Plain English Summary
Background and study aims
Rising healthcare costs, limited resources, and the aging population have created new and growing challenges in the management of osteoarthritis (OA). The promotion of physical activity (PA) is a priority for health organizations serving the general population and is highly recommended for individuals affected by chronic diseases. PA combined with strategies that promote PA behaviour, and self-management interventions can reduce the risk of disability and negative consequences of inactivity related to OA. The purpose of this study was to compare improvements in quality of life, pain, mobility, and endurance, adherence rates, and confidence and self-efficacy after completing a 12-month walking program based on evidence found by the Ottawa Panel.
Who can participate?
A total of 222 adults with knee OA were recruited. The average age of participants was 63.4 years. Participants were eligible to participate in the study if they had a confirmed diagnosis with mild to moderate OA according to the American College of Rheumatology criteria, reported pain for at least 3 months, expected their medication to change during the study period, demonstrated an ability to walk for a minimum of 20 minutes at their own pace with minimal reports of pain, were able to be treated as an out-patient, and were available three times a week over a period of 12 months.
What does the study involve?
The participants were randomly allocated to one of three groups: 1) Walking and Behavioural intervention, which included the supervised walking program combined with a behavioural intervention and an educational pamphlet on the benefits of walking for OA, 2) Walking intervention wherein participants only received the supervised walking program intervention and the educational pamphlet, 3) Self-directed control wherein participants only received the educational pamphlet.
What are the possible benefits and risks of participating?
The walking program, either supervised or unsupervised can improve quality of life, pain, mobility, and endurance. The risks of participating in a PA intervention such as a walking program are minimal, as participants may succumb to an injury, but this was not observed in this study.
Where is the study run from?
The study took place at three shopping centres in the Ottawa, Canada region: St.Laurent Shopping Centre, Billings Bridge Shopping Centre, and Les Promenades de l'Outaouais.
When is the study starting and how long is it expected to run for?
The study started in January 2007 and ran until May 2010. Participants were recruited until December 2009.
Who is funding the study?
The study was funded by the Canadian Institutes of Health Research (CIHR), University Research Chair (salary support for research staff), and the Ministry of Human Resources (summer student program) (Canada).
Who is the main contact?
Dr Lucie Brosseau
Dr Lucie Brosseau
University of Ottawa
451 Smyth Rd
+1 (0)613 562 5800 ext 8015
The impact of a community-based aerobic walking program for older individuals with mild to moderate knee osteoarthritis
RCT on walking
As long as individuals with OsteoArthritis (OA) continue to walk regularly, they will benefit from the positive effects of exercise and sustain a better Quality of Life (QoL) than those who do not. We also hypothesise that adding a tailored behavioral intervention to the Walking program (WB) will increase long-term adherence to the program and improve QoL.
Research Ethics Board of the Ottawa Hospital (Canada), 03/11/2006
Single-centre randomised parallel trial with study participant, investigator, outcome assessor and data analyst blinded
Primary study design
Secondary study design
Randomised parallel trial
Patient information sheet
Osteoarthritis of the knee
1. Long-term structured aerobic walking program and educational pamphlet: walking program (45 minutes per session, three sessions a week during 18 months)
2. Long-term structured aerobic walking and behavioral approach and educational pamphlet: walking program (45 minutes per session, three sessions a week during 18 months) and behavioral approach (average 10 minutes per session, three sessions a week during 12 months)
3. Home self-directed walking program and educational pamphlet: self-directed walking program (45 minutes per session, three sessions a week during 18 months)
Primary outcome measure
1. The Arthritis Impact Measurement Scale (AIMS2), each 3 months during 18 months
2. The Short Form health survey (SF-36), each 3 months during 18 months
Secondary outcome measures
1. Overall adherence and maintenance of physical activity (the number of walking sessions attended divided by the number of walking sessions prescribed), every 3 months during 18 months
2.Change in level of PA measured using the seven-day Physical Activity Recall (PAR), each 3 months during 18 months
3. Self-efficacy capacity will be measured using the Arthritis Self-Efficacy Scale (ASES), each 3 months during 18 months
4. Aerobic capacity (Volume of Oxygen inspired by the body in one minute [VO2max]), each 6 months during 18 months
5. Walking endurance (six-minute walk-test), each 3 months during 18 months
6. Blood pressure and heart rate, each 3 months during 18 months
7. Functional status will be measured using the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) questionnaire, each 3 months during 18 months
8. Gait speed (time to walk six metres), each 3 months during 18 months
9. Resource utilisation, each 3 months during 18 months
10. Cost (i.e. time lost from paid work), each 3 months during 18 months
11. Quality-adjusted life expectancy (societal-preference-based values will be elicited indirectly through completion of the EuroQoL questionnaire [EQ-5D]), each 3 months during 18 months
Overall trial start date
Overall trial end date
Reason abandoned (if study stopped)
Participant inclusion criteria
1. Male and female patients with osteoarthritis of the knee
2. 60 years and older
3. Pain for at least last 3 months
Target number of participants
Participant exclusion criteria
1. Participation during the previous six months in regular Physical Activity (PA) or aerobic sports more than or equal to two times per week for more than 20 minutes per session
2. Presence of pain at rest or at night
3. Current rehabilitation treatment or previous corticosteroids injection within the last 12 months or any other pain-related treatment besides medication for arthritis
4. Uncontrolled hypertension: Systolic Blood Pressure (BP) more than 160 mmHg
5. Individuals with obesity (Body Mass Index [BMI] more than 30 kg/m^2)
6. Other illness, judged by the patient or study physician to make participation in this study inadvisable
7. Significant cognitive deficit resulting in an inability to understand or comply with instructions
8. Surgery planned in the next year
9. Intention to move away from Ottawa in the next year
10. Inability to communicate in English or French
11. Unwillingness to sign informed consent
Recruitment start date
Recruitment end date
Countries of recruitment
Trial participating centre
University of Ottawa
Canadian Institutes of Health Research (CIHR) (grant no.: MCT-82367)
Instituts de Recherche en Santé du Canada, CIHR, IRSC
Funding Body Type
Funding Body Subtype
Results and Publications
Publication and dissemination plan
Not provided at time of registration
Intention to publish date
Participant level data
Not provided at time of registration
Basic results (scientific)
Brosseau L, Wells GA, Kenny GP, Reid R, Maetzel A, Tugwell P, Huijbregts M, McCullough C, De Angelis G, Chen L, The implementation of a community-based aerobic walking program for mild to moderate knee osteoarthritis (OA): a knowledge translation (KT) randomized controlled trial (RCT): Part I: The Uptake of the Ottawa Panel clinical practice guidelines (CPGs)., BMC Public Health, 2012, 12, 871, doi: 10.1186/1471-2458-12-871.
Brosseau L, Wells GA, Kenny GP, Reid R, Maetzel A, Tugwell P, Huijbregts M, McCullough C, De Angelis G, Chen L, The implementation of a community-based aerobic walking program for mild to moderate knee osteoarthritis: a knowledge translation randomized controlled trial: part II: clinical outcomes., BMC Public Health, 2012, 12, 1073, doi: 10.1186/1471-2458-12-1073.