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People with arthritis are often advised to stay active, as exercise has been proven to ease pain and improve mobility. But knowing which exercises — and how many of them — to do can be a challenge. This is especially true during the COVID-19 pandemic, where social distancing and shutdowns have forced people to work out on their own rather than with a class, trainer, or physical therapist.

But a new study suggests virtual training programs might be just as effective as in-person training when it comes to managing osteoarthritis (OA) pain.

The study, which was published in the journal JAMA Network Open, recruited 105 people with osteoarthritis from an existing database and split them into two groups. One group was advised to continue with their usual care, which included exercises approved by their general practitioner and physiotherapist; the other was assigned to a six-week exercise and educational program that was delivered via a smartphone app.

The program guided users through daily exercises designed to improve their leg strength and core stability. It also asked participants to rate the complexity and difficulty of each exercise, and automatically adjusted moves based on this feedback before the next virtual session. Users received daily emails, smartphone notifications or asynchronous (not in realtime) chat messages encouraging them to stick with the program. Participants were also provided educational sessions that covered the basics of osteoarthritis and its treatment, as well as tips for self-managing symptoms and maintaining a healthy lifestyle.

Participants were assessed when the study began and when it ended six weeks later through a series of questionnaires about osteoarthritis symptoms and physical tests that measure lower extremity strength, balance, and mobility.

The findings showed that app users fared better than the control group in a number of areas. To start, they reported lower pain and stiffness scores, as well as higher physical function scores, than those in the control group. Participants who used the app also improved more significantly on two common physical functioning tests — the sit-to-stand tests and timed up-and-go tests — than those who did not.

  • The sit-to-stand test, which assesses lower extremity strength, requires patients to go from sitting to standing (and vice versa) in an armless folding chair with their back straight and their arms across the chest.
  • The timed up-and-go test, which asses functional mobility, requires patients to stand from a chair, walk to a line 10 feet away, walk back to the chair, and sit down.

“In this randomized clinical trial, we found that an internet-based first-line knee osteoarthritis management program was superior to routine self-managed care,” the authors wrote. “The effect sizes attained with the internet-based program used in this study are comparable with or greater than those presented in systematic reviews of face-to-face exercise programs.

Whether these benefits are a direct result of the specific exercises or the motivational messages is not clear. What is clear, however, is that guided exercise helps, and an app or tailored digital program may be just as effective as in-person treatment.

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Gohir SA, et al. Effectiveness of Internet-Based Exercises Aimed at Treating Knee Osteoarthritis The iBEAT-OA Randomized Clinical Trial. JAMA Network Open. February 23, 2021. doi: https://doi.org/10.1001/jamanetworkopen.2021.0012.

Tingle C. Digital treatment of knee OA may improve pain, function vs self-managed care. Healio. March 12, 2021. https://www.healio.com/news/orthopedics/20210312/digital-treatment-of-knee-oa-may-improve-pain-function-vs-selfmanaged-care.

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