NEW ORLEANS – An innovative group behavioral counseling intervention shows promise as a means of getting older sedentary knee osteoarthritis patients to stick with a beneficial physical activity program, a preliminary study has shown.
Supplementing a traditional exercise therapy intervention with group-mediated cognitive-behavioral counseling (GMCB) sessions resulted in knee osteoarthritis patients spending significantly more minutes per week engaged in moderate to vigorous physical activity than with the standard exercise intervention alone, Brian C. Focht, Ph.D., reported at the annual meeting of the Society of Behavioral Medicine.
At least that was true following the 3-month intensive phase of the randomized, single-blind IMPACT-P (Improving Maintenance of Physical Activity–Pilot) trial. The real test of the durability of GMCB effectiveness will come later, at the prespecified 12-month follow-up. But Dr. Focht said he anticipates that the GMCB arm of the study will probably continue to show superior outcomes long term, as it has been his anecdotal impression that a substantial number of patients in the control arm returned to their sedentary ways fairly soon after the 3-month structured intervention ended.
And that, in a nutshell, has been the problem all along with exercise as therapy in patients with knee osteoarthritis, he added. Numerous studies have consistently shown that physical activity interventions result in clinically meaningful improvement in function and quality of life scores in older, sedentary patients with knee osteoarthritis. However, the long-term efficacy of these exercise interventions is often undermined by poor adherence to the physical activity regimen once the structured intervention is completed.
This observation was the impetus for the IMPACT-P trial. The hypothesis was that the targeted group counseling sessions would systematically instill in patients the self-regulatory skills required to consistently exercise on their own, explained Dr. Focht, an exercise scientist at Ohio State University, Columbus.
"To my mind, one of the unique elements of the GMCB intervention is that we’re trying to use the social dynamics of the group to develop commitment to the learning, practice, and implementation of the self-regulatory processes while also using peer-initiated solutions that come from those group sessions to overcome barriers that typically impede participation in physical activity," Dr. Focht explained.
The study included 80 sedentary knee osteoarthritis patients with an average age of 63. They were randomized to a standard exercise intervention or to exercise plus GMCB. Both interventions lasted for 3 months and included 36 hours of contact with health professionals. The exercise prescription was the same for both groups: 30-40 minutes of supervised moderate-intensity walking plus roughly 20 minutes of progressive lower-body strength training, with 8-12 repetitions of leg extensions, leg curls, step ups, and calf raises.
But while the control group had three supervised sessions per week in the gym for 3 months, the GMCB had two sessions per week during month 1 and one per week thereafter through month 4. This was followed by two sessions per month in months 5 and 6 and one monthly session during months 7 and 8. And after each supervised 1-hour exercise session, patients in the GMCB arm participated in a 20-minute group counseling session.
These cognitive-behavioral counseling sessions consisted of a standard package targeted at promoting self-monitoring of activity, effort, and symptoms; individual and group goal setting; social problem solving to overcome barriers to increasing physical activity; a mindfulness-based approach to pain management; and relapse-prevention strategies.
In keeping with a core tenet of cognitive-behavioral therapy, the GMCB intervention emphasized behavioral homework assignments. The goal, Dr. Focht noted, was to help patients phase in a reduced reliance on supervised, center-based exercise and an increase in independent physical activity.
The primary study end point was self-reported minutes per week of moderate to vigorous physical activity as assessed using the well-validated Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire. From a baseline of about 225 minutes, the GMCB group increased their average level to more than 350 minutes at 3 months, while the control group showed no significant change over time.
"This would be categorized as a moderate effect size in terms of change in physical activity," according to Dr. Focht.
IMPACT-P was funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Dr. Focht reported having no relevant financial conflicts.