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The maximum tolerated dose of walking for people with severe knee osteoarthritis: A Phase II randomised controlled trial
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Abstracts / Journal of Science and Medicine in Sport 20S (2017) e106–e128
these increases are associated with improved ratings of energy and fatigue. http://dx.doi.org/10.1016/j.jsams.2017.01.184 255 The maximum tolerated dose of walking for people with severe knee osteoarthritis: A Phase II randomised controlled trial J. Wallis 1,∗ , N. Taylor 1 , K. Webster 2 , P. Levinger 3 , P. Singh 4 , C. Fong 4 1
La Trobe University and Eastern Health, Australia La Trobe University, Australia 3 Victoria University, Australia 4 Monash University and Eastern Health, Australia 2
Introduction: Most people with knee osteoarthritis (OA) are physically inactive and at high risk of cardiovascular disease. Our phase I study found that people with severe knee OA safely tolerated 70 minutes of moderate intensity walking over one week in sessions lasting at least 10 min. Therefore, the primary aim was to evaluate the effect of a 12-week walking program of 70 min per week on knee pain for people with severe knee OA. Secondary aims were to evaluate the effects on cardiovascular health, WOMAC scores and physical function. Methods: Patients with severe knee OA and increased cardiovascular risk were randomly assigned to a 12-week walking program of 70 min/week of at least moderate intensity in bouts of at least 10 min, or to usual care. The primary outcome was average knee pain (0-10). The secondary outcomes were measures of cardiovascular risk including physical activity levels (using an accelerometer over 7 days), fasting blood lipid and glucose levels, waist circumference and blood pressure; WOMAC scores; and physical function using the 40 m walk test and 30s chair stand test. All outcomes were collected at baseline and post intervention (week 13) by a blinded assessor. Results: A total of 46 patients (23 walking group, 23 controls) aged 50-84 years, with average body mass index of 34 kg/m2 (SD 6) were recruited. Two patients assigned to the walking group did not complete the walking program due to increased knee pain levels. There was no between-group difference in knee pain (MD = 0.4, 95% CI -0.7 to 0.8, p = 0.918). For controls, there was an increase in knee pain over the 12 weeks (MD = 0.9, 95% CI 0.2 to 1.6, p = 0.016), but not for the walking group (MD = 0.5, 95% CI -0.19 to 1.2, p = 0.159). There were no significant between-group differences for any secondary outcomes, except for increased walking speed favouring the walking group (MD = 0.12 m/s, 95% CI 0.02 to 0.23, p = 0.024). The control group averaged 745 less daily steps (95% CI -95 to 1664, p = 0.079) and walked 11 minutes less per day (95% CI -0.2 to 22, p = 0.054) compared to the walking group, which approached statistical significance. Discussion: Patients with severe knee OA can complete a 12week walking program without increasing their knee pain, and compared to controls may take more daily steps and spend more time walking per day. There may be cardiovascular benefits in prescribing a walking program of 70 mins/week for patients with severe knee OA.
256 ‘Physical Activity 4 Everyone’ cluster RCT: 24-month physical activity outcomes of a school-based physical activity intervention targeting adolescents. Overall and school day physical activity outcomes R. Sutherland 1,2,3,∗ , E. Campbell 1,2,3 , D. Lubans 4 , P. Morgan 4 , N. Nathan 1,2,3 , A. Okely 5,6 , K. Gillham 1,3 , L. Davies 1,3 , J. Wiggers 1,2,3 1
Hunter New England Population Health, Australia School of Medicine and Public Health, University of Newcastle, Australia 3 Hunter Medical Research Institute, Australia 4 Priority Research Centre In Physical Activity and Nutrition, School of Education, University of Newcastle, Australia 5 Early Start Research Institute and School of Education, University of Wollongong, Australia 6 Illawarra Health and Medical Research Institute, Australia 2
Introduction: Few interventions have been successful in reducing the physical activity decline typically observed among adolescents, particular in adolescents from low socio-economic backgrounds. The aim of Physical Activity 4 Everyone (PA4E1)) was to reduce the decline in moderate-to-vigorous physical activity (MVPA) among secondary school students in disadvantaged areas of NSW, Australia. Methods: A cluster randomized controlled trial was conducted in five intervention and five control schools within secondary schools located in disadvantaged communities, with follow-up measures taken at 24-months post randomization. A multi-component school-based intervention based on the Health Promoting Schools Framework was implemented consisting of seven physical activity promotion strategies (1. Active PE lessons, 2. student physical activity plans, 3. enhances school sport programs, 4. school physical activity policy, 5. recess and lunchtime activities, 6. links with parents and 7. links with the community) and six additional strategies which supported school implementation of the physical activity intervention strategies. The primary outcome, minutes per day spent in moderate to vigorous physical activity (MVPA), was objectively measured by accelerometer, at baseline, mid-intervention (12-month) and 24-months. Mean minutes of school day MVPA was also assessed, along with cost effectiveness. Results: Participants (n = 1150, 49% male) were a cohort of students in Grade 7 at baseline and Grade 9 at follow-up. At 24-month follow-up there were significant effects in favour of the intervention group for daily minutes of MVPA. The adjusted mean difference in change in daily MVPA between groups was 7.0 min (95% confidence interval [CI]: 2.7, 11.4, p < 0.01). Additionally, within the school day, the adjusted mean difference in change in daily MVPA between groups was 5.2 min (95% confidence interval [CI]: 2.0, 8.4, p < 0.01). The intervention was effective in both males and females. Discussion: The PA4E1 intervention was effective in increasing adolescents’ overall minutes of MVPA, as well as school day MVPA. This suggest that implementation of the intervention by disadvantaged schools has the potential to slow the decline in physical activity. Evaluation of broader implementation model is warranted.
http://dx.doi.org/10.1016/j.jsams.2017.01.185 http://dx.doi.org/10.1016/j.jsams.2017.01.186
Abstracts / Journal of Science and Medicine in Sport 20S (2017) e106–e128
these increases are associated with improved ratings of energy and fatigue. http://dx.doi.org/10.1016/j.jsams.2017.01.184 255 The maximum tolerated dose of walking for people with severe knee osteoarthritis: A Phase II randomised controlled trial J. Wallis 1,∗ , N. Taylor 1 , K. Webster 2 , P. Levinger 3 , P. Singh 4 , C. Fong 4 1
La Trobe University and Eastern Health, Australia La Trobe University, Australia 3 Victoria University, Australia 4 Monash University and Eastern Health, Australia 2
Introduction: Most people with knee osteoarthritis (OA) are physically inactive and at high risk of cardiovascular disease. Our phase I study found that people with severe knee OA safely tolerated 70 minutes of moderate intensity walking over one week in sessions lasting at least 10 min. Therefore, the primary aim was to evaluate the effect of a 12-week walking program of 70 min per week on knee pain for people with severe knee OA. Secondary aims were to evaluate the effects on cardiovascular health, WOMAC scores and physical function. Methods: Patients with severe knee OA and increased cardiovascular risk were randomly assigned to a 12-week walking program of 70 min/week of at least moderate intensity in bouts of at least 10 min, or to usual care. The primary outcome was average knee pain (0-10). The secondary outcomes were measures of cardiovascular risk including physical activity levels (using an accelerometer over 7 days), fasting blood lipid and glucose levels, waist circumference and blood pressure; WOMAC scores; and physical function using the 40 m walk test and 30s chair stand test. All outcomes were collected at baseline and post intervention (week 13) by a blinded assessor. Results: A total of 46 patients (23 walking group, 23 controls) aged 50-84 years, with average body mass index of 34 kg/m2 (SD 6) were recruited. Two patients assigned to the walking group did not complete the walking program due to increased knee pain levels. There was no between-group difference in knee pain (MD = 0.4, 95% CI -0.7 to 0.8, p = 0.918). For controls, there was an increase in knee pain over the 12 weeks (MD = 0.9, 95% CI 0.2 to 1.6, p = 0.016), but not for the walking group (MD = 0.5, 95% CI -0.19 to 1.2, p = 0.159). There were no significant between-group differences for any secondary outcomes, except for increased walking speed favouring the walking group (MD = 0.12 m/s, 95% CI 0.02 to 0.23, p = 0.024). The control group averaged 745 less daily steps (95% CI -95 to 1664, p = 0.079) and walked 11 minutes less per day (95% CI -0.2 to 22, p = 0.054) compared to the walking group, which approached statistical significance. Discussion: Patients with severe knee OA can complete a 12week walking program without increasing their knee pain, and compared to controls may take more daily steps and spend more time walking per day. There may be cardiovascular benefits in prescribing a walking program of 70 mins/week for patients with severe knee OA.
256 ‘Physical Activity 4 Everyone’ cluster RCT: 24-month physical activity outcomes of a school-based physical activity intervention targeting adolescents. Overall and school day physical activity outcomes R. Sutherland 1,2,3,∗ , E. Campbell 1,2,3 , D. Lubans 4 , P. Morgan 4 , N. Nathan 1,2,3 , A. Okely 5,6 , K. Gillham 1,3 , L. Davies 1,3 , J. Wiggers 1,2,3 1
Hunter New England Population Health, Australia School of Medicine and Public Health, University of Newcastle, Australia 3 Hunter Medical Research Institute, Australia 4 Priority Research Centre In Physical Activity and Nutrition, School of Education, University of Newcastle, Australia 5 Early Start Research Institute and School of Education, University of Wollongong, Australia 6 Illawarra Health and Medical Research Institute, Australia 2
Introduction: Few interventions have been successful in reducing the physical activity decline typically observed among adolescents, particular in adolescents from low socio-economic backgrounds. The aim of Physical Activity 4 Everyone (PA4E1)) was to reduce the decline in moderate-to-vigorous physical activity (MVPA) among secondary school students in disadvantaged areas of NSW, Australia. Methods: A cluster randomized controlled trial was conducted in five intervention and five control schools within secondary schools located in disadvantaged communities, with follow-up measures taken at 24-months post randomization. A multi-component school-based intervention based on the Health Promoting Schools Framework was implemented consisting of seven physical activity promotion strategies (1. Active PE lessons, 2. student physical activity plans, 3. enhances school sport programs, 4. school physical activity policy, 5. recess and lunchtime activities, 6. links with parents and 7. links with the community) and six additional strategies which supported school implementation of the physical activity intervention strategies. The primary outcome, minutes per day spent in moderate to vigorous physical activity (MVPA), was objectively measured by accelerometer, at baseline, mid-intervention (12-month) and 24-months. Mean minutes of school day MVPA was also assessed, along with cost effectiveness. Results: Participants (n = 1150, 49% male) were a cohort of students in Grade 7 at baseline and Grade 9 at follow-up. At 24-month follow-up there were significant effects in favour of the intervention group for daily minutes of MVPA. The adjusted mean difference in change in daily MVPA between groups was 7.0 min (95% confidence interval [CI]: 2.7, 11.4, p < 0.01). Additionally, within the school day, the adjusted mean difference in change in daily MVPA between groups was 5.2 min (95% confidence interval [CI]: 2.0, 8.4, p < 0.01). The intervention was effective in both males and females. Discussion: The PA4E1 intervention was effective in increasing adolescents’ overall minutes of MVPA, as well as school day MVPA. This suggest that implementation of the intervention by disadvantaged schools has the potential to slow the decline in physical activity. Evaluation of broader implementation model is warranted.
http://dx.doi.org/10.1016/j.jsams.2017.01.185 http://dx.doi.org/10.1016/j.jsams.2017.01.186