Worksheet: exercise as a treatment for arthritis?! Note to instructors: This worksheet represents a way that I have taught this material, which incorporates figures/tables created by others. I have cited my sources, but I have not obtained formal permission to use the figures/tables. As far as I’m concerned, you’re welcome to use this worksheet as is or modify it. If you do the latter, please continue to cite the sources – and be aware that their inclusion here may or may not be permissible under “fair use” doctrine. --Greg Crowther, Everett Community College (gcrowther@everettcc.edu)

Worksheet: exercise as a treatment for arthritis?! Reference: Benjamin Waller et al. (2014), “Effect of therapeutic aquatic exercise on symptoms and function associated with lower limb osteoarthritis: systematic review with meta-analysis,” Physical Therapy 94(10): 1383-95. Q1. Arthritis is a very general term. What does it mean, as indicated by its roots “arthr-” and “-itis”? Q2. There are said to be three major categories of arthritis. Which one is being analyzed in the paper listed above? What are the other two major categories? Q3. This study was a meta-analysis. If cognition means “thinking,” and metacognition means “thinking about thinking,” what is a meta-analysis?

Q4. Based on what you know about arthritis, list 1-2 reasons why exercise could be BAD for arthritis patients. Q5. List 1-2 reasons why exercise could be GOOD for arthritis patients. Q6. There are many different ways to exercise. The paper listed above focused on aquatic exercise. Why might this form of exercise be relatively compatible with arthritis? Q7. Propose a survey or experimental study that could be done to determine whether therapeutic aquatic exercise (TAE) is helpful as a treatment for arthritis.

The next two pages show (A) a flow chart of how Waller et al The next two pages show (A) a flow chart of how Waller et al. found and chose previous studies and (B) a summary of those chosen studies. Q8. What were the main reasons why some studies found in the databases were not included in the meta-analysis? Q9. According to Table 2, were all of the chosen studies conducted in the same way? Q10. What are the advantages and limitations of trying to extract general trends from a set of studies that varied in many of their details? Q11. Each of the studies included in Table 2 involved a therapeutic aquatic exercise (TAE) group and a control group. How would the 2 groups be similar and different?

Figure 1: Flow diagram showing screening process and search results Figure 1: Flow diagram showing screening process and search results. RCT=randomized controlled trial, RA=rheumatoid arthritis, OA=osteoarthritis.

On the next page, Figure 2 shows two of the outcomes that were looked at by Waller et al. Q12. In the context of clinical research, what is an “outcome”? Q13. Which two specific outcomes are covered by Figure 2? Q14. What do the green squares mean in Figure 2? What do the black diamonds mean on the right side of this figure? Q15. What does Figure 2 indicate, overall, about research on the effect of therapeutic aquatic exercise (TAE) on joint pain and stiffness?

Figure 2: Forest plots showing the effect of therapeutic aquatic exercise (TAE) on pain and stiffness. 95% CI=95% confidence interval.