Adherence to a Community-based Exercise Program Is a Strong Predictor of Improved Back Pain Status in Older Adults

Abstract

Objectives To identify factors that were predictive of improved pain status among older adults with chronic back pain participating in the Adaptive Physical Activity (APA) program and to identify factors that were predictive of adherence to APA. Methods An observational cohort study of 392 older adults (ages 50–88) with chronic back pain participating in APA for 12 months. APA was a community-based group exercise program given for 1-hour, twice weekly, in local gyms. Primary outcome measures were improved pain based on a global rating of change evaluation and adherence to the APA program (defined as participation in >75% of exercise sessions). Potential predictor variables were entered into multivariate logistic regression models to determine the most accurate set of variables for predicting improved pain and adherence. Results Presence of depressive symptoms, poor self-rated health and adherence to APA were the best predictors of improved pain status, with adherence being the strongest predictor [Odds Ratio:13.88 (95% CI: 8.17, 23.59)] Better physical function, longer pain duration and positive rating of the trainer were all positively associated with adherence to APA; whereas poor self-rated health and further distance from the gym were inversely associated. Conclusions Given that adherence to APA is the key predictor of improved back pain, future efforts should focus on strategies to improve adherence. Our data suggest that enhanced training of exercise trainers, development of separate classes for people with different functional levels and use of psychosocial interventions to reduce health pessimism and depression may be potential targets for improving adherence.

Behavioural and social sciences to enhance the efficacy of health promotion interventions: redesigning the role of professionals and people

“…This high rate of uptake is the result of various social influences (peerto-peer word of mouth, me-too processes, social reputation), the availability of the programme locally in familiar settings (e.g., gyms, theatres, churches) and the assistance provided to those in need of transportation. Those who take part in APA courses become members of active local social groups, which remedies loneliness and improves health (Stuart et al, 2009;Hicks et al, 2012), improving their happiness, empowerment and self-confidence, while providing a means to make use of underemployed spaces (i.e., in otherwise empty gyms in the morning). Table 1 shows the results of the three case studies compared on the basis of the education, activation, engagement and empowerment principles.…”

Activating therapy modalities in older individuals with chronic non-specific low back pain: a systematic review

“…A, see online supplementary material). These included three randomised controlled trials [20][21][22] Page 7 of 25 A c c e p t e d M a n u s c r i p t 7 and six observational studies [23][24][25][26][27][28]. Articles were excluded for one or more of the following reasons: invalid patient age (112), no activating therapy (10), specific LBP instead of non-specific (7), no intervention study (3), only study protocol published [29,30] and review withdrawn [31].…”

“…Adherence and motivation in therapy programmes are distinct predictors for the improvement of back pain and function [24,26], although the results in the 2-year follow-up period by Mailloux et al remained relatively unchanged regardless of adherence after treatment [28]. There may be bias among older adults who voluntarily participate in studies regarding better health status and fitness levels [24,37], as well as motivation, leading to minor effects when implemented into overall daily care.…”

“…There may be bias among older adults who voluntarily participate in studies regarding better health status and fitness levels [24,37], as well as motivation, leading to minor effects when implemented into overall daily care. Therefore, easily practiced or conveniently-situated programmes seem to be particularly important for the elderly [24].…”

“…Most studies (n=6) applied mixed physiotherapy modalities, with a mixture of methods such as strengthening, endurance training, balance training and flexibility exercises [20,[22][23][24]27,28]. Two studies reported endurance training [21,26], and one study reported strength training [25].…”