Impact of a Hospital-Based Exercise Program on M usculoskeletal Health Outcomes in Older Adults

1. Impact of a Hospital-Based Exercise Program on Musculoskeletal Health Outcomes in Older Adults Sandra Goldsmith, MA, MS, RD Director, Public & Patient Education Titilayo Ologhobo, MPH Public Heath Outcomes Manager, Public & Patient Education Osteoarthritis Action Alliance Lunch & Learn October 15, 2014

2. Background • Osteoarthritis (OA) is the leading cause of disability in the US, with estimates showing that 27 million Americans have the disease at an estimated cost of $89.1 billion per year1 • One out of four people suffer from longstanding musculoskeletal conditions2 • OA affects more than 70% of adults between 55 - 78 years of age3 • Older adults with knee OA who engage in moderate physical activity at least 3 x/week can reduce the risk of arthritis-related disability by 47%4 Source: 1Leigh, J.P., Seavey, W., & Leistikow, B. (2001). Estimating the costs of job-related arthritis. Journal of Rheumatology, 28(7), 1647-1654. 2The Bone and Joint Decade. (2014). Global Alliance for Musculoskeletal Health. Retrieved on Jan 10, 2014 from http://bjdonline.org/?page_id=11 3Disability Guidelines (2012). Joint Disorders. Retrieved on August 8, 2014 from http://www.mdguidelines.com/joint-disorders 4Centers for Disease Control and Prevention. (2011). Healthy People 2020: Overview of physical activity. Retrieved on August 8, 2012 from http://www.cdc.gov/arthritis/press/questions.htm

3. Hospital for Special Surgery (HSS) • Orthopedic hospital known for its expertise in musculoskeletal and rheumatologic conditions • Committed to providing the highest quality patient care, improving mobility, and enhancing the quality of life of the community it serves • Longstanding history of providing community service and programs to populations of all socio-demographic backgrounds

4. Osteoarthritis Wellness Initiative (OAWI) • Educate, raise awareness and reduce the impact of OA in the community • Educational seminars and workshops • Exercise classes (focus of today’s presentation) • Free or low-cost programs • Open to the public

5. The OAWI Team • Laura Robbins, DSW – Senior Vice President • Sandra Goldsmith, MA, MS, RD –Director • Titilayo Ologhobo, MPH – Outcomes Manager • Robyn Wiesel, CHES – Manager • Huijuan Huang, MPA – Senior Program Coordinator • Linda Roberts, LCSW – Program Coordinator • Madeline Meislin – Assistant Coordinator

6. OAWI Exercise Classes • Goal: improve musculoskeletal health among exercise class participants by: • decreasing musculoskeletal pain, stiffness, fatigue, falls and health limitations • improving health status, level of physical activity and self-efficacy for exercise • improving balance ratings and reducing losses in balance

7. Program Description • Exercise classes 1x/week • Pilates, Tai Chi, Yoga, Dance, Yogalates • Led by certified exercise instructors • Participants • English-speaking older adults

8. Methodology • Pre/post surveys • changes in health outcomes • program satisfaction • Approved by the HSS IRB

9. Outcomes Measures • Standardized and validated instruments • Self-reported • Pain • Pain Relief (Yes/No) • Pain intensity measured by the Numeric Pain Intensity Scale • Pain interference on seven aspects of daily living from the Brief Pain Inventory • Stiffness • Single-item stiffness rating scale from the Brief Stiffness Inventory

10. Outcomes Measures • Fatigue • Single-item fatigue rating scale from the Brief Fatigue Inventory • Balance • 5-point rating scale • Physical Activity (PA) • Three-question Physical Activity Assessment

11. Data Analysis • Three levels of analysis • Total sample • Exercise type • Sample with arthritis conditions (OA & RA) • Matched pairs • Paired sample t-test • Chi-square test • Demographic data

12. Results • Time frame • Spring 2011 – Spring 2014 • Program Reach • 803 total participants • 204 respondents collected via matched pre/post-surveys • Demographic Data • Female (91%) and Caucasian (86%) • Participants were generally older • 65-74 yrs. (25%) • 75-84 yrs. (36%) • >85 yrs. (31%)

13. Results: Total Sample (n = 204) • Pain Relief • Pain significantly decreased from pre to post test (56% to 47%, p≤0.001) • Pain Intensity • Statistically significant reductions (p≤0.001) in mean pain intensity (pre-test = 4.6; post-test = 3.9)

14. Results: Total Sample (n = 204) *denotes statistical significance at p≤0.05 **denotes statistical significance at p≤0.01 ***denotes statistical significance at p≤0.001

15. Results: Total Sample (n = 204) Mean Stiffness and Fatigue Levels on an 11-point rating scale Pre Vs. Post ***denotes statistical significance at p≤0.001 *denotes statistical significance at p≤0.05

16. Results: Total Sample (n = 204) ***denotes statistical significance at p≤0.001 ***denotes statistical significance at p≤0.001

17. Results: Exercise Type Pain Interference on Aspects of Daily Living on an 11-point rating scale Pre vs. Post Pilates (n = 33) Yogalates (n = 41) *denotes statistical significance at p≤0.05 **denotes statistical significance at p≤0.01

18. Results: Exercise Type Balance Ratings (%) Pain Relief (%) *denotes statistical significance at p≤0.05 **denotes statistical significance at p≤0.01 ***denotes statistical significance at p≤0.001

19. Results: Exercise Type **denotes statistical significance at p≤0.01

20. Results: Sample with Arthritis Conditions (n = 20) • OA and/or RA* • Pain Intensity • mean pain intensity dropped from 3.6 to 2.9 • Pain Interference • mean pain interference reduced on all aspects of their quality of life • Fatigue • mean fatigue level dropped from 3.8 to 2.5(p ≤ 0.001) • Physical Activity • ≥ 20 minutes of vigorous – intensity PA increased from 13% to 25% (p ≤ 0.05) *Small sample size because collection of data on musculoskeletal conditions commenced in 2013.

21. Program Satisfaction 98% would recommend the program to a friend or family member

22. Qualitative Reviews • “This is a wonderful class, taught by a wonderful teacher” • “Superb! An amazing teacher...even her voice is calming” • “The exercise classes are terrific” • “I recommended this program to many of my friends” • “I recommend that HSS could offer the class twice a week” • “I have acquired many valuable exercises from this terrific program which I now incorporate into my daily routine” • “Excellent class, excellent instructor! We all love it!”

23. Limitations • Small sample size • Survey fatigue • Self-reported data • Participation in exercise programs outside of study

24. Summary • HSS exercise programs are effective in improving musculoskeletal health outcomes and are associated with positive changes in pain, balance, fatigue, fitness and certain aspects of QOL • It is important to identify effective programs that raise awareness and reduce the impact of musculoskeletal conditions

25. Next Steps • Implement necessary changes to program outcome measures and evaluation methodology based on results • Broaden the variety of classes offered and implement other models to increase program reach • Explore next phase of program evaluation

26. Thank You!