Exercise booster sessions as a mean to maintain the effect of an exercise-intervention - A systematic review

Abstract

Background: Exercise is known to have many beneficial effects. Nevertheless, long-term adherence remains a challenge. A concept suggested to attend this problem is Exercise Booster Sessions (EBS). However, the current knowledge on EBS is limited.

Objectives: This systematic review aimed to summarize and synthesize 1) the reported effects of EBS on physical function, pain, quality-of-life and societal costs and 2) delineate the basic components of EBS (frequency, intensity, type and time) following an exercise intervention in all clinical populations.

Methods Seven databases (MEDLINE, EMBASE, CINAHL, SportDISCUS, Physiotherapy Evidence Database PEDro, Web of Science, and Cochrane Central Register of Controlled Trials) were electronically searched in August 2021. Included studies were randomized controlled trials (RCTs) of exercise interventions in all clinical populations followed by a period of EBS or a control group not receiving EBS.

Results: Five studies on respectively knee osteoarthritis (n = 4) and low back pain (n = 1), reporting four different RCTs, were included. Four studies had a potential high risk of bias, whereas one was rated to have some concerns. One study found a positive effect of EBS on the Western Ontario and McMaster Universities Arthritis Index (WOMAC) score, −46.0 (-80.0, −12.0), whereas the others did not find any differences. The frequency of EBS ranged from 0.09 − 1 session/week, and one study found EBS to be cost-effective.

Conclusions: Current evidence suggests no or at best moderate effects of EBS on physical function and pain. However, the low number of trials, the potential risk of bias, plus the diversity in trial interventions prevent a firm conclusion.

Keywords:

• Rehabilitation
• physical function
• pain

Disclosure statement

STS is associate editor of the Journal of Orthopaedic & Sports Physical Therapy, has received grants from The Lundbeck Foundation, personal fees from Munksgaard, all of which are outside the submitted work. He is the cofounder of Good Life with Osteoarthritis in Denmark (GLA: D®), a not-for-profit initiative hosted at the University of Southern Denmark aimed at implementing clinical guidelines for OA in clinical practice .The other authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Author contributions

Conception or design of the work: LT-M, TK and UD. Data collection: LT-M and TK. Interpretation of data: all. Drafting the work: L-TM, TK and UD. Final approval and revision of the version to be published: all. Agreement to be accountable for all aspects of the work: all.

Additional information

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: UD has received research support, travel grants, and/or teaching honorary from Biogen Idec, Merck Serono, Novartis, Bayer Schering, and Sanofi Aventis as well as honoraria from serving on scientific advisory boards of Biogen Idec and Genzyme. STS is currently funded by a grant from Region Zealand (Exercise First) and a grant from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation program [Grant Agreement No. 801790].

Notes on contributors

Laurits Taul-Madsen

Laurits Taul-Madsen, BSc, MSc. Exercise biology, Department of Public Health, Aarhus University, Denmark. Ph.D. student Laurits Taul-Madsen, has a background as an exercise physiologist. Specifically, he has been working with exercise and Multiple Sclerosis (MS) for several years. Over the last two years, he has been working in an international project focusing on improving cognition in people with progressive MS.

Troels Kjeldsen

Troels Kjeldsen, BSc, MSc. Department of Orthopedic Surgery, Aarhus University Hospital, Denmark. Ph.D. student Troels Kjeldsen has a master's degree in Sports Science from Aarhus University and is currently undertaking his PhD studies in exercise for people with hip osteoarthritis. The focus of his research is to investigate optimal delivery and type of exercise as medicine in different populations.

Søren T. Skou

Søren T. Skou, PT, MSc, PhD. Professor in Exercise and Human Health, Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark. Head of Research, PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals. Professor Søren Thorgaard Skou (PT, MSc, PhD) from the University of Southern Denmark and Næstved-Slagelse-Ringsted Hospitals, Denmark has vast experience within the field of osteoarthritis and other chronic conditions and has been the principal investigator of several high-quality randomized controlled trials on surgical and non-surgical treatment, one of which was published in The New England Journal of Medicine (impact factor of 79.26), the highest ranked of all general medical journals. Currently, he is the principal investigator of a randomized, controlled trial of meniscal surgery vs. exercise therapy and education for young people with a meniscal tear (DREAM) and a 5-year EU-funded project (MOBILIZE, grant agreement No 801790) with the overall aim of improving health in people with more than one chronic condition (i.e. multimorbidity) through personalized exercise therapy and education.

Inger Mechlenburg

Inger Mechlenburg, PT, MSc, PhD, DMSc. Orthopaedic Department, Aarhus University Hospital, Department of Clinical Medicine, Aarhus University, Denmark. Professor Inger Mechlenburg's research goal is to fill knowledge gaps on optimal rehabilitation to patients with musculoskeletal illnesses and thus improve health and quality of life among these individuals. Her research will support the development, piloting and testing of treatments for common and costly musculoskeletal problems in primary and secondary care, including hip, knee and shoulder pain. She aim to develop and test the clinical and cost-effectiveness of different treatments, including identification of hip problems in young patients, support for patients of working age and approaches with focus on strengthening weak joints.

Ulrik Dalgas

Ulrik Dalgas, BSc, MSc, PhD. Exercise Biology, Department of Public Health, Aarhus University, Denmark. Professor Ulrik Dalgas is the head of a research team (1 associate professor, 1 post doc, 3 PhD students, 3 research assistant and ∼12 master students/year) specialised in exercise for neurological conditions. He has an international profile including involvement in several large multicentre studies, international executive boards and expert panels as well as a frequent reviewer of grant applications for organisations all over the world. Furthermore, he is an experienced international presenter as well as comprehensive teaching and supervision experience.