Maintenance of Exercise Adherence Among Older Adults with Osteoarthritis


To assess the effects of two different ways of enhancing long-term adherence to Fit and Strong!, an exercise program for older persons with lower extremity osteoarthritis.


Osteoarthritis (OA) is the most common condition affecting older people today. It is the leading cause of disability among older people and its impact is projected to increase substantially with the aging of the U.S population (CDC, 1999; CDC, 2003). To date, ten randomized trials of exercise interventions have been conducted among persons with OA. Although most report positive short-term outcomes at three months or less, only two have reported mixed findings on longer term adherence and related outcomes at 12 or 18 months. This paucity of data on the maintenance of long-term exercise behavior among persons with OA indicates an urgent need for additional studies of issue. This study uses a multi-site randomized controlled trial with repeated measures to assess the comparative effects of two different ways of enhancing long-term adherence to and benefits associated with participation in the evidence-based, Fit and Strong multi-component exercise intervention for older persons with lower extremity OA (Hughes et al., in press). We have recruited 600 persons to participate in the 8-week Fit and Strong program. At the conclusion of Fit and Strong, participants are stratified by arthritis severity and randomized to either Negotiated Maintenance, in which individualized tailored adherence plans are developed, or Mainstreamed Maintenance, in which participants are mainstreamed into an ongoing facility-based program at each of four participating study sites. In addition, half of the participants in both maintenance arms are randomly assigned to receive telephone reinforcement. We are using generalized estimating equations and random effects models to test the hypotheses. Negotiated maintenance participants experience significantly greater levels of adherence to exercise at two, six, 12, 18, and 24 months, and significant improvements in self-efficacy for exercise, self-efficacy for exercise adherence, self reported and observed functional status, and psychosocial measures compared to mainstreamed maintenance participants at two, six, 12, and 18 months.

Research Partner(s)

Abbott Park Satellite Senior Center
Northeast Levy Senior Center
Northwest Copernicus Senior Centers
Southeast Atlas Senior Center
Southwest Senior Center

Funding Agency

National Institute on Aging (Grant No. 5RO1 AG023424)


Principal investigator
Susan L. Hughes, DSW


Richard T. Campbell, PhD
Thomas R. Prohaska, PhD
James H. Rimmer, PhD
Rachel B. Seymour, PhD

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Related publications

See publications supported by this grant on this PubMed list

Desai PM, Hughes SL, Peters KE, Mermelstein RJ. Impact of telephone reinforcement and negotiated contracts on behavioral predictors of exercise maintenance in older adults with osteoarthritis. Am J Health Behav. 2014 May;38(3):465-77. [See abstract.]

Freeman VL, Ricardo AC, Campbell RT, Barrett RE, Warnecke RB. Association of census tract-level socioeconomic status with disparities in prostate cancer-specific survival. Cancer Epidemiol Biomarkers Prev. 2011 Oct;20(10):2150-9. [See abstract.]

Hughes SL, Seymour RB, Campbell RT, Desai P, Huber G, Chang HJ. Fit and Strong!: bolstering maintenance of physical activity among older adults with lower-extremity osteoarthritis. Am J Health Behav. 2010 Nov-Dec;34(6):750-63. [See abstract.]

Seymour RB, Hughes SL, Ory MG, Elliot DL, Kirby KC, Migneault J, Patrick H, Roll JM, Williams G. A lexicon for measuring maintenance of behavior change. Am J Health Behav. 2010 Nov-Dec;34(6):660-8. [See abstract.]

Seymour RB, Hughes SL, Campbell RT, Huber GM, Desai P. Comparison of two methods of conducting the Fit and Strong! program. Arthritis Rheum. 2009 Jul 15;61(7):876-84. [See abstract.]