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Does Adherence Make a Difference?: Results From a Community-Based Aquatic Exercise Program

Belza, Basia; Topolski, Tari; Kinne, Susan; Patrick, Donald L.; Ramsey, Scott D.


Background Evidence exists demonstrating the benefits of exercise for people with osteoarthritis, but little is known about whether exercise programs are effective, that is, whether the benefits of exercise can be seen in “real life” programs for “normal” people under nonlaboratory conditions.

Objective To identify characteristics of and outcomes for participants who adhere to a community-based aquatic exercise program.

Method Two hundred and forty-nine adults with osteoarthritis were recruited from Washington State for randomization to a 20-week Arthritis Foundation aquatic exercise program (n = 125) or a wait-list control group (n = 124). Adherers were defined as those attending at least two classes per week for 16 of 20 weeks. Measures included: Quality of Well Being Scale, Health Assessment Questionnaire, Center for Epidemiological Studies-Depression Scale, and a single arthritis quality of life rating-item.

Results Baseline to postintervention change scores revealed that treatment-group adherers (N = 35) reported improved quality of well-being, physical function, and change in arthritis quality of life compared to controls (N = 124). When comparing treatment-group adherers (N = 35) to treatment-group nonadherers (N = 67), quality of well-being and depressed mood improved for adherers, but not for nonadherers.

Conclusion When analyzed for level of participation, exercise benefits adults with osteoarthritis. Consistent participation in exercise programs results in better outcomes. Improved methods are needed to enhance adherence, with increased attention to the role of intrinsic factors such as self-efficacy and belief systems.

Basia Belza, PhD, RN, is Associate Professor, Department of Biobehavioral Nursing and Health Systems, School of Nursing, and Adjunct Associate Professor, Department of Orthopaedics, School of Medicine, University of Washington, Seattle.

Tari Topolski, PhD, is Research Analyst, Department of Health Services, University of Washington, Seattle.

Susan Kinne, PhD, is Research Scientist, Department of Health Services, University of Washington, Seattle.

Donald L. Patrick, PhD, MSPH, is Professor, Department of Health Services, University of Washington, Seattle.

Scott D. Ramsey, MD, PhD, is Associate Member, Fred Hutchinson Cancer Research Center and Associate Professor, Department of Medicine, University of Washington, Seattle.

Accepted for publication March 5, 2002.

This work was funded by the Centers for Disease Control and Prevention, Grant #U48/CCU00954. Previous versions of these analyses were presented at meetings of the American College of Rheumatology and Western Institute for Nursing.

Corresponding author: Basia Belza, PhD, RN, Department of Biobehavioral Nursing and Health Systems, Box 357266, University of Washington, Seattle, WA 98195-7266 (e-mail

© 2002 Lippincott Williams & Wilkins, Inc.