title: Evaluation of group and self-directed formats of the Arthritis Foundation's Walk With Ease Program.
abstract: OBJECTIVE
  To evaluate the effects of a revised 6-week walking program for adults with arthritis, Walk With Ease (WWE), delivered in 2 formats, instructor-led group or self-directed.
  
  
  METHODS
  In an observational pre-post study design, 462 individuals with self-reported arthritis selected either a group format (n = 192) or a self-directed (n = 270) format. Performance and self-reported outcomes were assessed at baseline and at 6 weeks. Self-reported outcomes were assessed at 1 year. Adjusted mean outcome values for group and self-directed participants were determined using regression models, adjusting for covariates.
  
  
  RESULTS
  At 6 weeks, significant adjusted mean improvements (P < 0.05) were seen for nearly all self-report and performance measures in both formats. Modest to moderate effect sizes (ES) were seen for disability (ES 0.16-0.23), pain, fatigue, and stiffness (ES 0.21-0.40), and helplessness (ES 0.24-0.28). The Arthritis Self-Efficacy (ASE) pain and symptom scales had modest improvements (ES 0.09-0.21). The performance measures of strength (ES 0.29-0.35), balance (ES 0.12-0.36), and walking pace (ES 0.12-0.32) all showed modest to moderate improvements. No adverse events were reported for either format. At 1 year, both formats showed modest improvement in ASE pain, but there were 5 outcomes where self-directed participants showed significant improvement, while the group participants did not.
  
  
  CONCLUSIONS
  The revised WWE program decreases disability and improves arthritis symptoms, self-efficacy, and perceived control, balance, strength, and walking pace in individuals with arthritis, regardless of whether they are taking a group class or doing the program as self-directed walkers. At 1 year, some benefits are maintained, particularly among the self-directed. This is a safe, easy, and inexpensive program to promote community-based physical activity.
authors.affiliation: University of North Carolina at Chapel Hill, Thurston Arthritis Research Center, 3300 Thurston Building, Chapel Hill, NC 27599, USA. leigh_callahan@med.unc.edu
authors.forename: Leigh F
authors.initials: LF
authors.lastname: Callahan
authors.forename: Jack H
authors.initials: JH
authors.lastname: Shreffler
authors.forename: Mary
authors.initials: M
authors.lastname: Altpeter
authors.forename: Britta
authors.initials: B
authors.lastname: Schoster
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hootman
authors.forename: Laura O
authors.initials: LO
authors.lastname: Houenou
authors.forename: Kathryn R
authors.initials: KR
authors.lastname: Martin
authors.forename: Todd A
authors.initials: TA
authors.lastname: Schwartz
mesh_terms: D000368:Aged; D001168:Arthritis / Q000523:psychology / Q000534:rehabilitation*; D001294:Attitude to Health; D001521:Behavior Therapy; D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D010349:Patient Compliance; D015397:Program Evaluation; D011615:Psychotherapy, Group; D012648:Self Care; D020377:Self Efficacy; D016896:Treatment Outcome; D016138:Walking