THE EFFECTIVENESS OF WALKING PROMOTION STRATEGIES IN PEOPLE WITH MUSCULOSKELETAL DISORDERS: A SYSTEMATIC REVIEW WITH META-ANALYSIS

B.T. Saragiotto¹, I. Fioratti¹, A. Tiedemann², M.J. Hancock³, T.P. Yamato¹, S.S.Y. Wang⁴, J.Y. Chau², C.-W.C. Lin²

Background: Physical inactivity is associated with more than 5 million deaths per year worldwide and is ranked as the fourth leading risk factor for mortality. The overall prevalence of insufficient physical activity in adults is estimated at 23.3%, but the prevalence is up to 70% in people with musculoskeletal disorders. Previous reviews have identified strategies, such as walking promotion, that are effective in increasing physical activity in the general population and, subsequently, overall health condition. Walking is an easily accessible and affordable form of low-cost physical activity that requires no prior training or equipment. Promoting walking for people with musculoskeletal disorders has been found to improve physical activity levels, improve functional status, and reduce pain intensity.

Purpose: To evaluate the effectiveness of walking promotion strategies on physical activity and clinical outcomes in people with musculoskeletal disorders.

Methods: A systematic review was performed on the MEDLINE, EMBASE, CENTRAL, and PEDro databases with search ending in August 2019. For the selection of studies we included randomized controlled trials evaluating interventions that promote walking compared with minimal intervention, usual care. or other supervised active treatment in people with musculoskeletal disorders. Two independent reviewers extracted data, assessed risk of bias and quality of evidence. We calculated the mean (MD) and standardized mean differences (SMD) and 95% confidence intervals (CI) using random effect models. We use the PEDro scale to assess risk of bias and the GRADE approach to assess the quality of evidence.

Results: Eleven trials (n = 1,360 participants) were identified. There is no difference in physical activity levels in walking promotion interventions compared with minimal intervention in short-term follow-ups (MD -0.78, 95% CI -2.12 to 0.55, 3 trials) with very low quality evidence, in intermediate follow-ups  (MD -1.10, 95% CI -2.77 to 0.56, 2 trials) with moderate quality evidence and in long-term follow-ups (MD -0.69, 95% CI -2.21 to 0.83, 1 trial) with very low quality evidence. There is high-quality evidence that walking promotion was effective in reducing pain in short term follow-ups (MD -3.98, 95% CI -7.16 to -0.80, 8 trials) and improving function in short term follow-ups (SMD -0.24, 95% CI -0.47 to -0.01, 5 trials), intermediate follow-ups (SMD -0.16, 95% CI -0.33 to 0.00, 6 trials) and long-term follow-ups (SMD -0.20, 95% CI -0.39 to -0.01, 4 trials) compared to minimal intervention. There is no difference in pain and function when compared to supervised exercise, with evidence of low to moderate quality. The promotion of walking was not associated with different rates of adverse events compared to the control.

Conclusion(s): Strategies to promote walking do not increase physical activity levels or walking volume in people with musculoskeletal disorders, however, they provide significant improvements in pain and function compared with minimal interventions. There was no difference between walking promotion and supervised exercises for clinical improvement.

Implications: Promoting physical activity in people with musculoskeletal disorders may require strategies other than promotion of walking. Promotion of walking can be a worthwhile treatment alternative to supervised exercise to manage pain and disability, particularly in more resource-poor or remote settings.

Funding, acknowledgements: There was no funding for this research.

Keywords: Walking, Physical Activity, Musculoskeletal Pain

Topic: Health promotion & wellbeing/healthy ageing/physical activity

Did this work require ethics approval? No

Institution: Universidade Cidade de São Paulo - UNICID

Committee: Comitê de Ética em Pesquisa da Universidade Cidade de São Paulo

Reason: Systematic Review