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International guidelines recommend exercise as the first choice treatment for knee osteoarthritis (KOA). Muscle strengthening training (MST) and behavioural graded activity (BGA) show comparable effects on KOA pain, but the mechanisms of action are unclear. Understanding these mechanisms is necessary to tailor exercise therapy towards specific mediators and thereby optimize treatment effects. Based on previous studies, both exercise-induced anti-inflammation and endogenous analgesia are promising pathways for pain reduction after exercise therapy. This study aims to examine (anti)-inflammation and endogenous analgesia as mediators for the effect of MST and/or BGA on pain in patients with KOA. Therefore, a 3-arm randomized clinical trial is established: 12 weeks of muscle strengthening training, behavioural graded activity or control. Mediator analysis will be performed. Unravelling the mechanisms of action of exercise therapy in KOA will not only be extremely valuable for researchers, but also for exercise immunology and pain scientists. The results of this research will also find their way into clinical practice: thanks to the current project, tailoring exercise therapy programs towards specific mechanistic factors and thereby optimizing treatment effects will be at the horizon for patients suffering from KOA.

LK3 Laptops & Desktops Driver Download


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Condition or disease Intervention/treatment Phase
Knee OsteoarthritisOther: Muscle Strengthening TrainingBehavioral: Behavioral graded activityNot Applicable

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Lk3 Laptops & Desktops Driver Downloads

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Layout table for study information
Study Type : Interventional (Clinical Trial)
Estimated Enrollment :90 participants
Allocation:Randomized
Intervention Model:Parallel Assignment
Intervention Model Description:

The patients will be randomly allocated to 12 weeks of either muscle strengthening training (MST), behavioural graded activity (BGA) or control. Randomization will be performed by using the method of randomly permuted blocks, utilising a computer-generated random number sequence. To keep both intervention groups balanced, randomization will be stratified for sex (male versus female) baseline inflammation status (hsCRP<3mg/L versus hsCRP ≥3mg/L) and baseline central sensitization status (central sensitization inventory (CSI) score <40 versus CSI score ≥ 40).

A list with patient numbers and the group allocation that results from this randomization procedure will be securely stored and only an independent researcher will have direct access to the randomization list. Patients will be scheduled to receive their first assessment within 1 week of randomisation.

Patients will be recruited in primary care and participating hospitals. Announcements will be placed in newspapers, pharmacies etc.

Masking: Triple (Care Provider, Investigator, Outcomes Assessor)
Masking Description: Outcome assessors will be blinded to the maximal extent possible. With regard to this, patients will be asked not to communicate with the assessors about the intervention received. The researcher who is responsible for the acute measurements, is not blinded for group allocation but the researcher responsible for the basal measurements is. Both researchers are blinded for the outcome analyses. Furthermore, at the end of each assessment, the success of assessor blinding will be examined by asking whether the assessor thought the participant had received the experimental or control intervention, including the percentage of certainty. The physiotherapists providing BGA will not be involved in providing MST, and vice versa. Additionally, the physiotherapists will be blinded for outcome measures. The statistician will be blinded to the allocation of the treatment groups and statistical analyses will be performed in a blinded manner.
Primary Purpose: Basic Science
Official Title:Exercise Therapy for Osteoarthritis Pain: How Does it Work?
Actual Study Start Date :January 10, 2020
Estimated Primary Completion Date :December 31, 2022
Estimated Study Completion Date :December 31, 2022
Resource links provided by the National Library of MedicineLK3 Laptops & Desktops Driver DownloadDownload
MedlinePlus Genetics related topics: Osteoarthritis
MedlinePlus related topics: Exercise and Physical FitnessOsteoarthritis