title: The steps to health randomized trial for arthritis: a self-directed exercise versus nutrition control program.
abstract: BACKGROUND
  Despite the established benefits of exercise for adults with arthritis, participation is low. Safe, evidence-based, self-directed programs, which have the potential for high reach at a low cost, are needed.
  
  
  OBJECTIVE
  To test a 12-week, self-directed, multicomponent exercise program for adults with arthritis.
  
  
  METHODS
  Randomized controlled trial. Data were collected from 2010 to 2012. Data were analyzed in 2013 and 2014.
  
  
  METHODS
  Adults with arthritis (N=401, aged 56.3 [10.7] years, 85.8% women, 63.8% white, 35.2% African American, BMI of 33.0 [8.2]) completed measures at a university research center and participated in a self-directed exercise intervention (First Step to Active Health(®)) or nutrition control program (Steps to Healthy Eating).
  
  
  METHODS
  Intervention participants received a self-directed multicomponent exercise program and returned self-monitoring logs for 12 weeks.
  
  
  METHODS
  Self-reported physical activity, functional performance measures, and disease-specific outcomes (arthritis symptoms and self-efficacy) assessed at baseline, 12 weeks, and 9 months.
  
  
  RESULTS
  Participants in the exercise condition showed greater increases in physical activity than those in the nutrition control group (p=0.01). Significant improvements, irrespective of condition, were seen in lower body strength, functional exercise capacity, lower body flexibility, pain, fatigue, stiffness, and arthritis management self-efficacy (p values<0.0001). More adverse events occurred in the exercise than nutrition control condition, but only one was severe and most were expected with increased physical activity.
  
  
  CONCLUSIONS
  The exercise program improves physical activity, and both programs improve functional and psychosocial outcomes. Potential reasons for improvements in the nutrition control condition are discussed. These interventions have the potential for large-scale dissemination. This study is registered at Clinicaltrials.gov NCT01172327.
authors.affiliation: Department of Exercise Science, University of South Carolina, Columbia, South Carolina; Prevention Research Center, University of South Carolina, Columbia, South Carolina. Electronic address: swilcox@sc.edu.
authors.forename: Sara
authors.initials: S
authors.lastname: Wilcox
authors.affiliation: Department of Exercise Science, University of South Carolina, Columbia, South Carolina.
authors.forename: Bruce
authors.initials: B
authors.lastname: McClenaghan
authors.affiliation: Department of Exercise Science, University of South Carolina, Columbia, South Carolina; Prevention Research Center, University of South Carolina, Columbia, South Carolina.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Sharpe
authors.affiliation: Department of Health Science, Saginaw Valley State University, University Center, Michigan.
authors.forename: Meghan
authors.initials: M
authors.lastname: Baruth
authors.affiliation: Division of Population Health, CDC, Atlanta, Georgia.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Hootman
authors.affiliation: College of Social Work, University of South Carolina, Columbia, South Carolina.
authors.forename: Katherine
authors.initials: K
authors.lastname: Leith
authors.affiliation: Department of Exercise Science, University of South Carolina, Columbia, South Carolina.
authors.forename: Marsha
authors.initials: M
authors.lastname: Dowda
mesh_terms: D001168:Arthritis / Q000178:diet therapy / Q000188:drug therapy / Q000534:rehabilitation*; D015897:Comorbidity; D004032:Diet / Q000592:standards*; D004522:Educational Status; D005081:Exercise Therapy / Q000379:methods* / Q000592:standards; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D018673:Nutrition Policy; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D012648:Self Care / Q000379:methods*; D013022:South Carolina