A home-based pedometer-driven walking program to increase physical activity in older adults with osteoarthritis of the knee: A preliminary study

OBJECTIVES: To determine whether a home-based pedometer-driven walking program with arthritis self-management education (Walk +) would increase physical activity, muscle strength, and functional performance in older adults with osteoarthritis (OA) of the knee as opposed to arthritis self-management education alone (EDU). DESIGN: A randomized two-by-three (group-by-time) design with participants assigned to Walk + (n = 17, mean age +/- standard deviation = 69.6 +/- 6.7) or EDU (n = 17, age = 70.8 +/- 4.7). SETTING: Community located in the Baltimore-Washington area. PARTICIPANTS: Thirty-four community-dwelling adults, aged 60 and older with symptomatic knee OA and self-reported functional impairment. INTERVENTIONS: Both groups received 12 hours of the Arthritis Self-Management program over 12 weeks and were followed for an additional 12 weeks. In addition, the Walk + group received individualized instruction in the use of a pedometer, with the goal of increasing their step count by 30% of their baseline step count. MEASUREMENTS: The outcome measures were physical activity (daily step counts and total activity vector magnitude as measured by a pedometer and Tritrac-R3D accelerometer), quadriceps femoris strength (isometric peak torque), and functional performance tasks (100-foot walk-turn-walk, timed stair climb, timed chair rise, and pain status). RESULTS: Daily steps walked showed a significant group-by-time interaction (P = .04) after controlling for age. From baseline to completion of training, a 23% increase in daily steps occurred in the Walk + group and a 15% decrease in the EDU group. Although steps increased in the Walk + group, total activity vector magnitude was maintained, suggesting a more efficient gait. The Walk + group became quicker than the EDU group in the normal-pace walk-turn-walk (P = .04). An isometric strength gain of 21% postintervention was seen in the Walk + group, compared with a loss of 3.5% in the EDU group. CONCLUSION: In older adults with symptomatic knee OA, Walk + appears to increase walking, with improvements in muscle strength and walking performance. The use of a home-based pedometer-driven program to increase physical activity, strength, and function in this population warrants further research.