1. Exercise / Physical Activity as Medicine Special interest group
10th July 2018
13:15 – 14:15pm

2. Overview
Welcome and introductions, including SIG aims and objectives (Emma Healey)
Research spotlight (Mel Holden)
Discussion about the scope of the SIG
Ideas for future meetings/ workshops
Next steps

3. Welcome & Introductions

4. Membership number to date: 22

5. Research Spotlight

6. Mel Holden on behalf of the STEER OA study team
The STEER OA study (Subgrouping and TargetEd Exercise pRogrammes for OsteoArthritis): an Individual Participant Data Meta-analysis
Mel Holden
on behalf of the STEER OA study team

7. Exercise for osteoarthritis (OA)
Exercise is recommended in every international clinical guideline for OA
Numerous randomised controlled trials, systematic reviews and meta-analyses show it can reduce pain and improve physical function
However benefits are small to moderate and short lived

8. (Targeted exercise adherence)
Hypothesis: Not everybody responds to exercise
Exercise intervention treatment responders:
OMERACT - OARSI
APEX
(Foster et al 2007)
BEEP
(Targeted exercise adherence)
(Foster et al [under review])
CAROT
(Christensen et al 2015)
6 months
43%
55%
41%

9. Better targeting of exercise for patients with knee and hip OA could lead to improved treatment effects
This requires identification of subgroups of patients who genuinely respond better to exercise than others
Age
Obesity
Moderator
Sex
Pain
Function
Alignment
Joint damage
Anxiety/ depression
Outcome expectations

10. Secondary analyses of our own RCTs were inconclusive
Q: Does the presence of co-morbidity moderate the response of exercise?
Type of co-morbidity
Number of co-morbidities
Severity of co-morbidities
Impact of co-morbidities
Secondary analyses of our own RCTs were inconclusive

11. Individual Participant Data (IPD)meta-analysis
CLINICAL QUESTION
Systematic review
Relevant studies
Study 1
Study 2 ……
Study K
Information required is not published in the report
IPD meta-analysis is the gold standard approach to subgroup analysis
It pools original patient-level data from across trials, enabling meta-analysis results for specific subgroups of participants, and assessment of differential effects across individuals
Investigate subgroup effects and differential intervention effects across individuals
Obtain the original data (IPD)
Meta-analysis of original patient-level data

13. Aims
To establish a database of IPD from randomised controlled trials of exercise for knee and hip OA
Determine overall effect of exercise on pain and function compared to a non-exercise control
b) Determine the characteristics of exercise interventions that are associated with improved overall effects (type, intensity, duration, setting, deliverer)
c) Identify modifiers of the effect of exercise

14. Systematic review update

15. Due for completion in August 2019
Contacting authors
Successfully made contact n=73
Still in communication n=10
No (no longer have the data) n= 3
Yes n=60 including data from approx participants
Due for completion in August 2019

16. Acknowledgements Thank you to: All collaborators The OA trial bank
Admin support (Sue Weir and Linsea Duffy)
IT support (Ashley Ford and Paul Machin)
The study team
Funders:
The STEER OA study is funded by:
the CSP PRF charitable trust
NIHR SPCR

17. The scope of the SIG Primary care vs public heath
Exercise / physical activity in the person vs the health condition
How to best share learning?

18. Ideas for future meetings & workshops
Meet face to face yearly at the SAPC conference
- Meeting format
Organise one workshop/webinar per year on a relevant topic for the members

19. Next steps

20. Research Institute for Primary Care and Health Sciences David Wetherall Building Keele University Newcaslte-under-Lyme ST5 5BG
Tel: Fax: