducted among persons with OA. Although most report positive short-term outcomes at three months or less, only two have reported mixed findings on longer-term adherence and related outcomes at 12 or 18 months. This paucity of data on the maintenance of long-term exercise behavior among persons with OA indicates an urgent need for additional studies of issue. This study will use a multi-site randomized controlled trial with repeated measures to assess the comparative effects of two different ways of enhancing tong-term adherence to and benefits associated with participation in the evidence-based, Fit and Strong multi-component exercise intervention for older persons with lower extremity OA (Hughes et al., in press). We will recruit 600 persons to participate in the 8-week Fit and Strong program. At the conclusion of Fit and Strong, participants will be stratified by arthritis severity and randomized to either Negotiated Maintenance, in which individualized tailored adherence plans will be developed, or Mainstreamed Maintenance, in which participants will be mainstreamed into an ongoing facility-based program at each of four participating study sites. In addition, half of the participants in both maintenance arms will be randomly assigned to receive telephone reinforcement. We will use generalized estimating equations and random effects models to test the hypotheses that Negotiated maintenance participants will experience significantly greater levels of adherence to exercise at 2, 6, 12, 18, and 24 months, and significant improvements in self-efficacy for exercise, self-efficacy for exercise adherence, self reported and observed functional status, and psychosocial measures compared to Mainstreamed maintenance participants at 2, 6, 12, and 18 months.