Feasibility, acceptability and effect on health outcomes of a pilot randomised controlled trial for people with osteoarthritis and thinking concerns: The Healthy Body & Mind Program

Feasibility, acceptability and effect on health outcomes of a pilot randomised controlled trial for people with osteoarthritis and thinking concerns: The Healthy Body & Mind Program | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Feasibility, acceptability and effect on health outcomes of a pilot randomised controlled trial for people with osteoarthritis and thinking concerns: The Healthy Body & Mind Program Claire V Burley, William Yeates, Stephanie Tsang, Matthew D Jones, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7590984/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Osteoarthritis (OA) is highly prevalent in older adults and is associated with increased dementia risk. The aims of this pilot randomized controlled trial (RCT) were to assess the feasibility, acceptability, and health outcomes of a 12-week multidisciplinary Healthy Body & Mind Program for individuals with OA and thinking concerns. Method Feasibility and acceptability were measured using retention, adherence, and participant feedback (interviews/focus groups). Health outcomes included quality of life pain, cognition, psychological and physical health. Data were analysed with ANOVAs (intervention/control) and paired t-tests (baseline/follow-up). Results Eighteen participants (mean age = 71 ± 5.7, mean MoCA = 19 ± 2.2) were randomly assigned to the program or a wait-list control group. Fifty-percent of participants completed the program, totalling 215/234 attended sessions (92% completion rate). Participants provided positive feedback and suggestions for future programs. There were significant interaction effects where the intervention group improved and the control group worsened for pain (p < .05;η²=0.348) and quality of life (p < .05; η²=0.380). The intervention group showed significant improvements in attentional processing and the 6-minute walk test (both p < .05). Conclusion The program was well-accepted by participants and significantly improved health outcomes. Future trials may benefit from focusing on increasing accessibility and flexibility and scaling the program for broader public health impact. cognitive decline dementia risk depression education exercise lifestyle nonpharmacological osteoarthritis pain physical activity quality of life Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 1. Introduction Dementia and osteoarthritis (OA) represent significant global health challenges. Worldwide, 55 million people are living with dementia ( 1 ), while 528 million experience OA ( 2 ). The relationship between these conditions is particularly complex, with OA associated with a 20 to 25 percent increase in dementia risk( 3 , 4 ). Remarkably, OA prevalence has been reported in almost half of people living with dementia ( 5 , 6 ), highlighting the intricate connection between these chronic conditions. Both dementia and OA are characterized by substantial negative impacts on individual health and are consistently associated with increased pain ( 3 , 7 , 8 ), depression ( 9 , 10 ), and reduced quality of life (QoL)( 7 , 11 ). An increasing number of older adults are becoming concerned with their brain health ( 12 ) and thinking concerns may develop before the onset of dementia. The interplay of comorbid conditions is particularly challenging, with research demonstrating that a higher number of comorbidities correlates with more severe pain and depression ( 13 ). This multimorbidity creates a complex healthcare landscape that requires nuanced, comprehensive interventions. The clinical implications extend beyond individual symptoms. QoL, depression, and anxiety are prevalent across both conditions, creating a compounding effect on the experience of people living such multimorbidity ( 9 , 11 , 14 ). Over 40% of people with OA( 14 ) and up to 62% of people with dementia( 10 ) experience depression. In addition, the risk of dementia increases dramatically with OA, rising from 1.2-fold to an alarming 5.7-fold when accompanied by additional chronic conditions ( 15 , 16 ). Nonpharmacological lifestyle approaches have emerged as a promising intervention strategy, with fourteen well-established and modifiable dementia risk factors having the potential to lead to a 45 percent reduction in dementia cases if eliminated ( 17 ). Physical activity (PA) has demonstrated improvements across 26 different chronic conditions ( 18 ), showing particular efficacy in improving health outcomes for people living with dementia( 17 ) and those with OA ( 10 ). Despite this potential, a significant gap remains in developing accessible, implementable, and scalable lifestyle programs for individuals experiencing thinking concerns and OA. Extensive research has consistently highlighted the beneficial impacts of PA and nonpharmacological lifestyle interventions. These approaches have been shown to reduce dementia risk ( 15 , 17 ), improve cognition( 19 , 20 ), enhance QoL ( 21 ), provide cost-effective interventions ( 22 ), and offer preferable treatment options for people living with dementia and their care partners ( 23 ). Systematic reviews reveal nuanced insights into intervention effectiveness. PA demonstrates positive effects on cognition ( 24 ), depression, and QoL ( 25 ). Critically, multimodal and mind-body approaches consistently outperform single interventions ( 10 ). For OA specifically, effective interventions have incorporated diverse strategies including aerobic and strengthening exercises, comprehensive lifestyle education, and targeted pain coping skills training ( 26 ). Existing healthcare interventions frequently overlook the complex interactions between conditions. Depression and anxiety, commonly experienced by people with cognitive decline ( 27 ) and OA, create intricate symptom patterns, with depression itself linked to increased dementia risk ( 28 ). The interconnected nature of these symptoms means that limitations in daily activities due to OA-related pain or cognitive difficulties can trigger or exacerbate depressive experiences. Recognising these complex interactions and that half of overall disease burden is due to modifiable factors such as PA and lifestyle, our research team has developed a novel multimodal lifestyle program. The Healthy Body & Mind Program (HBMP) represents an evidence-based intervention including PA and lifestyle education sessions that align with the dementia risk factors identified in the Lancet Commission and other reviews ( 17 , 29 ) (e.g., depression, smoking, alcohol, obesity) and tailored specifically for individuals with OA (e.g., including pain science education). This program fills a critical gap, as currently no programs exist for people living with OA and thinking concerns. The study's primary objectives were: first, to assess the feasibility of the HBMP within a community clinic setting, examining critical factors such as recruitment, retention, and participant adherence; and to evaluate the program's acceptability for individuals living with OA and cognitive decline. The secondary aim focused on generating pilot data comparing health outcomes between the intervention and control group (standard care). By addressing the complex intersections of cognitive decline and osteoarthritis, we aim to provide a meaningful, evidence-based approach to improving health outcomes for a vulnerable and often overlooked population. Comprehensive outcome measures capture a holistic view of participant health, including QoL, cognitive function, pain levels, psychological health metrics (depression, anxiety, stress), and physical health parameters. These encompassed weight, waist circumference, blood pressure, and various fitness measurements, including walking speed, grip strength and balance. 2. Methods 2.1. Ethical approval and study registration Ethical approval was obtained from the University of New South Wales Human Research Ethics Committee (HC230506; 18/09/2023). The clinical trial was prospectively registered at https://clinicaltrials.gov/ (NCT06070818; 18/09/2023), and the protocol( 30 ) was prepared in accordance with the SPIRIT guidelines (Standard Protocol Items: Recommendations for Intervention Trials)( 31 ). Results are reported in adherence to CONSORT statement guidelines( 32 ) (see Supplementary materials). Methods are briefly summarised below, and full details are available in the study protocol( 30 ). 2.2. Study design This 12-week pilot randomized controlled trial (RCT) used mixed quantitative and qualitative research methodology. The study and data collection took place at the UNSW Medicine & Health clinic facilities in Sydney, Australia. Data collection comprised clinical observations routinely completed as part of standard care, validated participant-reported outcome measures (including QoL, cognition, pain and psychological health), and focus group/interviews. Clinical observations and questionnaires were completed at baseline (0 weeks) and post-intervention (12 weeks) (Fig. 1 ). Initial community and stakeholder engagement assisted with developing the group program and ensuring it was feasible and acceptable to participants. The study team includes accredited exercise physiologists (AEP), accredited practicing dietitians (APD), a health and provisional clinical psychologist, and research assistants. Recruitment took place from November 2023 to February 2024. The trial took place from March to December 2024, ending after all recruited participants had completed the program. 2.2. Participants and recruitment Participants met the inclusion criteria if they were individuals aged 45 years or over, living with osteoarthritis (OA) diagnosed by a healthcare professional. They either lived with dementia or had subjective thinking concerns (i.e., expressed concerns over ageing and related changes in brain health). Our original inclusion criteria in the study protocol( 30 ) included a Montreal Cognitive Assessment (MoCA) ( 33 ) score of 18–25, indicating mild cognitive impairment or mild dementia, though this was removed due to recruitment challenges. Participants were required to be able to safely undertake study assessments and complete exercise without assistance and have appropriate medical clearance. Participants were excluded if they had a MoCA score below 18, were unable to provide written informed consent, could not speak and understand English (unless a translator was available), or had contraindications to exercise according to the American College of Sports Medicine (ACSM) guidelines ( 34 ). These contraindications included symptomatic hernias, proliferative retinopathy, uncontrolled arrhythmias, or terminal illness. The study was advertised through multiple channels, including the UNSW Medicine & Health Lifestyle Clinic, StepUp for Dementia Research, General Practitioner (GP) and Health District referrals, and online social media advertisements. An ethically approved protocol was in place for advising participants of health assessment results. Enrolled participants were randomly assigned (1:1) using a computer-generated list to an intervention group (n = 8) or a wait-list control group (n = 8). The list was produced by a researcher external to the study group, blind to group allocation ensuring an effective allocation concealment mechanism was in place. 2.4. Aims and outcome measures The primary aims were to determine the feasibility of the Healthy Body & Mind Program (HBMP) for people with OA and thinking concerns and to assess program acceptability. The secondary aim was to obtain pilot data on health outcomes, including QoL (QoL) ( 35 ), cognition( 33 ), pain ( 36 ), psychological health (depression, anxiety, stress) ( 37 ), and physical health. Feasibility and acceptability were assessed through retention, adherence (completion of exercises and engagement in education), session attendance, and participant feedback (post-program interviews/focus groups). Health outcomes were assessed including QoL [SF-36], pain (Western Ontario and McMaster Universities Arthritis Index [WOMAC]), cognition (MoCA and Cambridge Cognition), psychological health (Depression, Anxiety and Stress Scale [DASS-21]), and physical health assessments such as weight, waist circumference, blood pressure, and functional fitness. Measures were collected at baseline and follow-up (13–14 weeks after baseline) by a research assistant who was blind to participant group allocation. Participants were requested to not discuss their group allocation or trial activities with the research assistant to ensure the assessor remained blinded. 2.5. Healthy Body & Mind Program (HBMP) versus wait-list control The intervention was a 12-week program (described in more detail in the study protocol( 30 ) with twice-weekly sessions (24 total), lasting two hours per session. Each session included one hour of supervised group exercise and one hour of group lifestyle and behaviour change education. The exercise component was evidence-based and individually modified, combining aerobic, resistance, balance, and flexibility exercises. Participants were prescribed and engaged in two hours of clinic-based exercise and one hour of independent exercise each week, in line with ACSM exercise prescription guidelines of at least 150 minutes per week ( 34 ). Clinic-based exercise was overseen by an AEP and home-based exercise was self-reported and documented by the participant. One of the education sessions focused on independent exercise. The participant returned completed home-based exercise sheets to the AEP each week. The education component involved education delivery and group discussions focused on topics such as living with OA and cognitive decline, PA, nutritional advice, psychological health, social connections, and individual goal setting. Educational materials included resources from Dementia Australia, Arthritis NSW, Alzheimer's Association, and the Australian Government Department of Health. An adverse event management plan was in place in case any averse/serious adverse events occurred. PA risks were continuously monitored through risk assessment by trained professionals, documentation of adverse events, transparent reporting, and adherence to CONSORT statement guidelines ( 38 ). The wait-list control group were able to continue with their usual treatment and were offered the intervention after 12 weeks. All participants who attended the program took part in a focus group or interview and answered questions about their experience and were invited to provide honest feedback. 2.7. Statistical analysis Quantitative data were analysed using IBM SPSS Statistics (Version 30.0.0.0, 172), with normality checks and descriptive statistics for frequencies and distributions. Health outcomes were compared between pre- and post-program completion and between intervention and control group using T-tests and repeated measures ANOVAs. Statistical significance was set at p < 0.05 level. Effect sizes were calculated using Cohen’s d for T-tests and partial eta-squared (ηp²) for ANOVAs. Results are reported comparing intervention versus wait-list control and pre- versus post the 12-week program, with the exception of cognition measures which are only reported pre- versus post-program due to a technical complication and loss of control data. Qualitative data will be reported separately. Qualitative data will analysed using content analysis and be reported separately. 3. Results Eighteen participants with OA and thinking concerns completed baseline assessments (mean age = 71.5 ± 5.7years; mean telephone MoCA = 18.9 ± 2.2) and were randomised to either the intervention group (n = 9), where they would begin the 12-week program immediately, or a wait-list control group (n = 9), where they would begin the program 13 weeks later (all participants also completed a familiarisation week to become more comfortable with the procedures and equipment). The flow of participants through the study is shown in Fig. 2 . Participant characteristics are described in Table 1 . 3.1. Feasibility and Acceptability The study was advertised using three national recruitment platforms, through local health districts, social media and existing contacts of the research team. Despite this, recruitment was challenging. The inclusion criteria were changed (MoCA score of 18–25 was removed and the age was lowered) and terminology on recruitment posters were amended (‘cognitive decline’ was changed to ‘thinking difficulties/concerns’) to improve recruitment. Six participants withdrew from the study before they commenced the program (all could no longer make the session times; one from the intervention group and five from the wait-list control). Of the 12 participants who started the program, three participants withdrew, one due to COVID-19 infection after completing six weeks, one experienced a family emergency after completing two weeks, and one due to conflicting work commitments, after completing four weeks. Out of the total sample, nine participants (50%) completed the program. On average 22 (range 18–26) out of the total 26 sessions (92%) were attended and completed. Frequency of AEP sessions was twice weekly. Participants who completed sessions adhered to all the AEP delivered exercises and returned all completed home-based exercise record sheets. Ten percent of completed sessions were rescheduled sessions (i.e., they were rescheduled to an alternative time that was suitable for the participants and AEP). Exercises were modified by the AEP where required and progressed in intensity throughout the program. The program was delivered in four groups of between one (due to drop-out) and four participants. When asked “Would you continue to attend a Healthy Body & Mind service?” eight of the nine participants said “yes” and one participant did not answer the question as the discussion moved on. Participants said that they “would like it to go for longer, would keep going for as long as it was offered ” and suggested to “have somewhere they can be referred to after the program , ongoing support, check-ins, re-assessment at twelve months to see how they are going”. Others responded by acknowledging the benefits, “ most definitely, it was very good for me”, “yes, definitely”, “absolutely. Yeah, that's what we all advocate for. Because you become disciplined then too, when it's ongoing” , and “my answer is a resounding yes, if there was an ongoing program ”. Qualitative feedback revealed participants would continue to attend the program if it were available (all qualitative findings to be published separately). No adverse events or harm to participants occurred throughout the trial. One participant contracted COVID-19 six weeks into the program, though it was suspected this occurred off-site. All participants and staff were informed and were monitored for symptoms during this time. 3.2. Health outcome measures Health outcome measures for pain (WOMAC), QoL (SF-36), psychological health (DASS-21), physical health and cognition are detailed below. No significant differences were observed between intervention and control group baseline measures (Table 1 and Table 2 ). 3.2.1. Pain, QoL and psychological health Repeated measures ANOVAs revealed significant time by group interactions for overall pain (p = .034;η²=0.348) and QoL scores (p = .025;η²=0.380), where outcomes improved for the intervention group (N = 9) and worsened for the control group (N = 4). Significant interactions were also observed for the QoL subscales emotional (p = .036;η²=0.342), social (p < .001;η²=0.645), and general health (p = .046;η²=0.046). No significant differences were observed for psychological health measures (depression, anxiety and stress) (Table 2 ; Figs. 3 & 4 ). T-tests revealed a significant increase in the mean total WOMAC score and pain subscale (i.e., symptoms became worse) in the control group (both p < .05), following the 12-week wait period (Table 2 , Fig. 3 ). Total QoL scores significantly improved (p < .01) in the intervention group following completion of the program. In addition, significant improvements were observed in the QoL subscales, emotional health (limitations), emotional wellbeing (p < .05 and p < .005 respectively) and social functioning (p < 0.01) following completion of the program (Table 2 , Figs. 3 & 4 ). 3.2.2. Physical and functional health outcomes Physical and functional health measures were strength, function and balance. T-tests revealed a significant improvement in the 6-minute walk test at follow-up compared to baseline in the intervention group, where the mean distance walked increased by 36 metres from 421.4 (SD = 96.8) to 457.1 (SD = 97.0). No other significant differences were observed except for the mean diastolic blood pressure (reduced from 81mmHg; SD = 6.2 to 71mmHg; SD = 4.4; p = 0.38) in the control group (Table 2 ). 3.2.3. Cognition Overall cognition No significant improvements in overall cognition (assessed using the MoCA) were observed though the mean post-program MoCA score improved by 1.3 points (Table 2 ). Multitasking Test (MTT) Paired sampled t-tests revealed significant improvements in mean reaction latency across all correct responses (p = 0.02;d = 2.05), mean reaction latency when both ‘side’ and ‘direction’ rules are used (p = 0.004;d = 17.07), on incongruent trials (p = 0.006;d = 5.14), mean multitasking cost (p = 0.004;d = 1.80); and significant increase in total number of correct responses (p = 0.006;d = 3.39) and decrease in total omission errors (p = 0.002;d = 1.57) (Table 2 ; Fig. 5 ). Spatial working memory (SWM) and paired associated learning (PAL) No significant differences were observed for spatial working memory or paired associated learning between baseline and follow-up. Table 1 Participant characteristics (n = 18). Variable Mean ± SD, or n (%) Demographics Age, years 71.2 ± 5.7 Sex, female (%) 16 (89%) Ethnicity - Caucasian 14 (78%) - Asian 1 (6%) - Hispanic/Latin American 1 (6%) - Arabian/Middle Eastern 1 (6%) - Other (Māori & European) 1 (6%) Country of Birth - Australia 9 (50%) - New Zealand 3 (17%) - Other (see footnote) 6 (34%) Education - Postgraduate/ Higher Degree 7 (39%) - Bachelor Degree 5 (28%) - Graduate Diploma 3 (17%) - Certificate Level IV 3 (17%) Employment - Retired 14 (78%) - Employed 3 (17%) - Unemployed 1 (6%) Marital status - Married 6 (34%) - Widowed 5 (28%) - Separated/Divorced 3 (17%) - Single (never married) 3 (17%) - Domestic Partnership 1 (6%) Living arrangements - Alone 9 (50%) - With partner/children 9 (50%) Physical Characteristics Height, cm 163.2 ± 8.5 Weight, kg 80.4 ± 20.6 Body mass index, kg/m 2 29.9 ± 6.6 Waist circumference, cm 103.5 ± 17.9 Systolic blood pressure, mmHg 126.6 ± 20.3 Diastolic blood pressure, mmHg 77.4 ± 8.1 Heart rate, bpm 67.3 ± 11.8 Osteoarthritis characteristics Osteoarthritis location 18 (100%) - knee 8 (45%) - spine 6 (33%) - hands 6 (33%) - feet 4 (22%) - hip 2 (11%) Health characteristics Telephone MoCA score 19.1 ± 2.2 Currently taking medication/s 16 (89%) Comorbidities (range 1–5 with OA) 18 (100%) - Depression/anxiety/PTSD 11 (61%) - Osteoporosis 8 (45%) - Hypertension 7 (39%) - Cancer 5 (28%) - Cardiovascular disease 4 (22%) - Peripheral neuropathy 3 (17%) - Dementia/cognitive decline 2 (11%) - Other (see footnote) 4 (22%) Footnote. Other conditions (where n = 1) were high blood pressure, high cholesterol, chronic kidney disease. Other countries born (where n = 1) were Vietnam, Poland, Argentina, Bosnia, Soviet Union, Czech Republic. Abbreviations: OA = osteoarthritis; PTSD = posttraumatic stress disorder. Table 2 Means ± standard deviations for health outcome measures: pain, quality of life, psychological health, physical health and cognition. Pre/post program measures are shown for the intervention (n = 9) and control group (n = 4), followed by interaction effects. Significance values and effect sizes are reported. Program (n = 9) Control (n = 4) Program vs. Control Pre-program n = 19 Post-program n = 16 T-test n = 9 Pre-program n = 19 Post-program n = 16 T-test ANOVA (Interaction) Pain WOMAC Total 21.8 ± 12.6 17.2 ± 7.8 ↑ p = .073 21.5 ± 11.9 28.3 ± 14.9 ↓ p = .045 p = .034; η²=0.348 Pain 5.4 ± 3.7 3.4 ± 2.1 t ↑ p = .054 4.3 ± 2.6 8.8 ± 3.9 ↓ p = .043 p = .011; η²=0.458 Stiffness 2.1 ± 1.2 1.4 ± 2.1 ↑ p = .110 2.3 ± 0.5 2.3 ± 1.3 - p = .500 p = .428; η²=0.058 Physical function 14.2 ± 8.5 12.3 ± 6.4 ↑ p = .189 15.0 ± 9.8 17.8 ± 10.0 t ↓ p = .051 p = .175; η²=0.161 Quality of life SF-36 Total 58.0 ± 15.4 66.8 ± 14.0 ↑ p = .009 61.5 ± 22.4 55.7 ± 20.7 ↓ p = .178 p = .025; η²=0.380 Physical functioning 58.3 ± 23.8 67.2 ± 17.0 ↑ p = .120 52.5 ± 24.7 52.5 ± 24.7 - p = .500 p = .442; η²=0.055 Physical health (limit) 50.0 ± 41.5 55.6 ± 32.5 ↑ p = .256 62.5 ± 47.9 37.5 ± 47.9 t ↓ p = .091 t p = .073; η²=0.264 Emotional (limit) 40.7 ± 27.8 66.7 ± 37.3 ↑ p = .033 58.3 ± 50.0 41.7 ± 41.9 ↓ p = .302 p = .130; η²=0.196 Energy/fatigue 55.6 ± 18.1 59.4 ± 15.3 ↑ p = .205 58.8 ± 13.1 55.0 ± 19.1 ↓ p = .378 p = .451; η²=0.053 Emotional wellbeing 69.8 ± 13.3 79.2 ± 14.2 ↑ p = .002 74.0 ± 14.0 71.0 ± 14.0 ↓ p = .319 p = .036; η²=0.342 Social functioning 72.2 ± 19.5 79.2 ± 16.5 ↑ p = .007 84.4 ± 12.0 68.8 ± 21.7 ↓ p = .040 p = .001; η²=0.645 Pain 66.9 ± 11.3 66.4 ± 6.6 ↑ p = .441 54.4 ± 12.0 62.5 ± 14.9 ↑ p = .113 p = .211; η²=0.138 General Health 56.1 ± 24.8 63.3 ± 20.3 ↑ p = .121 63.8 ± 28.1 63.8 ± 30.4 - p = .500 p = .046; η²=0.529 Psychological health DASS-21 Total Distress 13.4 ± 71 12.3 ± 6.0 ↑ p = .279 14.5 ± 8.3 15.0 ± 8.2 ↓ p = .453 p = .674; η²=0.017 Depression 4.6 ± 3.4 4.1 ± 2.3 ↑ p = .289 5.3 ± 4.3 5.5 ± 4.2 ↓ p = .412 p = .888; η²=0.002 Anxiety 3.3 ± 2.1 3.2 ± 2.4 ↑ p = .424 4.0 ± 2.4 3.8 ± 2.2 ↑ p = .394 p = .730; η²=0.011 Stress 5.6 ± 5.0 5.0 ± 2.1 ↑ p = .277 5.3 ± 2.1 5.8 ± 3.3 ↓ p = .422 p = .978; η²=0.000 Physical health Systolic BP (mmHg) 125.6 ± 23.5 120.3 ± 18.1 - p = .292 128.8 ± 9.3 116.8 ± 12.0 t - p = .082 p = .533; η²=0.036 Diastolic BP (mmHg) 72.2 ± 6.0 71.7 ± 9.1 - p = .434 81.1 ± 6.2 70.7 ± 4.4 - p = .038 p = .095; η²=0.233 Heart rate 64.5 ± 11.6 62.9 ± 14.0 - p = .314 74.3 ± 4.5 70.1 ± 7.4 - p = .254 p = .353; η²=0.017 Waist circumference (cm) 103.7 ± 18.0 102.0 ± 15.2 ↑ p = .198 106.5 ± 17.5 106.5 ± 19.6 - p = .500 p = .584; η²=0.028 Height (cm) 162.7 ± 9.5 162.7 ± 9.5 - 161.5 ± 8.9 161.5 ± 8.9 - - Weight (kg) 79.1 ± 20.1 78.5 ± 18.9 ↑ p = .161 82.1 ± 24.1 83.8 ± 25.8 ↓ p = .128 p = .110; η²=0.215 Body mass index 29.6 ± 5.7 29.5 ± 5.4 - p = .235 31.1 ± 6.5 31.5 ± 7.1 - p = .131 p = .158; η²=0.173 Strength & fitness Handgrip strength 51.3 ± 14.1 49.7 ± 13.3 ↓ p = .133 42.0 ± 10.2 43.5 ± 9.7 ↑ p = .148 p = .191; η²=0.150 5 Sit-to-Stands (s) 12.4 ± 2.9 11.4 ± 2.7 ↑ p = .118 14.8 ± 6.9 13.5 ± 2.4 ↑ p = .314 p = .897; η²=0.002 8-foot walk (s) 3.1 ± 1.1 2.8 ± 1.5 ↑ p = .173 2.8 ± 1.5 3.0 ± 0.8 ↓ p = .404 p = .473; η²=0.048 6-minute walk distance (m) 421.4 ± 96.8 457.1 ± 97.0 ↑ p = .011 378.0 ± 145.8 392.0 ± 95.7 ↑ p = .393 p = .554; η²=0.033 Balance Side-by-side stand (s) 15.0 ± 0.0 15.0 ± 0.0 - 15.0 ± 0.0 15.0 ± 0.0 - - Semi-tandem stand (s) 15.0 ± 0.0 15.0 ± 0.0 - 15.0 ± 0.0 15.0 ± 0.0 - - Full tandem stand (s) 14.4 ± 1.7 15.0 ± 0.0 ↑ p = .173 13.0 ± 4.0 13.8 ± 2.5 ↓ p = .196 p = .846; η²=0.004 Eyes open, right (s) 9.6 ± 6.5 9.6 ± 10.0 - p = .139 2.0 ± 1.4 5.8 ± 6.2 ↑ p = .115 p = .413; η²=0.062 Eyes open, left (s) 9.6 ± 5.7 10.0 ± 6.0 ↑ p = .396 1.5 ± 1.3 4.8 ± 3.8 t ↑ p = .072 p = .324; η²=0.089 Eyes closed, right (s) 3.2 ± 3.0 2.4 ± 1.2 ↓ p = .209 0.8 ± 0.5 1.5 ± 1.7 ↑ p = .196 p = .323; η²=0.089 Eyes closed, left (s) 3.1 ± 2.6 3.0 ± 2.0 ↓ p = .437 0.8 ± 0.5 1.0 ± 0.8 ↑ p = .196 p = .738; η²=0.011 Cognition CANTAB attention MoCA 18.4 ± 2.07 19.7 ± 1.9 t ↑ p = .077 n/a n/a n/a n/a Mean RL: All correct 988 ± 107 938 ± 132 ↑ p = .020 n/a n/a n/a n/a Mean RL: Congruent (ms) 1240 ± 143 1113 ± 125 ↑ p = .004 n/a n/a n/a n/a Mean RL: Incongruent (ms) 1041 ± 129 972 ± 142 ↑ p = .006 n/a n/a n/a n/a Mean multitasking cost 489 ± 197 319 ± 103 ↑ p = .004 n/a n/a n/a n/a Total correct responses 145 ± 9.74 153 ± 7.52 ↑ p = .006 n/a n/a n/a n/a Total errors 6.89 ± 5.88 1.78 ± 2.64 ↑ p = .002 n/a n/a n/a n/a Values represent mean ± standard deviation. Bold font indicates significance is p ≤ 0.05. t shows a trend towards significance: 0.05 < p ≤ 0.1. Effect size is shown by eta-squared (η²). ↑=outcome improved; ↓=outcome worsened; - =outcome neither improved nor worsened. m = metres; s = seconds. Handgrip strength: total highest left plus right from three trials. Blood pressure, heart rate, waist circumference and weight were the average of three collected measures. n/a = Not applicable (no control group; insufficient data to complete analysis). 4. Discussion 4.1. Summary of findings This pilot randomized controlled trial tested feasibility, acceptability and health outcomes of a 12-week, multidisciplinary, and community-based Healthy Body & Mind Program. Feasibility was low based on recruitment and retention and there was a high drop-out rate from participants in the wait-list control group. However, acceptability was high in participants who completed the program where they attended most sessions and thoroughly enjoyed the experience, expressing a desire to continue participating in the program. The program led to improved health outcomes, including QoL, pain, and cognition, for people living with OA and thinking concerns. Some participants may have found alternative commitments during the 12-week wait period. Although statistically significant improvements were not observed in the Montreal Cognitive Assessment (MoCA) score, the mean difference was higher than the clinically meaningful threshold ( 39 ). Significant interactions were observed for QoL and pain outcomes, and significant main effects were observed for the Cambridge cognition (attention) task and 6-minute walk test. 4.2. Implications and other research Interventions that are public health focused and individualised are likely to be the most beneficial and cost-effective ( 40 ). Effective programs for managing chronic conditions such as OA and dementia prevention must empower individuals to make lifestyle changes through supportive, evidence-based strategies, yet be sufficiently flexible to allow new activities to be fitted into people's current lives and adaptable to new developments ( 41 ). Although our program led to some beneficial outcomes, for it to be successfully implemented widely, more choice in attendance sessions and flexibility for users would be required (e.g., online and home exercises component and/or self-managed options). This program aimed to meet the needs of people living with OA and dementia by interviewing people with lived experience regarding their views and recommendations, as well as involving consumers in the study design and ongoing development. Future research needs to continue with a consumer-driven approach as other aspects may need to be considered. The cost of multidisciplinary programs is also a major concern, and such effective lifestyle, exercise and education services would benefit from further Federal Government support (e.g., through Medicare Australia), similar to services for the only chronic condition funded by the Federal Government for group exercise and education, Type 2 Diabetes (e.g., Medicare Benefit Schedule Items 81115, 81100 ( 42 )). With the majority of dementia cases going undiagnosed, ( 43 ), many people may be living with early cognitive decline and not be aware. Further, many older adults may be living with OA and not know. This may have been one of the reasons why recruiting for our program using the initial inclusion criteria was difficult. Indeed, much work is needed in improving societal awareness of dementia and challenging stigma( 44 ), including that many people have limited awareness of dementia prevention strategies ( 45 ), including healthcare professionals. According to the World Alzheimer Report 2019, approximately 62% of healthcare professionals and 70% of the public think dementia is a part of normal ageing, and 25% believe that nothing can be done to prevent dementia ( 45 ). This is alarming given that approximately 45 percent of dementia cases could be prevented or delayed if modifiable risk factors such as those that formed the focus of the HBMP (i.e., physical inactivity, poor diet), were eliminated ( 17 ). This highlights a tremendous opportunity for dementia prevention globally that we cannot afford to miss. A recent large-scale online multidomain lifestyle intervention with 6,104 participants led to significant improvements in cognition at 3 years, demonstrating effective dementia risk approaches can be accessible and scalable, as well as personalised ( 46 ). The intervention targeted PA, nutrition, cognitive activity and depression or anxiety, and had great potential for large-scale dementia reduction. However, online interventions may not be suitable for everyone, particularly those with more complex needs. The participants’ feedback from our study highlighted preference for an in-person approach, providing individually tailored physical activities and prompts to ensure exercises are being completed effectively and safety. Participants described the social benefits of the group-based approach (qualitative findings to be published separately). However, due to participant drop-out, one participant did not complete the program in a group setting. Social interaction has been added to the most recent Lancet review on dementia prevention ( 17 ) and the effects of social isolation on brain health have also been highlighted ( 47 ). Further, some participants may require additional support to help them manage a particular chronic condition or risk factor (e.g., pain management for OA and dietary advice for diabetes or obesity). Intervention flexibility where the choice of attending in-person and/or online programs may be complementary and allow individuals to adjust the level of support they receive based on their current needs and circumstances. Web-support or a mobile application could provide sufficient ongoing support following the 12-week program if supplemented with a teaching component and ongoing technical support. Online health interventions (or ‘Telehealth’) have certainly increased in popularity though special attention should ensure that telehealth narrows, and not widens, the currently existing disparities in healthcare ( 48 ). Participants could choose to return to a more comprehensive approach if their health needs change. 4.3. Strengths and limitations Strengths of this study include comprehensive stakeholder involvement, bringing together expertise from people with lived experience of dementia, AEPs, health and provisional clinical psychologists, medical specialists, clinical researchers, population health experts, chronic disease specialists, and APDs. The program aligned with the Lancet Commission lifestyle factors for reducing dementia risk, such as PA, smoking, alcohol, and obesity management ( 17 ). Researchers included a wide range of health outcome assessments, covering QoL, pain, cognition, and various physical and psychological measures. The qualitative component provided rich insights into program feasibility and participant experiences. Limitations were evident in the study's low feasibility, challenging recruitment process, and high drop-out rate before participant enrolment. The wait-list randomised controlled trial design may not adequately address participants' immediate health concerns. As this was a pilot feasibility study, we only reported outcomes at baseline and immediately after completion of the program. Further investigation is needed to determine the long-term follow-up effects of similar programs. Further, the small sample size we recruited from a particular geographical area and all with a high level of education and sociodemographic status, indicates that caution is needed before generalising these findings to other populations. Computerised cognitive tests should be interpreted with caution given the potential learning effects( 49 ). However, in test-retest reliability study of CANTAB tasks, practice effects were only observed in the spatial learning memory task, and not the attention task( 50 ). 4.4. Recommendations Future trials may benefit from considering more flexible approaches to ensure programs reach more people who require similar support services (e.g., people with other chronic conditions or dementia risk factors). This includes less restrictive recruitment criteria, more adaptable time commitments, self-paced PA options, increased session availability, and flexible education components covering nutrition, pain management, psychological health and other well-established modifiable dementia risk factors ( 17 ). Improving program accessibility through online sessions and self-paced learning could enhance participant engagement. Scaling up the program to larger populations could help identify its potential for improving public health and reducing dementia risk at a national level. Though such programs require government support (e.g., through Medicare) to cover costs. Further discussions with all stakeholders will provide valuable considerations for future and larger scale implementation of the program into other settings (e.g., aged care settings) making the program more accessible to people living with these conditions. 4.5. Conclusion Currently, no programs exist to address the specific needs of people living with chronic conditions associated with increased dementia risk, such as osteoarthritis. This trial demonstrated participant acceptability and health improvements in pain, QoL, cognition and physical function. However, feasibility needs to be improved by less stringent recruitment criteria and increased flexibility and availability of program sessions. Future research should scale-up and deliver this program to larger populations to identify if such programs have the potential to improve public health and reduce dementia risk at a national level and in more diverse populations. Declarations Ethics and dissemination: Participant confidentiality will be maintained in line with ethical procedures. UNSW HREC Approval Number: HC230506. Clinical trial registration number: NCT06070818 (ClinicalTrials.gov). Acknowledgements We would also like to thank Dementia Australia Dementia Advocates and our Lifestyle Clinic members who provided feedback on the development of the program. Contributions CB designed the study, obtained funding and ethics, led the trial and drafted the manuscript. WY, ST & MJ assisted with the education development. WY, KM & BJ assisted with design of the study. KM & BJ assisted with obtaining funding and ethics, provided expertise for the exercise component of the intervention, interpretation of findings and review of the draft protocol and final outcome manuscript. ST and SA collected data. All authors approved the final version of the manuscript. Role of funding source This research was supported by a grant provided by the UNSW Neuroscience, Mental Health and Addiction theme and philanthropic funding provided by the Estate of the Late Faye Patricia Williams. Competing interests HB is or has been an advisory board member or consultant to Biogen, Eisai, Eli Lilly, Medicines Australia, Roche and Skin2Neuron. He is a Medical/Clinical Advisory Board member for Montefiore Homes and Cranbrook Care. All other authors have no conflict of interest to report. Data availability statement Deidentified data will be made available on request. ORCID Claire Burley: 0000-0002-7632-5632 Matthew D Jones: 0000-0002-5534-755X Nattai Borges: 0000-0002-4182-8088 Kelly McLeod: 0000-0001-8453-3039 Henry Brodaty: 0000-0001-9487-6617 Belinda J Parmenter: 0000-0001-8013-5658 Sara Asadi: 0000-0002-0887-244X References World Health Organisation (WHO). Dementia 2023. Available from: https://www.who.int/news-room/fact-sheets/detail/dementia World Health Organisation (WHO). Osteoarthritis 2023. Available from: https://www.who.int/news-room/fact-sheets/detail/osteoarthritis Ikram M, Innes K, Sambamoorthi U. Association of osteoarthritis and pain with Alzheimer's diseases and related dementias among older adults in the United States. Osteoarthr Cartil. 2019;27(10):1470–80. Weber A, Hung Mak S, Berenbaum F, Sellam J, Zheng Y-P, Han Y, Wen C. Association between osteoarthritis and increased risk of dementia: a systemic review and meta-analysis. Medicine. 2019;98(10). Halonen P, Enroth L, Jämsen E, Vargese S, Jylhä M. Dementia and related comorbidities in the population aged 90 and over in the vitality 90 + study, Finland: patterns and trends from 2001 to 2018. J Aging Health. 2023;35(5–6):370–82. Schubert CC, Boustani M, Callahan CM, Perkins AJ, Carney CP, Fox C, Unverzagt F, Hui S, Hendrie HC. Comorbidity profile of dementia patients in primary care: are they sicker? J Am Geriatr Soc. 2006;54(1):104–9. Cipher DJ, Clifford PA. Dementia, pain, depression, behavioral disturbances, and ADLs: Toward a comprehensive conceptualization of quality of life in long-term care. Int J Geriatr Psychiatry. 2004;19(8):741–8. Lin P-C, Li C-H, Chou P-L, Chen Y-M, Lin L-C. Prevalence of pain-related diagnoses in patients with dementia: a nationwide study. J Pain Res. 2018:1589–98. Burley CV, Burns K, Lam BC, Brodaty H. Nonpharmacological approaches reduce symptoms of depression in dementia: A systematic review and meta-analysis. Ageing Res Rev. 2022;79:101669. Burley CV, Casey A-N, Jones MD, Wright KE, Parmenter BJ. Nonpharmacological approaches for pain and symptoms of depression in people with osteoarthritis: systematic review and meta-analyses. Sci Rep. 2023;13(1):15449. Shalhoub M, Anaya M, Deek S, Zaben AH, Abdalla MA, Jaber MM, Koni AA, Zyoud SH. The impact of pain on quality of life in patients with osteoarthritis: a cross-sectional study from Palestine. BMC Musculoskelet Disord. 2022;23(1):1–11. Kessler E-M, Bowen CE, Baer M, Froelich L, Wahl H-W. Dementia worry: A psychological examination of an unexplored phenomenon. Eur J Ageing. 2012;9:275–84. Onubogu UD. Pain and depression in older adults with arthritis. Orthop Nurs. 2014;33(2):102–8. Axford J, Butt A, Heron C, Hammond J, Morgan J, Alavi A, Bolton J, Bland M. Prevalence of anxiety and depression in osteoarthritis: use of the Hospital Anxiety and Depression Scale as a screening tool. Clin Rheumatol. 2010;29:1277–83. Hassen CB, Fayosse A, Landré B, Raggi M, Bloomberg M, Sabia S, Singh-Manoux A. Association between age at onset of multimorbidity and incidence of dementia: 30 year follow-up in Whitehall II prospective cohort study. BMJ. 2022;376. Kostev K, Hadji P, Jacob L. Impact of osteoporosis on the risk of dementia in almost 60,000 patients followed in general practices in Germany. J Alzheimers Dis. 2018;65(2):401–7. Livingston G, Huntley J, Liu KY, Costafreda SG, Selbæk G, Alladi S, et al. Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. Lancet. 2024;404(10452):572–628. Pedersen BK, Saltin B. Exercise as medicine–evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports. 2015;25:1–72. Roman de Mettelinge T, Calders P, Cambier D. The effects of aerobic exercise in patients with early-onset dementia: A scoping review. Dement Geriatr Cogn Disord. 2021;50(1):9–16. Jia R-x, Liang J-h, Xu Y, Wang Y-q. Effects of physical activity and exercise on the cognitive function of patients with Alzheimer disease: a meta-analysis. BMC Geriatr. 2019;19:1–14. Rosenberg A, Ngandu T, Rusanen M, Antikainen R, Bäckman L, Havulinna S, et al. Multidomain lifestyle intervention benefits a large elderly population at risk for cognitive decline and dementia regardless of baseline characteristics: The FINGER trial. Alzheimer's Dement. 2018;14(3):263–70. Burley CV, Livingston G, Knapp MR, Wimo A, Norman R, Brodaty H. Time to invest in prevention and better care of behaviors and psychological symptoms associated with dementia. Int Psychogeriatr. 2020;32(5):567–72. Burley CV, Casey A-N, Chenoweth L, Brodaty H. Views of people living with dementia and their families/care partners: helpful and unhelpful responses to behavioral changes. Int Psychogeriatr. 2023;35(2):77–93. Venegas-Sanabria LC, Martínez-Vizcaino V, Cavero-Redondo I, Chavarro-Carvajal DA, Cano-Gutierrez CA, Alvarez-Bueno C. Effect of physical activity on cognitive domains in dementia and mild cognitive impairment: overview of systematic reviews and meta-analyses. Aging Ment Health. 2021;25(11):1977–85. Huang X, Zhao X, Li B, Cai Y, Zhang S, Wan Q, et al. Comparative efficacy of various exercise interventions on cognitive function in patients with mild cognitive impairment or dementia: a systematic review and network meta-analysis. J Sport Health Sci. 2022;11(2):212–23. Somers TJ, Blumenthal JA, Guilak F, Kraus VB, Schmitt DO, Babyak MA, et al. Pain coping skills training and lifestyle behavioral weight management in patients with knee osteoarthritis: a randomized controlled study. Pain. 2012;153(6):1199–209. Brzezińska A, Bourke J, Rivera-Hernández R, Tsolaki M, Woźniak J, Kaźmierski J. Depression in dementia or dementia in depression? Systematic review of studies and hypotheses. Curr Alzheimer Res. 2020;17(1):16–28. Kuring J, Mathias J, Ward L. Risk of Dementia in persons who have previously experienced clinically-significant Depression, Anxiety, or PTSD: A Systematic Review and Meta-Analysis. J Affect Disord. 2020;274:247–61. Livingston G, Huntley J, Sommerlad A, Ames D, Ballard C, Banerjee S, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet. 2020;396(10248):413–46. Burley CV, Yeates W, McLeod K, Jones MD, Borges N, Brodaty H, Parmenter BJ. Feasibility and acceptability of an evidence-based, pilot randomised controlled trial to improve health outcomes and reduce dementia risk in people with osteoarthritis. Study protocol for the Healthy Body & Mind Program (HBMP). JMIR Preprints 11/04/2025:75816. 2025. Chan A-W, Tetzlaff JM, Gøtzsche PC, Altman DG, Mann H, Berlin JA et al. SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ. 2013;346. Eldridge SM, Chan CL, Campbell MJ, Bond CM, Hopewell S, Thabane L et al. CONSORT 2010 statement: extension to randomised pilot and feasibility trials. BMJ. 2016;355. Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695–9. American College of Sports Medicine. ACSM's guidelines for exercise testing and prescription. Lippincott Williams & Wilkins; 2013. Lins L, Carvalho FM. SF-36 total score as a single measure of health-related quality of life: Scoping review. SAGE Open Med. 2016;4:2050312116671725. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rhuematol. 1988;15(12):1833–40. Henry JD, Crawford JR. The short-form version of the Depression Anxiety Stress Scales (DASS‐21): Construct validity and normative data in a large non‐clinical sample. Br J Clin Psychol. 2005;44(2):227–39. Ioannidis JP, Evans SJ, Gøtzsche PC, O'neill RT, Altman DG, Schulz K, et al. Better reporting of harms in randomized trials: an extension of the CONSORT statement. Ann Intern Med. 2004;141(10):781–8. Lindvall E, Abzhandadze T, Quinn TJ, Sunnerhagen KS, Lundström E. Is the difference real, is the difference relevant: the minimal detectable and clinically important changes in the Montreal Cognitive Assessment. Cereb Circulation-Cognition Behav. 2024;6:100222. Frost R, Avgerinou C, Goodman C, Clegg A, Hopkins J, Gould RL, et al. Clinical and cost-effectiveness of a personalised health promotion intervention enabling independence in older people with mild frailty (‘HomeHealth’) compared to treatment as usual: study protocol for a randomised controlled trial. BMC Geriatr. 2022;22(1):485. Poppe M, Mansour H, Rapaport P, Palomo M, Burton A, Morgan-Trimmer S, et al. Falling through the cracks; Stakeholders' views around the concept and diagnosis of mild cognitive impairment and their understanding of dementia prevention. Int J Geriatr Psychiatry. 2020;35(11):1349–57. McLeod KA, Thom JM, Jones MD, Parmenter BJ. Feasibility, acceptability and efficacy of a pilot exercise physiology group service for older people with type 2 diabetes. Australian J Gen Pract. 2024. Amjad H, Roth DL, Sheehan OC, Lyketsos CG, Wolff JL, Samus QM. Underdiagnosis of dementia: an observational study of patterns in diagnosis and awareness in US older adults. J Gen Intern Med. 2018;33:1131–8. Bacsu J-D, Johnson S, O’Connell ME, Viger M, Muhajarine N, Hackett P, et al. Stigma reduction interventions of dementia: a scoping review. Can J Aging/La Revue Canadienne Du Vieillissement. 2022;41(2):203–13. Lynch C. World Alzheimer Report 2019: Attitudes to dementia, a global survey: Public health: Engaging people in ADRD research. Alzheimer's Dement. 2020;16:e038255. Brodaty H, Chau T, Heffernan M, Ginige JA, Andrews G, Millard M et al. An online multidomain lifestyle intervention to prevent cognitive decline in at-risk older adults: a randomized controlled trial. Nat Med. 2025:1–9. Xiong Y, Hong H, Liu C, Zhang YQ. Social isolation and the brain: effects and mechanisms. Mol Psychiatry. 2023;28(1):191–201. Mahtta D, Daher M, Lee MT, Sayani S, Shishehbor M, Virani SS. Promise and perils of telehealth in the current era. Curr Cardiol Rep. 2021;23:1–6. Harvey PD, McGurk SR, Mahncke H, Wykes T. Controversies in computerized cognitive training. Biol Psychiatry: Cogn Neurosci Neuroimaging. 2018;3(11):907–15. Cacciamani F, Salvadori N, Eusebi P, Lisetti V, Luchetti E, Calabresi P, et al. Evidence of practice effect in CANTAB spatial working memory test in a cohort of patients with mild cognitive impairment. Appl Neuropsychology: Adult. 2018;25(3):237–48. Additional Declarations Competing interest reported. HB is or has been an advisory board member or consultant to Biogen, Eisai, Eli Lilly, Medicines Australia, Roche and Skin2Neuron. He is a Medical/Clinical Advisory Board member for Montefiore Homes and Cranbrook Care. All other authors have no conflict of interest to report. Supplementary Files BurleyCONSORT2025checklist.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7590984","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":513598659,"identity":"d0ea27f3-788a-49ab-b6b7-8c40ff1972cd","order_by":0,"name":"Claire V Burley","email":"data:image/png;base64,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","orcid":"","institution":"Curtin University","correspondingAuthor":true,"prefix":"","firstName":"Claire","middleName":"V","lastName":"Burley","suffix":""},{"id":513598660,"identity":"800283e8-6efd-46ab-827d-b262781869dc","order_by":1,"name":"William Yeates","email":"","orcid":"","institution":"Curtin University","correspondingAuthor":false,"prefix":"","firstName":"William","middleName":"","lastName":"Yeates","suffix":""},{"id":513598661,"identity":"b26bfde4-628c-494a-b5f2-bae776fef518","order_by":2,"name":"Stephanie Tsang","email":"","orcid":"","institution":"UNSW Sydney","correspondingAuthor":false,"prefix":"","firstName":"Stephanie","middleName":"","lastName":"Tsang","suffix":""},{"id":513598662,"identity":"29592c31-0719-42fc-9a1c-954262e7da55","order_by":3,"name":"Matthew D Jones","email":"","orcid":"","institution":"UNSW Sydney","correspondingAuthor":false,"prefix":"","firstName":"Matthew","middleName":"D","lastName":"Jones","suffix":""},{"id":513598663,"identity":"07e8bf71-8185-47a0-bda5-8385517dca70","order_by":4,"name":"Kelly McLeod","email":"","orcid":"","institution":"UNSW Sydney","correspondingAuthor":false,"prefix":"","firstName":"Kelly","middleName":"","lastName":"McLeod","suffix":""},{"id":513598664,"identity":"baed83c6-4639-4602-a33a-9c5844b14057","order_by":5,"name":"Nattai Borges","email":"","orcid":"","institution":"UNSW Sydney","correspondingAuthor":false,"prefix":"","firstName":"Nattai","middleName":"","lastName":"Borges","suffix":""},{"id":513598665,"identity":"517d3eb3-6b53-4082-a66f-e239b93855a6","order_by":6,"name":"Sara Asadi","email":"","orcid":"","institution":"UNSW Sydney","correspondingAuthor":false,"prefix":"","firstName":"Sara","middleName":"","lastName":"Asadi","suffix":""},{"id":513598666,"identity":"0b01ae1a-8b72-4e06-8e9b-cd656bce7d5d","order_by":7,"name":"Henry Brodaty","email":"","orcid":"","institution":"UNSW Sydney","correspondingAuthor":false,"prefix":"","firstName":"Henry","middleName":"","lastName":"Brodaty","suffix":""},{"id":513598667,"identity":"ecbdecc0-553c-45c0-a457-0031533fdc2a","order_by":8,"name":"Belinda J Parmenter","email":"","orcid":"","institution":"University of the Sunshine Coast","correspondingAuthor":false,"prefix":"","firstName":"Belinda","middleName":"J","lastName":"Parmenter","suffix":""}],"badges":[],"createdAt":"2025-09-11 10:53:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7590984/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7590984/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91515594,"identity":"9e85fed8-b049-43eb-b0c1-0f28293366ef","added_by":"auto","created_at":"2025-09-17 09:14:52","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":163471,"visible":true,"origin":"","legend":"\u003cp\u003eExperimental overview of study design.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7590984/v1/a31414ad0e93b3b11fe0ec97.png"},{"id":91518080,"identity":"5ced1751-238c-4295-b1ae-fec54557e04a","added_by":"auto","created_at":"2025-09-17 09:38:58","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":88672,"visible":true,"origin":"","legend":"\u003cp\u003eFlow of participants through the study.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7590984/v1/0f1d6efb91757f1b8cd25112.jpeg"},{"id":91515586,"identity":"0e2d32ee-e36e-4cdb-8760-243f88041267","added_by":"auto","created_at":"2025-09-17 09:14:52","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":47044,"visible":true,"origin":"","legend":"\u003cp\u003ePain (WOMAC) outcome measures for intervention/control groups pre/post program. *Indicates significant interaction or time effect at p\u0026lt;.05 (intervention/control and pre/post-program). Higher scores indicate higher pain/stiffness levels and worse functioning.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7590984/v1/5c178da65c9e64b4459940e9.png"},{"id":91515591,"identity":"b3153b58-5ffc-4960-ae73-05ad24bb03f6","added_by":"auto","created_at":"2025-09-17 09:14:52","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":44161,"visible":true,"origin":"","legend":"\u003cp\u003eQuality of life (SF-36) outcome measures for intervention/control groups pre/post program. Illustrates total score (a) and subscales emotional wellbeing (b), social functioning (c) and general health (d). *Indicates significant interaction or time effect at p\u0026lt;.05 (intervention/control and pre/post-program). Higher scores indicate better quality of life.\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-7590984/v1/e022c60035221fce489e0417.png"},{"id":91516102,"identity":"051a6391-5e72-410c-8d2f-b7d1e3df24f8","added_by":"auto","created_at":"2025-09-17 09:22:52","extension":"jpeg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":65232,"visible":true,"origin":"","legend":"\u003cp\u003eCognitive measures for CANTAB attention task measures collected pre- and post-program. Illustrates mean reaction latency for total correct responses, congruent trials, incongruent trials, and multitasking cost. *Indicates significant time effect at p\u0026lt;.05 (pre- versus post-program). Higher scores indicate slower response times (i.e., poorer responses).\u003c/p\u003e","description":"","filename":"floatimage5.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7590984/v1/b394d85c29a351a26ea179f7.jpeg"},{"id":92010036,"identity":"47ddea87-1f40-4aa4-8993-6ec85ae5df4c","added_by":"auto","created_at":"2025-09-23 15:38:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1736731,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7590984/v1/3a46622e-d9f7-4cfd-9aca-875b084a4e3f.pdf"},{"id":91515584,"identity":"5191b121-707c-4c39-bd34-e808b7d68d56","added_by":"auto","created_at":"2025-09-17 09:14:52","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":33949,"visible":true,"origin":"","legend":"","description":"","filename":"BurleyCONSORT2025checklist.docx","url":"https://assets-eu.researchsquare.com/files/rs-7590984/v1/185a658e7278b4e09d211b2b.docx"}],"financialInterests":"Competing interest reported. HB is or has been an advisory board member or consultant to Biogen, Eisai, Eli Lilly, Medicines Australia, Roche and Skin2Neuron. He is a Medical/Clinical Advisory Board member for Montefiore Homes and Cranbrook Care. All other authors have no conflict of interest to report.","formattedTitle":"Feasibility, acceptability and effect on health outcomes of a pilot randomised controlled trial for people with osteoarthritis and thinking concerns: The Healthy Body \u0026 Mind Program","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eDementia and osteoarthritis (OA) represent significant global health challenges. Worldwide, 55\u0026nbsp;million people are living with dementia (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e), while 528\u0026nbsp;million experience OA (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The relationship between these conditions is particularly complex, with OA associated with a 20 to 25 percent increase in dementia risk(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Remarkably, OA prevalence has been reported in almost half of people living with dementia (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), highlighting the intricate connection between these chronic conditions.\u003c/p\u003e\u003cp\u003eBoth dementia and OA are characterized by substantial negative impacts on individual health and are consistently associated with increased pain (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), depression (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), and reduced quality of life (QoL)(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). An increasing number of older adults are becoming concerned with their brain health (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) and thinking concerns may develop before the onset of dementia. The interplay of comorbid conditions is particularly challenging, with research demonstrating that a higher number of comorbidities correlates with more severe pain and depression (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). This multimorbidity creates a complex healthcare landscape that requires nuanced, comprehensive interventions.\u003c/p\u003e\u003cp\u003eThe clinical implications extend beyond individual symptoms. QoL, depression, and anxiety are prevalent across both conditions, creating a compounding effect on the experience of people living such multimorbidity (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Over 40% of people with OA(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) and up to 62% of people with dementia(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) experience depression. In addition, the risk of dementia increases dramatically with OA, rising from 1.2-fold to an alarming 5.7-fold when accompanied by additional chronic conditions (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eNonpharmacological lifestyle approaches have emerged as a promising intervention strategy, with fourteen well-established and modifiable dementia risk factors having the potential to lead to a 45 percent reduction in dementia cases if eliminated (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Physical activity (PA) has demonstrated improvements across 26 different chronic conditions (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), showing particular efficacy in improving health outcomes for people living with dementia(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) and those with OA (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Despite this potential, a significant gap remains in developing accessible, implementable, and scalable lifestyle programs for individuals experiencing thinking concerns and OA.\u003c/p\u003e\u003cp\u003eExtensive research has consistently highlighted the beneficial impacts of PA and nonpharmacological lifestyle interventions. These approaches have been shown to reduce dementia risk (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), improve cognition(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), enhance QoL (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e), provide cost-effective interventions (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), and offer preferable treatment options for people living with dementia and their care partners (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSystematic reviews reveal nuanced insights into intervention effectiveness. PA demonstrates positive effects on cognition (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), depression, and QoL (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Critically, multimodal and mind-body approaches consistently outperform single interventions (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). For OA specifically, effective interventions have incorporated diverse strategies including aerobic and strengthening exercises, comprehensive lifestyle education, and targeted pain coping skills training (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Existing healthcare interventions frequently overlook the complex interactions between conditions. Depression and anxiety, commonly experienced by people with cognitive decline (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) and OA, create intricate symptom patterns, with depression itself linked to increased dementia risk (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). The interconnected nature of these symptoms means that limitations in daily activities due to OA-related pain or cognitive difficulties can trigger or exacerbate depressive experiences.\u003c/p\u003e\u003cp\u003eRecognising these complex interactions and that half of overall disease burden is due to modifiable factors such as PA and lifestyle, our research team has developed a novel multimodal lifestyle program. The Healthy Body \u0026amp; Mind Program (HBMP) represents an evidence-based intervention including PA and lifestyle education sessions that align with the dementia risk factors identified in the Lancet Commission and other reviews (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e) (e.g., depression, smoking, alcohol, obesity) and tailored specifically for individuals with OA (e.g., including pain science education). This program fills a critical gap, as currently no programs exist for people living with OA and thinking concerns.\u003c/p\u003e\u003cp\u003e The study's primary objectives were: first, to assess the feasibility of the HBMP within a community clinic setting, examining critical factors such as recruitment, retention, and participant adherence; and to evaluate the program's acceptability for individuals living with OA and cognitive decline. The secondary aim focused on generating pilot data comparing health outcomes between the intervention and control group (standard care). By addressing the complex intersections of cognitive decline and osteoarthritis, we aim to provide a meaningful, evidence-based approach to improving health outcomes for a vulnerable and often overlooked population.\u003c/p\u003e\u003cp\u003eComprehensive outcome measures capture a holistic view of participant health, including QoL, cognitive function, pain levels, psychological health metrics (depression, anxiety, stress), and physical health parameters. These encompassed weight, waist circumference, blood pressure, and various fitness measurements, including walking speed, grip strength and balance.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003e\u003cb\u003e2.1. Ethical approval and study registration\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003cp\u003e was obtained from the University of New South Wales Human Research Ethics Committee (HC230506; 18/09/2023). The clinical trial was prospectively registered at \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://clinicaltrials.gov/\u003c/span\u003e\u003cspan address=\"https://clinicaltrials.gov/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (NCT06070818; 18/09/2023), and the protocol(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) was prepared in accordance with the SPIRIT guidelines (Standard Protocol Items: Recommendations for Intervention Trials)(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Results are reported in adherence to CONSORT statement guidelines(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e) (see Supplementary materials). Methods are briefly summarised below, and full details are available in the study protocol(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.2. Study design\u003c/h2\u003e\u003cp\u003eThis 12-week pilot randomized controlled trial (RCT) used mixed quantitative and qualitative research methodology. The study and data collection took place at the UNSW Medicine \u0026amp; Health clinic facilities in Sydney, Australia. Data collection comprised clinical observations routinely completed as part of standard care, validated participant-reported outcome measures (including QoL, cognition, pain and psychological health), and focus group/interviews. Clinical observations and questionnaires were completed at baseline (0 weeks) and post-intervention (12 weeks) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Initial community and stakeholder engagement assisted with developing the group program and ensuring it was feasible and acceptable to participants. The study team includes accredited exercise physiologists (AEP), accredited practicing dietitians (APD), a health and provisional clinical psychologist, and research assistants. Recruitment took place from November 2023 to February 2024. The trial took place from March to December 2024, ending after all recruited participants had completed the program.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2. Participants and recruitment\u003c/h2\u003e\u003cp\u003eParticipants met the inclusion criteria if they were individuals aged 45 years or over, living with osteoarthritis (OA) diagnosed by a healthcare professional. They either lived with dementia or had subjective thinking concerns (i.e., expressed concerns over ageing and related changes in brain health). Our original inclusion criteria in the study protocol(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) included a Montreal Cognitive Assessment (MoCA) (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e) score of 18\u0026ndash;25, indicating mild cognitive impairment or mild dementia, though this was removed due to recruitment challenges. Participants were required to be able to safely undertake study assessments and complete exercise without assistance and have appropriate medical clearance. Participants were excluded if they had a MoCA score below 18, were unable to provide written informed consent, could not speak and understand English (unless a translator was available), or had contraindications to exercise according to the American College of Sports Medicine (ACSM) guidelines (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). These contraindications included symptomatic hernias, proliferative retinopathy, uncontrolled arrhythmias, or terminal illness.\u003c/p\u003e\u003cp\u003eThe study was advertised through multiple channels, including the UNSW Medicine \u0026amp; Health Lifestyle Clinic, StepUp for Dementia Research, General Practitioner (GP) and Health District referrals, and online social media advertisements. An ethically approved protocol was in place for advising participants of health assessment results. Enrolled participants were randomly assigned (1:1) using a computer-generated list to an intervention group (n\u0026thinsp;=\u0026thinsp;8) or a wait-list control group (n\u0026thinsp;=\u0026thinsp;8). The list was produced by a researcher external to the study group, blind to group allocation ensuring an effective allocation concealment mechanism was in place.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.4. Aims and outcome measures\u003c/h2\u003e\u003cp\u003eThe primary aims were to determine the feasibility of the Healthy Body \u0026amp; Mind Program (HBMP) for people with OA and thinking concerns and to assess program acceptability. The secondary aim was to obtain pilot data on health outcomes, including QoL (QoL) (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e), cognition(\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e), pain (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e), psychological health (depression, anxiety, stress) (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e), and physical health.\u003c/p\u003e\u003cp\u003eFeasibility and acceptability were assessed through retention, adherence (completion of exercises and engagement in education), session attendance, and participant feedback (post-program interviews/focus groups). Health outcomes were assessed including QoL [SF-36], pain (Western Ontario and McMaster Universities Arthritis Index [WOMAC]), cognition (MoCA and Cambridge Cognition), psychological health (Depression, Anxiety and Stress Scale [DASS-21]), and physical health assessments such as weight, waist circumference, blood pressure, and functional fitness. Measures were collected at baseline and follow-up (13\u0026ndash;14 weeks after baseline) by a research assistant who was blind to participant group allocation. Participants were requested to not discuss their group allocation or trial activities with the research assistant to ensure the assessor remained blinded.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.5. \u003cem\u003eHealthy Body \u0026amp; Mind Program (HBMP) versus wait-list control\u003c/em\u003e\u003c/h2\u003e\u003cp\u003eThe intervention was a 12-week program (described in more detail in the study protocol(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) with twice-weekly sessions (24 total), lasting two hours per session. Each session included one hour of supervised group exercise and one hour of group lifestyle and behaviour change education. The exercise component was evidence-based and individually modified, combining aerobic, resistance, balance, and flexibility exercises. Participants were prescribed and engaged in two hours of clinic-based exercise and one hour of independent exercise each week, in line with ACSM exercise prescription guidelines of at least 150 minutes per week (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Clinic-based exercise was overseen by an AEP and home-based exercise was self-reported and documented by the participant. One of the education sessions focused on independent exercise. The participant returned completed home-based exercise sheets to the AEP each week. The education component involved education delivery and group discussions focused on topics such as living with OA and cognitive decline, PA, nutritional advice, psychological health, social connections, and individual goal setting. Educational materials included resources from Dementia Australia, Arthritis NSW, Alzheimer's Association, and the Australian Government Department of Health. An adverse event management plan was in place in case any averse/serious adverse events occurred. PA risks were continuously monitored through risk assessment by trained professionals, documentation of adverse events, transparent reporting, and adherence to CONSORT statement guidelines (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). The wait-list control group were able to continue with their usual treatment and were offered the intervention after 12 weeks. All participants who attended the program took part in a focus group or interview and answered questions about their experience and were invited to provide honest feedback.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e2.7. Statistical analysis\u003c/h2\u003e\u003cp\u003eQuantitative data were analysed using IBM SPSS Statistics (Version 30.0.0.0, 172), with normality checks and descriptive statistics for frequencies and distributions. Health outcomes were compared between pre- and post-program completion and between intervention and control group using T-tests and repeated measures ANOVAs. Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 level. Effect sizes were calculated using Cohen\u0026rsquo;s d for T-tests and partial eta-squared (ηp\u0026sup2;) for ANOVAs. Results are reported comparing intervention versus wait-list control and pre- versus post the 12-week program, with the exception of cognition measures which are only reported pre- versus post-program due to a technical complication and loss of control data. Qualitative data will be reported separately. Qualitative data will analysed using content analysis and be reported separately.\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eEighteen participants with OA and thinking concerns completed baseline assessments (mean age\u0026thinsp;=\u0026thinsp;71.5\u0026thinsp;\u0026plusmn;\u0026thinsp;5.7years; mean telephone MoCA\u0026thinsp;=\u0026thinsp;18.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2) and were randomised to either the intervention group (n\u0026thinsp;=\u0026thinsp;9), where they would begin the 12-week program immediately, or a wait-list control group (n\u0026thinsp;=\u0026thinsp;9), where they would begin the program 13 weeks later (all participants also completed a familiarisation week to become more comfortable with the procedures and equipment). The flow of participants through the study is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Participant characteristics are described in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e3.1. Feasibility and Acceptability\u003c/h2\u003e\u003cp\u003eThe study was advertised using three national recruitment platforms, through local health districts, social media and existing contacts of the research team. Despite this, recruitment was challenging. The inclusion criteria were changed (MoCA score of 18\u0026ndash;25 was removed and the age was lowered) and terminology on recruitment posters were amended (\u0026lsquo;cognitive decline\u0026rsquo; was changed to \u0026lsquo;thinking difficulties/concerns\u0026rsquo;) to improve recruitment.\u003c/p\u003e\u003cp\u003eSix participants withdrew from the study before they commenced the program (all could no longer make the session times; one from the intervention group and five from the wait-list control). Of the 12 participants who started the program, three participants withdrew, one due to COVID-19 infection after completing six weeks, one experienced a family emergency after completing two weeks, and one due to conflicting work commitments, after completing four weeks. Out of the total sample, nine participants (50%) completed the program. On average 22 (range 18\u0026ndash;26) out of the total 26 sessions (92%) were attended and completed. Frequency of AEP sessions was twice weekly. Participants who completed sessions adhered to all the AEP delivered exercises and returned all completed home-based exercise record sheets. Ten percent of completed sessions were rescheduled sessions (i.e., they were rescheduled to an alternative time that was suitable for the participants and AEP). Exercises were modified by the AEP where required and progressed in intensity throughout the program. The program was delivered in four groups of between one (due to drop-out) and four participants.\u003c/p\u003e\u003cp\u003eWhen asked \u003cem\u003e\u0026ldquo;Would you continue to attend a Healthy Body \u0026amp; Mind service?\u0026rdquo;\u003c/em\u003e eight of the nine participants said \u003cem\u003e\u0026ldquo;yes\u0026rdquo;\u003c/em\u003e and one participant did not answer the question as the discussion moved on. Participants said that they \u003cem\u003e\u0026ldquo;would like it to go for longer, would keep going for as long as it was offered\u003c/em\u003e\u0026rdquo; and suggested to \u003cem\u003e\u0026ldquo;have somewhere they can be referred to after the program\u003c/em\u003e, \u003cem\u003eongoing support, check-ins, re-assessment at twelve months to see how they are going\u0026rdquo;.\u003c/em\u003e Others responded by acknowledging the benefits, \u0026ldquo;\u003cem\u003emost definitely, it was very good for me\u0026rdquo;, \u0026ldquo;yes, definitely\u0026rdquo;, \u0026ldquo;absolutely. Yeah, that's what we all advocate for. Because you become disciplined then too, when it's ongoing\u0026rdquo;\u003c/em\u003e, and \u003cem\u003e\u0026ldquo;my answer is a resounding yes, if there was an ongoing program\u003c/em\u003e\u0026rdquo;. Qualitative feedback revealed participants would continue to attend the program if it were available (all qualitative findings to be published separately).\u003c/p\u003e\u003cp\u003eNo adverse events or harm to participants occurred throughout the trial. One participant contracted COVID-19 six weeks into the program, though it was suspected this occurred off-site. All participants and staff were informed and were monitored for symptoms during this time.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e3.2. Health outcome measures\u003c/h2\u003e\u003cp\u003eHealth outcome measures for pain (WOMAC), QoL (SF-36), psychological health (DASS-21), physical health and cognition are detailed below. No significant differences were observed between intervention and control group baseline measures (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section3\"\u003e\u003ch2\u003e3.2.1. Pain, QoL and psychological health\u003c/h2\u003e\u003cp\u003eRepeated measures ANOVAs revealed significant time by group interactions for overall pain (p\u0026thinsp;=\u0026thinsp;.034;η\u0026sup2;=0.348) and QoL scores (p\u0026thinsp;=\u0026thinsp;.025;η\u0026sup2;=0.380), where outcomes improved for the intervention group (N\u0026thinsp;=\u0026thinsp;9) and worsened for the control group (N\u0026thinsp;=\u0026thinsp;4). Significant interactions were also observed for the QoL subscales emotional (p\u0026thinsp;=\u0026thinsp;.036;η\u0026sup2;=0.342), social (p\u0026thinsp;\u0026lt;\u0026thinsp;.001;η\u0026sup2;=0.645), and general health (p\u0026thinsp;=\u0026thinsp;.046;η\u0026sup2;=0.046). No significant differences were observed for psychological health measures (depression, anxiety and stress) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e; Figs.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e \u0026amp; \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eT-tests revealed a significant increase in the mean total WOMAC score and pain subscale (i.e., symptoms became worse) in the control group (both p\u0026thinsp;\u0026lt;\u0026thinsp;.05), following the 12-week wait period (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Total QoL scores significantly improved (p\u0026thinsp;\u0026lt;\u0026thinsp;.01) in the intervention group following completion of the program. In addition, significant improvements were observed in the QoL subscales, emotional health (limitations), emotional wellbeing (p\u0026thinsp;\u0026lt;\u0026thinsp;.05 and p\u0026thinsp;\u0026lt;\u0026thinsp;.005 respectively) and social functioning (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) following completion of the program (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, Figs.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e \u0026amp; \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section3\"\u003e\u003ch2\u003e3.2.2. Physical and functional health outcomes\u003c/h2\u003e\u003cp\u003ePhysical and functional health measures were strength, function and balance. T-tests revealed a significant improvement in the 6-minute walk test at follow-up compared to baseline in the intervention group, where the mean distance walked increased by 36 metres from 421.4 (SD\u0026thinsp;=\u0026thinsp;96.8) to 457.1 (SD\u0026thinsp;=\u0026thinsp;97.0). No other significant differences were observed except for the mean diastolic blood pressure (reduced from 81mmHg; SD\u0026thinsp;=\u0026thinsp;6.2 to 71mmHg; SD\u0026thinsp;=\u0026thinsp;4.4; p\u0026thinsp;=\u0026thinsp;0.38) in the control group (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section3\"\u003e\u003ch2\u003e3.2.3. Cognition\u003c/h2\u003e\u003cp\u003e\u003cstrong\u003eOverall cognition\u003c/strong\u003e\u003cp\u003eNo significant improvements in overall cognition (assessed using the MoCA) were observed though the mean post-program MoCA score improved by 1.3 points (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMultitasking Test (MTT)\u003c/strong\u003e\u003cp\u003ePaired sampled t-tests revealed significant improvements in mean reaction latency across all correct responses (p\u0026thinsp;=\u0026thinsp;0.02;d\u0026thinsp;=\u0026thinsp;2.05), mean reaction latency when both \u0026lsquo;side\u0026rsquo; and \u0026lsquo;direction\u0026rsquo; rules are used (p\u0026thinsp;=\u0026thinsp;0.004;d\u0026thinsp;=\u0026thinsp;17.07), on incongruent trials (p\u0026thinsp;=\u0026thinsp;0.006;d\u0026thinsp;=\u0026thinsp;5.14), mean multitasking cost (p\u0026thinsp;=\u0026thinsp;0.004;d\u0026thinsp;=\u0026thinsp;1.80); and significant increase in total number of correct responses (p\u0026thinsp;=\u0026thinsp;0.006;d\u0026thinsp;=\u0026thinsp;3.39) and decrease in total omission errors (p\u0026thinsp;=\u0026thinsp;0.002;d\u0026thinsp;=\u0026thinsp;1.57) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e; Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eSpatial working memory (SWM) and paired associated learning (PAL)\u003c/strong\u003e\u003cp\u003eNo significant differences were observed for spatial working memory or paired associated learning between baseline and follow-up.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eParticipant characteristics (n\u0026thinsp;=\u0026thinsp;18).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, or n (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eDemographics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAge, years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e71.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSex, female (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16 (89%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEthnicity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e- Caucasian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14 (78%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e- Asian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e- Hispanic/Latin American\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e- Arabian/Middle Eastern\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e- Other (Māori \u0026amp; European)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCountry of Birth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e- Australia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (50%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e- New Zealand\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (17%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e- Other (see footnote)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (34%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEducation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e- Postgraduate/ Higher Degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (39%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e- Bachelor Degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (28%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e- Graduate Diploma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (17%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e- Certificate Level IV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (17%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmployment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e- Retired\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14 (78%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e- Employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (17%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e- Unemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarital status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e- Married\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (34%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e- Widowed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (28%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e- Separated/Divorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (17%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e- Single (never married)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (17%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e- Domestic Partnership\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLiving arrangements\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e- Alone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (50%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e- With partner/children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (50%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003ePhysical Characteristics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHeight, cm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e163.2\u0026thinsp;\u0026plusmn;\u0026thinsp;8.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWeight, kg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e80.4\u0026thinsp;\u0026plusmn;\u0026thinsp;20.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBody mass index, kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29.9\u0026thinsp;\u0026plusmn;\u0026thinsp;6.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWaist circumference, cm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e103.5\u0026thinsp;\u0026plusmn;\u0026thinsp;17.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSystolic blood pressure, mmHg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e126.6\u0026thinsp;\u0026plusmn;\u0026thinsp;20.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDiastolic blood pressure, mmHg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e77.4\u0026thinsp;\u0026plusmn;\u0026thinsp;8.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHeart rate, bpm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e67.3\u0026thinsp;\u0026plusmn;\u0026thinsp;11.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eOsteoarthritis characteristics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOsteoarthritis location\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18 (100%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e- knee\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (45%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e- spine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (33%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e- hands\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (33%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e- feet\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (22%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e- hip\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (11%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eHealth characteristics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTelephone MoCA score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCurrently taking medication/s\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16 (89%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eComorbidities (range 1\u0026ndash;5 with OA)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18 (100%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e- Depression/anxiety/PTSD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 (61%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e- Osteoporosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (45%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e- Hypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (39%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e- Cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (28%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e- Cardiovascular disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (22%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e- Peripheral neuropathy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (17%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e- Dementia/cognitive decline\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (11%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e- Other (see footnote)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (22%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003eFootnote. Other conditions (where n\u0026thinsp;=\u0026thinsp;1) were high blood pressure, high cholesterol, chronic kidney disease. Other countries born (where n\u0026thinsp;=\u0026thinsp;1) were Vietnam, Poland, Argentina, Bosnia, Soviet Union, Czech Republic. Abbreviations: OA\u0026thinsp;=\u0026thinsp;osteoarthritis; PTSD\u0026thinsp;=\u0026thinsp;posttraumatic stress disorder.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMeans\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations for health outcome measures: pain, quality of life, psychological health, physical health and cognition. Pre/post program measures are shown for the intervention (n\u0026thinsp;=\u0026thinsp;9) and control group (n\u0026thinsp;=\u0026thinsp;4), followed by interaction effects. Significance values and effect sizes are reported.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eProgram (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;4)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eProgram vs. Control\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePre-program\u003c/p\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePost-program\u003c/p\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eT-test\u003c/p\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePre-program\u003c/p\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePost-program\u003c/p\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eT-test\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eANOVA (Interaction)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ePain\u003c/p\u003e\u003cp\u003eWOMAC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21.8\u0026thinsp;\u0026plusmn;\u0026thinsp;12.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17.2\u0026thinsp;\u0026plusmn;\u0026thinsp;7.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026uarr; p\u0026thinsp;=\u0026thinsp;.073\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e21.5\u0026thinsp;\u0026plusmn;\u0026thinsp;11.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e28.3\u0026thinsp;\u0026plusmn;\u0026thinsp;14.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e\u0026darr; p\u0026thinsp;=\u0026thinsp;.045\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;.034; η\u0026sup2;=0.348\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003csup\u003et\u003c/sup\u003e \u003cb\u003e\u0026uarr;\u003c/b\u003e p\u0026thinsp;=\u0026thinsp;.054\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e8.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e\u0026darr; p\u0026thinsp;=\u0026thinsp;.043\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;.011; η\u0026sup2;=0.458\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStiffness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026uarr; p\u0026thinsp;=\u0026thinsp;.110\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e- p\u0026thinsp;=\u0026thinsp;.500\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;.428; η\u0026sup2;=0.058\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePhysical function\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.2\u0026thinsp;\u0026plusmn;\u0026thinsp;8.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12.3\u0026thinsp;\u0026plusmn;\u0026thinsp;6.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026uarr; p\u0026thinsp;=\u0026thinsp;.189\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e15.0\u0026thinsp;\u0026plusmn;\u0026thinsp;9.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e17.8\u0026thinsp;\u0026plusmn;\u0026thinsp;10.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003csup\u003et\u003c/sup\u003e\u0026darr; p\u0026thinsp;=\u0026thinsp;.051\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;.175; η\u0026sup2;=0.161\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eQuality of life\u003c/p\u003e\u003cp\u003eSF-36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e58.0\u0026thinsp;\u0026plusmn;\u0026thinsp;15.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e66.8\u0026thinsp;\u0026plusmn;\u0026thinsp;14.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026uarr; p\u0026thinsp;=\u0026thinsp;.009\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e61.5\u0026thinsp;\u0026plusmn;\u0026thinsp;22.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e55.7\u0026thinsp;\u0026plusmn;\u0026thinsp;20.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026darr; p\u0026thinsp;=\u0026thinsp;.178\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;.025; η\u0026sup2;=0.380\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePhysical functioning\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e58.3\u0026thinsp;\u0026plusmn;\u0026thinsp;23.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e67.2\u0026thinsp;\u0026plusmn;\u0026thinsp;17.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026uarr; p\u0026thinsp;=\u0026thinsp;.120\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e52.5\u0026thinsp;\u0026plusmn;\u0026thinsp;24.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e52.5\u0026thinsp;\u0026plusmn;\u0026thinsp;24.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e- p\u0026thinsp;=\u0026thinsp;.500\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;.442; η\u0026sup2;=0.055\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePhysical health (limit)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50.0\u0026thinsp;\u0026plusmn;\u0026thinsp;41.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e55.6\u0026thinsp;\u0026plusmn;\u0026thinsp;32.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026uarr; p\u0026thinsp;=\u0026thinsp;.256\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e62.5\u0026thinsp;\u0026plusmn;\u0026thinsp;47.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e37.5\u0026thinsp;\u0026plusmn;\u0026thinsp;47.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003csup\u003et\u003c/sup\u003e\u0026darr; p\u0026thinsp;=\u0026thinsp;.091\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003csup\u003et\u003c/sup\u003e p\u0026thinsp;=\u0026thinsp;.073; η\u0026sup2;=0.264\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmotional (limit)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40.7\u0026thinsp;\u0026plusmn;\u0026thinsp;27.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e66.7\u0026thinsp;\u0026plusmn;\u0026thinsp;37.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026uarr; p\u0026thinsp;=\u0026thinsp;.033\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e58.3\u0026thinsp;\u0026plusmn;\u0026thinsp;50.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e41.7\u0026thinsp;\u0026plusmn;\u0026thinsp;41.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026darr; p\u0026thinsp;=\u0026thinsp;.302\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;.130; η\u0026sup2;=0.196\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEnergy/fatigue\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55.6\u0026thinsp;\u0026plusmn;\u0026thinsp;18.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e59.4\u0026thinsp;\u0026plusmn;\u0026thinsp;15.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026uarr; p\u0026thinsp;=\u0026thinsp;.205\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e58.8\u0026thinsp;\u0026plusmn;\u0026thinsp;13.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e55.0\u0026thinsp;\u0026plusmn;\u0026thinsp;19.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026darr; p\u0026thinsp;=\u0026thinsp;.378\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;.451; η\u0026sup2;=0.053\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmotional wellbeing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e69.8\u0026thinsp;\u0026plusmn;\u0026thinsp;13.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e79.2\u0026thinsp;\u0026plusmn;\u0026thinsp;14.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026uarr; \u003cb\u003ep\u0026thinsp;=\u0026thinsp;.002\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e74.0\u0026thinsp;\u0026plusmn;\u0026thinsp;14.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e71.0\u0026thinsp;\u0026plusmn;\u0026thinsp;14.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026darr; p\u0026thinsp;=\u0026thinsp;.319\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;.036; η\u0026sup2;=0.342\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSocial functioning\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e72.2\u0026thinsp;\u0026plusmn;\u0026thinsp;19.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e79.2\u0026thinsp;\u0026plusmn;\u0026thinsp;16.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026uarr; \u003cb\u003ep\u0026thinsp;=\u0026thinsp;.007\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e84.4\u0026thinsp;\u0026plusmn;\u0026thinsp;12.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e68.8\u0026thinsp;\u0026plusmn;\u0026thinsp;21.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026darr; \u003cb\u003ep\u0026thinsp;=\u0026thinsp;.040\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;.001; η\u0026sup2;=0.645\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66.9\u0026thinsp;\u0026plusmn;\u0026thinsp;11.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e66.4\u0026thinsp;\u0026plusmn;\u0026thinsp;6.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026uarr; p\u0026thinsp;=\u0026thinsp;.441\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e54.4\u0026thinsp;\u0026plusmn;\u0026thinsp;12.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e62.5\u0026thinsp;\u0026plusmn;\u0026thinsp;14.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026uarr; p\u0026thinsp;=\u0026thinsp;.113\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;.211; η\u0026sup2;=0.138\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGeneral Health\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e56.1\u0026thinsp;\u0026plusmn;\u0026thinsp;24.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e63.3\u0026thinsp;\u0026plusmn;\u0026thinsp;20.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026uarr; p\u0026thinsp;=\u0026thinsp;.121\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e63.8\u0026thinsp;\u0026plusmn;\u0026thinsp;28.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e63.8\u0026thinsp;\u0026plusmn;\u0026thinsp;30.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e- p\u0026thinsp;=\u0026thinsp;.500\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;.046; η\u0026sup2;=0.529\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003ePsychological health\u003c/p\u003e\u003cp\u003eDASS-21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal Distress\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.4\u0026thinsp;\u0026plusmn;\u0026thinsp;71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12.3\u0026thinsp;\u0026plusmn;\u0026thinsp;6.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026uarr; p\u0026thinsp;=\u0026thinsp;.279\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14.5\u0026thinsp;\u0026plusmn;\u0026thinsp;8.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e15.0\u0026thinsp;\u0026plusmn;\u0026thinsp;8.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026darr; p\u0026thinsp;=\u0026thinsp;.453\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;.674; η\u0026sup2;=0.017\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDepression\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026uarr; p\u0026thinsp;=\u0026thinsp;.289\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5.5\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026darr; p\u0026thinsp;=\u0026thinsp;.412\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;.888; η\u0026sup2;=0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAnxiety\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026uarr; p\u0026thinsp;=\u0026thinsp;.424\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026uarr; p\u0026thinsp;=\u0026thinsp;.394\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;.730; η\u0026sup2;=0.011\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStress\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026uarr; p\u0026thinsp;=\u0026thinsp;.277\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026darr; p\u0026thinsp;=\u0026thinsp;.422\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;.978; η\u0026sup2;=0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ePhysical health\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSystolic BP (mmHg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e125.6\u0026thinsp;\u0026plusmn;\u0026thinsp;23.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e120.3\u0026thinsp;\u0026plusmn;\u0026thinsp;18.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e- p\u0026thinsp;=\u0026thinsp;.292\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e128.8\u0026thinsp;\u0026plusmn;\u0026thinsp;9.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e116.8\u0026thinsp;\u0026plusmn;\u0026thinsp;12.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003csup\u003et\u003c/sup\u003e - p\u0026thinsp;=\u0026thinsp;.082\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;.533; η\u0026sup2;=0.036\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDiastolic BP (mmHg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e72.2\u0026thinsp;\u0026plusmn;\u0026thinsp;6.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e71.7\u0026thinsp;\u0026plusmn;\u0026thinsp;9.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e- p\u0026thinsp;=\u0026thinsp;.434\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e81.1\u0026thinsp;\u0026plusmn;\u0026thinsp;6.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e70.7\u0026thinsp;\u0026plusmn;\u0026thinsp;4.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e- p\u0026thinsp;=\u0026thinsp;.038\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;.095; η\u0026sup2;=0.233\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHeart rate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e64.5\u0026thinsp;\u0026plusmn;\u0026thinsp;11.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e62.9\u0026thinsp;\u0026plusmn;\u0026thinsp;14.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e- p\u0026thinsp;=\u0026thinsp;.314\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e74.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e70.1\u0026thinsp;\u0026plusmn;\u0026thinsp;7.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e- p\u0026thinsp;=\u0026thinsp;.254\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;.353; η\u0026sup2;=0.017\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWaist circumference (cm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e103.7\u0026thinsp;\u0026plusmn;\u0026thinsp;18.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e102.0\u0026thinsp;\u0026plusmn;\u0026thinsp;15.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026uarr; p\u0026thinsp;=\u0026thinsp;.198\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e106.5\u0026thinsp;\u0026plusmn;\u0026thinsp;17.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e106.5\u0026thinsp;\u0026plusmn;\u0026thinsp;19.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e- p\u0026thinsp;=\u0026thinsp;.500\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;.584; η\u0026sup2;=0.028\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHeight (cm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e162.7\u0026thinsp;\u0026plusmn;\u0026thinsp;9.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e162.7\u0026thinsp;\u0026plusmn;\u0026thinsp;9.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e161.5\u0026thinsp;\u0026plusmn;\u0026thinsp;8.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e161.5\u0026thinsp;\u0026plusmn;\u0026thinsp;8.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWeight (kg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e79.1\u0026thinsp;\u0026plusmn;\u0026thinsp;20.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e78.5\u0026thinsp;\u0026plusmn;\u0026thinsp;18.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026uarr; p\u0026thinsp;=\u0026thinsp;.161\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e82.1\u0026thinsp;\u0026plusmn;\u0026thinsp;24.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e83.8\u0026thinsp;\u0026plusmn;\u0026thinsp;25.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026darr; p\u0026thinsp;=\u0026thinsp;.128\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;.110; η\u0026sup2;=0.215\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBody mass index\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e29.5\u0026thinsp;\u0026plusmn;\u0026thinsp;5.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e- p\u0026thinsp;=\u0026thinsp;.235\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e31.1\u0026thinsp;\u0026plusmn;\u0026thinsp;6.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e31.5\u0026thinsp;\u0026plusmn;\u0026thinsp;7.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e- p\u0026thinsp;=\u0026thinsp;.131\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;.158; η\u0026sup2;=0.173\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eStrength \u0026amp; fitness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHandgrip strength\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e51.3\u0026thinsp;\u0026plusmn;\u0026thinsp;14.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e49.7\u0026thinsp;\u0026plusmn;\u0026thinsp;13.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026darr; p\u0026thinsp;=\u0026thinsp;.133\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e42.0\u0026thinsp;\u0026plusmn;\u0026thinsp;10.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e43.5\u0026thinsp;\u0026plusmn;\u0026thinsp;9.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026uarr; p\u0026thinsp;=\u0026thinsp;.148\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;.191; η\u0026sup2;=0.150\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 Sit-to-Stands (s)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026uarr; p\u0026thinsp;=\u0026thinsp;.118\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14.8\u0026thinsp;\u0026plusmn;\u0026thinsp;6.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e13.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026uarr; p\u0026thinsp;=\u0026thinsp;.314\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;.897; η\u0026sup2;=0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8-foot walk (s)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026uarr; p\u0026thinsp;=\u0026thinsp;.173\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026darr; p\u0026thinsp;=\u0026thinsp;.404\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;.473; η\u0026sup2;=0.048\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6-minute walk distance (m)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e421.4\u0026thinsp;\u0026plusmn;\u0026thinsp;96.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e457.1\u0026thinsp;\u0026plusmn;\u0026thinsp;97.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026uarr; p\u0026thinsp;=\u0026thinsp;.011\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e378.0\u0026thinsp;\u0026plusmn;\u0026thinsp;145.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e392.0\u0026thinsp;\u0026plusmn;\u0026thinsp;95.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026uarr; p\u0026thinsp;=\u0026thinsp;.393\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;.554; η\u0026sup2;=0.033\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBalance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSide-by-side stand (s)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e15.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e15.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSemi-tandem stand (s)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e15.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e15.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFull tandem stand (s)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026uarr; p\u0026thinsp;=\u0026thinsp;.173\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e13.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e13.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026darr; p\u0026thinsp;=\u0026thinsp;.196\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;.846; η\u0026sup2;=0.004\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEyes open, right (s)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.6\u0026thinsp;\u0026plusmn;\u0026thinsp;6.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.6\u0026thinsp;\u0026plusmn;\u0026thinsp;10.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e- p\u0026thinsp;=\u0026thinsp;.139\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5.8\u0026thinsp;\u0026plusmn;\u0026thinsp;6.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026uarr; p\u0026thinsp;=\u0026thinsp;.115\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;.413; η\u0026sup2;=0.062\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEyes open, left (s)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10.0\u0026thinsp;\u0026plusmn;\u0026thinsp;6.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026uarr; p\u0026thinsp;=\u0026thinsp;.396\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003csup\u003et\u003c/sup\u003e\u0026uarr; p\u0026thinsp;=\u0026thinsp;.072\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;.324; η\u0026sup2;=0.089\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEyes closed, right (s)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026darr; p\u0026thinsp;=\u0026thinsp;.209\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026uarr; p\u0026thinsp;=\u0026thinsp;.196\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;.323; η\u0026sup2;=0.089\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEyes closed, left (s)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026darr; p\u0026thinsp;=\u0026thinsp;.437\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026uarr; p\u0026thinsp;=\u0026thinsp;.196\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;.738; η\u0026sup2;=0.011\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eCognition\u003c/p\u003e\u003cp\u003eCANTAB\u003c/p\u003e\u003cp\u003eattention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMoCA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003csup\u003et\u003c/sup\u003e\u0026uarr; p\u0026thinsp;=\u0026thinsp;.077\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003en/a\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003en/a\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003en/a\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003en/a\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean RL: All correct\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e988\u0026thinsp;\u0026plusmn;\u0026thinsp;107\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e938\u0026thinsp;\u0026plusmn;\u0026thinsp;132\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026uarr; p\u0026thinsp;=\u0026thinsp;.020\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003en/a\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003en/a\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003en/a\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003en/a\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean RL: Congruent (ms)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1240\u0026thinsp;\u0026plusmn;\u0026thinsp;143\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1113\u0026thinsp;\u0026plusmn;\u0026thinsp;125\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026uarr; p\u0026thinsp;=\u0026thinsp;.004\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003en/a\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003en/a\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003en/a\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003en/a\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean RL: Incongruent (ms)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1041\u0026thinsp;\u0026plusmn;\u0026thinsp;129\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e972\u0026thinsp;\u0026plusmn;\u0026thinsp;142\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026uarr; p\u0026thinsp;=\u0026thinsp;.006\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003en/a\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003en/a\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003en/a\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003en/a\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean multitasking cost\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e489\u0026thinsp;\u0026plusmn;\u0026thinsp;197\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e319\u0026thinsp;\u0026plusmn;\u0026thinsp;103\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026uarr; p\u0026thinsp;=\u0026thinsp;.004\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003en/a\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003en/a\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003en/a\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003en/a\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal correct responses\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e145\u0026thinsp;\u0026plusmn;\u0026thinsp;9.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e153\u0026thinsp;\u0026plusmn;\u0026thinsp;7.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026uarr; p\u0026thinsp;=\u0026thinsp;.006\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003en/a\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003en/a\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003en/a\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003en/a\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal errors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.89\u0026thinsp;\u0026plusmn;\u0026thinsp;5.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.78\u0026thinsp;\u0026plusmn;\u0026thinsp;2.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026uarr; p\u0026thinsp;=\u0026thinsp;.002\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003en/a\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003en/a\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003en/a\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003en/a\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eValues represent mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. Bold font indicates significance is \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026le;\u0026thinsp;0.05. \u003csup\u003et\u003c/sup\u003e shows a trend towards significance: 0.05\u0026thinsp;\u0026lt;\u0026thinsp;\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026le;\u0026thinsp;0.1. Effect size is shown by eta-squared (η\u0026sup2;). \u0026uarr;=outcome improved; \u0026darr;=outcome worsened; - =outcome neither improved nor worsened. m\u0026thinsp;=\u0026thinsp;metres; s\u0026thinsp;=\u0026thinsp;seconds. Handgrip strength: total highest left plus right from three trials. Blood pressure, heart rate, waist circumference and weight were the average of three collected measures. n/a\u0026thinsp;=\u0026thinsp;Not applicable (no control group; insufficient data to complete analysis).\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003e4.1. Summary of findings\u003c/h2\u003e\u003cp\u003eThis pilot randomized controlled trial tested feasibility, acceptability and health outcomes of a 12-week, multidisciplinary, and community-based \u003cem\u003eHealthy Body \u0026amp; Mind Program.\u003c/em\u003e Feasibility was low based on recruitment and retention and there was a high drop-out rate from participants in the wait-list control group. However, acceptability was high in participants who completed the program where they attended most sessions and thoroughly enjoyed the experience, expressing a desire to continue participating in the program. The program led to improved health outcomes, including QoL, pain, and cognition, for people living with OA and thinking concerns. Some participants may have found alternative commitments during the 12-week wait period. Although statistically significant improvements were not observed in the Montreal Cognitive Assessment (MoCA) score, the mean difference was higher than the clinically meaningful threshold (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Significant interactions were observed for QoL and pain outcomes, and significant main effects were observed for the Cambridge cognition (attention) task and 6-minute walk test.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003e4.2. Implications and other research\u003c/h2\u003e\u003cp\u003eInterventions that are public health focused and individualised are likely to be the most beneficial and cost-effective (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). Effective programs for managing chronic conditions such as OA and dementia prevention must empower individuals to make lifestyle changes through supportive, evidence-based strategies, yet be sufficiently flexible to allow new activities to be fitted into people's current lives and adaptable to new developments (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). Although our program led to some beneficial outcomes, for it to be successfully implemented widely, more choice in attendance sessions and flexibility for users would be required (e.g., online and home exercises component and/or self-managed options). This program aimed to meet the needs of people living with OA and dementia by interviewing people with lived experience regarding their views and recommendations, as well as involving consumers in the study design and ongoing development. Future research needs to continue with a consumer-driven approach as other aspects may need to be considered. The cost of multidisciplinary programs is also a major concern, and such effective lifestyle, exercise and education services would benefit from further Federal Government support (e.g., through Medicare Australia), similar to services for the only chronic condition funded by the Federal Government for group exercise and education, Type 2 Diabetes (e.g., Medicare Benefit Schedule Items 81115, 81100 (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e)).\u003c/p\u003e\u003cp\u003eWith the majority of dementia cases going undiagnosed, (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e), many people may be living with early cognitive decline and not be aware. Further, many older adults may be living with OA and not know. This may have been one of the reasons why recruiting for our program using the initial inclusion criteria was difficult. Indeed, much work is needed in improving societal awareness of dementia and challenging stigma(\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e), including that many people have limited awareness of dementia prevention strategies (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e), including healthcare professionals. According to the World Alzheimer Report 2019, approximately 62% of healthcare professionals and 70% of the public think dementia is a part of normal ageing, and 25% believe that nothing can be done to prevent dementia (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e). This is alarming given that approximately 45 percent of dementia cases could be prevented or delayed if modifiable risk factors such as those that formed the focus of the HBMP (i.e., physical inactivity, poor diet), were eliminated (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). This highlights a tremendous opportunity for dementia prevention globally that we cannot afford to miss.\u003c/p\u003e\u003cp\u003eA recent large-scale online multidomain lifestyle intervention with 6,104 participants led to significant improvements in cognition at 3 years, demonstrating effective dementia risk approaches can be accessible and scalable, as well as personalised (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e). The intervention targeted PA, nutrition, cognitive activity and depression or anxiety, and had great potential for large-scale dementia reduction. However, online interventions may not be suitable for everyone, particularly those with more complex needs. The participants\u0026rsquo; feedback from our study highlighted preference for an in-person approach, providing individually tailored physical activities and prompts to ensure exercises are being completed effectively and safety. Participants described the social benefits of the group-based approach (qualitative findings to be published separately). However, due to participant drop-out, one participant did not complete the program in a group setting. Social interaction has been added to the most recent Lancet review on dementia prevention (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) and the effects of social isolation on brain health have also been highlighted (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). Further, some participants may require additional support to help them manage a particular chronic condition or risk factor (e.g., pain management for OA and dietary advice for diabetes or obesity). Intervention flexibility where the choice of attending in-person and/or online programs may be complementary and allow individuals to adjust the level of support they receive based on their current needs and circumstances. Web-support or a mobile application could provide sufficient ongoing support following the 12-week program if supplemented with a teaching component and ongoing technical support. Online health interventions (or \u0026lsquo;Telehealth\u0026rsquo;) have certainly increased in popularity though special attention should ensure that telehealth narrows, and not widens, the currently existing disparities in healthcare (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e). Participants could choose to return to a more comprehensive approach if their health needs change.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003e4.3. Strengths and limitations\u003c/h2\u003e\u003cp\u003eStrengths of this study include comprehensive stakeholder involvement, bringing together expertise from people with lived experience of dementia, AEPs, health and provisional clinical psychologists, medical specialists, clinical researchers, population health experts, chronic disease specialists, and APDs. The program aligned with the Lancet Commission lifestyle factors for reducing dementia risk, such as PA, smoking, alcohol, and obesity management (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Researchers included a wide range of health outcome assessments, covering QoL, pain, cognition, and various physical and psychological measures. The qualitative component provided rich insights into program feasibility and participant experiences. Limitations were evident in the study's low feasibility, challenging recruitment process, and high drop-out rate before participant enrolment. The wait-list randomised controlled trial design may not adequately address participants' immediate health concerns. As this was a pilot feasibility study, we only reported outcomes at baseline and immediately after completion of the program. Further investigation is needed to determine the long-term follow-up effects of similar programs. Further, the small sample size we recruited from a particular geographical area and all with a high level of education and sociodemographic status, indicates that caution is needed before generalising these findings to other populations. Computerised cognitive tests should be interpreted with caution given the potential learning effects(\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e). However, in test-retest reliability study of CANTAB tasks, practice effects were only observed in the spatial learning memory task, and not the attention task(\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003e4.4. Recommendations\u003c/h2\u003e\u003cp\u003eFuture trials may benefit from considering more flexible approaches to ensure programs reach more people who require similar support services (e.g., people with other chronic conditions or dementia risk factors). This includes less restrictive recruitment criteria, more adaptable time commitments, self-paced PA options, increased session availability, and flexible education components covering nutrition, pain management, psychological health and other well-established modifiable dementia risk factors (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Improving program accessibility through online sessions and self-paced learning could enhance participant engagement. Scaling up the program to larger populations could help identify its potential for improving public health and reducing dementia risk at a national level. Though such programs require government support (e.g., through Medicare) to cover costs. Further discussions with all stakeholders will provide valuable considerations for future and larger scale implementation of the program into other settings (e.g., aged care settings) making the program more accessible to people living with these conditions.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003e4.5. Conclusion\u003c/h2\u003e\u003cp\u003eCurrently, no programs exist to address the specific needs of people living with chronic conditions associated with increased dementia risk, such as osteoarthritis. This trial demonstrated participant acceptability and health improvements in pain, QoL, cognition and physical function. However, feasibility needs to be improved by less stringent recruitment criteria and increased flexibility and availability of program sessions. Future research should scale-up and deliver this program to larger populations to identify if such programs have the potential to improve public health and reduce dementia risk at a national level and in more diverse populations.\u003c/p\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics and dissemination:\u003c/strong\u003e Participant confidentiality will be maintained in line with ethical procedures. UNSW HREC Approval Number: HC230506.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial registration number:\u0026nbsp;\u003c/strong\u003eNCT06070818 (ClinicalTrials.gov).\u003c/p\u003e\u003ch3\u003eAcknowledgements\u003c/h3\u003e\n\u003cp\u003eWe would also like to thank Dementia Australia Dementia Advocates and our Lifestyle Clinic members who provided feedback on the development of the program.\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003eContributions\u003c/h3\u003e\n\u003cp\u003eCB designed the study, obtained funding and ethics, led the trial and drafted the manuscript. WY, ST \u0026amp; MJ assisted with the education development. WY, KM \u0026amp; BJ assisted with design of the study. KM \u0026amp; BJ assisted with obtaining funding and ethics, provided expertise for the exercise component of the intervention, interpretation of findings and review of the draft protocol and final outcome manuscript. ST and SA collected data. All authors approved the final version of the manuscript.\u003c/p\u003e\n\u003ch3\u003eRole of funding source\u003c/h3\u003e\n\u003cp\u003eThis research was supported by a grant provided by the UNSW Neuroscience, Mental Health and Addiction theme and philanthropic funding provided by the Estate of the Late Faye Patricia Williams.\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003eCompeting interests\u003c/h3\u003e\n\u003cp\u003eHB is or has been an advisory board member or consultant to Biogen, Eisai, Eli Lilly, Medicines Australia, Roche and Skin2Neuron. He is a Medical/Clinical Advisory Board member for Montefiore Homes and Cranbrook Care. All other authors have no conflict of interest to report.\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003eData availability statement\u003c/h3\u003e\n\u003cp\u003eDeidentified data will be made available on request.\u003c/p\u003e\n\u003ch3\u003eORCID\u003c/h3\u003e\n\u003cp\u003eClaire Burley: 0000-0002-7632-5632\u003c/p\u003e\n\u003cp\u003eMatthew D Jones: 0000-0002-5534-755X\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNattai Borges: 0000-0002-4182-8088\u003c/p\u003e\n\u003cp\u003eKelly McLeod: 0000-0001-8453-3039\u003c/p\u003e\n\u003cp\u003eHenry Brodaty: 0000-0001-9487-6617\u003c/p\u003e\n\u003cp\u003eBelinda J Parmenter: 0000-0001-8013-5658\u003c/p\u003e\n\u003cp\u003eSara Asadi: 0000-0002-0887-244X\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organisation (WHO). Dementia 2023. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/fact-sheets/detail/dementia\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/fact-sheets/detail/dementia\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organisation (WHO). Osteoarthritis 2023. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/fact-sheets/detail/osteoarthritis\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/fact-sheets/detail/osteoarthritis\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIkram M, Innes K, Sambamoorthi U. Association of osteoarthritis and pain with Alzheimer's diseases and related dementias among older adults in the United States. Osteoarthr Cartil. 2019;27(10):1470\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWeber A, Hung Mak S, Berenbaum F, Sellam J, Zheng Y-P, Han Y, Wen C. Association between osteoarthritis and increased risk of dementia: a systemic review and meta-analysis. Medicine. 2019;98(10).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHalonen P, Enroth L, J\u0026auml;msen E, Vargese S, Jylh\u0026auml; M. Dementia and related comorbidities in the population aged 90 and over in the vitality 90\u0026thinsp;+\u0026thinsp;study, Finland: patterns and trends from 2001 to 2018. J Aging Health. 2023;35(5\u0026ndash;6):370\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSchubert CC, Boustani M, Callahan CM, Perkins AJ, Carney CP, Fox C, Unverzagt F, Hui S, Hendrie HC. Comorbidity profile of dementia patients in primary care: are they sicker? J Am Geriatr Soc. 2006;54(1):104\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCipher DJ, Clifford PA. Dementia, pain, depression, behavioral disturbances, and ADLs: Toward a comprehensive conceptualization of quality of life in long-term care. Int J Geriatr Psychiatry. 2004;19(8):741\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLin P-C, Li C-H, Chou P-L, Chen Y-M, Lin L-C. Prevalence of pain-related diagnoses in patients with dementia: a nationwide study. J Pain Res. 2018:1589\u0026ndash;98.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBurley CV, Burns K, Lam BC, Brodaty H. Nonpharmacological approaches reduce symptoms of depression in dementia: A systematic review and meta-analysis. Ageing Res Rev. 2022;79:101669.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBurley CV, Casey A-N, Jones MD, Wright KE, Parmenter BJ. Nonpharmacological approaches for pain and symptoms of depression in people with osteoarthritis: systematic review and meta-analyses. Sci Rep. 2023;13(1):15449.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShalhoub M, Anaya M, Deek S, Zaben AH, Abdalla MA, Jaber MM, Koni AA, Zyoud SH. The impact of pain on quality of life in patients with osteoarthritis: a cross-sectional study from Palestine. BMC Musculoskelet Disord. 2022;23(1):1\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKessler E-M, Bowen CE, Baer M, Froelich L, Wahl H-W. Dementia worry: A psychological examination of an unexplored phenomenon. Eur J Ageing. 2012;9:275\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOnubogu UD. Pain and depression in older adults with arthritis. Orthop Nurs. 2014;33(2):102\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAxford J, Butt A, Heron C, Hammond J, Morgan J, Alavi A, Bolton J, Bland M. Prevalence of anxiety and depression in osteoarthritis: use of the Hospital Anxiety and Depression Scale as a screening tool. Clin Rheumatol. 2010;29:1277\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHassen CB, Fayosse A, Landr\u0026eacute; B, Raggi M, Bloomberg M, Sabia S, Singh-Manoux A. Association between age at onset of multimorbidity and incidence of dementia: 30 year follow-up in Whitehall II prospective cohort study. BMJ. 2022;376.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKostev K, Hadji P, Jacob L. Impact of osteoporosis on the risk of dementia in almost 60,000 patients followed in general practices in Germany. J Alzheimers Dis. 2018;65(2):401\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLivingston G, Huntley J, Liu KY, Costafreda SG, Selb\u0026aelig;k G, Alladi S, et al. Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. Lancet. 2024;404(10452):572\u0026ndash;628.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePedersen BK, Saltin B. Exercise as medicine\u0026ndash;evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports. 2015;25:1\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRoman de Mettelinge T, Calders P, Cambier D. The effects of aerobic exercise in patients with early-onset dementia: A scoping review. Dement Geriatr Cogn Disord. 2021;50(1):9\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJia R-x, Liang J-h, Xu Y, Wang Y-q. Effects of physical activity and exercise on the cognitive function of patients with Alzheimer disease: a meta-analysis. BMC Geriatr. 2019;19:1\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRosenberg A, Ngandu T, Rusanen M, Antikainen R, B\u0026auml;ckman L, Havulinna S, et al. Multidomain lifestyle intervention benefits a large elderly population at risk for cognitive decline and dementia regardless of baseline characteristics: The FINGER trial. Alzheimer's Dement. 2018;14(3):263\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBurley CV, Livingston G, Knapp MR, Wimo A, Norman R, Brodaty H. Time to invest in prevention and better care of behaviors and psychological symptoms associated with dementia. Int Psychogeriatr. 2020;32(5):567\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBurley CV, Casey A-N, Chenoweth L, Brodaty H. Views of people living with dementia and their families/care partners: helpful and unhelpful responses to behavioral changes. Int Psychogeriatr. 2023;35(2):77\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVenegas-Sanabria LC, Mart\u0026iacute;nez-Vizcaino V, Cavero-Redondo I, Chavarro-Carvajal DA, Cano-Gutierrez CA, Alvarez-Bueno C. Effect of physical activity on cognitive domains in dementia and mild cognitive impairment: overview of systematic reviews and meta-analyses. Aging Ment Health. 2021;25(11):1977\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHuang X, Zhao X, Li B, Cai Y, Zhang S, Wan Q, et al. Comparative efficacy of various exercise interventions on cognitive function in patients with mild cognitive impairment or dementia: a systematic review and network meta-analysis. J Sport Health Sci. 2022;11(2):212\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSomers TJ, Blumenthal JA, Guilak F, Kraus VB, Schmitt DO, Babyak MA, et al. Pain coping skills training and lifestyle behavioral weight management in patients with knee osteoarthritis: a randomized controlled study. Pain. 2012;153(6):1199\u0026ndash;209.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrzezińska A, Bourke J, Rivera-Hern\u0026aacute;ndez R, Tsolaki M, Woźniak J, Kaźmierski J. Depression in dementia or dementia in depression? Systematic review of studies and hypotheses. Curr Alzheimer Res. 2020;17(1):16\u0026ndash;28.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKuring J, Mathias J, Ward L. Risk of Dementia in persons who have previously experienced clinically-significant Depression, Anxiety, or PTSD: A Systematic Review and Meta-Analysis. J Affect Disord. 2020;274:247\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLivingston G, Huntley J, Sommerlad A, Ames D, Ballard C, Banerjee S, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet. 2020;396(10248):413\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBurley CV, Yeates W, McLeod K, Jones MD, Borges N, Brodaty H, Parmenter BJ. Feasibility and acceptability of an evidence-based, pilot randomised controlled trial to improve health outcomes and reduce dementia risk in people with osteoarthritis. Study protocol for the Healthy Body \u0026amp; Mind Program (HBMP). JMIR Preprints 11/04/2025:75816. 2025.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChan A-W, Tetzlaff JM, G\u0026oslash;tzsche PC, Altman DG, Mann H, Berlin JA et al. SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ. 2013;346.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEldridge SM, Chan CL, Campbell MJ, Bond CM, Hopewell S, Thabane L et al. CONSORT 2010 statement: extension to randomised pilot and feasibility trials. BMJ. 2016;355.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNasreddine ZS, Phillips NA, B\u0026eacute;dirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAmerican College of Sports Medicine. ACSM's guidelines for exercise testing and prescription. Lippincott Williams \u0026amp; Wilkins; 2013.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLins L, Carvalho FM. SF-36 total score as a single measure of health-related quality of life: Scoping review. SAGE Open Med. 2016;4:2050312116671725.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rhuematol. 1988;15(12):1833\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHenry JD, Crawford JR. The short-form version of the Depression Anxiety Stress Scales (DASS‐21): Construct validity and normative data in a large non‐clinical sample. Br J Clin Psychol. 2005;44(2):227\u0026ndash;39.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIoannidis JP, Evans SJ, G\u0026oslash;tzsche PC, O'neill RT, Altman DG, Schulz K, et al. Better reporting of harms in randomized trials: an extension of the CONSORT statement. Ann Intern Med. 2004;141(10):781\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLindvall E, Abzhandadze T, Quinn TJ, Sunnerhagen KS, Lundstr\u0026ouml;m E. Is the difference real, is the difference relevant: the minimal detectable and clinically important changes in the Montreal Cognitive Assessment. Cereb Circulation-Cognition Behav. 2024;6:100222.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFrost R, Avgerinou C, Goodman C, Clegg A, Hopkins J, Gould RL, et al. Clinical and cost-effectiveness of a personalised health promotion intervention enabling independence in older people with mild frailty (\u0026lsquo;HomeHealth\u0026rsquo;) compared to treatment as usual: study protocol for a randomised controlled trial. BMC Geriatr. 2022;22(1):485.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePoppe M, Mansour H, Rapaport P, Palomo M, Burton A, Morgan-Trimmer S, et al. Falling through the cracks; Stakeholders' views around the concept and diagnosis of mild cognitive impairment and their understanding of dementia prevention. Int J Geriatr Psychiatry. 2020;35(11):1349\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMcLeod KA, Thom JM, Jones MD, Parmenter BJ. Feasibility, acceptability and efficacy of a pilot exercise physiology group service for older people with type 2 diabetes. Australian J Gen Pract. 2024.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAmjad H, Roth DL, Sheehan OC, Lyketsos CG, Wolff JL, Samus QM. Underdiagnosis of dementia: an observational study of patterns in diagnosis and awareness in US older adults. J Gen Intern Med. 2018;33:1131\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBacsu J-D, Johnson S, O\u0026rsquo;Connell ME, Viger M, Muhajarine N, Hackett P, et al. Stigma reduction interventions of dementia: a scoping review. Can J Aging/La Revue Canadienne Du Vieillissement. 2022;41(2):203\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLynch C. World Alzheimer Report 2019: Attitudes to dementia, a global survey: Public health: Engaging people in ADRD research. Alzheimer's Dement. 2020;16:e038255.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrodaty H, Chau T, Heffernan M, Ginige JA, Andrews G, Millard M et al. An online multidomain lifestyle intervention to prevent cognitive decline in at-risk older adults: a randomized controlled trial. Nat Med. 2025:1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eXiong Y, Hong H, Liu C, Zhang YQ. Social isolation and the brain: effects and mechanisms. Mol Psychiatry. 2023;28(1):191\u0026ndash;201.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMahtta D, Daher M, Lee MT, Sayani S, Shishehbor M, Virani SS. Promise and perils of telehealth in the current era. Curr Cardiol Rep. 2021;23:1\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHarvey PD, McGurk SR, Mahncke H, Wykes T. Controversies in computerized cognitive training. Biol Psychiatry: Cogn Neurosci Neuroimaging. 2018;3(11):907\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCacciamani F, Salvadori N, Eusebi P, Lisetti V, Luchetti E, Calabresi P, et al. Evidence of practice effect in CANTAB spatial working memory test in a cohort of patients with mild cognitive impairment. Appl Neuropsychology: Adult. 2018;25(3):237\u0026ndash;48.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"cognitive decline, dementia risk, depression, education, exercise, lifestyle, nonpharmacological, osteoarthritis, pain, physical activity, quality of life","lastPublishedDoi":"10.21203/rs.3.rs-7590984/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7590984/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eOsteoarthritis (OA) is highly prevalent in older adults and is associated with increased dementia risk. The aims of this pilot randomized controlled trial (RCT) were to assess the feasibility, acceptability, and health outcomes of a 12-week multidisciplinary Healthy Body \u0026amp; Mind Program for individuals with OA and thinking concerns.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e\u003cp\u003eFeasibility and acceptability were measured using retention, adherence, and participant feedback (interviews/focus groups). Health outcomes included quality of life pain, cognition, psychological and physical health. Data were analysed with ANOVAs (intervention/control) and paired t-tests (baseline/follow-up).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eEighteen participants (mean age\u0026thinsp;=\u0026thinsp;71\u0026thinsp;\u0026plusmn;\u0026thinsp;5.7, mean MoCA\u0026thinsp;=\u0026thinsp;19\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2) were randomly assigned to the program or a wait-list control group. Fifty-percent of participants completed the program, totalling 215/234 attended sessions (92% completion rate). Participants provided positive feedback and suggestions for future programs. There were significant interaction effects where the intervention group improved and the control group worsened for pain (p\u0026thinsp;\u0026lt;\u0026thinsp;.05;η\u0026sup2;=0.348) and quality of life (p\u0026thinsp;\u0026lt;\u0026thinsp;.05; η\u0026sup2;=0.380). The intervention group showed significant improvements in attentional processing and the 6-minute walk test (both p\u0026thinsp;\u0026lt;\u0026thinsp;.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe program was well-accepted by participants and significantly improved health outcomes. Future trials may benefit from focusing on increasing accessibility and flexibility and scaling the program for broader public health impact.\u003c/p\u003e","manuscriptTitle":"Feasibility, acceptability and effect on health outcomes of a pilot randomised controlled trial for people with osteoarthritis and thinking concerns: The Healthy Body \u0026amp; Mind Program","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-17 09:14:47","doi":"10.21203/rs.3.rs-7590984/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"28abba6e-d804-4078-8c6b-a79b7aa8db90","owner":[],"postedDate":"September 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-23T15:38:29+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-17 09:14:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7590984","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7590984","identity":"rs-7590984","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}