Exercise Adhrence Among Older Adults with Osteoarthritis

描述（由申请人提供）：骨关节炎（OA）是当今影响老年人的最常见疾病。它是老年人残疾的主要原因，随着美国人口的老龄化，其影响预计将大幅增加（CDC，1999年; CDC，2003年）。迄今为止，在OA患者中进行了10项运动干预的随机试验。虽然大多数报告在3个月或更短的时间内有积极的短期结果，但只有两个报告了12个月或18个月的长期依从性和相关结果的混合结果。缺乏关于OA患者长期运动行为维持的数据表明迫切需要对该问题进行更多的研究。本研究将使用多中心随机对照试验，重复测量，以评估两种不同方法的比较效果，以增强长期坚持和参与基于证据的健康和强壮多组分运动干预对下肢OA老年人的益处（Hughes等人，出版中）。我们将招募600人参加为期8周的健康与强壮计划。在Fit and Strong结束时，将根据关节炎严重程度对参与者进行分层，并将其随机分配至协商维持组（将制定个性化定制的依从性计划）或主流化维持组（将参与者纳入四个参与研究中心的正在进行的基于机构的计划）。此外，两个维修组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以下假设：协商维持参与者在2个月、6个月、12个月、18个月和24个月时将体验到更高水平的锻炼依从性，以及锻炼自我效能、锻炼依从性自我效能、自我报告和观察到的功能状态的显著改善，在2个月、6个月、12个月和18个月时，与主流化维护参与者进行比较。

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.