Exercise, both therapeutic and recreational, is an effective therapy in successful management of osteoarthritis. Exercise is integral in reducing impairment, improving function, and preventing disability. Benefits of flexibility, muscular... more
Exercise, both therapeutic and recreational, is an effective therapy in successful management of osteoarthritis. Exercise is integral in reducing impairment, improving function, and preventing disability. Benefits of flexibility, muscular conditioning, and cardiovascular exercise and the role of regular physical activity in maintaining general health are discussed. Exercise recommendations and safety considerations are provided.
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This study investigated factors related to an initial exercise experience to explain exercise maintenance in 120 adults with rheumatoid arthritis or osteoarthritis. Integral secondary analysis was used to incorporate data from a... more
This study investigated factors related to an initial exercise experience to explain exercise maintenance in 120 adults with rheumatoid arthritis or osteoarthritis. Integral secondary analysis was used to incorporate data from a prospective, controlled trial of exercise (Minor et al.: Arthritis Rheum 32:1396, 1989) with data collected at 18 months follow-up. The dependent variable was self-directed exercise (min/wk) reported at 3, 9, and 18 or more months after exercise class participation. Predictor variables included physical, psychosocial, disease, and programmatic factors. The all possible regressions search procedure resulted in three explanatory models (p = .0001). At 3 months the model (R2 = .45) included initial aerobic capacity, depression, and anxiety; and changes in depression and social activity. The 9-month model (R2 = .35) consisted of initial anxiety and physical activity, change in depression, support of friends for exercise, and exercise behavior at prior assessment. At 18 or more months (R2 = .42), model variables were initial aerobic capacity, change in pain, and exercise behavior at the two prior assessments. Neither disease nor program factors appeared as significant. This limited study indicates that factors associated with exercise behavior in this sample are similar to those in the general population; explanatory factors change over time, and changes ascribed to a trial behavior may influence subsequent decision making.
Research Interests: Education, Decision Making, Pain, Depression, Physical Activity, and 18 moreRheumatoid Arthritis, Osteoarthritis, Prospective studies, Humans, Female, Male, Regression Analysis, Patient Compliance, Exercise, Follow-up studies, Data Collection, Arthritis, Aged, Middle Aged, Adult, Randomized Controlled Trial, General Population, and Aerobic Capacity
Outcome assessments of physical fitness attributes such as endurance, strength, and flexibility are not measured routinely in clinical trials or clinical practice in either adults or children with rheumatic diseases. Although physical... more
Outcome assessments of physical fitness attributes such as endurance, strength, and flexibility are not measured routinely in clinical trials or clinical practice in either adults or children with rheumatic diseases. Although physical fitness is not a measure of disease severity, it can be a critical indicator of capacity to function. Adequate fitness is necessary for the performance of positive health behaviors that enhance health status and wellness in spite of chronic disease. The purpose of this paper is to explore the conceptual, methodologic, and analytic issues related to the use of exercise tests as outcome measurements of physical functioning in persons with rheumatic disease.
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To identify innovative strategies to support appropriate, self-directed exercise that increase physical activity levels of people with arthritis. This article reports on one interactive, multimedia exercise performance support system... more
To identify innovative strategies to support appropriate, self-directed exercise that increase physical activity levels of people with arthritis. This article reports on one interactive, multimedia exercise performance support system (PSS) for people with lower extremity impairments in strength or flexibility. An interdisciplinary team developed the PSS using self-report of lower extremity musculoskeletal impairments (flexibility and strength) to produce an individualized exercise program with video and print educational materials. Initial evaluation has investigated the validity and reliability of program assessments and recommendations. PSS self-report and professional assessments were similar, with more impairments indicated by self-report. PSS exercise recommendations were similar to those made by 3 expert physical therapists using the same exercise data base. Results of PSS impairment assessments were stable over a 1-week period. PSS exercise recommendations appear to be reliable and a valid reflection of current exercise knowledge in rheumatology. Furthermore, users were able to complete the computer-based program with minimal assistance and reported it to be enjoyable and informative.
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... 1 Felson DT, Niu J, Clancy M, Sack B, Aliabadi P, Zhang Y. Effect of recreational physical activities on the development of knee osteoarthritis in older adults of different weights: The Framingham Study. Arthritis Rheum 2006; 59:... more
... 1 Felson DT, Niu J, Clancy M, Sack B, Aliabadi P, Zhang Y. Effect of recreational physical activities on the development of knee osteoarthritis in older adults of different weights: The Framingham Study. Arthritis Rheum 2006; 59: 612. ... M, Arden NK, Barlow J, Birrell F, et al. ...
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... Editorial. You have full text access to this OnlineOpen article Arthritis and exercise: The timesthey are a-changin'. Marian A. Minor PT, PhD. ... How to Cite. Minor, MA (1996), Arthritis and exercise: The times they are... more
... Editorial. You have full text access to this OnlineOpen article Arthritis and exercise: The timesthey are a-changin'. Marian A. Minor PT, PhD. ... How to Cite. Minor, MA (1996), Arthritis and exercise: The times they are a-changin'. Arthritis & Rheumatism, 9: 7981. ...
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Osteoarthritis is the most common form of arthritis, affecting millions of people in the United States. It is a complex disease whose etiology bridges biomechanics and biochemistry. Evidence is growing for the role of systemic factors,... more
Osteoarthritis is the most common form of arthritis, affecting millions of people in the United States. It is a complex disease whose etiology bridges biomechanics and biochemistry. Evidence is growing for the role of systemic factors, such as genetics, diet, estrogen use, and bone density, and local biomechanical factors, such as muscle weakness, obesity, and joint laxity. These risk factors are particularly important in the weight-bearing joints, and modifying them may help prevent osteoarthritis-related pain and disability. Major advances in management to reduce pain and disability are yielding a panoply of available treatments ranging from nutriceuticals to chondrocyte transplantation, new oral anti-inflammatory medications, and health education. This article is part 2 of a two-part summary of a National Institutes of Health conference that brought together experts in osteoarthritis from diverse backgrounds and provided a multidisciplinary and comprehensive summary of recent advances in the prevention of osteoarthritis onset, progression, and disability. Part 2 focuses on treatment approaches; evidence for the efficacy of commonly used oral therapies is reviewed and information on alternative therapies, including nutriceuticals and acupuncture, is presented. Biomechanical interventions, such as exercise and bracing, and behavioral interventions directed toward enhancing self-management are reviewed. Current surgical approaches are described and probable future biotechnology-oriented approaches to treatment are suggested.
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ABSTRACT
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Chronic health conditions and multiple health risk factors afflict Americans and burden employers, but effective, affordable, workplace-based health promotion interventions have not been widely implemented. This is the first study to... more
Chronic health conditions and multiple health risk factors afflict Americans and burden employers, but effective, affordable, workplace-based health promotion interventions have not been widely implemented. This is the first study to adapt the empirically validated Chronic Disease Self-Management Program for a general employee population in a workplace setting with an emphasis on disease prevention and health promotion. A quasi-experimental, wellness standard of care comparison, prospective cohort design was used among employee participants at a large University employer. Ninety-one individuals participated in the program. Participants reported significantly increased health behavior frequency and self-efficacy after the intervention, compared with their pre-intervention scores, and improvements were sustained at 3-month follow-up [self-rated abilities for health practices scale (SRA): F = 30.89, P < 0.001; health promoting lifestyle profile-II (HPLP-II): F = 36.30 P < 0.001]....
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Knee alignment has been shown to affect incidence, progression and treatment of knee osteoarthritis (OA). The gold standard for measuring alignment is a radiograph that is often difficult to obtain. This study demonstrates that a clinical... more
Knee alignment has been shown to affect incidence, progression and treatment of knee osteoarthritis (OA). The gold standard for measuring alignment is a radiograph that is often difficult to obtain. This study demonstrates that a clinical non-radiographic measure can serve as a surrogate assessment of knee alignment in older adults with knee OA. We believe these findings will allow more widespread evaluation of one critical mechanical factor essential to the study of knee OA.
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Due to reduced physical activity, adults with arthritis experience significant disability and comorbidities including cardiovascular disease. This meta-analytic review integrates results from primary research studies testing interventions... more
Due to reduced physical activity, adults with arthritis experience significant disability and comorbidities including cardiovascular disease. This meta-analytic review integrates results from primary research studies testing interventions to increase physical activity in arthritis patients. Extensive literature searching strategies were employed to locate published and unpublished empirical studies testing physical activity interventions. Results were coded for studies that had at least 5 participants. Effect sizes (ESs) were calculated for measures of physical activity, pain, and objective and subjective measures of functional ability. Twenty-eight research studies with 4111 subjects were synthesized. The mean ES for 2-group comparisons (treatment versus control) was 0.69 for physical activity, 0.21 for pain, 0.49 for objectively measured function, and 0.14 for subjectively measured function. This average effect on subjective function is consistent with a Health Assessment Questionnaire mean of 0.64 for treatment subjects as compared with 0.70 for control subjects. For pain assessed using the 0 to 10 visual analog scale, the average effect amounts to a mean of 3.78 for treatment subjects versus 4.33 for control subjects. Control group subjects experienced statistically significant improvements in pain and, to a lesser extent, objectively measured functional ability during study participation. Physical activity interventions resulted in moderate positive effects on physical activity behavior and small positive effects on pain and physical function outcomes. Future research should examine specific intervention characteristics that result in optimal results, such as frequency, type, and intensity of exercise.
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Adequate characterization of the mechanical environment of the knee with osteoarthritis (OA) is important. These local intrinsic factors are difficult to measure and there is little evidence to guide their selection. This study makes an... more
Adequate characterization of the mechanical environment of the knee with osteoarthritis (OA) is important. These local intrinsic factors are difficult to measure and there is little evidence to guide their selection. This study makes an evidence-based recommendation for the inclusion of specific factors in the future study of knee OA. Forty-six subjects with knee OA were examined. Observed function was measured by the Timed Chair Rise (TCR). Self-reported function was measured by the WOMAC Function Scale and pain was measured by the WOMAC Pain Scale. Local intrinsic factors measured included varus/valgus alignment, anterior/posterior (A/P) laxity, proprioception, isometric knee extension (KE) strength, isometric knee flexion (KF) strength, and knee range of motion (ROM). Factors were recommended for inclusion in future research if they were significantly correlated with at least one measure of function or pain and if the factor made a significant unique contribution to a regression model when more than one local intrinsic factor was correlated with the same measure of function or pain. Alignment was correlated with pain (r=0.48, p=0.001) and WOMAC function (r=0.38, p=0.009). A/P laxity was correlated with pain (r=0.30, p=0.04) and WOMAC function (r=0.37, p=0.01). Knee ROM was correlated to WOMAC function (r=-0.35, p=0.02). KE strength was correlated with TCR (r=0.32, p=0.03). Alignment made a significant contribution to prediction of pain (p=0.003). A/P laxity (p=0.004) and ROM (p=0.008) made a significant contribution to WOMAC function. We recommend future knee OA studies include the variables varus/valgus alignment, A/P laxity, ROM, and KE strength.
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This paper reviews randomized, controlled trials (RCTs) that have attempted to increase physical activity behavior by aging adults. A systematic review was necessary because numerous studies target older adults, and previous reviews have... more
This paper reviews randomized, controlled trials (RCTs) that have attempted to increase physical activity behavior by aging adults. A systematic review was necessary because numerous studies target older adults, and previous reviews have addressed a limited range of primary studies. Computerized database, ancestry, and extensive search strategies by authors of research reported in English between 1960 and 2000 located diverse intervention trials. RCTs reporting endurance physical activity or exercise behavioral outcomes for at least five subjects were included. Integrative review methods were used to summarize extant research. Forty-two studies were retrieved. Seventeen RCTs with 6,391 subjects were reviewed. A wide variety of intervention strategies were reported. The most common interventions were self-monitoring, general health education, goal setting, supervised center-based exercise, problem solving, feedback, reinforcement, and relapse prevention education. Few studies individually adapted motivational interventions, used mediated intervention delivery, or integrated multiple theoretical frameworks into the intervention. Links between individual intervention components and effectiveness were not clear. Common methodological weaknesses included small samples, untested outcome measures, and time-limited longitudinal designs. Significant numbers of aging adults increased their physical activity in response to experimental interventions. The amount of increased activity rarely equaled accepted behavior standards to achieve positive health outcomes. Further work is essential to identify successful strategies to increase activity by larger numbers of elders and to accelerate the increase in activity by those who change activity behaviors. Sex and ethnic differences need further investigation. There is a vital need for rigorously designed studies to contribute to this science.
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The aim of this study was to examine sedentary older women&amp;amp;amp;amp;#39;s experiences with exercise. Interview-administered questionnaires and physical measures assessed exercise history variables, health-related quality of... more
The aim of this study was to examine sedentary older women&amp;amp;amp;amp;#39;s experiences with exercise. Interview-administered questionnaires and physical measures assessed exercise history variables, health-related quality of life, functional status, depression, perceived vigor, adiposity, and body mass index. Women aged 65 to 97 years (N = 198) participated in the study. Most women reported at least 1 experience with episodic exercise but only 27% had experience with 2 forms of exercise and just 7% had experience with 3 exercise types. Many women began regular continuous exercise during their 5th, 6th, or 7th decades, but stopped exercising after a few years. Correlations between past exercise and potential health outcomes were very modest. These sedentary elderly women had very limited repertoires of experience with episodic exercise. Interventions designed to help women in their 50s, 60s, and 70s maintain the exercise programs may prove particularly valuable.
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Frontal plane knee malalignment may increase progression of knee osteoarthritis (OA) and hasten functional decline. An accurate nonradiographic measure of knee alignment is necessary because the gold standard measure, the long-leg... more
Frontal plane knee malalignment may increase progression of knee osteoarthritis (OA) and hasten functional decline. An accurate nonradiographic measure of knee alignment is necessary because the gold standard measure, the long-leg radiograph, is costly and often unavailable. Moreover, nonradiographic measures of knee alignment have not been validated in an obese population, where knee OA is common. The purpose of this study was to develop and assess the concurrent validity and reliability of a nonradiographic measure of frontal plane knee alignment and demonstrate the accuracy of the measure in an obese population. Fifty-five subjects (41 women, 14 men; mean +/- SD age 62.9 +/- 10.3 years) with knee OA were examined. A nonradiographic measure (umbilical method) of frontal plane alignment, using the landmarks of the umbilicus, knee, and ankle, was compared with the radiograph gold standard. Statistical significance was accepted at P &amp;amp;amp;amp;amp;amp;lt; 0.05. Eighty-nine percent of the participants had a body mass index (BMI) placing them in the overweight or obese category (mean +/- SD BMI for all subjects 31.3 +/- 6.1 kg/m(2)). Radiographic measures of alignment ranged from 9.1 degrees valgus to 14.3 degrees varus (76% of the participants had varus alignment, 12% had valgus alignment, and 2% had neutral alignment). Umbilical measures ranged from 1 degrees valgus to 21 degrees varus. The umbilical measure was significantly correlated with the radiographic method (r = 0.75, P &amp;amp;amp;amp;amp;amp;lt; 0.001). The error of the umbilical measure was not significantly correlated with the BMI (r = -0.21, P = 0.13). The umbilical method of assessing frontal plane knee alignment is a valid surrogate for the radiographic gold standard and retains its accuracy in an obese population.
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To investigate physical fitness and work capacity in women with rheumatoid arthritis (RA). The 42 subjects were a subset of a prospective trial of conditioning exercise in rheumatic disease. Assignment to an exercise or nonexercise group... more
To investigate physical fitness and work capacity in women with rheumatoid arthritis (RA). The 42 subjects were a subset of a prospective trial of conditioning exercise in rheumatic disease. Assignment to an exercise or nonexercise group was determined by proximity to the intervention, a 3-month supervised group exercise program. Physical fitness and work capacity were assessed at baseline, 3 months, and 12 months. At baseline, subjects were deconditioned and limited in hand function, lifting ability, and lower extremity mobility. Only the exercise group improved their aerobic capacity and exercise tolerance. There were no significant changes in measured work capacity in either group. Moderate to strong correlations were found between aerobic capacity, mobility, hand function, and work capacity. Grip strength was a strong and consistent correlate of work capacity. Our findings suggest that physical capacity, particularly hand function, may be important in the complex phenomenon of work disability in RA.
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... Address correspondence to Marian A. Minor, PT, PhD, Physical Therapy Program, 121 Lewis Hall, University of Missouri, Colum-... The comparative efficacy of heat modalities was studied in an evaluation of US, SWD, and galvanic current... more
... Address correspondence to Marian A. Minor, PT, PhD, Physical Therapy Program, 121 Lewis Hall, University of Missouri, Colum-... The comparative efficacy of heat modalities was studied in an evaluation of US, SWD, and galvanic current in hip or knee OA. ...
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A group of 120 patients with rheumatoid arthritis or osteoarthritis volunteered to be subjects for this study of aerobic versus nonaerobic exercise. Patients were stratified by diagnosis and randomized into an exercise program of aerobic... more
A group of 120 patients with rheumatoid arthritis or osteoarthritis volunteered to be subjects for this study of aerobic versus nonaerobic exercise. Patients were stratified by diagnosis and randomized into an exercise program of aerobic walking, aerobic aquatics, or nonaerobic range of motion (controls). The retention rate for the 12-week program was 83%. Exercise tolerance, disease-related measures, and self-reported health status were assessed. The aquatics and walking exercise groups showed significant improvement over the control group in aerobic capacity, 50-foot walking time, depression, anxiety, and physical activity after the 12-week exercise program. There were no significant between-group group differences in the change scores for flexibility, number of clinically active joints, duration of morning stiffness, or grip strength. Our findings document the feasibility and efficacy of conditioning exercise for people who have rheumatoid arthritis or osteoarthritis.
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To compare the effectiveness of biofeedback/relaxation, exercise, and a combined program for the treatment of fibromyalgia. Subjects (n = 119) were randomly assigned to one of 4 groups: 1) biofeedback/relaxation training, 2) exercise... more
To compare the effectiveness of biofeedback/relaxation, exercise, and a combined program for the treatment of fibromyalgia. Subjects (n = 119) were randomly assigned to one of 4 groups: 1) biofeedback/relaxation training, 2) exercise training, 3) a combination treatment, or 4) an educational/attention control program. All 3 treatment groups produced improvements in self-efficacy for function relative to the control condition. In addition, all treatment groups were significantly different from the control group on tender point index scores, reflecting a modest deterioration by the attention control group rather than improvements by the treatment groups. The exercise and combination groups also resulted in modest improvements on a physical activity measure. The combination group best maintained benefits across the 2-year period. This study demonstrates that these 3 treatment interventions result in improved self-efficacy for physical function which was best maintained by the combination group.
Research Interests: Immunology, Evaluation, Treatment, Treatment Outcome, Exercise therapy, and 17 moreActivities of Daily Living, Prospective studies, Humans, Fibromyalgia, Female, Male, Relaxation, Technique, Exercise, Arthritis, Clinical Sciences, Middle Aged, Adult, Public health systems and services research, Physical Exercise, Relaxation Therapy, and Combined Modality Therapy
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ABSTRACT
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To test 2 interventions to increase older women&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s physical activity. A randomized 2-way factorial experimental design compared the effects of 2 limited-contact... more
To test 2 interventions to increase older women&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s physical activity. A randomized 2-way factorial experimental design compared the effects of 2 limited-contact interventions, motivational sessions and periodic prompts, among 190 women. Experimental participants received a 3-encounter motivational intervention. Those randomized to prompts received weekly telephone or mail-delivered cues. The prompting intervention consistently increased exercise and physical activity scores. The motivational intervention did not affect outcome scores. Prompting is a low-cost strategy for increasing exercise and physical activity among older women. Future research should examine alternative modes for prompt delivery.
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To determine older adults&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#x27; attitudes toward fall risks and home modification to alter these risks, we assessed participants&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#x27; houses and used... more
To determine older adults&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#x27; attitudes toward fall risks and home modification to alter these risks, we assessed participants&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#x27; houses and used semi-structured interviews to explore their fall and injury history, fall risk, and attitudes toward modifying their residence to reduce their fall risk. Using a grounded theory approach, interview transcripts were coded by three investigators and analyzed inductively. The authors