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An evidence-based walking program among older people with knee osteoarthritis: the PEP (participant exercise preference) pilot randomized controlled trial


Knee osteoarthritis is a common joint problem leading to an increase of pain and a loss of function in older individuals. The main objective of this study was to evaluate if a participant who was randomly assigned to his preferred group improved his adherence to an effective walking program compared to a participant who did not receive his preferred group. This was a 9-month pilot randomized clinical trial, based on a patient treatment preferences design. The 69 eligible participants had a diagnosis of knee osteoarthritis. Participants were randomized to one of two groups: a supervised community-based or unsupervised walking program, based on the Ottawa Panel guidelines. At 6 months, participants who expressed a preference, either for the supervised or unsupervised program, and who were assigned to their preferred choice of program showed significantly higher adherence to walking sessions (supervised 60.7 ± 12.3%, P < 0.0001; unsupervised 43.1 ± 12.1%, P = 0.03), compared to the participants who did not obtain their preferred choice of program. After 9 months, significant improvements were shown according to the level of stiffness evaluated with the WOMAC (P = 0.01) and the functional status assessed with the Timed Up and GO Test (P = 0.04), among the adherent participants who obtained their preference, as compared to those who did not receive their preference. We show this approach promotes long-term adherence to a community-based walking program, while ensuring the maintenance of clinical benefits of walking, among older adults susceptible to avoid or not properly engage in physical activity.

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The authors are grateful to Ana Lakic, Prinon Rahman, the Pacesetters Walking Club and Marion Russell-D. from the Arthritis Society. The Arthritis Health Professions Association (AHPA) and The Arthritis Research Foundation Movement and Mobility supported the pilot trial. The study protocol was awarded the 2012 Arthritis Research Foundation Movement and Mobility Award. In addition, the first author received multiple other funds to support this work. The scholarships were from Fonds de recherche en santé du Québec (FRSQ), University of Ottawa Research Chair, Knowledge Translation Canada, in collaboration with the Canadian Institutes of Health Research (CIHR), Ontario Physiotherapy Association (OPA), Government of Ontario, and the University of Ottawa Research Chair (Graduate Students Salary Support).

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Correspondence to Laurianne Loew.

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Ethical standards

Ethics approval was obtained from the Research Ethics Board of the University of Ottawa without modifications to the design and measurement as registered for the pilot RCT (H01-07-08C).



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Trial Registration

International Standard Randomized Controlled Trial Number Register (ISRCTN no. 51981241) and Current Controlled Trials.

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CONSORT checklist (PDF 256 kb)


Full study protocol published (PDF 492 kb)

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Loew, L., Brosseau, L., Kenny, G.P. et al. An evidence-based walking program among older people with knee osteoarthritis: the PEP (participant exercise preference) pilot randomized controlled trial. Clin Rheumatol 36, 1607–1616 (2017).

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  • Clinical trials
  • Implementation
  • Knee
  • Osteoarthritis
  • Preference
  • Walking