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

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

Welcome & Introductions

Membership number to date: 22

Research Spotlight

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

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

(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%

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

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

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

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

Systematic review update

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. 8500 participants Due for completion in August 2019

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

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?

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

Next steps

Research Institute for Primary Care and Health Sciences David Wetherall Building Keele University Newcaslte-under-Lyme ST5 5BG Tel: 01782 733905 Fax: 01782 734719 www.keele.ac.uk/pchs