Exercise and diet for people with hip osteoarthritis: the ECHO feasibility study

All participants will receive a diet and exercise program. Exercise: Participants will receive six individual consultations with a physiotherapist over 6-months, in addition to educational material (booklets about osteoarthritis and non-surgical management). The physiotherapist consultations will include a structured exercise program. Participants will be given three exercise resistance bands and ankle-cuff weights for home strengthening exercises. The initial physiotherapy consultation will be approximately 45 minutes long, with follow-up consultations being approximately 30 minutes. Consultations are recommended to occur in weeks 1, 3, 7, 11, 16 and 21, but timing can be negotiated between each participant and their physiotherapist. Physiotherapists will choose from a list of exercises and aim to prescribe 5-6 exercises. This will include strengthening exercises (hip abductors/extensors/adductors/flexors) and some functional exercises. The exact number of exercises, as well as sets/repetitions, will be determined in consultation between the physiotherapist and participant. Intensity is determined using a modified Rating of Perceived Exertion (RPE) scale, where it should feel “hard” to “very hard” to perform a full set of each exercises. Participants will be encouraged to complete exercises three times per week. Physiotherapists will encourage the participant to increase their general and incidental levels of physical/aerobic activity. Prescription of exercises/physical activity plans is based on the clinical history and functional ability of the participant. Physiotherapists will encourage the use of a provided logbook to improve adherence and motivation but the logbook will not be collected. Diet: Participants will also receive six individual consultations with a dietitian over 6 months to help the participant undertake a weight management program. Participants’ first consultation with the dietitian will be approximately 45 minutes in duration, with follow-up consultations of approximately 30 minutes. Consultations are recommended to occur in weeks 1, 3, 6, 10, 14-17, and 19-23 but timing will be individualised as required. During the initial consultation, appropriate weight loss goals and a management plan are developed. During subsequent consultations, dietitians monitor progress and use motivational interviewing principles and techniques to develop motivation and self-efficacy and provide assistance in overcoming obstacles to completing the agreed self-management plan. Once the participant has reached their target weight, they can choose whether to transition to a weight maintenance phase or continue with the very low calorie (VLE)/ketogenic diet program and aim for further weight loss. Ongoing education, information and advice are key components of the intervention to optimally support weight loss. Resources and strategies will include keeping a food diary and monitoring weight weekly and discussing these with the dietitian. The VLE/ketogenic diet used will involve replacing two meals, generally breakfast and lunch, with VLE products (Optifast meal replacements, or Optislim). Optifast products provide most of the vitamins, minerals, and metals required for optimal nutrition, and come as bars, shakes, or soups in a variety of flavours. Optifast will be provided to the participants. On the diet, one meal (generally dinner) comprises protein (e.g. white or red meat, fish or seafood, eggs, or tofu) and non-starchy vegetables/salad. In total, the diet contains 800 calories (3280 kilojoules) per day. Participants will be provided with guidelines and recipes for this meal but will have to source ingredients and prepare it themselves. Participants will be encouraged to aim to lose at least 10% body weight. Once participants reach this target they can choose whether to commence transition to maintenance or continue with the VLE/ketogenic diet program and aim for further weight loss. Transitioning off the VLE/ketogenic diet is done by reintroducing foods containing carbohydrates and moving to only one meal replacement per day. This transition phase usually lasts at least two weeks. After this, participants commence a healthy eating diet (weight management phase) which is consistent with the principles of the Commonwealth Scientific and Industrial Research Organisation (CSIRO) total wellbeing diet (i.e. high protein, low glycaemic index carbohydrate, low fat). Food choice during this phase is at the discretion of the participant. Participants are encouraged to weigh themselves regularly thereafter (e.g. once per week). Participants who regain 2 kilograms or more are advised to restart the VLE/ketogenic diet with meal replacements for 1-2 weeks. Clinicians: Physiotherapists and dietitians from private practice around metropolitan Melbourne will be recruited to deliver the exercise and diet programs respectively. Physiotherapists who have previously delivered a similar exercise program in people with hip osteoarthritis and who have treated at least 5 individuals with hip osteoarthritis in the last 12 months will be eligible to participate and will attend a face-to-face training session on the protocol and components of this feasibility study, delivered by the research staff. Dietitians who are delivering the same weight management intervention in the Better Knee, Better Me (BKBM) RCT (ACTRN12618000930280) will deliver the weight loss support for this feasibility study and will already be trained in Motivational Interviewing and relevant OA management. They will be provided with the protocol and appropriate training for this study. As part of the BKBM training, they will have attended a two-day face-to-face Motivational Interviewing course with an external consulting company, a half day workshop in evidence-based management of OA (delivered by members of the BKBM research team) and a 1-hour webinar delivered by the BKBM research team on the specifics of the VLCD. Delivery of the intervention: All participants will receive the physiotherapist and dietitian consultations online (i.e. video consultation using a computer and Zoom software). Videoconferencing software: Zoom videoconferencing will be used as a platform for video consultations. Zoom provides video, audio and content sharing to enable participant interaction. Participants will be sent instructions on how to set up Zoom and clinicians will be trained in its use. Telephone contact details to access research staff for support will be provided in case participants need additional assistance or encounter technical difficulties.