Telehealth Exercise Program for Arthritis

Overseen By Andrew T Stephens

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: VA Office of Research and Development

Disqualifiers: Recent surgery, Cardiovascular event, Mental health, Terminal illness, Motor neuron diseases, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 3

50 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests a group telehealth exercise program to determine its practicality and reception among Veterans with knee or hip osteoarthritis. Participants will engage in either a program with text messages alone or one that includes exercise sessions to support routine maintenance. Eligible participants are Veterans with knee or hip arthritis who have recently visited a VA clinic in Eastern Colorado and are not regularly active. As an unphased trial, this study provides Veterans the chance to contribute to innovative telehealth approaches for managing osteoarthritis.

Do I need to stop my current medications to join the trial?

The trial information does not specify whether you need to stop taking your current medications. It is best to discuss this with the study team or your primary care physician.

What prior data suggests that this telehealth exercise program is safe for Veterans with osteoarthritis?

Research has shown that telehealth exercise programs are generally safe for people with osteoarthritis (OA). One study found that an 8-week online group exercise program was well-received by individuals with knee OA. Another review found that telehealth services for managing joint and muscle conditions, such as OA, are both safe and effective. Overall, these programs tend to improve movement and reduce pain without causing serious side effects. This suggests that a group telehealth exercise program for arthritis is likely safe for participants. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores a unique approach to managing arthritis through telehealth exercise programs. Unlike traditional arthritis treatments that often focus on medication and physical therapy sessions in person, this method leverages technology to deliver exercise routines remotely. The trial includes a group telehealth exercise program with text messaging support and optional booster sessions, offering flexibility and accessibility for participants. This approach could make it easier for people to stick with an exercise regimen, potentially improving outcomes for those with arthritis by integrating supportive communication and regular engagement without needing to travel to a clinic.

What evidence suggests that this telehealth exercise program is effective for arthritis?

Research shows that telehealth-supported exercise programs can benefit people with osteoarthritis (OA). Studies indicate these programs improve movement and reduce pain. In this trial, participants will join different treatment arms to evaluate the effectiveness of telehealth exercise programs. One arm includes exercise initiation and maintenance with text messaging and booster sessions, while another involves exercise initiation and maintenance with text messaging alone. A review found telehealth exercise as acceptable as in-person therapy for knee OA. Another study confirmed that delivering group exercises through telehealth was well-received and offered similar benefits to traditional methods. Overall, early evidence suggests telehealth exercise programs can effectively manage osteoarthritis symptoms. ^{2 3 6 7 8}

Who Is on the Research Team?

Lauren Abbate, MD

Principal Investigator

Rocky Mountain Regional VA Medical Center, Aurora, CO

Are You a Good Fit for This Trial?

This trial is for Veterans with knee or hip arthritis who are patients at Eastern Colorado Healthcare System, haven't been active lately, and have had a VA visit in the past year. It's not for those without phone access, recent serious health events, current participation in similar studies, or conditions that would limit joining group exercises.

Inclusion Criteria

Veterans at Eastern Colorado Healthcare System Primary Care Clinics with at least one VA visit within the past year

I have been diagnosed with painful knee or hip arthritis.

Physically inactive individuals (defined as...)

Exclusion Criteria

I haven't seen a primary care doctor in the last year.

I have had hip or knee surgery, or a recent severe knee injury.

I was recently hospitalized for a heart or stroke-related event.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Exercise Initiation

Participants receive a group telehealth exercise program for 3 months

3 months

Weekly group telehealth sessions

Exercise Maintenance

Participants continue with text messaging alone or text messaging plus monthly group telehealth exercise booster sessions

6 months

Monthly group telehealth sessions for booster group

Follow-up

Participants are monitored for changes in physical activity and osteoarthritis symptoms

3 months

Data collection at 3-, 6-, and 9-month follow-up

What Are the Treatments Tested in This Trial?

Interventions

• Group Telehealth Exercise Sessions

Trial Overview

The study tests a telehealth exercise program for Veterans with arthritis over 9 months. Participants will do group exercises via telehealth for 3 months followed by text message support or additional booster sessions to maintain exercise habits.

How Is the Trial Designed?

Group I: Exercise Initiation and Maintenance with Text Messaging and Booster Sessions Experimental Treatment 1 Intervention

Participants receive 3 months of group telehealth exercise initiation plus text messaging followed by 6 months of text messaging plus monthly group telehealth exercise booster sessions.

Group II: Exercise Initiation and Maintenance with Text Messaging alone Active Control 1 Intervention

Participants receive 3 months of group telehealth exercise initiation plus text messaging followed by 6 months of text messaging alone.

Group Telehealth Exercise Sessions is already approved in United States for the following indications:

Approved in United States as Group Telehealth Exercise Sessions for:

• Lower extremity osteoarthritis (OA)

Who Is Running the Clinical Trial?

VA Office of Research and Development

Lead Sponsor

Trials

1,691

Recruited

3,759,000+

Published Research Related to This Trial

The revised 6-week Walk With Ease (WWE) program significantly improved self-reported outcomes and performance measures in adults with arthritis, showing benefits in disability, pain, fatigue, and strength, with no reported adverse events.

Both instructor-led and self-directed formats of the WWE program were effective, with self-directed participants maintaining more significant improvements in certain outcomes at the 1-year mark, highlighting the program's safety and accessibility for promoting physical activity.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluation of group and self-directed formats of the Arthritis Foundation's Walk With Ease Program. Callahan, LF., Shreffler, JH., Altpeter, M., et al.[2011]

In a study involving 197 participants with arthritis, a self-directed exercise program showed high engagement, with 73.2% reading most materials and 90.4% rating the program as 'good' or 'excellent' after 12 weeks.

The program effectively encouraged self-management behaviors, as 63.3% set goals and 83.9% reported success in following their plans, although there was a decline in the use of self-monitoring logs over time.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

"Participation, satisfaction, perceived benefits, and maintenance of behavioral self-management strategies in a self-directed exercise program for adults with arthritis". Sharpe, PA., Wilcox, S., Schoffman, DE., et al.[2019]

Clinical video telehealth is an effective method for providing functional circuit exercise training to older veterans who live in remote areas, ensuring they have access to important physical activity.

This approach allows for personalized exercise programs to be delivered safely and effectively, improving the health and well-being of older veterans without the need for them to travel.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Providing Rural Veterans With Access to Exercise Through Gerofit. Briggs, BC., Jain, C., Morey, MC., et al.[2020]

A study involving 10 adults with cystic fibrosis demonstrated that assessing exercise capacity through a 3-minute step test via telehealth is feasible and accurate, with no significant differences in physiological responses compared to in-person assessments.

Participants reported high usability of the telehealth system, achieving an average score of 85.63 out of 100, although they noted that the sound quality of the metronome was significantly poorer during remote assessments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Assessing exercise capacity using telehealth: a feasibility study in adults with cystic fibrosis. Cox, NS., Alison, JA., Button, BM., et al.[2013]

The Gerofit facility-based exercise program successfully transitioned to a telehealth format during COVID-19, allowing 27% of participating Veterans to continue exercising remotely.

Remote physical performance testing indicated that participants were able to retain their physical function, suggesting that telehealth exercise programs can effectively mitigate health risks associated with decreased mobility in older adults.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Rapid Transition to Telehealth Group Exercise and Functional Assessments in Response to COVID-19. Jennings, SC., Manning, KM., Bettger, JP., et al.[2021]

Participants with knee osteoarthritis who attended more physical therapy (PT) visits showed significant improvements in overall knee function and pain, with benefits lasting up to 8 months after treatment, based on a study of 259 individuals.

In contrast, the use of an internet-based exercise training (IBET) program did not lead to significant improvements in any measured outcomes, suggesting that traditional PT may be more effective for managing knee osteoarthritis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Level of participation in physical therapy or an internet-based exercise training program: associations with outcomes for patients with knee osteoarthritis. Pignato, M., Arbeeva, L., Schwartz, TA., et al.[2019]

Patients who participated in telehealth for knee osteoarthritis found it to be easy, convenient, and flexible, leading to a positive perception of its acceptability, especially among those with prior exposure to telehealth.

Both telehealth and in-person participants reported similar benefits from the GLA:D® program, including reduced fear of pain, improved beliefs about exercise, and enhancements in pain and function, suggesting that telehealth can effectively provide high-quality care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

"Much better than I thought it was going to be": Telehealth delivered group-based education and exercise was perceived as acceptable among people with knee osteoarthritis. Ezzat, AM., Bell, E., Kemp, JL., et al.[2022]

In a study of 345 participants with knee osteoarthritis, telehealth-delivered exercise programs significantly improved pain and function, with increased arthritis self-efficacy and reduced fear of movement identified as key mediators of these improvements.

The combination of diet and exercise led to additional benefits, including weight loss, which further enhanced pain reduction and functional improvements compared to exercise alone.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

How Does Exercise, With and Without Diet, Improve Pain and Function in Knee Osteoarthritis? A Secondary Analysis of a Randomized Controlled Trial Exploring Potential Mediators of Effects. Lawford, BJ., Hinman, RS., McManus, F., et al.[2023]

The telehealth-delivered Otago exercise program successfully engaged 21 low-income older adults over 12 weeks, promoting physical activity and potentially reducing fall risks, as it is a CDC-endorsed program for improving balance and strength.

Postintervention interviews highlighted significant differences in community engagement and mental health concerns, with one site experiencing high participation and social interaction, while the other faced issues of depression and isolation, indicating the need for integrated mental health support in similar programs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

When More Than Exercise Is Needed to Increase Chances of Aging in Place: Qualitative Analysis of a Telehealth Physical Activity Program to Improve Mobility in Low-Income Older Adults. VanRavenstein, K., Davis, BH.[2020]

Live video exercise groups for older adults showed improvements in physical function, with no significant differences compared to in-person sessions, based on a systematic review of nine studies involving participants aged 65 and older.

Participants in a case study reported similar attendance rates and benefits, such as improved balance, from both virtual and in-person sessions, suggesting that live video formats can be an effective alternative for exercise programs during the COVID-19 pandemic.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Physical Function Effects of Live Video Group Exercise Interventions for Older Adults: A Systematic Review and Veteran's Gerofit Group Case Study. Fernandez, D., Wilkins, SS., Melrose, RJ., et al.[2023]

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