Self-managed Exercise Research Articles

Effect of Group Counseling Plus Tailored Exercise on Mobility Function in Multiple Sclerosis.

Multiple sclerosis (MS) impairs muscular function and limits individuals' ability to perform everyday activities requiring mobility. People with MS frequently exhibit mobility problems (ie, slower walking speed, shorter strides). General exercise training (eg, resistance, aerobic) provides modest physiological and walking mobility benefits. However, researchers suggest tailoring of interventions to address mobility specifically. We conducted a phase 2a pre-post intervention development study (Obesity-Related Behavioral Intervention Trials [ORBIT] intervention development model) of mobility exercise plus cognitive behavioral counseling to improve function and social cognitions known to encourage exercise. The intervention was conducted twice per week for 8 weeks followed by 1 month of self-managed mobility exercise. Participants (N = 29; mean ± SD age = 52.24 ± 11.36 years, mean time since MS diagnosis ≥11 years) were assessed at baseline and after follow-up for mobility function, social cognitions, and intervention fidelity indicators. Results indicated significant improvements in a variety of valid measures of mobility function (eg, 400-m walk), self-regulatory efficacy for mobility exercise and symptom control, and fidelity measures with small to medium effect sizes. Positive findings suggest that the intervention seems to merit testing as a randomized pilot study following the ORBIT model.

Exercise to Reduce Mobility Disability and Prevent Falls After Fall-Related Leg or Pelvic Fracture: RESTORE Randomized Controlled Trial

BackgroundDisability and falls are common following fall-related lower limb and pelvic fractures.ObjectiveTo evaluate the impact of an exercise self-management intervention on mobility-related disability and falls after lower limb or pelvic fracture.DesignRandomized controlled trial.ParticipantsThree hundred thirty-six community dwellers aged 60+ years within 2 years of lower limb or pelvic fracture recruited from hospitals and community advertising.InterventionsRESTORE (Recovery Exercises and STepping On afteR fracturE) intervention (individualized, physiotherapist-prescribed home program of weight-bearing balance and strength exercises, fall prevention advice) versus usual care.Main MeasuresPrimary outcomes were mobility-related disability and rate of falls.Key ResultsPrimary outcomes were available for 80% of randomized participants. There were no significant between-group differences in mobility-related disability at 12 months measured by (a) Short Physical Performance Battery (continuous version, baseline-adjusted between-group difference 0.08, 95% CI − 0.01 to 0.17, p = 0.08, n = 273); (b) Activity Measure Post Acute Care score (0.18, 95% CI − 2.89 to 3.26, p = 0.91, n = 270); (c) Late Life Disability Instrument (1.37, 95% CI − 2.56 to 5.32, p = 0.49, n = 273); or in rate of falls over the 12-month study period (incidence rate ratio 0.96, 95% CI 0.69 to 1.34, n = 336, p = 0.83). Between-group differences favoring the intervention group were evident in some secondary outcomes: balance and mobility, fall risk (Physiological Profile Assessment tool), physical activity, mood, health and community outings, but these should be interpreted with caution due to risk of chance findings from multiple analyses.ConclusionsNo statistically significant intervention impacts on mobility-related disability and falls were detected, but benefits were seen for secondary measures of balance and mobility, fall risk, physical activity, mood, health, and community outings.Trial RegistrationAustralian New Zealand Clinical Trials Registry: ACTRN12610000805077

EHealth-supported case management for patients with panic disorder or depression in primary care: Study protocol for a cRCT (PREMA)

BackgroundPanic disorder (PD), frequently occurring with agoraphobia (AG), and depression are common mental disorders in primary care and associated with considerable individual and societal costs. Early detection and effective treatment of depression and PD/AG are of major importance. Cognitive behavioural exposure exercises have been shown to be effective in reducing anxiety and depressive symptoms. Practice team-based case management can improve clinical outcomes for patients with chronic diseases in primary care. The present study aims at evaluating the effects and cost-effectiveness of a primary care team-based intervention using behavioural therapy elements and case management supported by eHealth components in patients with PD/AG or depression compared to treatment as usual.Methods/designThis is a two-arm cluster-randomized, controlled trial (cRCT). General practices represent the units of randomisation. General practitioners recruit adult patients with depression and PD ± AG according to the International Classification of Diseases, version 10 (ICD-10). In the intervention group, patients receive cognitive behaviour therapy-oriented psychoeducation and instructions to self-managed exposure exercises in four manual-based appointments with the general practitioner. A trained health care assistant from the practice team delivers case management and is continuously monitoring symptoms and treatment progress in ten protocol-based telephone contacts with patients. Practice teams and patients are supported by eHealth components. In the control group, patients receive usual care from general practitioners. Outcomes are measured at baseline (T0), at follow-up after 6 months (T1), and at follow-up after 12 months (T2). The primary outcome is the mental health status of patients as measured by the Mental Health Index (MHI-5). Effect sizes of 0.2 standard deviation (SD) are regarded as relevant. Assuming a drop-out rate of 20% of practices and patients each, we aim at recruiting 1844 patients in 148 primary care practices. This corresponds to 12.5 patients on average per primary care practice. Secondary outcomes include depression and anxiety-related clinical parameters and health-economic costs.DiscussionIf the intervention is more effective than treatment as usual, the three-component (cognitive behaviour therapy, case-management, eHealth) primary care-based intervention for patients suffering from PD/AG or depression could be a valuable low-threshold option that benefits patients and primary care practice teams.Trial registrationGerman clinical trials register, DRKS00016622. Registered on February 22nd, 2019.

Limited effect of a self-management exercise program added to spa therapy for increasing physical activity in patients with knee osteoarthritis: A quasi-randomized controlled trial.

The efficacy of spa therapy in osteoarthritis (OA) has ever been demonstrated, with a good level of evidence for pain and disability. The effect of a self-management program with spa therapy on physical activity (PA) level has never been demonstrated. This study aimed to assess, at 3 months, the effectiveness of 5 sessions of a self-management exercise program in patients with knee OA (KOA) who benefit from 18 days of spa therapy and received an information booklet (on proposed physical exercises) on improvement in at least one PA level. This was an interventional, multicentre, quasi-randomized controlled trial with a cluster randomized design (1-month period). People 50 to 75 years old with symptomatic knee OA were included in 3 spa therapy centres in France (Bourbon Lancy, Le Mont Dore, Royat). Both groups received conventional spa therapy sessions during 18 days and an information booklet on the benefits of PA practice for KOA. The intervention group additionally received 5 self-management exercise sessions. The main outcome was improvement in at least one PA level according to the International Physical Activity Questionnaire (IPAQ) short-form categorical score (low to moderate or high, or moderate to high) at 3 months. Secondary outcomes were the evolution of PA (MET-min/week), disability, pain, anxiety, depression, self-efficacy, fears and beliefs concerning KOA, barriers to and facilitators of regular PA practice, consumption of painkillers and adherence to physical exercise program at 3 months. Assessors but not participants or caregivers were blinded. In total, 123 patients were randomized, 54 to the intervention group and 69 to the control group. Considering the main outcome, at 3 months, 37% of patients in the intervention group showed improvement in at least one PA level according to the IPAQ categorical score versus 30.4% in the control group (P=0.44). In the intervention group, 13 (24.1%) patients showed improvement from low to moderate PA level (vs. 8 [11.6%] in the control group), 2 (3.7%) from low to high (vs. 2 [2.9%]) and 5 (9.3%) from moderate to highvs. 11 [15.9%]). Both intervention and control groups showed increased IPAQ continuous scores (MET-min/week) at 3 months, although not significantly. HAD anxiety and depression scores were significantly reduced in the intervention group (P=0.001 and P=0.049, respectively) and the perception of PA was better in the intervention than control group for motivation and barriers scores (P=0.019 and P=0.002, respectively). This study showed the lack of impact of a short self-management program on PA level in addition to 18-day spa therapy for KOA, but both intervention and control groups showed improved PA level.

Clinical guidelines for type 1 diabetes mellitus with an emphasis on older adults: an Executive Summary.

We present a summary of a guideline produced by an international group of experts for managing type 1 diabetes in adults with an emphasis on the special needs of older people with this condition. The rationale for delivering high-quality diabetes care for adults with type 1 diabetes, why it is important to include older people in our considerations, and the key underpinning principles of the guideline are included. The structure of the recommendations given is described and consists of 'general' recommendations followed by 'specific' recommendations according to three categories depending on the characteristics of adults addressed, such as functional level or self-management ability. Recommendations are provided in the areas of: clinical diagnosis, establishing management plans and glucose regulation, diabetes self-management education, nutritional therapy, physical activity, exercise and lifestyle modification, insulin treatments and regimens, use of technology in diabetes management, hypoglycaemia, managing cardiovascular risk, management of microvascular risk, and inpatient management of type 1 diabetes and ketoacidosis.

Barriers and facilitators of loaded self-managed exercises and physical activity in people with patellofemoral pain: understanding the feasibility of delivering a multicentred randomised controlled trial, a UK qualitative study

ObjectivesThere is an emergent body of evidence supporting exercise therapy and physical activity in the management of musculoskeletal pain. The purpose of this study was to explore potential barriers and...

The Effectiveness of a Self-managed Digital Exercise Programme to Prevent Falls in Older Community-dwelling People

The Effectiveness of a Self-managed Digital Exercise Programme to Prevent Falls in Older Community-dwelling People

A loaded self-managed exercise programme for patellofemoral pain: a mixed methods feasibility study

BackgroundA novel loaded self-managed exercise programme that includes pain education and self-management strategies may result in better outcomes for people with patellofemoral pain (PFP). However, establishing program feasibility is an essential first step before testing efficacy. The purpose of this study was to evaluate the feasibility and acceptability of conducting a definitive RCT which will evaluate the clinical and cost-effectiveness of a loaded self-managed exercise programme for people with PFP compared with usual physiotherapy.MethodsIn a mixed methods, pragmatic, randomised controlled feasibility study, 60 participants with PFP (57% female; mean age 29 years) were recruited from a physiotherapy clinic within a large UK teaching hospital. They were randomly allocated to receive either a loaded self-managed exercise programme (n = 30) or usual physiotherapy (n = 30). Feasibility indicators of process, resources, and management were collected through follow-up of standardised questionnaires six months after recruitment and semi-structured interviews with 20 participants and physiotherapists.ResultsRecruitment rate was 5 participants per month; consent rate was 99%; adherence to intervention appointments was 87%; completeness of questionnaire data was 100%; and adherence to intervention delivery was 95%.Three exercise diaries were returned at six months (5%). At six months, 25 questionnaire booklets were returned (9 in the loaded self-managed group, 16 in the usual physiotherapy group), with a total retention rate of 42%.At six months, 56% (5/9) of respondents in the loaded self-managed group and 56% (9/16) in the usual physiotherapy group were classified as ‘recovered’.Both groups demonstrated improvements in average pain (VAS), kinesiophobia, pain catastrophizing, general self-efficacy and EQ-5D-5 L from baseline to six months.ConclusionThe results of this feasibility study confirm that it is feasible and acceptable to deliver a loaded self-managed exercise programme to adults with PFP in an NHS physiotherapy outpatient setting. However, between group differences in lost to follow up and poor exercise diary completion mean we are uncertain on some feasibility aspects. These methodological issues need addressing prior to conducting a definitive RCT.Trial registrationISRCTN 35272486. Registered 19th December 2016.

\u2018Managing pieces of a personal puzzle\u2019 \u2014 Older people\u2019s experiences of self-management falls prevention exercise guided by a digital program or a booklet

BackgroundExercise is effective in order to prevent falls in community-dwelling older people. Self-management programs have the potential to increase access and reduce costs related to exercise-based fall prevention. However, information regarding older people’s views of participating in such programs is needed to support implementation. The aim of this study was to explore older people’s experiences of a self-management fall prevention exercise routine guided either by a digital program (web-based or mobile) or a paper booklet.MethodsThis qualitative study was part of a feasibility study exploring two completely self-managed exercise interventions in which the participants tailored their own program, guided either by a digital program or a paper booklet. Individual face-to-face semi-structured interviews were conducted with a purposeful sample of 28 participants (18 women), mean age 76 yrs. Qualitative content analysis was used to analyse the data.ResultsSelf-managing and self-tailoring these exercise programs was experienced as ‘Managing pieces of a personal puzzle’. To independently being able to create a program and manage exercise was described in the categories ‘Finding my own level’ and ‘Programming it into my life’. The participants experienced the flexibility and independence provided by completely self-managed exercise as positive and constructive although it required discipline. Furthermore, different needs and preferences when managing their exercise were described, as well as varying sources of motivation for doing the exercise, as highlighted in the category ‘Defining my source of motivation’. The category ‘Evolving my acquired knowledge’ captures the participants’ views of building their competence and strategies for maintenance of the exercise. It describes a combined process of learning the program and developing reflection, which was more clearly articulated by participants using the digital program.ConclusionsThis study provides new knowledge regarding experiences, preferences and motivations of older people to engage in home-based self-managed fall prevention exercise. They expressed both a capability and willingness to independently manage their exercise. A digital program seems to have strengthened the feeling of support while creating their own exercise program and tailoring it to their preferences and circumstances, which might therefore create better opportunities for adoption and adherence in the long term.

Weight management telehealth intervention for overweight and obese rural cardiac rehabilitation participants: A randomised trial.

To determine whether a weight management intervention (WMI) plus cardiac rehabilitation (CR) compared to CR alone improves outcomes for overweight and obese cardiac revascularisation patients. Despite participating in cardiac rehabilitation (CR), few cardiac patients lose enough weight to achieve clinically significant cardiovascular disease risk reduction. A randomised controlled design was used with measurements at baseline, 4 and 6months, guided by the CONSORT checklist, see Supporting Information File S1. Adults who had undergone either coronary artery bypass surgery (CABS) or percutaneous coronary intervention (PCI) and participated in a rural CR programmes were recruited. Subjects were randomised to a 12-week telehealth WMI or control group. The primary outcome was weight loss. Secondary outcomes included physical activity, patient activation, perceived self-efficacy and use of weight management behaviours. A total of 43 subjects participated, with a mean age of 63 (±9.3) years. The WMI group had significantly more weight loss averaged across the 4 and 6months of 13.8 (±2.8) pounds compared to the control group [mean=7.8 (±2.2) pounds]. There were no significant differences in physical activity (activity counts or daily minutes in moderate or more intense activity). The WMI group had significantly higher levels of patient activation. They also had significantly higher total scores on the Diet and Exercise Self-Management survey, and subscales that included self-efficacy for specific eating habits and managing diet behaviour. Findings demonstrated the usefulness and feasibility of using telehealth delivery of the WMI for cardiac rehabilitation participants in rural communities to improve weight management outcomes. Study findings underscore the opportunity to further improve weight loss of overweight and obese cardiac participants using a weight management intervention to augment CR participation.

Barriers and facilitators of loaded self-managed exercises and physical activity in people with patellofemoral pain - a UK qualitative study

Purpose: There is an emergent body of evidence supporting exercise therapy and physical activity in the management of musculoskeletal pain. The purpose of this study was to explore potential barriers and facilitators with patients and physiotherapists with patellofemoral pain involved in a feasibility randomised controlled trial (RCT) study. The trial investigated a loaded self-managed exercise intervention, which included education and advice on physical activity versus usual physiotherapy as the control.

Efficacy of self-management exercise program with spa therapy for behavioral management of knee osteoarthritis: research protocol for a quasi-randomized controlled trial (GEET one)

BackgroundOsteoarthritis (OA) is not limited to joint pain and stiffness, which can lead to disability; it is also linked to comorbidities such as overweight, obesity and fears and beliefs related to the pathology. The knee OA population appears more affected by these risk factors and has a lower physical activity (PA) level than the general population. The key challenge for OA treatment is increasing the PA level to decrease the risk factors.MethodsWe aim to perform a prospective, multicentric, quasi-randomized controlled trial with an alternate-month design (1-month periods). People aged 50–75 years old with symptomatic knee OA (stage I-IV Kellgren and Lawrence scale) with low and moderate PA level will be included in 3 spa therapy resorts. The experimental arm will receive 5 self-management exercise sessions (1.5 h each; education, aerobics, strength training, range of motion) + an information booklet + 18 sessions (1 h each) of spa therapy treatment (STT). The active comparator arm will receive an information booklet + 18 sessions of STT. The primary outcome will be a change at 3 months in PA level (International Physical Activity Questionnaire short form score). Secondary outcomes will be function (WOMAC) pain (numerical scale), anxiety/depression (HAD), fears and beliefs about OA (KOFBeQ) and arthritis self-efficacy (ASES). The barriers to and facilitators of regular PA practice will be assessed by using specific items specifically designed for the study because of lack of any reference scale.DiscussionThe study could demonstrate the impact of a self-management exercise program associated with spa therapy in the medium term by increasing PA level in people with OA. A benefit for ameliorating fears and beliefs and anxiety/depression and improving self-efficacy will also be analysed. The findings could offer new prospects while establishing best clinical practice guidelines for this population.Trial registrationClinicalTrials.gov NCT02598804 (November 5, 2015).

A Multidisciplinary Approach to the Management of Chronic Pain through a Self-managed Behavioral Exercise Program : A Pilot Study in Japan.

We conducted this study to determine the short-term treatment outcomes of multidisciplinary approaches to chronic pain management for outpatients in Japan. We evaluated pain reduction and improvement in quality of life (QOL) after treatment. We analyzed 32 patients who had experienced intractable chronic pain for > 3 months. The patients received multidisciplinary therapeutic self-managed exercise instructions and then underwent evaluations 1 and 3 months after the treatment. We used the Pain Disability Short Form-36 (SF-36), Pain Catastrophizing Scale (PCS), and Pain Disability Assessment Scale (PDAS) to evaluate QOL. Although the pain levels were the same before and after the physical exercise program, the patients showed significant improvements in physical function on the SF-36 (48.5 vs. 54.5, 3 months vs. 1 month; p=0.0124), the magnification subscale on the PCS (6.8 vs. 5.9, 1 month vs. before; p=0.0164) and the PDAS (29.2 vs. 23.4, 3 months vs. before; p=0.0055). Chronic pain should be treated with a biopsychosocial approach, but time constraints and costs have limited the implementation of multidisciplinary and behavioral approaches to chronic pain management. Our findings demonstrate that clinical improvements are possible for patients with chronic pain, using multidisciplinary team resources widely available in Japanese clinical practice.

Effects Of A 12-week Self-managed Exercise Program On Fatigability In Older Adults

Aging is associated with greater fatigability and reduced participation in physical activity. Exercise training in older adults has been associated with a number of health benefits; however, less is known about the effects of self-managed exercise on perceived and performance fatigability. PURPOSE: Compare the effects of a 12-week self-managed exercise program on perceived (PercF) and performance (PerfF) fatigability in a group of unimpaired older adults. METHODS: 28 older adults participated in a self-managed exercise program (15 men and 13 women; age 71.3 ± 4.2 years). The program consisted of educational lectures on aerobic (AT), resistance (RT), and balance (BT) training methods as described by the National Institute of Aging. 17 adults completed the 12-week program in three exercise groups: AT only (n=8), AT/RT (n=5), and AT/RT/BT (n=4). Fatigability was assessed following a standardized 10-minute walk test at a self-selected speed at baseline (PRE) and at the conclusion of the 12-week exercise program (POST). PercF was calculated at the completion of walking by dividing participant-perceived changes in fatigue by the total distance walked in meters. PerfF was calculated as the change in walking velocity (at 2.5 and 10 minutes), divided by the total distance walked. Within-group data were analyzed with a paired t-test and between-group effects using one-way ANOVA. RESULTS: Within the AT and AT/RT groups, significantly lower PerfF was observed at POST (p = .011 and p = .035, respectively) with no differences found in the AT/RT/BT group (p = .437). PercF was unchanged in all groups (AT, p = .50, AT/RT, p = .65, AT/RT/BT, p = .70). No difference was observed between groups for PercF (F (2,14) = 0.443, p = .651) or PerfF (F (2,14) =. 528, p = .601). Further, Cohen’s effect size for changes in PerfF was moderate for AT (d = .48), AT/RT (d = .38), and AT/RT/BT (d =. 38). CONCLUSIONS: Participation in a 12-week self-managed exercise program reduced performance fatigability in unimpaired older adults. However, our results did not reveal specific exercise recommendations for older adults to improve both performance and perceived fatigability. Future studies are needed to investigate the influence of exercise training on measures of fatigability to optimize exercise interventions.

Dynamic Balance Changes in Older Adults Following 12-Weeks of a Self-Managed Exercise Program

Dynamic Balance Changes in Older Adults Following 12-Weeks of a Self-Managed Exercise Program

Changes in Global Health Status in Older Adults Following a Self-Managed Exercise Program

Changes in Global Health Status in Older Adults Following a Self-Managed Exercise Program

Gauging the Effects of Self-efficacy, Social Support, and Coping Style on Self-management Behaviors in Chinese Cancer Survivors.

Better self-management control in cancer survivors would benefit their functional status, quality of life, and health service utilization. Factors such as self-efficacy, social support, and coping style are important predictors of self-management behaviors of cancer survivors; however, the impact of these factors on self-management behaviors has not yet been empirically tested in Chinese cancer survivors. The aim of this study was to examine how self-efficacy, social support, and coping style affect specific self-management behaviors. A secondary data analysis was completed from a cross-sectional study. A total of 764 cancer survivors were recruited in the study. Validated instruments were used to assess patients' self-efficacy, social support, and coping style. Structural equation modeling (SEM) was used to test the hypothesis. The SEM model fits the data very well, with root mean square error of approximation (RMSEA) of 0.034; close-fit test cannot reject the hypothesis of root mean square error of approximation of 0.05 or less, comparative fit index of 0.91, Tucker-Lewis index of 0.90, and weighted root mean square residual of 0.82. For the measurement models in the SEM, all items loaded highly on their underlying first-order factors, and the first-order factors loaded highly on their underlying second-order factors (self-efficacy and social support, respectively). The model demonstrated that self-efficacy and social support directly and indirectly, via coping style, affect 3 self-management behaviors (ie, communication, exercise, and information seeking). Our results provide evidence that self-efficacy and social support impose significant direct effects, as well as indirect effects via copying style, on the self-management of cancer survivors. Our findings may help nurses to further improve their care of cancer survivors in terms of their self-management behaviors, specifically communication, exercise, and information seeking.

The Role of Affect and Coping in Diabetes Self-Management in Rural Adults with Uncontrolled Diabetes and Depressive Symptoms.

Many patients with diabetes have poorly controlled blood sugar levels and remain at risk for serious diabetes complications, despite access to effective diabetes treatments and services. Using the transactional model of stress and coping framework, the study investigated the contributions of affect (Positive and Negative Affect Schedule) and coping (maladaptive and adaptive coping from the Brief Cope) on diabetes self-management behaviors, namely diet and exercise. One hundred seventy-eight rural adults with uncontrolled diabetes and moderate depressive symptoms completed the measures. Multiple regression analyses demonstrated that positive affect and negative affect were significantly associated with diet and exercise, even after adjusting for diabetes severity, illness intrusiveness, and diabetes knowledge. However, two path analyses clarified that adaptive coping mediated the relationships between affect (positive and negative) and self-management behaviors (diet and exercise). Comprehensive diabetes treatments that include self-management support can assist patients in recognition and use of adaptive emotion-focused coping skills.

Modality of exercise influences rate of decrease in depression for cancer survivors with elevated depressive symptomatology.

This three-arm feasibility controlled trial examined whether different exercise modalities provide reductions in depression symptoms to cancer survivors with elevated depression. Thirty-two participants (58.9 ± 9.4years) were allocated to a 12-week supervised exercise group (EX; n = 10), a self-managed home-based exercise group (SMHB; n = 8), or a usual care control group (CONT; n = 14). EX performed two supervised resistance and aerobic sessions per week. SMHB were provided with printed material about benefits of exercise and encouraged to complete 150min of exercise weekly. CONT received no exercise or printed material and were encouraged to maintain usual activity. A group × time interaction was found for the primary outcome of depression scores, measured using the Hospital Anxiety and Depression Scale (HADS-D; p = .008). SMHB (6.4 ± 5.3 to 2.2 ± 2.9, p = .006) and EX (6.9 ± 4.2 to 4.0 ± 2.4, p = .021) interventions both effectively reduced HADS-D scores compared to CONT (7.2 ± 2.5 to 7.7 ± 3.6). SMHB decreased depression to a greater extent, and this occurred more rapidly with greatest changes noted at 6weeks (d = 0.50). Further favourable outcomes for exercise were also noted for several secondary outcome measures. The rate of exercise-related reduction in depression is influenced by the modality of exercise. However, increasing the duration of the programme appears to diminish the favourable short-term response to self-managed exercise with subsequent secondary outcomes of mental health favouring supervised exercise.

Conservative management strategies to mitigate the increasing burden of osteoarthritis on the healthcare system

In Canada, the incidence is expected to increase in the upcoming years due to changing population demographics. As such, researchers have recently started to focus on conservative management strategies. This article will review the current evidence available for the effectiveness of self-management and therapeutic exercise programs in individuals with hip and knee OA, as well as discuss the potential for mitigating rising healthcare costs in this population.