Treadmill Walking for Knee Osteoarthritis

Overseen By Jocelyn F Hafer, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Delaware

Must not be taking: Beta blockers, Balance medications

Disqualifiers: Fracture, Joint replacement, Stroke, others

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

Compensation: Varies

Number of Visits: 2

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how fatigue affects the risk of falling in adults with and without knee osteoarthritis, particularly during walking. It includes a 30-minute treadmill walk and various tests to measure mental fatigue, strength, and balance. Researchers aim to determine if individuals with knee osteoarthritis are more prone to tripping or falling when fatigued compared to those without the condition. Participants should experience knee pain and be able to walk for 30 minutes unassisted. As an unphased trial, this study provides participants the opportunity to contribute to important research that could enhance understanding and prevention of falls related to fatigue.

Do I need to stop taking my current medications to join the trial?

Yes, you may need to stop taking certain medications. The trial excludes participants who use beta blockers or other medications that affect fatigue and balance.

Will I have to stop taking my current medications?

The trial requires that you do not use beta blockers or other medications that affect fatigue, as well as medications that affect balance. If you are taking these types of medications, you may need to stop them to participate.

What prior data suggests that treadmill walking is safe for adults with and without knee osteoarthritis?

Research shows that walking exercises, such as a 30-minute treadmill walk, are generally safe and manageable. For people with knee osteoarthritis, studies have found treadmill walking to be a suitable exercise choice. However, some evidence suggests that walking for 30 minutes or more might stress the knee joint, potentially causing discomfort or increasing the risk of joint wear.

For those without knee osteoarthritis, treadmill walking is usually safe and carries few risks. Overall, both groups in the study can expect treadmill exercise to be manageable, but individuals with knee osteoarthritis should monitor any knee pain or discomfort. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about using treadmill walking for knee osteoarthritis because it offers a non-invasive and drug-free alternative to current treatments like pain relievers and physical therapy. Unlike medications, which can have side effects, or surgery, which is invasive, treadmill walking can safely enhance joint mobility and reduce pain over time. Additionally, this method encourages regular physical activity, which is beneficial for overall health.

What evidence suggests that treadmill walking is effective for knee osteoarthritis?

This trial will compare the effects of treadmill walking on individuals with knee osteoarthritis to those who are healthy. Research has shown that various walking exercises can benefit people with knee osteoarthritis (OA). For instance, walking backward can strengthen muscles and reduce stress on knee joints. Some studies suggest that treadmill walking, especially with reduced pressure on the lower body, can decrease pain and improve leg strength. However, walking for 30 minutes or more might increase stress on the knee joints for those with knee OA. Overall, treadmill walking can be beneficial but should be done carefully to avoid stressing the joints. ^{1 3 5 6 7}

Are You a Good Fit for This Trial?

This trial is for adults aged 55-70 who sometimes to often feel knee pain, mainly on the inside of the knee joint, with little morning stiffness. They should be able to walk for half an hour without help like a cane or walker.

Inclusion Criteria

I often have knee pain, mostly on the inner side, with little morning stiffness.

I can walk for 30 minutes without help.

Exclusion Criteria

I am taking beta blockers or medications that can cause tiredness.

History of joint replacement

I have not had any fractures or surgeries in the past year.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Baseline Assessment

Participants complete questionnaires and wear a device that measures physical activity for 5-7 days

1 week

1 visit (in-person)

Treadmill Walk and Testing

Participants complete a 30 minute walk on a treadmill and undergo tests for mental fatigue, maximal strength, and balance before and after the walk

1 day

1 visit (in-person)

Follow-up

Participants are monitored for safety and effectiveness after the treadmill walk and testing

1-2 weeks

What Are the Treatments Tested in This Trial?

Interventions

• 30 minute treadmill walk

Trial Overview

Researchers are testing how tiredness from walking might increase tripping and falling risks in people with and without knee osteoarthritis. Participants will fill out surveys, wear an activity tracker for up to a week, do a treadmill walk, and take tests before and after walking to measure fatigue's effects.

How Is the Trial Designed?

Group I: Knee osteoarthritis Experimental Treatment 1 Intervention

Group II: Healthy Experimental Treatment 1 Intervention

Who Is Running the Clinical Trial?

University of Delaware

Lead Sponsor

Trials

167

Recruited

25,700+

National Institute of General Medical Sciences (NIGMS)

Collaborator

Trials

315

Recruited

251,000+

Published Research Related to This Trial

In a study of 1,212 participants aged 50 and older with knee osteoarthritis, those who walked for exercise had a 40% lower likelihood of developing new frequent knee pain compared to non-walkers (odds ratio 0.6).

Walking for exercise was also linked to a reduced progression of medial joint space narrowing in the knee, suggesting that regular walking may help slow down the structural progression of knee osteoarthritis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Association Between Walking for Exercise and Symptomatic and Structural Progression in Individuals With Knee Osteoarthritis: Data From the Osteoarthritis Initiative Cohort. Lo, GH., Vinod, S., Richard, MJ., et al.[2023]

Exercise treatment shows small to moderate beneficial effects on pain and disability in patients with knee osteoarthritis, based on a review of 23 randomized controlled trials.

Despite the positive short-term effects, the evidence is limited and more research is needed to understand long-term benefits and optimal exercise interventions, but doctors should still recommend exercise for patients with mild to moderate osteoarthritis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Is exercise effective treatment for osteoarthritis of the knee? Petrella, RJ.[2019]

The 30-second fast-paced walk test (30SFW) has been shown to have excellent reliability and validity for measuring walking performance in individuals with knee osteoarthritis, making it a useful tool for clinicians and researchers.

Participants with knee osteoarthritis walked significantly shorter distances in the 30SFW compared to healthy controls, indicating that the test effectively differentiates between those with and without the condition.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Validity, Reliability, Measurement Error, and Minimum Detectable Change of the 30-Second Fast-Paced Walk Test in Persons with Knee Osteoarthritis: A Novel Test of Short-Distance Walking Ability. Hoglund, LT., Folkins, E., Pontiggia, L., et al.[2022]

Walking with a 15% shorter stride length increases energy expenditure by 4.6%, which may aid in weight loss for obese women, but does not significantly reduce all biomechanical risk factors for knee osteoarthritis.

While the shorter stride length decreased the knee adduction angular impulse, it did not significantly lower the peak external knee adduction moment or impact shock, indicating that this walking protocol may not fully mitigate the risk of knee osteoarthritis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Does stride length influence metabolic cost and biomechanical risk factors for knee osteoarthritis in obese women? Russell, EM., Braun, B., Hamill, J.[2022]

A review of 47 randomized controlled trials on exercise interventions for knee osteoarthritis revealed a low average reporting quality score of 4.42 out of 19, indicating that many studies do not provide sufficient details for replication.

There is a moderate correlation between the reporting standards of the Consensus on Exercise Reporting Template and the American College of Sports Medicine guidelines, particularly for aerobic interventions, suggesting a need for improved standardization in reporting exercise interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Assessment of the content reporting for therapeutic exercise interventions among existing randomized controlled trials on knee osteoarthritis. O'Neil, J., McEwen, D., Del Bel, MJ., et al.[2019]

A combined dietary and exercise intervention led to significant weight loss in older obese adults with knee osteoarthritis, with the exercise and diet group losing an average of 18.8 lb (8.5 kg) over 6 months compared to just 4.0 lb (1.8 kg) in the exercise-only group.

Both groups experienced improvements in knee pain, disability, and physical performance, but the combined intervention showed trends suggesting better gait mechanics, indicating potential additional benefits of diet alongside exercise for this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exercise and weight loss in obese older adults with knee osteoarthritis: a preliminary study. Messier, SP., Loeser, RF., Mitchell, MN., et al.[2022]

In a study of 100 adults with knee osteoarthritis, higher self-efficacy for managing pain and other symptoms was linked to lower pain levels, reduced perceived exertion while walking, and lower depression scores, suggesting that psychological factors play a significant role in physical functioning.

Self-efficacy for managing symptoms was also associated with faster walking speeds, indicating that improving self-efficacy could enhance both emotional well-being and physical capabilities in individuals with knee osteoarthritis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Physical and psychological correlates of disability among a cohort of individuals with knee osteoarthritis. Marks, R.[2015]

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 four-week underwater treadmill exercise program was found to be as effective as a home exercise regimen in relieving pain and improving function in obese patients with knee osteoarthritis, based on a study of 80 participants.

While both exercise methods led to significant improvements in pain, walking distance, and quadriceps strength, participants in the underwater treadmill group reported greater overall satisfaction and perceived improvement compared to those exercising at home.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Is four-week underwater treadmill exercise regimen compared to home exercise efficacious for pain relief and functional improvement in obese patients with knee osteoarthritis? A randomized controlled trial. Kuptniratsaikul, V., Kittichaikarn, C., Suntornpiyapan, P., et al.[2019]

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]

A pilot study involving 65 individuals with mild to moderate knee osteoarthritis showed that using a web-based Therapeutic Exercise Resource Center (TERC) significantly improved clinical outcomes, including pain and function, after 8 weeks of exercise.

Participants reported high satisfaction with the TERC, with 94% finding the website easy to use and 90% appreciating the helpful exercise animations, indicating that this digital tool could enhance patient engagement in their treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Web-based therapeutic exercise resource center as a treatment for knee osteoarthritis: a prospective cohort pilot study. Brooks, MA., Beaulieu, JE., Severson, HH., et al.[2022]

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]

In a study of 27 patients with knee osteoarthritis, continuous walking for 45 minutes increased knee pain, while interval walking (three 15-minute sessions with breaks) did not lead to increased pain, suggesting a safer option for exercise.

Both walking formats resulted in increased knee contact forces after 30 and 45 minutes, indicating that longer durations of walking may put more stress on the knee joint, but interval walking may help mitigate pain associated with this stress.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The influence of continuous versus interval walking exercise on knee joint loading and pain in patients with knee osteoarthritis. Farrokhi, S., Jayabalan, P., Gustafson, JA., et al.[2018]

Citations

1.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC5669616/

The Influence of Continuous Versus Interval Walking ...

Walking exercise durations of 30 minutes or greater may lead to undesirable knee joint loading in patients with knee OA.

2.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC8686144/

Effects of lower body positive pressure treadmill on ...

This finding indicates that LBPP treadmill walking training might be an effective approach for alleviating pain symptoms and improving lower extremity ...

3.

clinicaltrials.gov

clinicaltrials.gov/study/NCT06802107

Effects of Different Walking Exercises on Pain, Physical ...

The aim of this study is to investigate and compare the effects of forward and backward walking exercises on treadmill in addition to traditional ...

4.

tandfonline.com

tandfonline.com/doi/full/10.1080/09593985.2025.2550532?src=

Effectiveness of backward walking exercises combined ...

Backward walking exercise (BWE) has been shown to improve lower muscle strength and reduce knee adduction moment, making it a recommended intervention for knee ...

5.

acrjournals.onlinelibrary.wiley.com

acrjournals.onlinelibrary.wiley.com/doi/10.1002/acr2.70079

Gait Retraining to Reduce Tibial Acceleration Versus a ...

However, gait retraining to reduce peak tibial acceleration was no more effective than a standard walking program for reducing knee pain and ...

6.

sciencedirect.com

sciencedirect.com/science/article/pii/S004901722500126X

The effect of walking interventions on biomechanical knee ...

One article investigating 30-minutes of treadmill walking for knee osteoarthritis was excluded because it reported non-knee joint-specific kinematic outcomes [ ...

7.

josr-online.biomedcentral.com

josr-online.biomedcentral.com/articles/10.1186/s13018-023-03711-x

Effects of backward walking exercise using lower body ...

The primary aim is to compare the effects of backward walking exercise to forward walking exercise on knee pain, knee functions, and thigh muscle strength