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Purpose: The effectiveness of a 12-month home-exercise program on trunk muscle strength after lumbar spine fusion surgery was evaluated. Three months postoperatively, 98 patients were randomized either to the exercise group (EG), with a progressive 12-month home-based exercise program, or to usual care group (UCG), with one guidance session for light home-exercises. Maximal trunk muscle strength was measured by a strain-gauge dynamometer and trunk extensor endurance was measured by Biering-Sørensen's test at baseline and after the intervention. The mean change in extension strength during the intervention was 75 N in EG and 58 N in UCG. Flexion strength improved 50 N in UCG and 45 N in EG. Trunk extension/flexion strength ratio changed from 0.90 to 1.02 in EG and from 0.98 to 1.00 in UCG. In EG, Biering-Sørensen's test improved by 17 s, and in UCG, it improved by 24 s. No statistically significant between-group differences were found in any variables. Median exercise frequency in EG decreased from 2.5×/week during the first two intervention months to 1.7×/week during the last two intervention months. Twelve-month progressive exercise program was equally effective as usual care in improving trunk muscle strength. Home exercise adherence decreased, which may have influenced the strength changes. The 12-month home-based exercise program was equally as effective as usual care after lumbar spine fusion (LSF) in improving trunk muscle strength, however, the back-specific exercises led to better trunk muscle strength balance in exercise group only. The adherence to the home based exercise program is a challenge; therefore, different techniques could be implemented to provide purposeful support for each individual in their long-term exercising. It is important to recognize those who need more individualized rehabilitation in recovery of the spine function, while others may manage with subtle intervention after LSF. [ABSTRACT FROM AUTHOR]

Purpose: Exercise therapy is an effective intervention in a variety of chronic diseases. The prescription of exercise therapy is usually directed toward an index disease. The presence of comorbidity may require adaptations to the exercise program as intended for the index disease. This paper aims to structure the clinical reasoning process of health professionals when prescribing exercise therapy for the individual patient with an index disease and comorbidity. Methods: We adapted the previously published strategy for developing guidelines and protocols on comorbidity-adapted exercise to a version that can be used for individual exercise prescription. Results: Essential steps and considerations involved in prescribing an exercise program to an individual patient with comorbidity are described. A case description is used as an example of how the proposed strategy leads to clinical decisions. Conclusions: The proposed strategy may have a role in educational and professional development. The advanced clinical expertise needed for safe and effective exercise therapy in patients with a complex health status is emphasized. The presence of comorbidity may require adaptations to exercise therapy. We describe the essential steps and considerations involved in prescribing an exercise program to an individual patient with an index disease and comorbidity. The proposed strategy can be used to structure the clinical reasoning process of health professionals. [ABSTRACT FROM AUTHOR]

E-Exercise is an effective 12-week blended intervention consisting of around five face-to-face physiotherapy sessions and a web-based application for patients with hip/knee osteoarthritis. In order to facilitate effective implementation of e-Exercise, this study aims to identify physiotherapists' experiences and determinants related to the usage of e-Exercise. Methods: An explanatory sequential mixed methods design embedded in a randomized controlled trial comparing e-Exercise with usual physiotherapy in patients with hip/knee osteoarthritis. Usage of e-Exercise was based on recruitment rates of 123 physiotherapists allocated to e-Exercise and objective web-based application usage data. Experiences and determinants related to e-Exercise usage were investigated with a questionnaire and clarified with semi-structured interviews. Results: Of the 123 physiotherapists allocated to e-Exercise, 54 recruited more than one eligible patient, of whom 10 physiotherapists continued using e-Exercise after the study period. Physiotherapists had mixed experiences with e-Exercise. Determinants related to intervention usage were appropriateness, added value, time, workload, professional autonomy, environmental factors, and financial consequences. Physiotherapists recommended to improve the ability to tailor e-Exercise to the individual needs of the patient patients' individual needs. Discussion: Determinants related to the usage of e-Exercise provided valuable information for the implementation of e-Exercise on broader scale. Most importantly, the flexibility of e-Exercise needs to be improved. Next, there is a need for education on how to integrate an online program within physiotherapy. [ABSTRACT FROM AUTHOR]

Purpose:Delivery of exercise interventions to patients with early-stage breast cancer undergoing chemotherapy requires complex clinical decisions. The purpose of this study was to develop a framework to support clinical decisions for tailoring exercise interventions to common comorbidities and cancer treatment-induced adverse effects. Method:Tailored exercise prescriptions were developed in four steps, following the i3-S strategy. All steps were based on current best available evidence, complemented with expert opinions. First, common comorbidities and treatment-induced adverse effects were identified. In the subsequent steps, contra-indications and restrictions for exercise were described, along with possible exercise adaptations. In the final step, the obtained information was synthesized into a framework. Results:Prevalent comorbidities were hypertension, heart disease, diabetes mellitus, (osteo)arthritis, chronic obstructive pulmonary disease, and obesity. Adverse effects included conditions induced by pretreatment (e.g., lymphedema as a result of surgery) or by chemotherapy (e.g., reduced blood cell counts). Adaptations to the recommended exercise program were related to exercise tolerance, safety, and hygiene. A framework was proposed to guide clinical decisions during the exercise intervention. Conclusion:Comorbidities and adverse effects of breast cancer treatment require exercise adaptations. The proposed framework provides guidance on tailored exercise prescriptions in patients with breast cancer undergoing chemotherapy.Implications for RehabilitationExercise is recommended for patients with breast cancer undergoing chemotherapy, but requires complex clinical decisions of the health professional.We identified the most important comorbidities and adverse effects of breast cancer treatment, and the resultant contra-indications and restrictions to exercise.We incorporated these findings into a clinical decision framework that provides suggestions for exercise adaptations in patients with breast cancer undergoing chemotherapy. [ABSTRACT FROM PUBLISHER]

Purpose:Psychological adjustment has a major impact on chronic disease health outcomes. However, the classification of psychological adjustment is unclear in the current version of the International Classification of Functioning, Disability and Health (ICF). We aim (i) to characterize the process of psychological adjustment to chronic disease, and (ii) to analyze how various categories of the psychological adjustment process could be incorporated into the ICF. Method:We provide a summary of models of psychological adjustment to chronic disease. We also evaluate various options for incorporating categories of psychological adjustment into the ICF. Results:Acute and ongoing illness stressors; emotional, cognitive and behavioral responses; personal background; and social and environmental background are major categories in the adjustment process. These categories could, in principle, be integrated with various components of the ICF. Any future revision of the ICF should explicitly incorporate psychological adjustment and its (sub)categories. Conclusion:The ICF could incorporate categories of psychological adjustment to chronic disease, although several adaptations and clarifications will be required.Implications for RehabilitationIn the context of an ageing society and large numbers of people living with chronic diseases, it is essential to understand psychological adjustment to chronic disease.However, the classification of psychological adjustment to chronic disease is unclear in the current version of the International Classification of Functioning, Disability and Health (ICF).We demonstrate that the ICF could incorporate categories of psychological adjustment to chronic disease, although several adaptations and clarifications would first be required.We suggest that these adaptations and clarifications should be considered in any future revision of the ICF. [ABSTRACT FROM PUBLISHER]

Purpose: Exercise therapy is effective in a wide range of chronic diseases. Comorbid disease necessitates adaptations to exercise therapy. Guidance on how to develop such adaptations is currently not available. We present an innovative strategy for the development of comorbidity-related adaptations to exercise therapy in an index disease.Method: We previously developed comorbidity-related adaptations to exercise therapy in osteoarthritis. We now broaden this approach into a general strategy for the development of comorbidity-related adaptations to exercise therapy in an index disease.Results: The i3-S strategy consists of four steps. The first three steps involve creating an inventory of comorbid disease, an inventory of contraindications and restrictions on exercise therapy, and an inventory of potential adaptations to exercise therapy. In the fourth step, this information is synthesized into guidance on comorbidity-related adaptations to exercise therapy in the index disease. The adaptations concern physiological, behavioural and environmental factors.Conclusion: In view of the general effectiveness of exercise therapy and the high prevalence of comorbidity in older people, there is a great need for comorbidity-related adaptations to exercise therapy. We recommend to use and evaluate the i3-S strategy in future research.Implications for RehabilitationExercise therapy is effective in a wide range of chronic diseases.Comorbid disease necessitates adaptations to exercise therapy. Guidance on how to develop such adaptations is currently not available.We present an innovative strategy for the development of comorbidity-related adaptations to exercise therapy in an index disease.Researchers and clinicians can use this strategy to develop guidance on the adaptation of exercise therapy to comorbidity. [ABSTRACT FROM PUBLISHER]

Purpose: To explore the associations between (improvement in) fatigue and (improvement in) clinical and cognitive factors in patients with chronic widespread pain (CWP), participating in multidisciplinary rehabilitation treatment. Methods: Data were used from baseline, 6 and 18 months of follow-up during a prospective cohort study of 120 CWP patients who completed multidisciplinary rehabilitation treatment. Cross-sectional and longitudinal relationships were analyzed between fatigue, clinical (i.e. pain, interference of pain and depression) and pain related cognitive factors (i.e. negative emotional cognitions, active cognitive coping, and control and chronicity beliefs). Results: Higher levels of pain, interference of pain, depression, negative emotional cognitions, and negative control and chronicity beliefs were associated with a higher level of fatigue. Improvement in depression was related to improvement in fatigue. Conclusions: In CWP patients, worse clinical status, and dysfunctional pain-related cognitions are associated with a higher level of fatigue. Our results suggest that improvement in depression might be a mechanism of improvement in fatigue. Furthermore, improvement in fatigue seems to be independent of improvement in pain related cognitions. Targeting fatigue in multidisciplinary pain treatment may need specific strategies. [ABSTRACT FROM AUTHOR]

Background: Exercise interventions in physical therapy (PT) are often not well described in research reports. Omitting details of the intervention hampers the transfer to daily clinical practice. Objective: To develop a framework for describing goals and content of exercise interventions, in order to provide structured and detailed information for use in research reports. Methods: A framework was developed in three steps using a mixed method approach. First, the scientific literature was systematically searched for available methods to describe PT interventions. An inventory of these methods was made and relevant elements were extracted. Second, based on the results of the literature search, a global framework was developed by a focus group of experts in the field of PT. Third, the framework was field tested by describing four different exercise interventions, leading to a final version. Results: In the developed framework intervention goals at the level of body functions and activities/participation were listed using the International Classification of Functioning, Disability and Health. To guide the description of the content of the exercise intervention a list of intervention details was developed, which was derived from an existing classification of PT interventions. Goals and content of exercise interventions were linked. Field testing of the framework led to adequate descriptions of exercise interventions. Conclusion: The developed framework is a promising first step in offering a feasible guide for a structured and detailed description of goals and content of exercise interventions within research reports. [ABSTRACT FROM AUTHOR]

Purpose: To assess the efficacy of client-centred occupational therapy (OT) according to a client-centred process framework, as compared to usual care OT, in patients with multiple sclerosis (MS). Method: A multicentre cluster randomised controlled trial with the institution (i.e. hospital or rehabilitation centre) as the unit of randomisation was performed. A total of 269 outpatients with MS, 13 hospitals and rehabilitation centres and 29 occupational therapists participated. Primary outcomes included measures of disability, participation and autonomy. Secondary outcomes included fatigue, generic health-related quality of life, quality and evaluation of therapy, therapy compliance and therapy frequency. Measurements were taken at baseline, four months and at eight months follow-up. Results: Primary outcome measures did not show significant differences between the two interventions. Secondary outcomes revealed significant differences in favour of the usual care OT on fatigue (physical scale and total scale) and health-related quality of life (bodily pain and vitality) at four months. After eight months only significant differences on mental health were found. Process outcomes (i.e. the information scale of therapy quality and the client-centredness of the organisation) were in favour of the client-centred intervention. Conclusion: Because the client-centred intervention resulted in no effects on the primary outcomes and small but negative effects on the secondary functional outcomes, we should seriously reconsider the application of client-centred practice. [ABSTRACT FROM AUTHOR]

Background: Osteoarthritis (OA) has a very high rate of comorbidity. Exercise therapy is recommended in current guidelines on the management of OA of the hip and knee. Unfortunately, current protocols and guidelines for exercise therapy in OA of the hip and knee do not offer advice concerning comorbidity-associated adaptations for exercise therapy in OA patients. Because of the high prevalence of comorbidity in OA, it is important to establish when exercise therapy for OA of the hip and knee should be adapted when patients have one or more comorbidities. Objective: To identify restrictions and contraindications for exercise therapy for common comorbidities (cardiac diseases, hypertension, type 2 diabetes, obesity, chronic obstructive pulmonary disease (COPD), depression, chronic pain, low back pain (LBP), visual or hearing impairments, and chronic cystitis) in hip and knee OA patients. Major findings: Cardiac diseases, hypertension, type 2 diabetes, COPD, and chronic cystitis are associated with restrictions resulting from physiological impairments. Conversely, LBP, chronic pain syndromes, and depression are associated with psychological and behavioural restrictions to exercise therapy. Visual and hearing impairments result predominantly in environmental restrictions to exercise. Obesity is associated with restrictions resulting from physiological and psychological impairments and behavioural barriers. Several absolute contraindications exist and patient safety cannot be guaranteed when these are not taken into account during exercise therapy. Conclusion: Restrictions and contraindications for exercise in patients with OA of the hip and knee and comorbidity have been identified. This overview is helpful in decisions on the treatment of patients and will be instrumental in the development of a protocol for comorbidity related adaptations in exercise therapy for OA patients. [ABSTRACT FROM AUTHOR]

Purpose: To identify outcome predictors for multidisciplinary treatment in patients with chronic widespread pain (CWP) or fibromyalgia (FM). Methods: A systematic literature search in PubMed, PsycINFO, CINAHL, Cochrane Library, EMBASE and Pedro. Selection criteria included: age over 18; diagnosis CWP or FM; multidisciplinary treatment; longitudinal study design; original research report. Outcome domains: pain, physical functioning, emotional functioning, global treatment effect and 'others'. Methodological quality of the selected articles was assessed and a qualitative data synthesis was performed to identify the level of evidence. Results: Fourteen studies (all with FM patients) fulfilled the selection criteria. Six were of high quality. Poorer outcome (pain, moderate evidence; physical functioning and quality of life, weak evidence) was predicted by depression. Similarly, poorer outcome was predicted by the disturbance and pain profile of the Minnesota Multiphasic Personality Inventory (MMPI), strong beliefs in fate and high disability (weak evidence). A better outcome was predicted by a worse baseline status, the dysfunctional and the adaptive copers profile of the Multidimensional Pain Inventory (MPI), and high levels of pain (weak evidence). Some predictors were related to specific multidisciplinary treatment (weak evidence). Inconclusive evidence was found for other demographic and clinical factors, cognitive and emotional factors, symptoms and physical functioning as predictors of outcome. Discussion: It was found that a higher level of depression was a predictor of poor outcome in FM (moderate evidence). In addition, it was found that the baseline status, specific patient profiles, belief in fate, disability, and pain were predictors of the outcome of multidisciplinary treatment. Our results highlight the lack of high quality studies for evaluating predictors of the outcome of multidisciplinary treatment in FM. Further research on predictors of multidisciplinary treatment outcome is needed. [ABSTRACT FROM AUTHOR]

Purpose: To assess psychometric properties of the Western Ontario and MacMasters Universities Osteoarthritis Index (WOMAC)-pf, an osteoarthritis (OA)-specific questionnaire used to establish the level of physical functioning in patients with late-onset sequels of poliomyelitis (LOSP) and Parkinson's disease (PD). Study design and setting: Unidimensionality (using principal component analyses [PCA] and Rasch analyses) was separately established for three diagnostic groups: OA (n = 288), LOSP (n = 168) and PD (n = 200). Additionally, differential item functioning (DIF) among the three diagnostic groups was assessed using ordinal regression (Polytomous Universal Model) analyses. Baseline data were used from an ongoing cohort study of these three patient populations. Results: Unidimensionality was adequate, with all items loading on the first principal component. The Rasch analyses revealed that item fit was generally good. Uniform and non-uniform DIF were found to be present among the three diagnostic groups in three and one of the 17 physical functioning subscale (WOMAC-pf) items, respectively. Conclusion: The WOMAC-pf is a unidimensional measure of physical functioning in patients with LOSP and PD, in addition to its established use in OA. [ABSTRACT FROM AUTHOR]

Purpose. (i) To determine whether adaptations for non-native patients have been implemented in pain rehabilitation programmes; (ii) to determine whether characteristics of the rehabilitation institute are related to having adaptations for non-native patients in place. Subjects. Rehabilitation institutes and rehabilitation departments of general hospitals in The Netherlands who offer a pain rehabilitation programme. Method. A questionnaire was handed over in person or by e-mail to the rehabilitation physicians of the participating institutes. Twenty-seven (90%%) questionnaires were returned. The questionnaire concerned programme adaptations and institute characteristics. The data were analysed by χχ2 tests or Fischer's exact tests and logistic regression analysis. Results. Twelve institutes (44.4%%) reported having adaptations in place for non-native patients in their pain rehabilitation programme. The most common adaptations were as follows: increased number of consultations (25.9%% of the institutes); longer consultations (25.9%%) and education for employees regarding cultural competency (11.1%%). Institutes which treated a high percentage (≥≥11%%) of non-native patients had implemented significantly more frequently adaptations to their rehabilitation programme ( p == 0.04). The number of adaptations was neither associated with the proportion of non-native citizens in the local population nor with the number of the institutes' employees. Conclusion. Less than half of the institutes had implemented one or more programme adaptations for non-native patients. Institutes which had made adaptations to their rehabilitation programme treated more non-native patients. [ABSTRACT FROM AUTHOR]

Coping strategies were compared across adolescents and young adults with several chronic digestive disorders and healthy peers, and across age groups. Subsequently, the impact of coping on performance in school and leisure activities was investigated. Participants were adolescents and young adults (age 12 to 25 years) suffering from inflammatory bowel diseases (IBD), chronic liver diseases, congenital diseases, coeliac disease or food allergy (total n   =  521) and healthy controls ( n   =  274). For comparison reasons, a generic coping measuring instrument was employed: the shortened version of the Coping Inventory for Stressful Situations (CISS-21). The CISS-21 assesses three meta coping strategies: task-oriented, emotion-oriented and avoidance coping. Comparisons between several groups only revealed less use of coping strategies in the youngest adolescents. No differences were found among diagnostic groups, nor between diagnostic groups and control group. Coping was found to be related to school and leisure activities of adolescents and young adults with chronic digestive disorders. [ABSTRACT FROM AUTHOR]

Objective: When comparing outcomes of the Functional Independence Measure (FIM™) between patient groups, item characteristics of the FIM™ should be consistent across groups. The purpose of this study was to compare item difficulty of the FIM™ in 3 patient groups with neurological disorders. Subjects: Patients with stroke ( n =295), multiple sclerosis ( n =150), and traumatic brain injury ( n =88). Methods: FIM™ scores were administered in each group. The FIM™ consists of a motor domain (13 items) and a cognitive domain (5 items). Rasch rating scale analysis was performed to investigate differences in item difficulty (differential item functioning) between groups. Results: Answering categories of the FIM™ items were reduced to 3 (from the original 7) because of disordered thresholds and low answering frequencies. Two items of the motor domain (“bladder” and “bowel”) did not fit the Rasch model. For 7 out of the 11 fitting motor items, item difficulties were different between groups (i.e. showed differential item functioning). All cognitive items fitted the Rasch model, and 4 out of 5 cognitive items showed differential item functioning. Conclusion: Differential item functioning is present in several items of both the motor and cognitive domain of the FIM™. Adjustments for differential item functioning may be required when FIM™ data will be compared between groups or will be used in a pooled data analysis. [ABSTRACT FROM AUTHOR]

Clinimetrics in rehabilitation medicine, i.e. the field of developing, evaluating and applying measurement instruments, has undergone considerable progress. Despite this progress, however, several issues remain. These include: (i) selection of an instrument out of the wide range available; (ii) using an instrument in a variety of diagnostic groups; (iii) using an instrument in individual patients, as opposed to a group of patients; and (iv) the use of instruments in clinical practice. This paper reviews these issues, as well as current attempts at resolving them. Illustrative examples are given. It is concluded that solutions seem to be available, but considerable research effort is required to make these a reality. Clinimetrics in rehabilitation medicine remains a field with challenging opportunities for research. [ABSTRACT FROM AUTHOR]

The objective of the present study was to determine in a controlled study the efficacy of strategy training in left hemisphere stroke patients with apraxia. A total of 113 left hemisphere stroke patients with apraxia were randomly assigned to two treatment groups; (1) strategy training integrated into usual occupational therapy and (2) usual occupational therapy only. Assessments took place at baseline, after an 8 week treatment period and 5 months after baseline (follow-up). Patients were assessed on apraxia, motor functioning and activities of daily living (ADL). The primary outcome measure was a standardised ADL observation by a blinded research assistant. Additional ADL measures were used as secondary outcome measures (Barthel ADL index, ADL judgement by occupational therapist and by patient). After 8 weeks of treatment, patients who received strategy training (n = 43) improved significantly more than patients in the usual treatment group (n = 39) on the ADL observations (mean change .24; 90% CI, .15–.34 vs. .12, .03–.21). This reflects a small to medium effect (effect size .37) of strategy training on ADL functioning. With respect to the secondary outcome measures a medium effect (effect size .47) was found on the Barthel ADL index. No beneficial effects of strategy training were found after 5 months (at follow-up). In this trial evidence was found for the short-term effectiveness of strategy training in left hemisphere stroke patients with apraxia. [ABSTRACT FROM AUTHOR]

The objective of the present study was to determine the clinical and construct validity of the assessment of disabilities in stroke patients with apraxia. Disabilities were assessed by means of observation of activities of daily living (ADL), such as washing the face and upper body and putting on a blouse or shirt. The study was carried out at occupational therapy departments in general hospitals, rehabilitation centres, and nursing homes. Patients diagnosed to have had a stroke in the left hemisphere and to have apraxia participated in the study (n = 45, 21 males, 24 females age 39–91). Guidelines were offered for the ADL observations and the assessment of disabilities in these activities. Clinical validity was investigated by comparing the scores of the patients with those of a group of stroke patients without apraxia (n = 36, 14 males, 22 females age 35–88). Construct validity was examined by investigating relationships between several measures of interest: an apraxia test, a motor functioning test, a set of ADL observations, and the Barthel index as a general measure of disability. Comparison of the results of the patients with apraxia with the control group of stroke patients without apraxia showed that the clinical validity of the ADL observations is good: On the basis of the ADL observations, differences between patients with apraxia and patients without apraxia are measured. Correlation analyses of the group of patients with apraxia showed that the ADL observations were highly associated with apraxia, but only to a lesser degree with motor impairments; while motor impairments correlated strongly with the Barthel index (a general measure of physical disability), but only marginally with ADL observations. A LISREL analysis supported these findings. The results indicate that ADL observations have clinical validity and that the construct validity of the observational method is good. ADL observations appear to measure disability ties caused by apraxia in stroke patients. [ABSTRACT FROM AUTHOR]

The internal consistency and the diagnostic value of a test for apraxia in patients having had a stroke are presented. Results indicate that the items of the test form a strong and consistent scale: Cronbach's alpha as well as the results of a Mokken scale analysis present good reliability and good scalability. The diagnostic value of the test was determined by comparison of test results in three groups of patients: 44 stroke patients with apraxia (patients), 35 stroke patients without apraxia (patient controls), and 50 healthy nursing home residents with no history of stroke (normal controls). The diagnostic value is expressed by means of the sensitivity and specificity and the predictive value of the test. In addition, Receiver Operator Characteristics (ROC) curves are presented. The sensitivity and specificity of the apraxia test appear to be good: all values are higher than 80%. The test also has high predictive value. The ROC curves illustrate that the test is sufficiently discriminative to allow a differentiation between persons with apraxia and persons without apraxia. [ABSTRACT FROM AUTHOR]

A 5-8 year follow-up was conducted on 140 couples treated for sexual dysfunctions, of whom 88 couples (63%) actually participated. Differences between participant and nonparticipant clients were analyzed. Clients evaluated various aspects of their sexual and nonsexual functioning before and after therapy and in the follow-up period. The correlation between retrospective and original pre- and post-therapeutic data was determined. The effects of treatment for couples not divorced or given additional therapy, couples who separated, and couples given additional therapy were analyzed and compared. The treatments generally led to increased satisfaction about sexual and nonsexual interaction with the partner. The improvement was found to be fairly stable in the follow-up. [ABSTRACT FROM PUBLISHER]

The article presents the authors' reply to the commentary on their article which discusses the restrictions and contraindications on exercise therapy for hip and knee osteoarthritis (OA) patients. Topics discussed include adherence to exercise program, guidelines for hip and knee OA management, and comorbid diseases.

The article presents a response to a commentary on the article "Restrictions and contraindications for exercise therapy in patients with hip and knee osteoarthritis and comorbidity" by M. de Rooij and colleagues. It discusses contraindications for osteoarthritis (OA) exercise therapy for people with cardiac diseases, hypertension, type 2 diabetes and chronic obstructive pulmonary disease. The article also discusses the development of a patient-specific comorbidity-adapted exercise protocol.