Exercise for Chronic Knee Pain

Overseen By Kosaku Aoyagi, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Texas, El Paso

Must not be taking: Opioids

Disqualifiers: Peripheral neuropathy, Pregnancy, Cognitive impairment, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 3

Duration: 2 days (separated by at least 1 week)

60 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

The objective of the study is to explore the effects of arm exercise (UE, arm ergometer) vs. leg exercise (LE, cycling ergometer) on exercise-induced hypoalgesia (EIH), central pain mechanisms and knee pain in people with knee osteoarthritis (OA). Furthermore, we will explore relations of socioeconomic status, racial discrimination, acculturative stress, and autonomic function to exercise effects on EIH, central pain mechanisms, and knee pain. This will be a pilot randomized cross-over study where all participants undergo Day 1 (baseline assessments), Day 2 (UE or LE), and Day 3 (UE or LE).

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but it excludes those who use opioids regularly. It's best to discuss your specific medications with the trial coordinators.

Is exercise safe for people with chronic knee pain?

Exercise is generally safe for people with chronic knee pain and can help reduce pain and improve function. Unlike some pain medications, exercise does not have harmful side effects and can improve muscle strength and overall health. ^{1 2 3 4 5}

How is exercise different from other treatments for chronic knee pain?

Exercise is a non-drug treatment that helps reduce pain and improve function in knee osteoarthritis by strengthening muscles, improving joint movement, and increasing physical activity levels. Unlike medications, it doesn't have side effects and can be tailored to individual needs, including weight loss and addressing other health conditions. ^{1 2 6 7 8}

What data supports the effectiveness of the treatment Exercise, Physical Activity, Workout, Fitness Training for chronic knee pain?

Research shows that exercise and physical activity can improve pain and function in people with knee osteoarthritis, a common cause of chronic knee pain. High-intensity exercise may offer greater health benefits, and task-specific training has been shown to improve pain and function in individuals with chronic knee pain. ^{1 9 10 11 12}

Who Is on the Research Team?

Kosaku Aoyagi, PhD

Principal Investigator

Assistant Professor

Are You a Good Fit for This Trial?

This trial is for people over 45 with knee osteoarthritis and a pain level of at least 4 out of 10. They must understand English, have activity-related knee pain, and not have morning stiffness lasting over half an hour. Excluded are those with pacemakers, pregnant women, severe diseases, past knee replacements, sensation loss where pain is measured, chronic opioid use or certain arthritis types.

Inclusion Criteria

My main pain issue is in my knee.

My knee pain is at least a 4 out of 10.

I am 45 years old or older.

Exclusion Criteria

I have numbness or loss of feeling in areas like my wrist, knee, or forearm.

You have been taking opioids for a long time.

I cannot exercise because of severe pain or symptoms.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Baseline Assessment

Day 1: Collection of participant characteristics, race/ethnicity data, and baseline pain assessments

1 day

1 visit (in-person)

Treatment

Day 2 and Day 3: Participants undergo either upper extremity or lower extremity exercise with pain assessments before and after exercise

2 days (separated by at least 1 week)

2 visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Exercise

Trial Overview The study tests how arm exercises using an arm ergometer versus leg exercises on a cycling ergometer affect pain relief after exercise in individuals with knee osteoarthritis. It also examines the impact of socioeconomic factors and stress on this exercise-induced hypoalgesia through a pilot randomized cross-over design.

How Is the Trial Designed?

Group I: Exercise Experimental Treatment 1 Intervention

Arm 1: All participants, knee OA and pain-free individuals, will undergo a single exercise of arm exercise using an arm ergometer and;

Group II: Lower Body Exercise Active Control 1 Intervention

Arm 2: All participants, knee OA and pain-free individuals, will undergo a single exercise of leg exercise using a cycling ergometer.

Who Is Running the Clinical Trial?

University of Texas, El Paso

Lead Sponsor

Trials

17

Recruited

3,000+

Published Research Related to This Trial

A novel task-specific training approach for patients with chronic knee pain led to significant improvements in both pain and physical function for most of the seven participants aged 40 and older, who had reported moderate difficulty with daily activities.

The study suggests that this approach may be more effective than traditional impairment-based rehabilitation, but further research with larger sample sizes is needed to confirm these findings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Task-Specific Training for Adults With Chronic Knee Pain: A Case Series. Bove, AM., Baker, N., Livengood, H., et al.[2022]

A systematic review of six studies involving 656 participants with knee or hip osteoarthritis found no significant clinical benefits of high-intensity exercise over low-intensity exercise in reducing pain or improving physical function, with evidence rated as low to very low quality.

While some small improvements in pain and function were noted immediately after exercise programs, these effects did not persist long-term, and there was uncertainty regarding the safety of high-intensity programs, as adverse effects were poorly monitored.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

High-intensity versus low-intensity physical activity or exercise in people with hip or knee osteoarthritis. Regnaux, JP., Lefevre-Colau, MM., Trinquart, L., et al.[2022]

In a study involving 514 older adults with knee pain due to osteoarthritis, changes in physical activity levels during exercise interventions did not correlate with improvements in pain or physical function at 3 or 6 months follow-up.

The findings suggest that other factors may influence clinical outcomes after exercise interventions, and the Physical Activity Scale for the Elderly (PASE) may not be sensitive enough to detect meaningful changes in physical activity levels.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Change in physical activity level and clinical outcomes in older adults with knee pain: a secondary analysis from a randomised controlled trial. Quicke, JG., Foster, NE., Croft, PR., et al.[2022]

A study involving 12,796 patients with knee osteoarthritis found that both physically inactive and active individuals experienced similar significant reductions in knee pain after a 12-session exercise therapy program, with pain decreasing by about 13.4 points immediately post-intervention and 12.8 points at 12 months.

Regardless of their initial activity levels, all patients benefited from the supervised exercise therapy and education, indicating that exercise therapy is effective for pain relief in knee OA patients, whether they are already active or not.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The impact of physical activity level on the short- and long-term pain relief from supervised exercise therapy and education: a study of 12,796 Danish patients with knee osteoarthritis. Skou, ST., Bricca, A., Roos, EM.[2019]

In a study of 1,304 participants with knee pain, 20.3% experienced pain resolution after 30 and 60 months, indicating that improvement is possible for many individuals with knee pain.

Factors associated with higher chances of pain resolution included having a lower BMI, stronger quadriceps muscles, and engaging in gardening or moderate-intensity recreational activities, while walking was linked to lower odds of resolution.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Factors associated with pain resolution in those with knee pain: the MOST study. Felson, D., Rabasa, G., Jafarzadeh, SR., et al.[2023]

Exercise therapy is effective in reducing pain and activity limitations in patients with knee osteoarthritis, and it is likely beneficial for hip osteoarthritis as well, highlighting its role as a non-invasive treatment option.

Combining exercise therapy with weight loss can further alleviate symptoms in overweight osteoarthritis patients, and new targeted exercise modalities are being developed to address specific activity limitations and joint instability.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Exercise therapy in hip or knee osteoarthritis]. Dekker, J., Peter, W., van der Leeden, M., et al.[2011]

The review of nine studies found mixed results regarding the impact of knee pain on physical activity (PA), with some studies showing that increased knee pain decreased PA, while one study indicated that increased pain could lead to more PA.

Psychological factors, such as catastrophizing and pain-related activity interference, were identified as risk factors for insufficient PA, suggesting that interventions to increase PA in individuals with knee pain should address these psychological aspects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The relationship between experience of knee pain and physical activity participation: A scoping review of quantitative studies. Yang, L., Wang, P., McGill, B.[2023]

This study, involving 60 older adults with knee pain, aims to evaluate the effectiveness of a personalized exercise program tailored to specific physical impairments, such as weak quadriceps and poor balance, over a 12-week period.

By focusing on individual impairments rather than a standard exercise regimen, the study seeks to determine if this targeted approach can lead to significant improvements in strength, range of motion, and balance, potentially offering a more effective treatment for knee pain and osteoarthritis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impairment-targeted exercises for older adults with knee pain: protocol for a proof-of-principle study. Wood, LR., Peat, GM., Mullis, R., et al.[2021]

Exercise is a safe and effective non-drug treatment for osteoarthritis (OA) of the hip and knee, showing small to moderate improvements in pain and function similar to those achieved with NSAIDs.

Both aerobic and strengthening exercises are equally effective for managing pain and improving function in OA patients, and combining diet with exercise may provide additional benefits, especially for obese individuals.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness and safety of strengthening, aerobic, and coordination exercises for patients with osteoarthritis. Bischoff, HA., Roos, EM.[2022]

In a study of 182 participants with knee osteoarthritis, both Tai Chi and physical therapy showed a linear dose-response effect, with improvements in pain and function correlating to the number of weeks attended, resulting in significant reductions in pain and enhancements in function.

The minimum effective dose for noticeable improvements in pain and function was found to be between 2 to 5 weeks, and patients' expectations about the benefits of exercise were linked to how quickly they experienced these improvements.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Dose-Response Effects of Tai Chi and Physical Therapy Exercise Interventions in Symptomatic Knee Osteoarthritis. Lee, AC., Harvey, WF., Price, LL., et al.[2019]

A systematic review of 55 studies found that land-based exercises, particularly strengthening, proprioception, and aerobic exercises, significantly reduce pain in patients with knee osteoarthritis.

For optimal pain reduction, exercises should be performed three times a week for durations of either 8-11 weeks or 12-15 weeks, providing a clear guideline for health professionals working with these patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evidence synthesis of types and intensity of therapeutic land-based exercises to reduce pain in individuals with knee osteoarthritis. Imoto, AM., Pardo, JP., Brosseau, L., et al.[2020]

A systematic review of 39 studies involving 2646 participants found that all five types of exercise therapy (aquatic exercise, stationary cycling, resistance training, traditional exercise, and yoga) significantly improved outcomes for knee osteoarthritis compared to control groups.

Aquatic exercise was the most effective for pain relief, while yoga excelled in improving joint stiffness, function, and overall quality of life, indicating that tailored exercise programs can effectively manage symptoms of knee osteoarthritis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exercise Therapy for Knee Osteoarthritis: A Systematic Review and Network Meta-analysis. Mo, L., Jiang, B., Mei, T., et al.[2023]

Citations

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

Task-Specific Training for Adults With Chronic Knee Pain: A Case Series. [2022]

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

High-intensity versus low-intensity physical activity or exercise in people with hip or knee osteoarthritis. [2022]

3. England pubmed.ncbi.nlm.nih.gov

Change in physical activity level and clinical outcomes in older adults with knee pain: a secondary analysis from a randomised controlled trial. [2022]

4. England pubmed.ncbi.nlm.nih.gov

The impact of physical activity level on the short- and long-term pain relief from supervised exercise therapy and education: a study of 12,796 Danish patients with knee osteoarthritis. [2019]

5. England pubmed.ncbi.nlm.nih.gov

Factors associated with pain resolution in those with knee pain: the MOST study. [2023]

6. Netherlands pubmed.ncbi.nlm.nih.gov

[Exercise therapy in hip or knee osteoarthritis]. [2011]

7. China pubmed.ncbi.nlm.nih.gov

The relationship between experience of knee pain and physical activity participation: A scoping review of quantitative studies. [2023]

8. England pubmed.ncbi.nlm.nih.gov

Impairment-targeted exercises for older adults with knee pain: protocol for a proof-of-principle study. [2021]

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

Effectiveness and safety of strengthening, aerobic, and coordination exercises for patients with osteoarthritis. [2022]

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

Dose-Response Effects of Tai Chi and Physical Therapy Exercise Interventions in Symptomatic Knee Osteoarthritis. [2019]

11. Germany pubmed.ncbi.nlm.nih.gov

Evidence synthesis of types and intensity of therapeutic land-based exercises to reduce pain in individuals with knee osteoarthritis. [2020]

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

Exercise Therapy for Knee Osteoarthritis: A Systematic Review and Network Meta-analysis. [2023]