Chronic diseases such as arthritis, diabetes, and heart disease that cause pain, functional impairment, social and emotional dysfunction, and premature loss of wage earnings constitute a challenging problem for American society. In the absence of any effective cure for these frequently progressive conditions, the secondary prevention of complications, which requires a high degree of communication and cooperation between patient and clinician, and improving quality of life and functional capacity through better disease self-management becomes critical and are key objectives of Healthy People 2010. Part I of this two-part article described the common clinical features of chronic disease, the diverse disease management strategies used for alleviating pain and preventing disability, and the role of self-efficacy as a framework for intervention. This companion article identifies and synthesizes the key research evidence for educational interventions designed to enhance individual self-efficacy perceptions and presents implications for improving practices in patient education for chronic diseases.

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Disability and poor quality of life attributable to chronic diseases such as arthritis, diabetes, and heart disease constitute challenging public health problems for American society. In the absence of any effective cure for these conditions, the secondary prevention of complications and improving quality of life and functional capacity through better disease self-management becomes critical and are key objectives of Healthy People 2010. The organizing focus of such disease self-management should be on improving coping, communication, and control by enhancing self-efficacy. Part I of this two-part article describes the common clinical features of chronic diseases and the diverse disease management strategies used for alleviating pain and preventing disability associated with these and reviews the role of self-efficacy as a theoretical framework for successful self-management interventions. Part II identifies and synthesizes the key research evidence for educational interventions designed to enhance individual self-efficacy perceptions and presents implications for practice in patient education.

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Individuals with knee osteoarthritis, a painful debilitating joint disease affecting many aging adults, are commonly encouraged to pursue a variety of exercise regimens. However, very few studies have specifically focused on barriers and facilitators of exercise adherence as related to knee osteoarthritis. This review focuses on what is known about exercise adherence, as well as those factors that influence exercise adherence, both generally, and in the context of knee osteoarthritis. To this end, a wide array of related studies were retrieved and reviewed. The objective was to better understand the relationship between this disabling health condition and exercise, and factors that might specifically determine long-term exercise participation among this population. Results of this search revealed: 1) strong support for the application of exercise to allay the progression and/or severity of knee osteoarthritis and its consequences, but poor adherence rates in reality; 2) a vast array of disease-associated, as well as other exercise adherence barriers; 3) many recommendations for promoting exercise adherence including improving the nature of the patient-provider relationship, and the importance of individualized exercise prescriptions. It is concluded that life-long exercise is crucial for maximizing the well-being and function of adults with knee osteoarthritis, but recommendations to exercise are often pursued inconsistently. To encourage exercise adherence among this cohort, a comprehensive individualized assessment, active patient involvement in the decision-making process, and long-term monitoring are indicated.

Osteoarthritis (OA) is a chronic disease that disables many aging adults. People with OA are often asked to adhere to prescribed exercise regimens that must be undertaken in the presence of pain and other disease-related symptoms. We conducted a review of literature that focused on what is known about exercise adherence and the factors that infl uence exercise adherence among people with OA. Results revealed multiple determinants of exercise adherence; however, these determinants have not been carefully studied in the context of exercise adherence and OA. Almost all studies of exercise adherence among people with OA are short-term and do not use validated measures of adherence. Moreover, poor adherence is the most compelling explanation for the declining impact of the benefi ts of exercise over time. We conclude that interventions to enhance self-effi cacy, social support, and skills in long-term monitoring of progress are necessary to foster exercise adherence among people with OA.

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