Interventions to improve adherence to exercise for chronic musculoskeletal pain in adults

Abstract

Background Chronic musculoskeletal pain (CMP) is a major health problem, accounting for approximately one-quarter of general practice (GP) consultations in the United Kingdom (UK). Exercise and physical activity is beneficial for the most common types of CMP, such as back and knee pain. However, poor adherence to exercise and physical activity may limit long-term e ectiveness. Objectives To assess the e ects of interventions to improve adherence to exercise and physical activity for people with chronic musculoskeletal pain. Search methods We searched the trials registers of relevant Cochrane Review Groups. In addition, we searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, AMED, PsycINFO, Science Citation Index and Social Science Citation Index and reference lists of articles to October 2007. We consulted experts for unpublished trials. Selection criteria Randomised or quasi-randomised trials evaluating interventions that aimed to improve adherence to exercise and physical activity in adults with pain for three months and over in the axial skeleton or large peripheral joints. Data collection and analysis Two of the four authors independently assessed the quality of each included trial and extracted data. We contacted study authors for missing information. Main results We included 42 trials with 8243 participants, mainly with osteoarthritis and spinal pain. Methods used for improving and measuring adherence in the included trials were inconsistent. Two of the 17 trials that compared di erent types of exercise showed positive e ects, suggesting that the type of exercise is not an important factor in improving exercise adherence. Six trials studied di erent methods of delivering exercise, such as supervising exercise sessions, refresher sessions and audio or videotapes of the exercises to take home. Of these, five trials found interventions improved exercise adherence. Four trials evaluated specific interventions targeting exercise adherence; three of these showed a positive e ect on exercise adherence. In eight trials studying self-management programmes, six improved adherence measures. One trial found graded activity was more e ective than usual care for improving exercise adherence. Interventions to improve adherence to exercise for chronic musculoskeletal pain in adults (Review)

Nordic Walking as an Exercise Intervention to Reduce Pain in Women With Aromatase Inhibitor–Associated Arthralgia: A Feasibility Study

“…This is consistent with previous findings that supervised exercise can increase adherence in both cancer and musculoskeletal populations. 48,49 Nevertheless, during the independent component, participants maintained one to two sessions of Nordic walking per week and four sessions of exercise in total per week; and as reductions in pain were maintained, four sessions of Nordic walking specifically may not be necessary to achieve a reduction in pain. In addition, normal walking was evaluated as the participants' preferred form of activity, which has been previously found to be the exercise of choice for female cancer survivors.…”

Effects of Two Physiotherapy Booster Sessions on Outcomes With Home Exercise in People With Knee Osteoarthritis: A Randomized Controlled Trial

“…Numerous strategies have been proposed to assist with patient adherence (9) and there is some suggestion that the addition of "booster" sessions with a therapist after an initial period of exercise treatment can improve longerterm clinical outcomes (12). However, a recent Cochrane Review investigating a range of interventions to improve adherence to exercise in patients with chronic musculoskeletal pain concluded that further high quality clinical trials are needed (13).…”

“…While numerous strategies are suggested to help improve adherence to exercise interventions in people with OA (9,13,28), there are few RCTs in this area. A 2010 Cochrane Review of adherence strategies in chronic musculoskeletal pain, including OA, stated that the most promising strategies are those that include supervised exercise, individualized exercise, booster sessions, provision of supplementary materials such as exercise audiotapes/ videotapes, and that incorporate graded activity, selfmanagement programs, and cognitive behavioral principles (13).…”

“…A 2010 Cochrane Review of adherence strategies in chronic musculoskeletal pain, including OA, stated that the most promising strategies are those that include supervised exercise, individualized exercise, booster sessions, provision of supplementary materials such as exercise audiotapes/ videotapes, and that incorporate graded activity, selfmanagement programs, and cognitive behavioral principles (13). However, the authors of the review also concluded that firm conclusions could not be drawn given limited and inconsistent effects across studies and variations in implemented strategies.…”

“…Various methods have been described in the literature, including diaries, recall questionnaires, and activity monitors (13). These all have limitations, including the fact that recording exercise adherence may actually influence the behavior of interest.…”