Exercise Programs for Knee Arthritis

(CaRE Trial)

Overseen By Gaupp

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Recruiting

Sponsor: University of Pittsburgh

Disqualifiers: Cardiovascular disease, Hypertension, Inflammatory disorders, others

No Placebo Group

Trial Summary

What is the purpose of this trial?

This pilot randomize trial tests the feasibility of administering two different exercise programs in people with knee osteoarthritis. One group receives the exercise program administered as usual, and the other group received the exercise program with resting intervals.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. However, if you have a history of cardiovascular disease or hypertension, it must be controlled by medication to participate.

What data supports the effectiveness of the treatment Exercise without Rest, Exercise with Rest for knee arthritis?

Research shows that exercise programs, including home-based exercises and therapeutic exercises, are effective in reducing pain and improving function in people with knee arthritis. Different types of exercises, such as strengthening and aerobic exercises, can be beneficial when done at appropriate levels. ^{1 2 3 4 5}

Is exercise safe for people with knee arthritis?

Exercise is generally safe for people with knee arthritis, with few side effects or risks. It is recommended as a first-line treatment and can help reduce pain and improve function. ^{4 5 6 7 8}

How does the 'Exercise without Rest, Exercise with Rest' treatment for knee arthritis differ from other treatments?

This treatment is unique because it focuses on specific exercise regimens, either continuous or with rest periods, to manage knee arthritis, unlike traditional treatments that may rely more on medication or surgery. It emphasizes strengthening exercises, particularly for the quadriceps, which can help improve pain and function in the knee. ^{9 10 11 12 13}

Research Team

Sara Piva

Principal Investigator

University of Pittsburgh

Eligibility Criteria

This trial is for people with knee osteoarthritis. It's designed to see if they can participate in two different exercise programs—one with rest breaks and one without. Specific eligibility details are not provided, so general health status may be considered.

Inclusion Criteria

I lead a sedentary lifestyle.

I am between 45 and 79 years old.

BMI range of 25 to 35 kg/m2

Exclusion Criteria

I use a cane, walker, or crutches to walk.

Contraindication to MRI

Pregnant female

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo an exercise program 3 times a week for 12 weeks, with or without resting intervals

12 weeks

36 visits (in-person)

Assessment

Participants undergo assessments including gait analysis, MRI imaging, muscle strength tests, and questionnaires

1-2 weeks

Follow-up

Participants are monitored for adherence, retention, and safety of interventions

4 weeks

Treatment Details

Interventions

• Exercise without Rest (Behavioral Intervention)
• Exercise with Rest (Behavioral Intervention)

Trial Overview The study compares the feasibility of two exercise regimens for those with knee arthritis: a standard program versus one that includes rest periods. Participants will be randomly assigned to either group to evaluate which method works best.

Participant Groups

Group I: Exercise With Rest Experimental Treatment 1 Intervention

Participants in this arm exercise 3 times a week for 12 weeks. Exercise program consists of warm-up, strengthening exercises of the lower major extremity muscle groups, and aerobic training using a treadmill. These sessions include two 45 minute rest periods between exercises and take about two and a half hours.

Group II: Exercise Without Rest Active Control 1 Intervention

Exercise without Rest

Who Is Running the Clinical Trial?

University of Pittsburgh

Lead Sponsor

Trials

1,820

Recruited

16,360,000+

Carnegie Mellon University

Collaborator

Trials

80

Recruited

540,000+

Findings from Research

In a randomized controlled trial with 48 participants, both sensory-motor training and resistance training showed similar effectiveness in improving symptoms of knee osteoarthritis, as measured by the WOMAC index after 8 weeks.

Resistance training led to significant improvements in pain levels during movement and quality of life after 4 and 8 weeks, respectively, suggesting it may offer additional benefits over sensory-motor training in these specific areas.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Sensory-motor training versus resistance training in the treatment of knee osteoarthritis: A randomized controlled trial. Kuş, G., Tarakçı, E., Razak Ozdincler, A., et al.[2023]

A randomized controlled trial involving 40 adults with knee osteoarthritis showed that adding mobilisation with movement to usual care significantly improved disability, pain, and function over six months, with a mean difference of 7.4 points in disability at six months.

Participants receiving mobilisation with movement reported better outcomes in all measured areas, except for knee mobility, indicating that this intervention can enhance overall patient satisfaction and functional abilities in managing knee osteoarthritis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Long term efficacy of mobilisation with movement on pain and functional status in patients with knee osteoarthritis: a randomised clinical trial. Nigam, A., Satpute, KH., Hall, TM.[2022]

A study involving 80 patients with knee osteoarthritis showed that both home exercise programs significantly improved knee range of motion, muscle strength, and overall function, as measured by various health indices.

However, patients who received guidance from a physiotherapist experienced greater improvements compared to those who followed an exercise brochure alone, highlighting the added value of professional support in home exercise therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison of effectiveness of the home exercise program and the home exercise program taught by physiotherapist in knee osteoarthritis. Yilmaz, M., Sahin, M., Algun, ZC.[2019]

Recent systematic reviews and clinical trials indicate that progressive resistance training and aerobic exercise have a modest positive effect on strength, pain, and function in older adults and those with knee arthritis.

However, there is little evidence that exercise programs effectively prevent disability, suggesting that current exercise strategies may need to be revised or new approaches developed to better address disability outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exercise: necessary but not sufficient for improving function and preventing disability? Keysor, JJ., Brembs, A.[2011]

Therapeutic exercise is a safe and effective first-line treatment for patients with knee and hip osteoarthritis, with various types of exercises (like aerobic and strengthening) improving pain and function when performed at recommended dosages.

To enhance adherence to therapeutic exercise, strategies such as patient education and goal-setting are beneficial, especially since many patients face barriers to achieving the ideal exercise dosage.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Guidance for Implementing Best Practice Therapeutic Exercise for Patients With Knee and Hip Osteoarthritis: What Does the Current Evidence Base Tell Us? Holden, MA., Button, K., Collins, NJ., et al.[2022]

Exercise is an effective intervention for reducing pain and improving function in individuals with knee osteoarthritis, and it also provides pain relief for those with hip osteoarthritis, based on a review of multiple studies.

Despite the positive outcomes, there is a lack of clarity regarding the optimal frequency, dose, and duration of exercise for managing osteoarthritis, highlighting the need for more standardized research in this area.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Managing Hip and Knee Osteoarthritis with Exercise: What is the Best Prescription? Iversen, MD.[2021]

A 12-week lower-body positive pressure (LBPP)-supported treadmill exercise program significantly reduced knee pain and improved joint function in 19 overweight patients with knee osteoarthritis, with benefits maintained for at least 6 months after the program ended.

Participants also retained gains in thigh muscle strength and reported continued improvements in quality of life, indicating that this exercise strategy could be effective for long-term management of knee OA symptoms.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of Body Weight-Supported Exercise on Symptoms of Knee Osteoarthritis: A Follow-up Investigation. Peeler, J., Leiter, J., MacDonald, P.[2021]

Exercise is a safe and effective intervention for patients with knee osteoarthritis (OA), showing minimal adverse side effects, making it a suitable treatment option for managing the disease.

Obesity is identified as the most modifiable risk factor for knee OA, and the article discusses how weight loss and exercise can positively impact the condition, emphasizing the importance of these interventions in clinical practice.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Diet and exercise for obese adults with knee osteoarthritis. Messier, SP.[2022]

A 5-week quadriceps-strengthening exercise program was feasible for an elderly man with severe dementia and knee osteoarthritis, indicating that such nonpharmacologic treatments can be implemented in this population.

While the exercise program improved the patient's sleep, the effectiveness on pain relief was inconclusive due to the inadequacy of the pain measurement tool for individuals with low cognitive functioning.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Feasibility of using quadriceps-strengthening exercise to improve pain and sleep in a severely demented elder with osteoarthritis - a case report. Tsai, PF., Richards, K., FitzRandolph, R.[2020]

The straight leg raise (SLR) exercise showed greater activation of the vastus medialis (VM) muscle compared to single leg stance and bilateral squat exercises, indicating its effectiveness in knee rehabilitation.

Among the weight-bearing exercises, step-up and unilateral leg press exercises resulted in the highest VM activation, suggesting they may be beneficial for progressing rehabilitation after SLR.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Vastus medialis activation during knee extension exercises: evidence for exercise prescription. Bolgla, LA., Shaffer, SW., Malone, TR.[2022]

Mind-body exercise programs, such as Hatha Yoga and Tai Chi, have been shown to effectively improve pain relief and physical function in patients with knee osteoarthritis, based on a systematic review of high-quality studies.

Hatha Yoga and Tai Chi Qigong received high grades for their effectiveness, with significant improvements noted in pain relief and quality of life, making them valuable non-traditional exercise options for managing knee osteoarthritis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part one: introduction, and mind-body exercise programs. Brosseau, L., Taki, J., Desjardins, B., et al.[2022]

Billie Jean King effectively managed her knee arthritis through a vigorous exercise program, demonstrating the potential benefits of physical activity for arthritis control.

Her experience highlights the importance of exercise as a therapeutic intervention for individuals with arthritis, suggesting that it can lead to improved joint function and overall well-being.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

King vs Arthritis: Advantage, King. Duda, M.[2016]

A systematic review of 26 high-quality studies found that various strengthening exercise programs significantly improve pain relief, physical function, and quality of life for patients with knee osteoarthritis within a six-month period.

Combining strengthening exercises with other therapeutic activities, like coordination and balance training, further enhances these benefits, indicating a comprehensive approach may be more effective for managing knee osteoarthritis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part two: strengthening exercise programs. Brosseau, L., Taki, J., Desjardins, B., et al.[2022]

References

1. England pubmed.ncbi.nlm.nih.gov

Sensory-motor training versus resistance training in the treatment of knee osteoarthritis: A randomized controlled trial. [2023]

2. England pubmed.ncbi.nlm.nih.gov

Long term efficacy of mobilisation with movement on pain and functional status in patients with knee osteoarthritis: a randomised clinical trial. [2022]

3. Netherlands pubmed.ncbi.nlm.nih.gov

Comparison of effectiveness of the home exercise program and the home exercise program taught by physiotherapist in knee osteoarthritis. [2019]

4. United States pubmed.ncbi.nlm.nih.gov

Exercise: necessary but not sufficient for improving function and preventing disability? [2011]

5. United States pubmed.ncbi.nlm.nih.gov

Guidance for Implementing Best Practice Therapeutic Exercise for Patients With Knee and Hip Osteoarthritis: What Does the Current Evidence Base Tell Us? [2022]

6. England pubmed.ncbi.nlm.nih.gov

Managing Hip and Knee Osteoarthritis with Exercise: What is the Best Prescription? [2021]

7. United States pubmed.ncbi.nlm.nih.gov

Effect of Body Weight-Supported Exercise on Symptoms of Knee Osteoarthritis: A Follow-up Investigation. [2021]

8. United States pubmed.ncbi.nlm.nih.gov

Diet and exercise for obese adults with knee osteoarthritis. [2022]

9. England pubmed.ncbi.nlm.nih.gov

Feasibility of using quadriceps-strengthening exercise to improve pain and sleep in a severely demented elder with osteoarthritis - a case report. [2020]

10. United States pubmed.ncbi.nlm.nih.gov

Vastus medialis activation during knee extension exercises: evidence for exercise prescription. [2022]

11. England pubmed.ncbi.nlm.nih.gov

The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part one: introduction, and mind-body exercise programs. [2022]

12. England pubmed.ncbi.nlm.nih.gov

King vs Arthritis: Advantage, King. [2016]

13. England pubmed.ncbi.nlm.nih.gov

The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part two: strengthening exercise programs. [2022]