title: Effects of muscle strengthening versus aerobic exercise program in fibromyalgia Supervised and non-supervised Nordic walking in the treatment of chronic low back pain: a single blind randomized clinical trial The Effectiveness of Multidisciplinary Rehabilitation in the Treatment of Fibromyalgia: A Randomized Controlled Trial Pedometer-driven Walking for Chronic Low Back Pain: A Feasibility Randomized Controlled Trial Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the Arthritis, Diet, and Activity Promotion Trial. Synovial fluid chondroitin sulphate epitopes 3B3 and 7D4, and glycosaminoglycan in human knee osteoarthritis after exercise Aerobic fitness effects in fibromyalgia. An exercise program in the treatment of fibromyalgia. Pedometer-Based Internet-Mediated Intervention For Adults With Chronic Low Back Pain: Randomized Controlled Trial A randomized trial of walking versus physical methods for chronic pain management 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 A four-week walking exercise programme in patients with knee osteoarthritis improves the ability of dual-task performance: a randomized controlled trial Physical Activity-Related Injuries in Walkers and Runners in the Aerobics Center Longitudinal Study Group exercise, education, and combination self-management in women with fibromyalgia: a randomized trial. Effectiveness of a home-based exercise therapy and walking program on osteoarthritis of the knee Impact of an exercise and walking protocol on quality of life for elderly people with OA of the knee. A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST). A home-based pedometer-driven walking program to increase physical activity in older adults with osteoarthritis of the knee: a preliminary study. One-year followup of patients with osteoarthritis of the knee who participated in a program of supervised fitness walking and supportive patient education. Utilizing exercise to affect the symptomology of fibromyalgia: a pilot study. Intensive weight loss program improves physical function in older obese adults with knee osteoarthritis. Update on the Methods of the U.S. Preventive Services Task Force: Estimating Certainty and Magnitude of Net Benefit Improved cardiovascular health following a progressive walking and dietary intervention for type 2 diabetes. Graded Exercise for Recurrent Low-Back Pain: A Randomized, Controlled Trial With 6-, 12-, and 36-Month Follow-ups Improving Physical Activity and Function in Overweight and Obese Older Adults with Osteoarthritis of the Knee: A Feasibility Study Supervised fitness walking in patients with osteoarthritis of the knee. A randomized, controlled trial. Randomised controlled trial of home-based walking programmes at and below current recommended levels of exercise in sedentary adults An aerobic walking programme versus muscle strengthening programme for chronic low back pain: a randomized controlled trial Changes associated with a quota-based approach on a walking program for individuals with fibromyalgia.
abstract: The purpose of this study was to compare the effects of aerobic training with a muscle-strengthening program in patients with fibromyalgia . Thirty women with fibromyalgia were r and omized to either an aerobic exercise ( AE ) program or a strengthening exercise ( SE ) program for 8 weeks . Outcome measures included the intensity of fibromyalgia-related symptoms , tender point count , fitness ( 6-min walk distance ) , hospital anxiety and depression ( HAD ) scale , and short-form health survey ( SF-36 ) . There were significant improvements in both groups regarding pain , sleep , fatigue , tender point count , and fitness after treatment . HAD-depression scores improved significantly in both groups while no significant change occurred in HAD-anxiety scores . Bodily pain subscale of SF-36 and physical component summary improved significantly in the AE group , whereas seven subscales of SF-36 , physical component summary , and mental component summary improved significantly in the SE group . When the groups were compared after treatment , there were no significant differences in pain , sleep , fatigue , tender point count , fitness , HAD scores , and SF-36 scores . AE and SE are similarly effective at improving symptoms , tender point count , fitness , depression , and quality of life in fibromyalgia Background Active approaches including both specific and unspecific exercise are probably the most widely recommended treatment for patients with chronic low back pain but it is not known exactly which types of exercise provide the most benefit . Nordic Walking - power walking using ski poles - is a popular and fast growing type of exercise in Northern Europe that has been shown to improve cardiovascular metabolism . Until now , no studies have been performed to investigate whether Nordic Walking has beneficial effects in relation to back pain . Methods A total of 151 patients with low back and /or leg pain of greater than eight weeks duration were recruited from a hospital based outpatient back pain clinic . Patients continuing to have pain greater than three on the 11-point numeric rating scale after a multidisciplinary intervention were included . Fifteen patients were unable to complete the baseline evaluation and 136 patients were r and omized to receive A ) Nordic walking supervised by a specially trained instructor twice a week for eight weeks B ) One-hour instruction in Nordic walking by a specially trained instructor followed by advice to perform Nordic walking at home as much as they liked for eight weeks or C ) Individual oral information consisting of advice to remain active and about maintaining the daily function level that they had achieved during their stay at the backcenter . Primary outcome measures were pain and disability using the Low Back Pain Rating Scale , and functional limitation further assessed using the Patient Specific Function Scale . Furthermore , information on time off work , use of medication , and concurrent treatment for their low back pain was collected . Objective measurements of physical activity levels for the  supervised and unsupervised Nordic walking groups were performed using accelerometers . Data were analyzed on an intention-to-treat basis . Results No mean differences were found between the three groups in relation to any of the outcomes at baseline . For pain , disability , and patient specific function the supervised Nordic walking group generally faired best however no statistically significant differences were found . Regarding the secondary outcome measures , patients in the supervised group tended to use less pain medication , to seek less concurrent care for their back pain , at the eight-week follow-up . There was no difference between physical activity levels for the supervised and unsupervised Nordic walking groups . No negative side effects were reported . Conclusion We did not find statistically significant differences between eight weeks of supervised or unsupervised Nordic walking and advice to remain active in a group of chronic low back pain patients . Nevertheless , the greatest average improvement tended to favor the supervised Nordic walking group and - taking into account other health related benefits of Nordic walking - this form of exercise may potentially be of benefit to selected groups of chronic back pain patients .Trial registration http://www . Clinical Trials.gov # Objectives : To assess the effectiveness of multidisciplinary rehabilitation in the treatment of fibromyalgia in comparison to st and ard medical care . Methods : Seventy-nine men and women were r and omly assigned to one of two groups . The intervention group consisted of a rheumatologist and physical therapist intake and discharge , 18 group supervised exercise therapy sessions , 2 group pain and stress management lectures , 1 group education lecture , 1 group dietary lecture , and 2 massage therapy sessions . The control group consisted of st and ard medical care with the patients ' family physician . Outcome measures included self-perceived health status , pain-related disability , average pain intensity , depressed mood , days in pain , hours in pain , prescription and nonprescription medication usage , and work status . Outcomes were measured at the end of the 6-week intervention and at 15-month follow-up . Results : Thirty-five out of 43 patients from the intervention group and 36 out of 36 patients from the control group completed the study . There were no statistically significant differences between the 2 groups prior to intervention . Intention-to-treat analysis revealed that the intervention group , in comparison to the control group , experienced statistically significant changes at intervention completion in self-perceived health status , average pain intensity , pain related disability , depressed mood , days in pain , and hours in pain , but no significant differences in nonprescription drug use , prescription drug use , or work status . At 15 months , all health outcomes retained their significance except health status . Nonprescription and prescription drug use demonstrated significant reductions at 15 months . Binary logistic regression indicated that long-term changes in Pain Disability Index were influenced by long-term exercise adherence and income status . Conclusions : Positive health-related outcomes in this mostly unresponsive condition can be obtained with a low-cost , group multidisciplinary intervention in a community-based , non clinical setting Objectives : To evaluate the feasibility of an RCT of a pedometer-driven walking program and education/advice to remain active compared with education/advice only for treatment of chronic low back pain ( CLBP ) . Methods : Fifty-seven participants with CLBP recruited from primary care were r and omly allocated to either : ( 1 ) education/advice ( E , n=17 ) or ( 2 ) education/advice plus an 8-week pedometer-driven walking program ( EWP , n=40 ) . Step targets , actual daily step counts , and adverse events were recorded in a walking diary over the 8 weeks of intervention for the EWP group only . All other outcomes ( eg , functional disability using the Oswestry Disability Question naire ( ODQ ) , pain scores , physical activity ( PA ) measurement etc . ) were recorded at baseline , week 9 ( immediately post-intervention ) , and 6 months in both groups . Results : The recruitment rate was 22 % and the dropout rate was lower than anticipated ( 13 % to 18 % at 6 mo ) . Adherence with the EWP was high , 93 % ( n=37/40 ) walked for ≥6 weeks , and increased their steps/day ( mean absolute increase in steps/d , 2776 , 95 % confidence interval [ CI ] , 1996 - 3557 ) by 59 % ( 95 % CI , 40.73%-76.25 % ) from baseline . Mean percentage adherence with weekly step targets was 70 % ( 95 % CI , 62%-77 % ) . Eight ( 20 % ) minor-related adverse events were observed in 13 % ( 5/40 ) of the participants . The EWP group participants demonstrated an 8.2 % point improvement ( 95 % CI , −13 to −3.4 ) on the ODQ at 6 months compared with 1.6 % points ( 95 % CI , –9.3 to 6.1 ) for the E group ( between group d=0.44 ) . There was also a larger mean improvement in pain ( d=0.4 ) and a larger increase in PA ( d=0.59 ) at 6 months in EWP . Discussion : This preliminary study demonstrated that a main RCT is feasible . EWP was safe and produced a real increase in walking ; CLBP function and pain improved , and participants perceived a greater improvement in their PA levels . These improvements require confirmation in a fully powered RCT OBJECTIVE The Arthritis , Diet , and Activity Promotion Trial ( ADAPT ) was a r and omized , single-blind clinical trial lasting 18 months that was design ed to determine whether long-term exercise and dietary weight loss are more effective , either separately or in combination , than usual care in improving physical function , pain , and mobility in older overweight and obese adults with knee osteoarthritis ( OA ) . METHODS Three hundred sixteen community-dwelling overweight and obese adults ages 60 years and older , with a body mass index of > or = 28 kg/m(2 ) , knee pain , radiographic evidence of knee OA , and self-reported physical disability , were r and omized into healthy lifestyle ( control ) , diet only , exercise only , and diet plus exercise groups . The primary outcome was self-reported physical function as measured with the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) . Secondary outcomes included weight loss , 6-minute walk distance , stair-climb time , WOMAC pain and stiffness scores , and joint space width . RESULTS Of the 316 r and omized participants , 252 ( 80 % ) completed the study .  Adherence was as follows : for healthy lifestyle , 73 % ; for diet only , 72 % ; for exercise only , 60 % ; and for diet plus exercise , 64 % . In the diet plus exercise group , significant improvements in self-reported physical function ( P < 0.05 ) , 6-minute walk distance ( P < 0.05 ) , stair-climb time ( P < 0.05 ) , and knee pain ( P < 0.05 ) relative to the healthy lifestyle group were observed . In the exercise group , a significant improvement in the 6-minute walk distance ( P < 0.05 ) was observed . The diet-only group was not significantly different from the healthy lifestyle group for any of the functional or mobility measures . The weight-loss groups lost significantly ( P < 0.05 ) more body weight ( for diet , 4.9 % ; for diet plus exercise , 5.7 % ) than did the healthy lifestyle group ( 1.2 % ) . Finally , changes in joint space width were not different between the groups . CONCLUSION The combination of modest weight loss plus moderate exercise provides better overall improvements in self-reported measures of function and pain and in performance measures of mobility in older overweight and obese adults with knee OA compared with either intervention alone OBJECTIVE Walking exercise alleviates some symptoms , such as pain , in patients with mild to moderate knee osteoarthritis ( OA ) . However , a major concern is that weightbearing exercise on osteoarthritic joints may exacerbate articular cartilage degradation . Loading of proteoglycan depleted articular cartilage in vitro increased expression of the chondroitin sulphate epitope 3B3 , suggesting that loading may influence metabolism of osteoarthritic cartilage . This study aim ed at evaluating the effects of walking exercise on articular cartilage metabolism in patients with knee OA , as reflected by changes in concentrations of synovial fluid markers . METHODS Thirty elderly patients with knee OA ( Kellgren-Lawrence grade s II to IV ) were r and omly allocated to  control  ( n = 15 ) and 12 week exercise  ( n = 15 ) groups . Synovial fluid obtained from 21 of the patients at time zero and after 12 weeks was examined by enzyme linked immunosorbent assay ( ELISA ) for the chondroitin sulphate epitopes 3B3 and 7D4 , and by a dye binding assay with 1,9-dimethylmethylene blue for total sulphated glycosaminoglycan ( GAG ) concentrations . The 3B3/GAG and 7D4/GAG ratios were calculated . RESULTS No significant changes in concentrations of 3B3 , 7D4 , GAG , 3B3/GAG , or 7D4/GAG between time zero and 12 weeks were found in either group . However , there were significant declines in 3B3 ( p=0.001 ) , GAG ( p=0.007 ) , and the 3B3/GAG ratio ( p=0.049 ) with aging . CONCLUSION Twelve weeks of walking exercise had no demonstrable adverse effects on articular cartilage metabolism , as reflected by the concentrations of synovial fluid GAG or the chondroitin sulphate epitopes 3B3 and 7D4 OBJECTIVE To compare 2 exercise modalities , aerobic fitness training and stretching exercises , in patients with fibromyalgia ( FM ) in relation to function , pain , quality of life , depression , and anxiety , and to correlate the cardiorespiratory fitness gain with symptom improvement . METHODS Seventy-six women with FM between 18 and 60 years old were r and omized to either an aerobic program or stretching program , for 20 weeks . They were evaluated at the beginning of the program and after 10 and 20 weeks in relation to the improvement of aerobic fitness , flexibility , function , Fibromyalgia Impact Question naire ( FIQ ) , Short-form Health Survey ( SF-36 ) , and depression and anxiety levels . Ventilatory anaerobic threshold ( VT ) and maximum oxygen uptake ( VO2max ) were determined by expired gas analyses . RESULTS Aerobic exercise was superior to stretching in relation to VO2 max , VT , function , depression , pain , and the emotional aspects and mental health domains of SF-36 . Patients in the stretching group showed no improvement in depression , " role emotional , " and " mental health . " No association was noted between improvement in aerobic fitness as measured by VT and the improvement of pain , function , or scores in FIQ and SF-36 . CONCLUSION Our results confirm that aerobic exercise is beneficial to patients with FM , but the cardiorespiratory fitness gain is not related to improvement of FM symptoms OBJECTIVE To assess the utility of an exercise program , which included aerobic , flexibility and strengthening elements , in the treatment of fibromyalgia ( FM ) . FM is a chronic musculoskeletal condition characterized by diffuse musculoskeletal pain and aching . It has been suggested that aerobic exercise is helpful in its treatment . METHODS We studied 60 patients who met American College of Rheumatology criteria for FM and had no significant comorbidities . Measurements performed on each patient at the pre and post study assessment included the number of tender points ( TP ) , total myalgic scores ( TM ) , aerobic fitness ( AF ) , flexibility and isokinetic strength . After initial evaluation patients were r and omly assigned to either an exercise or a relaxation group . Each group met 3 times per week for 6 weeks for 1 h of supervised exercise or relaxation . All patients data were stored in a computerized data base and statistical analysis was performed on all pre and post study assessment s. RESULTS Thirty-eight patients ( 18 exercise and 20 relaxation ) completed the study . Analysis of our data showed no significant difference between the groups in their pre study assessment . Post study assessment s , however , showed a significant improvement between the exercise and relaxation groups in TP ( p < 0.05 ) , TM ( p < 0.05 ) , and AF ( p < 0.05 ) . Similar improvements were also found when the pre and post study assessment of the exercise group were compared . CONCLUSION Exercise is helpful in the management of FM in the short term . It also shows that FM patients can undertake an exercise program which includes aerobic , flexibility , and strength training exercises without adverse effects . The long term utility of this type of exercise requires further evaluation Background Chronic pain , especially back pain , is a prevalent condition that is associated with disability , poor health status , anxiety and depression , decreased quality of life , and increased health services use and costs . Current evidence suggests that exercise is an effective strategy for managing chronic pain . However , there are few clinical programs that use generally available tools and a relatively low-cost approach to help patients with chronic back pain initiate and maintain an exercise program . Objective The objective of the study was to determine whether a pedometer-based , Internet-mediated intervention can reduce chronic back pain-related disability . Methods A parallel group r and omized controlled trial was conducted with 1:1 allocation to the intervention or usual care group . 229 veterans with nonspecific chronic back pain were recruited from one Department of Veterans Affairs ( VA ) health care system . Participants r and omized to the intervention received an uploading pedometer and had access to a website that provided automated walking goals , feedback , motivational messages , and social support through an e-community ( n=111 ) . Usual care participants ( n=118 ) also received the uploading pedometer but did not receive the automated feedback or have access to the website . The primary outcome was measured using the Rol and Morris Disability Question naire ( RDQ ) at 6 months ( secondary ) and 12 months ( primary ) with a difference in mean scores of at least 2 considered clinical ly meaningful . Both a complete case and all case analysis , using linear mixed effects models , were conducted to assess differences between study groups at both time points . Results Baseline mean RDQ scores were greater than 9 in both groups . Primary outcome data were provided by approximately 90 % of intervention and usual care participants at both 6 and 12 months . At 6 months , average RDQ scores were 7.2 for intervention participants compared to 9.2 for usual care , an adjusted difference of 1.6 ( 95 % CI 0.3 - 2.8 , P=.02 ) for the complete case analysis and 1.2 ( 95 % CI -0.09 to 2.5 , P=.07 ) for the all case analysis . A post hoc analysis of patients with baseline RDQ scores ≥4 revealed even larger adjusted differences between groups at 6 months but at 12 months the differences were no longer statistically significant . Conclusions Intervention participants , compared with those receiving usual care , reported a greater decrease in back pain-related disability in the 6 months following study enrollment . Between-group differences were especially prominent for patients reporting greater baseline levels of disability but did not persist over 12 months . Primarily , automated interventions may be an efficient way to assist patients with managing chronic back pain ; additional support may be needed to ensure continuing improvements . Trial Registration Clinical Trials.gov NCT00694018 ; http:// clinical trials.gov/ct2/show/NCT00694018 ( Archived by WebCite at http://www.webcitation.org/6IsG4Y90E ) We conducted a pilot study to evaluate a practical exercise program for elderly people with chronic musculo-skeletal pain . Thirty-three subjects ( mean age , 73 years ; 69 % back pain ; 24 % knee pain ; 9 % hip pain ) were r and omly assigned to one of three groups . Group 1 received a 6-week supervised program of walking . Group 2 received a pain education program that included instruction and demonstration of use of heat , cold , massage , relaxation and distraction . Group 3 received usual care . Outcomes including pain , self-reported health and functional status , and performance-based measures of functional status were evaluated at baseline , at two weeks and at eight weeks ( end of study ) . Attendance was 100 % for the education sessions and 93 % for walking sessions . No injuries were sustained . Both intervention groups demonstrated significant improvements in pain ( p<0.05 ) and performance-based measures of functional status ( p<0.05 ) , while the control group had no changes . These data suggest that patient education and fitness walking can improve overall pain management and related functional limitations among elderly people with chronic musculo-skeletal pain Background Osteoarthritis ( OA ) is the most common joint disorder in the world , as it is appears to be prevalent among 80 % of individuals over the age of 75 . Although physical activities such as walking have been scientifically proven to improve physical function and arthritic symptoms , individuals with OA tend to adopt a sedentary lifestyle . There is therefore a need to improve knowledge translation in order to influence individuals to adopt effective self-management interventions , such as an adapted walking program . Methods A single-blind , r and omized control trial was conducted . Subjects ( n = 222 ) were r and omized to one of three knowledge translation groups : 1 ) Walking and Behavioural intervention ( WB ) ( 18 males , 57 females ) which included the supervised community-based aerobic walking program combined with a behavioural intervention and an educational pamphlet on the benefits of walking ;  2 )  Walking intervention ( W ) ( 24 males , 57 females ) wherein participants only received the supervised community-based aerobic walking program intervention and the educational pamphlet ; 3 ) Self-directed control ( C ) ( 32 males , 52 females ) wherein participants only received the educational pamphlet . One-way analyses of variance were used to test for differences in quality of life , adherence , confidence , and clinical outcomes among the study groups at each 3 month assessment during the 12-month intervention period and 6-month follow-up period . Results The clinical and quality of life outcomes improved among participants in each of the three comparative groups . However , there were few statistically significant differences observed for quality of life and clinical outcomes at long-term measurements at 12-months end of intervention and at 6- months post intervention ( 18-month follow-up ) . Outcome results varied among the three groups . Conclusion The three groups were equivalent when determining the effectiveness of knowledge uptake and improvements in quality of life and other clinical outcomes . OA can be managed through the implementation of a proven effective walking program in existing community-based walking clubs . Trial registration Current Controlled Trials Objective : To investigate whether a four-week walking exercise programme in patients with knee osteoarthritis improves the ability of dual-task performance in older adults with knee osteoarthritis . Design : A r and omized controlled trial with two groups : a walking group and a control group . Subjects : Forty older adults with knee osteoarthritis , 20 participants in each group . Intervention : The walking intervention was design ed to increase the number of steps walked daily . The walking group was instructed to increase their number of steps to 3000 steps more than before the intervention . Main outcome measures : Dual-task performance was computed by an automaticity index : the walking velocity under single-task condition/under dual-task conditions × 100 ( % ) , defined as automaticity . The nearer to 100 % automaticity , the better the dual-task performance . Decrease of the Trail Making Test ( TMT ) performance was defined as ΔTMT . ΔTMT was calculated as the difference between times ( part B – part A ) as a measure of executive function . In addition , functional ability was measured by the Japanese Knee Osteoarthritis Measure . Results : The walking group improved significantly in automaticity ( P < 0.001 , from 75.2 ( 7.6 ) to 86.9 ( 10.4 ) , ΔTMT ( P < 0.001 , from 63.4 ( 43.1 ) to 48.3 ( 29.6 ) ) and Japanese Knee Osteoarthritis Measure score ( P < 0.001 , from 54.4 to 51.9 ) compared with before the intervention , while the control group displayed no significant differences . Conclusions : We found that walking exercise improves executive function and dual-task performance Objective To examine the association between  physical activity-related injuries  and participation in walking versus running . Design Nested case-control study . Setting Cooper Clinic Preventive Medicine Center , Dallas , Texas . Participants 5,327 men and women undergoing exams between 1987 and 1995 and completing follow-up health history question naires in 1990 or 1995 . Participants were classified as those reporting regular participation in walking or jogging/running at baseline . Those reporting both or neither activity were excluded from the study ( n = 1404 ) . Cases ( 698 men , 169 women ) were those reporting physical activity-related injuries requiring physician visits in the previous year on the follow-up question naire . Controls ( 2,358 men , 698 women ) were r and omly selected from the remaining population . Main Outcome Measures Logistic regression was used to examine the risk of injury in walkers versus runners and risk of injury by exercise dose while considering age , body mass index , previous injury , and strength training . Results There was a significantly lower risk of injury for walkers compared with runners in young ( < 45 years old ) ( odds ratio [ OR ] = 0.75 , 95 % confidence interval [ CI ] = 0.58–0.97 ) and older ( ≥45 years ) men ( OR = 0.64 , 95 % CI = 0.49–0.82 ) , and a nonsignificantly lower risk among young ( OR = 0.73 , 95 % CI = 0.39–1.37 ) and older women ( OR = 0.72 , 95 % CI = 0.38–1.35 ) . There was no effect of greater amounts of walking on injuries for either gender ; however , there was a higher injury risk associated with running 15–30 min/day ( OR = 1.36 , 95 % CI = 1.07–1.73 ) and 30 + min/day ( OR = 1.52 , 95 % CI = 1.14–2.04 ) compared with < 15 min/day among men , but not among women . Conclusions This low risk of musculoskeletal injury suggests that participation in walking can be safely recommended as a way to improve health and fitness BACKGROUND Self-management has increasingly been recommended as part of st and ard care for fibromyalgia , a common , poorly understood condition with limited treatment options . Data that assess popular self-management recommendations are scarce . We evaluated and compared the effectiveness of 4 common self-management treatments on function , symptoms , and self-efficacy in women with fibromyalgia . METHODS A total of 207 women with confirmed fibromyalgia were recruited from September 16 , 2002 , through November 30 , 2004 , and r and omly assigned to 16 weeks of ( 1 ) aerobic and flexibility exercise ( AE ) ; ( 2 ) strength training , aerobic , and flexibility exercise ( ST ) ; ( 3 ) the Fibromyalgia Self-Help Course ( FSHC ) ; or ( 4 ) a combination of ST and FSHC ( ST-FSHC ) . The primary outcome was change in physical function from baseline to completion of the intervention . Secondary outcomes included social and emotional function , symptoms , and self-efficacy . RESULTS Improvements in the mean Fibromyalgia Impact Question naire score in the 4 groups were -12.7 for the ST-FSHC group , -8.2 for the AE group , -6.6 for the ST group , and -0.3 for the FSHC group . The ST-FSHC group demonstrated greater improvement than the FSHC group ( mean difference , -12.4 ; 95 % confidence interval [ CI ] , -23.1 to -1.7 ) . The ST-FSHC ( mean difference , 13.6 ; 95 % CI , 2.3 to 24.9 ) and AE ( mean difference , 13.1 ; 95 % CI , 1.6 to 25.6 ) groups had similar improvements in physical function scores on the 36-Item Short-Form Health Survey . Bodily pain scores on the 36-Item Short-Form Health Survey improved in the ST-FSHC ( 14.8 ) , AE ( 13.2 ) , and ST ( 5.7 ) groups . Social function , mental health , fatigue , depression , and self-efficacy also improved . The beneficial effect on physical function of exercise alone and in combination with education persisted at 6 months . CONCLUSIONS Progressive walking , simple strength training movements , and stretching activities improve functional status , key symptoms , and self-efficacy in women with fibromyalgia actively being treated with medication . The benefits of exercise are enhanced when combined with targeted self-management education . Our findings suggest that appropriate exercise and patient education be included in the treatment of fibromyalgia Abstract . Osteoarthritis ( OA ) of the knee is a very common rheumatological disease , and there are various treatment modalities for it . The aim of this study was to investigate the effects of home-based exercise and walking programs in the treatment of OA . A total of 90 patients with knee osteoarthritis were included . Their ages ranged between 48 and 71 years . The patients were separated into three groups . None of them had practice d a daily simple exercise program during the previous year . Group 1 ( n=30 ) was given a home-based exercise program . Group 2 ( n=30 ) had regular a walking program three times per week , starting with 10-min duration . Group 3 ( n=30 ) was accepted as the control group . Patients were assessed according to pain , functional capacity , and quality of life parameters . Pain was evaluated by the Western Ontario McMaster osteoarthritis index ( WOMAC ) of pain score and visual analogue scale ( VAS ) . Functional capacity was measured by WOMAC physical function index . Quality of life was assessed by the Nottingham Health Profile question naire ( NHP ) . All groups continued the program for 3 months . At the end of the therapy , the patients were called and 81 were accepted to come to the hospital . Although WOMAC pain and physical functional scores and VAS scores were statistically lower in both groups than in the control group ( P<0.001 ) , the difference between groups 1 and 2 was not statistically significant ( P>0.05 ) . But the result of the NHP showed a statistically significant improvement in the walking group when compared to the home-based exercise and control groups ( P<0.001 ) . As a result , we conclude that a simple home-based exercise therapy and a regular walking program are effective in treating the symptoms of OA BACKGROUND AND PURPOSE The knee is the weight-bearing joint most commonly affected by osteoarthritis ( OA ) . The symptoms of pain , morning stiffness of short duration and physical dysfunction in the activities of daily living ( ADL ) can have an effect on many aspects of health , affecting quality of life . Regular and moderate physical activity adapted to individuals ' life-styles and education , and joint protection strategies have been advocated as conservative management . The purpose of the present study was to assess the impact of an exercise and walking protocol on the quality of life of elderly people with knee OA . METHOD The study design was a r and omized controlled clinical trial . The subjects comprised 50 elderly people , aged 65 or more , with knee OA who had been referred to the geriatric outpatient unit for rehabilitation . Changes in severity of pain and quality of life were compared between a control group ( CG ) and an experimental group ( EG ) . Both groups participated in an educational session and the EG also received a 12-week exercise and walking protocol . Both groups were assessed at baseline and after three and six months by an independent observer . The Lequesne Index of Knee OA Severity ( LI ) , the Health Assessment Question naire ( HAQ ) and the Medical Outcomes Short-Form Health Survey ( SF-36 ) were used as measurement instruments . RESULTS In the CG , the measures of quality of life ( SF-36 ) , the HAQ and the LI between subjects did not yield statistically significant differences over the three measurement points . For the EG , there was a significant improvement in function , measured by HAQ , and decreasing OA symptom severity , measured by LI . For the SF-36 there were significant improvements in physical function , functional role limitation and pain . Comparisons between the groups showed statistically significant differences after three and six months for all measures , except for the SF-36 emotional domains . CONCLUSION The exercise protocol and walking programme had a positive effect on the quality of life of elderly individuals with knee OA OBJECTIVE To determine the effects of structured exercise programs on  self-reported disability in older adults with knee osteoarthritis . SETTING AND DESIGN A r and omized , single-blind clinical trial lasting 18 months conducted at 2 academic medical centers . PARTICIPANTS A total of 439 community-dwelling adults , aged 60 years or older , with radiographically evident knee osteoarthritis , pain , and self-reported physical disability .  INTERVENTIONS An aerobic exercise program , a resistance exercise program , and a health education program . MAIN OUTCOME MEASURES The primary outcome was self-reported disability score ( range , 1 - 5 ) . The secondary outcomes were knee pain score ( range , 1 - 6 ) , performance measures of physical function , x-ray score , aerobic capacity , and knee muscle strength . RESULTS A total of 365 ( 83 % ) participants completed the trial . Overall compliance with the exercise prescription was 68 % in the aerobic training group and 70 % in the resistance training group . Postr and omization , participants in the aerobic exercise group had a 10 % lower adjusted mean ( + /- SE ) score on the physical disability question naire ( 1.71 + /- 0.03 vs 1.90 + /- 0.04 units ; P<.001 ) , a 12 % lower score on the knee pain question naire ( 2.1 + /- 0.05 vs 2.4 + /- 0.05 units ; P=.001 ) , and performed better ( mean [ + /- SE ] ) on the 6-minute walk test ( 1507 + /- 16 vs 1349 + /- 16 ft ; P<.001 ) , mean ( + /-SE ) time to climb and descend stairs ( 12.7 + /- 0.4 vs 13.9 + /- 0.4 seconds ; P=.05 ) , time to lift and carry 10 pounds ( 9.1 + /- 0.2 vs 10.0 + /- 0.1 seconds ; P<.001 ) , and mean ( + /-SE ) time to get in and out of a car ( 8.7 + /- 0.3 vs 10.6 + /- 0.3 seconds ; P<.001 ) than the health education group . The resistance exercise group had an 8 % lower score on the physical disability question naire ( 1.74 + /- 0.04 vs 1.90 + /- 0.03 units ; P=.003 ) , 8 % lower pain score ( 2.2 + /- 0.06 vs 2.4 + /- 0.05 units ; P=.02 ) , greater distance on the 6-minute walk ( 1406 + /- 17 vs 1349 + /- 16 ft ; P=.02 ) , faster times on the lifting and carrying task ( 9.3 + /- 0.1 vs 10.0 + /- 0.16 seconds ; P=.001 ) , and the car task ( 9.0 + /- 0.3 vs 10.6 + /- 0.3 seconds ; P=.003 ) than the health education group . There were no differences in x-ray scores between either exercise group and the health education group . CONCLUSIONS Older disabled persons with osteoarthritis of the knee had modest improvements in measures of disability , physical performance , and pain from participating in either an aerobic or a resistance exercise program . These data suggest that exercise should be prescribed as part of the treatment for knee osteoarthritis OBJECTIVES To determine whether a home-based pedometer-driven walking program with arthritis self-management education ( Walk + ) would increase physical activity , muscle strength , and functional performance in older adults with osteoarthritis ( OA ) of the knee as opposed to arthritis self-management education alone ( EDU ) . DESIGN A r and omized two-by-three ( group-by-time ) design with participants assigned to  Walk + ( n = 17 , mean age + /- st and ard deviation = 69.6 + /- 6.7 ) or EDU ( n = 17 , age = 70.8 + /- 4.7 ) . SETTING Community located in the Baltimore-Washington area . PARTICIPANTS Thirty-four community-dwelling adults , aged 60 and older with symptomatic knee OA and self-reported functional impairment . INTERVENTIONS Both groups received 12 hours of the Arthritis Self-Management program over 12 weeks and were followed for an additional 12 weeks . In addition , the Walk + group received individualized instruction in the use of a pedometer , with the goal of increasing their step count by 30 % of their baseline step count . MEASUREMENTS The outcome measures were physical activity ( daily step counts and total activity vector magnitude as measured by a pedometer and Tritrac-R3D accelerometer ) , quadriceps femoris strength ( isometric peak torque ) , and functional performance tasks ( 100-foot walk-turn-walk , timed stair climb , timed chair rise , and pain status ) . RESULTS Daily steps walked showed a significant group-by-time interaction ( P = .04 ) after controlling for age . From baseline to completion of training , a 23 % increase in daily steps occurred in the Walk + group and a 15 % decrease in the EDU group . Although steps increased in the Walk + group , total activity vector magnitude was maintained , suggesting a more efficient gait . The Walk + group became quicker than the EDU group in the normal-pace walk-turn-walk ( P = .04 ) . An isometric strength gain of 21 % postintervention was seen in the Walk + group , compared with a loss of 3.5 % in the EDU group . CONCLUSION In older adults with symptomatic knee OA , Walk + appears to increase walking , with improvements in muscle strength and walking performance . The use of a home-based pedometer-driven program to increase physical activity , strength , and function in this population warrants further research OBJECTIVE To determine whether gains in functioning observed immediately following participation in an 8-week program of supervised fitness walking for patients with knee osteoarthritis were sustained at 1-year followup . METHODS Twenty-nine ( 61.1 % ) of 47 original intervention program patients and 23 ( 51.1 % ) of 45 original control patients were interviewed by telephone at 1-year followup . Patients completed the Arthritis Impact Measurement Scales physical activity , arthritis impact , pain , medication use , and general health perceptions subscales , as well as a separate visual analog pain scale and measures of perceived self-efficacy to cope with arthritis pain and other symptoms . RESULTS Adherence to walking was low , and there were no statistically significant differences between intervention and control patients at one year . CONCLUSIONS The failure of intervention patients to maintain regular walking result ed in loss of functional benefits that were observed at 8 weeks in the original study . Long-term adherence to walking is critical to maintenance of initial gains in functional outcomes UNLABELLED Fibromyalgia ( FM ) , a rheumatological disorder of unknown origin , is characterized by both physical and psychological symptoms . Although inconclusive results have been reported for most treatment modalities , exercise appears to have universal support for decreasing the myriad of symptoms associated with FM . Weaknesses in the literature , however , prevent conclusive statements regarding exercise prescription and concomitant impact on FM symptomology . PURPOSE The current pilot study attempted to examine the effect of a 24-wk walking program at predetermined intensities on FM . METHODS Initial design was a r and omized control trial with  high- and low-intensity exercise groups  , and a control group . Subsequent nonr and omized control trials were based on actual exercise behavior . RESULTS No differences between initial groups were identified . By collapsing groups , heart rate ( HR ) decreased ( P < 0.05 ) weeks 0 - 12 . Functional impairments were reduced 54 % weeks 0 - 24 , with exercise having a large impact ( omega2 = 0.30 ) on this decrease . By reassigning groups , impact of FM on current health status decreased in the low-intensity group ( P < 0.05 ) and increased in the high-intensity group ( P < 0.02 ) weeks 0 - 24 . Omega squared indicated strong influence of exercise on pain ( omega2 = 0.51 ) , with greater pain in the high-intensity group . CONCLUSIONS A larger number of subjects and direct supervision of the training program to increase compliance is necessary to clarify the effects of a walking program on the manifestations of FM . Results indicate that intensity of the walking program is an important consideration . Individuals with FM can adhere to low-intensity walking programs two to three times per week , possibly reducing FM impact on daily activities OBJECTIVE Physical function and body composition in older obese adults with knee osteoarthritis ( OA ) were examined after intensive weight loss . RESEARCH METHODS AND PROCEDURES Older obese adults ( n = 87 ; > or = 60 years ; BMI > or = 30.0 kg/m2 ) with symptomatic knee OA and difficulty with daily activities were recruited for a 6-month trial . Participants were r and omized into either a weight stable ( WS ) or weight loss ( WL ) program . Participants in WL ( 10 % weight loss goal ) were prescribed a 1000 kcal/d energy deficit diet with exercise 3 d/wk . WS participants attended health information sessions . Body composition and physical function ( Western Ontario and McMaster University Osteoarthritis Index , 6-minute walking distance , and stair climb time ) were assessed at baseline and 6 months . Statistical analysis included univariate analysis of covariance on 6-month measurements using baseline values as covariates . Associations between physical function and body composition were performed . RESULTS Body weight decreased 8.7 + /- 0.8 % in WL and 0.0 + /- 0.7 % in WS . Body fat and fat-free mass were lower for WL than WS at 6 months ( estimated means : fat = 38.1 + /- 0.4 % vs. 40.9 + /- 0.4 % , respectively ; fat-free mass = 56.7 + /- 0.4 vs. 58.8 + /- 0.4 kg , respectively ) . WL had better function than WS , with lower Western Ontario and McMaster University Osteoarthritis Index scores , greater 6-minute walk distance , and faster stair climb time ( p < 0.05 ) . Changes in function were associated with weight loss in the entire cohort . DISCUSSION An intensive weight loss intervention incorporating energy deficit diet and exercise training improves physical function in older obese adults with knee OA . Greater improvements in function were observed in those with the most weight loss The major goal of the U.S. Preventive Services Task Force ( USPSTF ) is to provide clinicians and policymakers with a reliable and accurate source of evidence -based recommendations on a wide range of preventive services . To accomplish this goal , the USPSTF systematic ally review s the evidence concerning both the benefits and harms of widespread implementation of a preventive service . It then assesses the certainty of the evidence and the magnitude of the benefits and harms . On the basis of this assessment , the USPSTF assigns a letter grade to each preventive service signifying its recommendation about provision of the service ( Table 1 ) . Table 1 . U.S. Preventive Services Task Force Recommendation Grid * An important , but often challenging , step is determining the balance between benefits and harms to estimate net benefit ( that is , benefits minus harms ) . In this issue , the Task Force reports an up date to its recommendation for carotid artery stenosis screening ( 1 , 2 ) . Because carotid artery stenosis screening has both known benefits and harms , estimating net benefit was critical in the final USPSTF recommendation that clinicians not provide carotid artery stenosis screening in asymptomatic people ( recommendation letter grade D ) . Release of this recommendation provides an opportunity for the Task Force to up date and explain to a clinical audience the process by which it evaluates evidence , determines the certainty and magnitude of net benefit , and gives a letter grade to the recommendation . We will do this by considering 3 questions : 1 ) What evidence does the Task Force consider to estimate net benefit ? 2 ) How does the Task Force estimate the certainty of net benefit ? and 3 ) How does the Task Force estimate the magnitude of net benefit ? What Evidence Does the Task Force Consider to Estimate Net Benefit ? The overarching question that the Task Force seeks to answer for every preventive service is whether evidence suggests that provision of the service would improve health outcomes if implemented in a general primary care population . For screening topics , this st and ard could be met by a large r and omized , controlled trial ( RCT ) in a representative asymptomatic population with follow-up of all members of both the group invited for screening and the group not invited for screening . For example , the Multicentre Aneurysm Screening Study ( 3 ) was a population -based RCT of screening for abdominal aortic aneurysm in which 67800 asymptomatic men age 65 to 74 years in the United Kingdom were r and omly assigned to be invited or not to be invited for screening . Both groups were followed for a mean of 4.1 years , and abdominal aortic aneurysmrelated mortality and all-cause mortality were compared . No RCTs of carotid artery stenosis screening have been published ; however , RCTs comparing carotid endarterectomy to medical management of asymptomatic carotid artery stenosis are available . The distinction between RCTs that r and omly assign people to undergo screening  versus RCTs that r and omly assign people known to have a condition to an intervention is important . In contrast to the latter , RCTs of screening take into account the false-positive and false-negative rates of the screening test , the possibility of adverse events from the test , the accuracy and potential for adverse events of any subsequent confirmatory diagnostic tests , and the inevitable failure to follow through on the test or any subsequent steps needed before the therapeutic intervention is delivered . In addition , conditions detected by screening may have different biological characteristics than those detected in other ways . The benefits of treating screened individuals , therefore , can not be assumed to be the same as those of treating symptomatic individuals . Screening trials directly answer a simple question important to the primary care setting : Does screening for a certain condition improve health outcomes ? Direct RCT evidence about screening is often unavailable , so the Task Force considers indirect evidence . To guide its selection of indirect evidence , the Task Force constructs a chain of evidence within an analytic framework . Figure 1 of the evidence up date ( 2 ) in this issue ( page 861 ) shows the analytic framework for the Task Force assessment of carotid artery stenosis screening . Each arrow in the framework defines a key question , and each key question represents a link in the chain of evidence . Rectangles in the framework represent the intermediate outcomes ( rounded corners ) or the health outcomes ( square corners ) ; ovals represent harms . To form an unbroken chain , evidence must support each link in the chain , thereby connecting the target population ( far left side of the framework ) to the improved health outcome ( far right side of the framework ) . For each key question , the body of pertinent literature is critically appraised , focusing on 6 questions ( Table 2 ) . The USPSTF will now describe its judgment about the evidence for each key question as convincing , adequate , or inadequate . Evidence may be considered convincing when derived from several high- quality studies with consistent , logical results that are generalizable to the U.S. primary care population and setting . Evidence may be deemed adequate when , on the basis of judgment , most but not all of these 6 questions are answered favorably . When evidence is conflicting or the studies are of poor quality individually or in aggregate , the evidence for a key question is considered inadequate . Inadequate evidence may create a critical gap in the evidence chain . Table 2 . Questions Considered by the U.S. Preventive Services Task Force for Evaluating Evidence Related Both to Key Questions and to the Overall Certainty of the Evidence of Net Benefit for the Preventive Service How Does the Task Force Estimate the Certainty of Net Benefit ? The next step in the Task Force process is to use the evidence from the key questions to assess whether there would be net benefit if the service were implemented . In 2001 , the USPSTF published an article that documented its systematic processes of evidence evaluation and recommendation development ( 4 ) . At that time , the Task Force 's overall assessment of evidence was described as good , fair , or poor . The Task Force realized that this rating seemed to apply only to how well studies were conducted and did not fully capture all of the issues that go into an overall assessment of the evidence about net benefit . To avoid confusion , the USPSTF has changed its terminology . Whereas individual study quality will continue to be characterized as good , fair , or poor , the term certainty will now be used to describe the Task Force 's assessment of the overall body of evidence about net benefit of a preventive service and the likelihood that the assessment is correct . Certainty will be determined by considering all 6 questions in Table 2 ; the judgment about certainty will be described as high , moderate , or low . In making its assessment of certainty about net benefit , the evaluation of the evidence from each key question plays a primary role . It is important to note that the Task Force makes recommendations for real-world medical practice in the United States and must determine to what extent the evidence for each key question even evidence from screening RCTs or treatment RCTs can be applied to the general primary care population . Frequently , studies are conducted in highly selected population s under special conditions . The Task Force must consider differences between the general primary care population and the population s studied in RCTs and make judgments about the likelihood of observing the same effect in actual practice . For carotid artery stenosis screening , the Task Force search ed for evidence about the true prevalence of high- grade carotid artery stenosis in the general population , the generalizability of treatment effectiveness estimates based on RCTs conducted in selected population s , and the complication rate from carotid endarterectomy in asymptomatic individuals if performed in nontrial setting s ( for example , community hospitals ) . It is also important to note that 1 of the key questions in the analytic framework refers to the potential harms of the preventive service . The Task Force considers the evidence about the benefits and harms of preventive services separately and equally . Data about harms are often obtained from observational studies because harms observed in RCTs may not be representative of those found in usual practice and because some harms are not completely measured and reported in RCTs . For example , the surgeons who enrolled patients in RCTs of carotid artery stenosis were selected on the basis of their low postoperative stroke and mortality rates . Widespread screening for carotid artery stenosis would invariably lead to surgical treatment provided in hospitals ( or by surgeons ) with higher rates of complications . The harms of screening for carotid artery stenosis , including the harms from carotid angiography to confirm the diagnosis of carotid artery stenosis in patients screening positive by carotid ultrasonography  , were not captured in some treatment RCTs . Putting the body of evidence for all key questions together as a chain , the Task Force assesses the certainty of net benefit of a preventive service by asking the 6 major questions in Table 2 . The Task Force would rate a body of convincing evidence about the benefits of a service that , for example , derives from several RCTs of screening in which the estimate of benefits can be generalized to the general primary care population as high certainty ( Table 3 ) . The Task Force would rate a body of evidence that was not clearly applicable to general practice or has other defects in quality , research design , or consistency of studies as moderate certainty . Certainty is low when , for example , there are gaps in the evidence linking parts of the analytic framework , when evidence to determine the harms of treatment is unavailable , or AIM To examine the impact of two different lifestyle programmes on cardiovascular health and glycaemic control among people with type 2 diabetes . METHODS A two-phase 24-week r and omized trial . During the first phase , participants were to increase daily steps using a pedometer . At week 12 , participants were r and omly allocated to either an enhanced lifestyle programme ( ELP ) targeting walking speed or a basic lifestyle programme ( BLP ) targeting total daily steps . Both programmes focused on increasing the intake of low glycaemic index foods but utilized different goal setting strategies . Clinical measurements were completed at baseline , week 12 and week 24 . Principal outcomes were change in resting pulse rate ( PR ) and glycated haemoglobin A1c ( A1c ) between week 12 and week 24 compared between groups using analysis of covariance . RESULTS Forty-one participants [ mean + /- s.d . : age = 56.5 + /- 7.2 years , body mass index ( BMI ) = 32.7 + /- 6.1 kg/m(2 ) ] were r and omized . After 12 weeks , we observed an increase in average total daily steps of 1688 ( 95 % confidence interval : 330 - 3040 , [ corrected ] p = 0.02 ) . Weight , BMI and systolic and diastolic blood pressure improved ( p < 0.01 for all ) . No changes were observed for energy intake . At week 24 , those in the ELP had a lower resting PR ( 71 + /- 12 b.p.m . ) compared with those in the BLP ( 78 + /- 12 b.p.m . ) ( adjusted p = 0.03 ) , while no group differences for total daily steps or glycaemic control were observed . CONCLUSIONS Improvements in cardiovascular health can be expected following a pedometer-based lifestyle modification programme that progresses from walking more to walking faster Study Design . The study was a r and omized controlled trial . Treatment was for 8 weeks , with follow-up posttreatment and at 6- , 12- , and 36- months . Objective . The purpose was to evaluate the effect of a grade d exercise intervention emphasizing stabilizing exercises in patients with nonspecific , recurrent low back pain ( LBP ) . Summary of Background Data . Exercise therapy is recommended and widely used as treatment for LBP . Although stabilizing exercises are reportedly effective in the management of certain subgroups of LBP , such intervention protocol s have not yet been evaluated in relation to a more general exercise regimen in patients with recurrent LBP , all at work . Methods . Seventy-one patients recruited consecutively ( 36 men , 35 women ) with recurrent nonspecific LBP seeking care at an outpatient physiotherapy clinic were r and omized into 2 treatment groups ; grade d exercise intervention or daily walks . The primary outcome was perceived disability and pain at 12-month follow-up . Secondary outcomes included physical health , fear-avoidance , and self-efficacy beliefs . Results . Of the participants , 83 % provided data at the 12-month follow-up and 79 % at 36 months . At 12 months , between-group comparison showed a reduction in perceived disability in favor of the exercise group , whereas such an effect for pain emerged only immediately postintervention . Ratings of physical health and self-efficacy beliefs also improved in the exercise group over the long term , though no changes were observed for fear-avoidance beliefs . Conclusion . A grade d exercise intervention , emphasizing stabilizing exercises , for patients with recurrent LBP still at work seems more effective in improving disability and health parameters than daily walks do . However , no such positive results emerged for improvement regarding pain over a longer term , or for fear-avoidance beliefs & NA ; Osteoarthritis of the knee , a prevalent condition in older adults , can impact physical function and ability to perform physical activity . This r and omized controlled trial examined the effects of a 6‐month self‐efficacy‐based , individually delivered , lower‐extremity exercise and fitness walking intervention with 6‐month follow‐up on physical activity and function . The 26 subjects were mostly older ( M = 63.2 years , SD = 9.8 ) , White ( 83 % ) , obese ( BMI M = 33.3 , SD = 6.0 ) women ( 96 % ) . Physical activity was measured by diaries . Physical function was measured by the 6‐minute walk , Short Physical Performance Battery ( SPPB ) , and WOMAC Physical Function subscale . Exercise self‐efficacy was assessed by a question naire . Results showed significant increases in self‐reported performance of lower‐extremity exercise and participation in fitness walking , distance in the 6‐minute walk , and SPPB scores from baseline to 6‐month follow‐up with a trend for improvement in self‐efficacy . Results suggest that the intervention was feasible , acceptable , and improved physical activity and function OBJECTIVE To assess the effect of a program of supervised fitness walking and patient education on functional status , pain , and use of medication in patients with osteoarthritis of the knee . DESIGN An 8-week r and omized , controlled trial . SETTING Inpatient and outpatient services of an orthopedic hospital in an academic medical center . PATIENTS A total of 102 patients with a documented diagnosis of primary osteoarthritis of one or both knees participated in the study . Data were obtained on 47 of 51 intervention patients and 45 of 51 control patients . INTERVENTIONS An 8-week program of supervised fitness walking and patient education or st and ard routine medical care . MEASUREMENTS Patients were evaluated and outcomes assessed before and after the intervention using a 6-minute test of walking distance and scores on the physical activity , arthritis impact , pain , and medication subscales of the Arthritis Impact Measurement Scale ( AIMS ) . RESULTS Patients r and omly assigned to the walking program had a 70-meter increase in walking distance relative to their baseline assessment , which represents an improvement of 18.4 % ( 95 % Cl , 9.8 % to 27.0 % ) . In contrast , controls showed a 17-meter decrease in walking distance relative to their baseline assessment ( P less than 0.001 ) . Improvements in functional status as measured by the AIMS physical activity subscale were also observed in the walking group but not in the control group ( P less than 0.001 ) ; patients assigned to the walking program improved 39 % ( Cl , 15.6 % to 60.4 % ) . Although changes in scores on the arthritis impact subscale were similar in the two groups ( P = 0.093 ) , the walking group experienced a decrease in arthritis pain of 27 % ( Cl , 9.6 % to 41.4 % ) ( P = 0.003 ) . Medication use was less frequent in the walking group than in the control group at the post-test ( P = 0.08 ) . CONCLUSIONS A program of supervised fitness walking and patient education can improve functional status without worsening pain or exacerbating arthritis-related symptoms in patients with osteoarthritis of the knee Objectives : To determine , using unsupervised walking programmes , the effects of exercise at a level lower than currently recommended to improve cardiovascular risk factors and functional capacity . Design : 12 week r and omised controlled trial . Setting : Northern Irel and Civil Service ; home-based walking . Participants : 106 healthy , sedentary 40 to 61 year old adults of both sexes . Interventions : Participants were r and omly allocated to a walking programme ( 30 minutes brisk walking three days a week ( n = 44 ) or five days a week ( n = 42 ) ) or a control group ( n = 20 ) . Participants could choose to walk in bouts of at least 10 minutes . They used pedometers to record numbers of steps taken . Intention to treat analysis of changes within groups was done using paired t tests ; extent of change ( baseline to 12 week measurements ) was compared between groups using analysis of variance and Gabriel ’s post hoc test . Main outcome measures : Blood pressure , serum lipids , body mass index , waist : hip ratio , and functional capacity ( using a 10 m shuttle walk test ) . Main results : 89 % ( 93/106 ) completed the study . Systolic blood pressure and waist and hip circumferences fell significantly both in the three day group ( 5 mm Hg , 2.6 cm , and 2.4 cm , respectively ) and in the five day group ( 6 mm Hg , 2.5 cm , and 2.2 cm ) ( p<0.05 ) . Functional capacity increased in both groups ( 15 % ; 11 % ) . Diastolic blood pressure fell in the five day group ( 3.4 mm Hg , p<0.05 ) . No changes occurred in the control group . Conclusions : This study provides evidence of benefit from exercising at a level below that currently recommended in healthy sedentary adults . Further studies are needed of potential longer term health benefits for a wider community from low levels of exercise Objective : To assess the effect of aerobic walking training as compared to active training , which includes muscle strengthening , on functional abilities among patients with chronic low back pain . Design : R and omized controlled clinical trial with blind assessors . Setting : Outpatient clinic . Subjects : Fifty-two sedentary patients , aged 18–65 years with chronic low back pain . Patients who were post surgery , post trauma , with cardiovascular problems , and with oncological disease were excluded . Intervention : Experimental ‘ walking ’ group : moderate intense treadmill walking ; control ‘ exercise ’ group : specific low back exercise ; both , twice a week for six weeks . Main measures : Six-minute walking test , Fear-Avoidance Belief Question naire , back and abdomen muscle endurance tests , Oswestry Disability Question naire , Low Back Pain Functional Scale ( LBPFS ) . Results : Significant improvements were noted in all outcome measures in both groups with non-significant difference between groups . The mean distance in metres covered during 6 minutes increased by 70.7 ( 95 % confidence interval ( CI ) 12.3–127.7 ) in the ‘ walking ’ group and by 43.8 ( 95 % CI 19.6–68.0 ) in the ‘ exercise ’ group . The trunk flexor endurance test showed significant improvement in both groups , increasing by 0.6 ( 95 % CI 0.0–1.1 ) in the ‘ walking ’ group and by 1.1 ( 95 % CI 0.3–1.8 ) in the ‘ exercise ’ group . Conclusions : A six-week walk training programme was as effective as six weeks of specific strengthening exercises programme for the low back STUDY DESIGN Single-subject , multiple-baseline design across 3 subjects . OBJECTIVE To investigate the use of a quota-based approach to prescribing a walking program for individuals with fibromyalgia ( FM ) . BACKGROUND Exercise has been found to be beneficial for individuals with FM . What has not been determined is the best way to implement an exercise program that does not increase FM symptoms . METHODS AND MEASURES Three women with FM were r and omly assigned a baseline period of 5 , 6 , or 7 weeks , which served as the control phase , followed by an intervention period consisting of an 8-week walking program . The walking program progression was prescribed using a quota-based approach . Weekly outcome measures were the Fibromyalgia Impact Question naire ( FIQ ) , Arthritis Self-Efficacy Scale ( ASES ) , and SF-36v2 ( acute ) . A 6-minute walk test was recorded twice : at the start of the baseline phase ( after a trial phase ) and at the end of the intervention phase . RESULTS Subjects 1 and 3 had a significant decrease in the symptoms associated with FM during the intervention phase ( FIQ , P<.05 ) , but no significant increase in self-efficacy ( ASES ) . They increased their walking distances used for exercise by 640 and 480 m , respectively . Subject 2 had no significant improvements in her symptoms of FM . Despite a significant decrease in ASES ( P<.05 ) , walking distance used for exercise by subject 2 increased by 2080 m. Six-minute walk test distances increased 76 , 32 , and 106 m for subjects 1 , 2 , and 3 , respectively . CONCLUSIONS Prescribing a walking program using a quota-based exercise prescription result ed in increasing the distance walked for 3 subjects . It also decreased symptoms associated with FM in 2 of the 3 subjects , but did not increase self-efficacy
target: Evidence of fair method ological quality suggests that walking is associated with significant improvements in outcome compared with control interventions but longer-term effectiveness is uncertain .
  With the use of the U.S. Preventive Services Task Force system , walking can be recommended as an effective form of exercise or activity for individuals with chronic musculoskeletal pain but should be supplemented with strategies aim ed at maintaining participation .
background: OBJECTIVE To systematic ally review the evidence examining effects of walking interventions on  pain and self-reported function in individuals with chronic musculoskeletal pain .