Background and Significance: Exercise can improve physical function and pain among seniors with osteoarthritis and may prevent or delay the need for costly joint replacement surgery. As nearly half of seniors have osteoarthritis—with osteoarthritis rates rising due to longer lifespans —finding long-term solutions to facilitate active lifestyles is key to preserving quality of life in aging adults. Due to their availability at no extra cost, SilverSneakers exercise benefits hold potential to provide long-term support for exercise over extended time periods to about half of Medicare beneficiaries enrolled in Medicare Advantage plans nationwide. However, only about 21% of seniors with osteoarthritis use their SilverSneakers benefits, and fewer than 15% engage in other structured exercise.
Previous tobacco cessation research has demonstrated that proactive care interventions that use time- and cost-efficient mailed material and phone calls to alert health plan members to the existence of free tobacco cessation benefits can double benefit enrollment and use relative to usual care. Despite the public health potential of proactive care interventions, they have not yet been evaluated in a randomized controlled trial for their effects on boosting participation in insurance-covered exercise benefit plans.
Study Aims: The study team aims to conduct a randomized controlled trial to compare the effects of proactive care, involving mailed material and phone calls for seniors plus a faxed information sheet for seniors’ primary care providers, relative to usual care, involving the standard insurance-benefit information packet provided to seniors, on:
- Increasing participation in SilverSneakers exercise programs.
- Improving physical, social and psychological outcomes identified as important to seniors with osteoarthritis.
- Reducing osteoarthritis-related health service use.
Study Description: Approximately 1,454 Medicare Advantage members aged 65 years or over with osteoarthritis and no prior SilverSneakers participation will be recruited across the United States. Participants will be randomly assigned to the proactive care or usual care conditions. The study team will aim to ensure that participants are recruited from diverse U.S. geographic regions and across urban, small-town and rural areas. The proactive care condition will guide seniors with osteoarthritis through an action plan to activate their SilverSneakers benefits and choose a convenient joint-friendly SilverSneakers exercise option appropriate for their fitness level. Exercise options including diverse fitness classes and exercise resources are available both online (to accommodate transportation barriers or infectious disease pandemics) and in-person. An information sheet will also be faxed to seniors’ primary care providers to encourage further discussion about SilverSneakers and physical activity participation. The usual care condition will include the standard information provided to senior Medicare Advantage beneficiaries about SilverSneakers. Patient-, primary care-, community- and policy-level stakeholder partners will provide input throughout the project period to ensure the design, delivery and dissemination of proactive care procedures are patient-centered and incorporate diverse stakeholder perspectives. The primary outcomes are:
- Change in reported physical function at two-year follow-up.
- The activation and use of SilverSneakers exercise benefits.
- Two-year retention rate of SilverSneakers participants who activate the SilverSneakers benefit.
Secondary outcomes include other factors identified as important to seniors with osteoarthritis in the team’s prior patient-centered research, including reported pain, fatigue, depression, social and physical activity participation, loneliness, social network support and patient-physician communication about SilverSneakers, as well as the number of database-recorded hip, knee or other joint replacement surgeries; inpatient hospital visits; primary care/physiotherapy/specialist visits; radiography/imaging procedures; and medications used. Outcomes will be measured at the beginning of the study and at six months, one year and two years after the study ends. Outcomes will:
- Help seniors with osteoarthritis to decide if participating in SilverSneakers is feasible and can help improve their physical and mental wellbeing relative to doing little or no physical activity.
- Help insurers to decide if funding proactive care interventions can improve seniors’ health-related outcomes and reduce healthcare costs relative to not providing funding.
Impact: Adding proactive care procedures to health insurance systems could increase the ease of accessing insurance-covered, joint-friendly exercise opportunities among seniors with osteoarthritis. If proactive care procedures improve exercise participation and health outcomes and reduce costly health-service use, it could lead health insurers to adopt these procedures more widely and help large numbers of seniors with osteoarthritis to improve the quality of their daily lives.
*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.