Diet and Exercise for Osteoarthritis Prevention

(TOPS Trial)

Recruiting at 3 trial locations

Overseen By Jovita Newman

Age: 18+

Sex: Female

Trial Phase: Academic

Sponsor: Wake Forest University

Disqualifiers: Coronary artery disease, Type 1 diabetes, Cancer, others

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

Compensation: Varies

Number of Visits: Unknown

Duration: 48 months

1230 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if a combination of diet and exercise can prevent knee osteoarthritis (OA) in women. It will compare two groups: one focusing on diet and exercise for weight loss, and the other receiving general healthy lifestyle guidance. The study also examines how these approaches affect pain, movement, and overall quality of life. Women aged 50 or older, who are obese and have little to no knee pain, may be suitable candidates for this trial. As an unphased trial, it offers participants the opportunity to contribute to valuable research that could lead to improved prevention strategies for knee OA.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It might be best to discuss this with the trial coordinators or your doctor.

What prior data suggests that this diet and exercise intervention is safe for preventing knee osteoarthritis?

Research has shown that diet and exercise programs are generally safe and easy to follow. In one study, participants who followed a combined diet and exercise plan reported less knee pain and improved physical function, with no major side effects.

Another study found that a similar program helped older adults with knee osteoarthritis (a type of joint inflammation) lose weight, which can reduce stress and pain in the joints. Participants followed the program without major problems.

Overall, these studies suggest that diet and exercise plans to prevent osteoarthritis are safe for most people. It is important to follow the program as instructed and inform the study team of any concerns. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Unlike the standard treatments for osteoarthritis, which often involve medications or surgical options, this approach focuses on lifestyle changes through diet and exercise. Researchers are excited because this treatment targets weight management, which can directly reduce joint stress and potentially slow the progression of osteoarthritis. The program includes a structured, energy-restricted diet with behavioral support and a long-term exercise plan, aiming to achieve and maintain a 10% weight loss over four years. This holistic approach not only aims to prevent osteoarthritis but also promotes overall health, making it a promising option for sustainable joint care.

What evidence suggests that this diet and exercise intervention is effective for preventing knee osteoarthritis?

Research has shown that diet and exercise, included in the treatment arm of this trial, can help prevent knee osteoarthritis (OA). One study found that losing just 11 pounds (about 5.1 kg) halved the risk of developing knee OA over ten years. Another study demonstrated that a combination of diet and exercise reduced pain in people with OA. Participants in this trial who lose 10% of their body weight through diet and exercise may experience less knee pain, as previous findings suggest. These findings indicate that maintaining a healthy weight and staying active might help prevent knee OA. ^{1 3 4 6 7}

Who Is on the Research Team?

Stephen P Messier, Ph.D.

Principal Investigator

Wake Forest University

Are You a Good Fit for This Trial?

This trial is for women over 50 with obesity who have no or rare knee pain and no signs of knee osteoarthritis on X-rays or MRI. They must not be using walking aids, have a BMI ≥ 30 kg/m2, and can't be undergoing cancer treatment, have type 1 diabetes, severe heart issues, recent major knee injuries or surgeries.

Inclusion Criteria

BMI ≥ 30 kg/m2

I rarely have knee pain, less than 15 days a month.

I am female.

Exclusion Criteria

Blindness

I experience pain in both knees for more than 15 days each month.

I am currently receiving treatment for cancer.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo a 48-month intervention of dietary weight loss, exercise, and weight-loss maintenance

48 months

Bi-weekly exercise sessions, quarterly group meetings

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Diet and Exercise

Trial Overview The study tests if dieting to lose weight combined with exercise can prevent knee osteoarthritis in at-risk women. Participants will either follow this program or join an attention control group. The effects on their knees will be monitored through MRIs and other health measures.

How Is the Trial Designed?

Group I: Diet and Exercise Experimental Treatment 1 Intervention

The dietary component of the weight loss intervention is characterized by the frequency of contacts, methods to induce dietary restriction, and behavioral therapy strategies. The first 6 months of the diet program is an energy-restricted diet with the option of using partial meal replacements and nutritious snacks (Rapid Nutrition, PLC). The weight loss goal for the diet and exercise group is a minimum of 10% of baseline body weight by the end of year 1. The weight loss phase is followed by 3 years of a weight-loss maintenance program, with the goal of sustaining the achieved weight loss. The exercise component includes 60-minute sessions 2 days per week for 48 months.

Group II: Attention Control Active Control 1 Intervention

This comparison group provides attention, social interaction, and healthy lifestyle classes. There will be 4, 1-hour face-to-face group meetings per year featuring community health professionals, quarterly newsletters, and quarterly text messages.

Who Is Running the Clinical Trial?

Wake Forest University

Lead Sponsor

Trials

193

Recruited

151,000+

Centers for Disease Control and Prevention

Collaborator

Trials

902

Recruited

25,020,000+

University of Missouri-Columbia

Collaborator

Trials

387

Recruited

629,000+

Arthritis Foundation

Collaborator

Trials

36

Recruited

46,500+

National Center for Complementary and Integrative Health (NCCIH)

Collaborator

Trials

886

Recruited

677,000+

Office of Research on Women's Health (ORWH)

Collaborator

Trials

34

Recruited

36,300+

Office of Behavioral and Social Sciences Research (OBSSR)

Collaborator

Trials

6

Recruited

8,100+

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

Collaborator

Trials

508

Recruited

1,090,000+

Office of Disease Prevention

Collaborator

Trials

1

Recruited

1,200+

Rapid Nutrition PLC

Collaborator

Trials

1

Recruited

1,200+

Published Research Related to This Trial

A multi-component dietary weight loss program, including a ketogenic very low calorie diet and video consultations, was well-received by 24 patients with knee osteoarthritis, highlighting its ease of use and convenience as key factors for adherence.

Support from dietitians and the program's holistic approach, which included educational resources and exercise, were crucial for participants' success, leading to improved knee pain and function over the 6-month period.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

"It's the single best thing I've done in the last 10 years": a qualitative study exploring patient and dietitian experiences with, and perceptions of, a multi-component dietary weight loss program for knee osteoarthritis. Lawford, BJ., Bennell, KL., Jones, SE., et al.[2021]

In a study of 192 obese patients with knee osteoarthritis, those who received dietary support maintained a greater weight loss (11.0 kg) over one year compared to those in the knee-exercise program (6.2 kg) and control group (8.2 kg), indicating the effectiveness of dietary support in long-term weight management.

All groups experienced significant reductions in knee pain, but there was no difference in pain relief among the groups, suggesting that weight loss alone, regardless of the maintenance program, can improve symptoms of knee osteoarthritis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of weight maintenance on symptoms of knee osteoarthritis in obese patients: a twelve-month randomized controlled trial. Christensen, R., Henriksen, M., Leeds, AR., et al.[2022]

In a study of 89 obese patients with knee osteoarthritis, those on an intensive low-energy diet (LED) lost an average of 10.9 kg (11%) over one year, compared to a 3.6 kg (4%) loss in the control group, indicating significant weight loss efficacy (p<0.0001).

While both groups showed improvement in knee osteoarthritis symptoms, the LED group experienced a notable reduction in pain (7.2 mm difference on the WOMAC scale, p=0.022), suggesting that weight loss can lead to meaningful pain relief in this patient population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Weight loss as treatment for knee osteoarthritis symptoms in obese patients: 1-year results from a randomised controlled trial. Bliddal, H., Leeds, AR., Stigsgaard, L., et al.[2011]

The IDEA trial is a randomized controlled study involving 450 older adults with osteoarthritis, testing the effects of intensive dietary restriction, exercise, or a combination of both over 18 months to see how these interventions impact inflammation and joint loads.

Preliminary results show excellent reliability in measuring knee joint loads and MRI scoring of knee conditions, suggesting that the study's methods are robust and can effectively assess the impact of weight loss on osteoarthritis progression.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Intensive Diet and Exercise for Arthritis (IDEA) trial: design and rationale. Messier, SP., Legault, C., Mihalko, S., et al.[2021]

A systematic review of three trials involving 794 overweight and obese older adults with knee osteoarthritis found that combining physical activity and dietary restriction did not show significant improvements in mobility after 6 months, as indicated by the 6-minute walk test.

Despite the lack of strong evidence from meta-analysis, narrative synthesis suggested that participants in the combined intervention group experienced reductions in body weight and improvements in walking ability compared to control groups.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of physical activity and dietary restriction interventions on weight loss and the musculoskeletal function of overweight and obese older adults with knee osteoarthritis: a systematic review and mixed method data synthesis. Alrushud, AS., Rushton, AB., Kanavaki, AM., et al.[2022]

In a study involving overweight and obese individuals with knee osteoarthritis, changes in systemic inflammation due to diet and exercise accounted for 15% of the reduction in pain and 29% of the improvement in function over 18 months, indicating a significant role of inflammation in managing OA symptoms.

The findings suggest that while changes in body mass index (BMI) contributed minimally to improvements in function, the reduction in inflammatory markers was a strong mediator of both pain relief and functional enhancement, emphasizing the importance of targeting inflammation in OA treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Inflammatory cytokines mediate the effects of diet and exercise on pain and function in knee osteoarthritis independent of BMI. Runhaar, J., Beavers, DP., Miller, GD., et al.[2020]

The paper outlines a set of best practices for conducting clinical trials focused on lifestyle diet and exercise interventions for osteoarthritis (OA), aimed at both newcomers and experienced researchers in the field.

These recommendations cover essential aspects of trial design, including participant recruitment, study methods, and assessment techniques, providing a comprehensive guide for effective research in OA interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

OARSI Clinical Trials Recommendations: Design and conduct of clinical trials of lifestyle diet and exercise interventions for osteoarthritis. Messier, SP., Callahan, LF., Golightly, YM., et al.[2022]

The ProMuscle in Practice study involves 200 community-dwelling older adults (≥65 years) and evaluates a 24-week combined resistance exercise and nutrition intervention aimed at improving physical functioning and quality of life.

Preliminary insights suggest that this intervention, which includes guided exercise and increased protein intake, may effectively enhance muscle strength and overall physical performance in frail older adults, although results from the ongoing study will provide more definitive conclusions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect, process, and economic evaluation of a combined resistance exercise and diet intervention (ProMuscle in Practice) for community-dwelling older adults: design and methods of a randomised controlled trial. van Dongen, EJI., Haveman-Nies, A., Wezenbeek, NLW., et al.[2023]

A combination of diet and exercise treatments significantly reduces pain in overweight and obese adults with knee osteoarthritis, while diet-only treatments do not show a meaningful reduction in pain.

Both diet-only and combined diet and exercise treatments moderately improve physical function, but the effects on inflammatory biomarkers are unclear, with only IL-6 showing a reduction from diet-only treatments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Diet-induced weight loss alone or combined with exercise in overweight or obese people with knee osteoarthritis: A systematic review and meta-analysis. Hall, M., Castelein, B., Wittoek, R., et al.[2019]

Combining diet and exercise is essential for effective obesity treatment, as neither alone is sufficient; however, very-low-calorie diets can help maintain physical function during significant weight loss.

Long-term success in maintaining weight loss is heavily dependent on adopting regular exercise habits after dieting, highlighting the importance of promoting lifelong exercise practices for sustained weight management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exercise during and after very-low-calorie dieting. Phinney, SD.[2018]

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]

Despite the widespread use of diet and exercise interventions to combat obesity, these strategies have shown limited long-term effectiveness, with most individuals experiencing relapse within 3-5 years after initial weight loss.

The paper suggests that future obesity interventions should focus on promoting healthy lifestyles and chronic disease risk reduction rather than solely targeting weight loss, as many popular dieting techniques can be hazardous to health.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

How effective are traditional dietary and exercise interventions for weight loss? Miller, WC.[2019]

In a study of 67 obese adults, both exercise-focused and weight-focused maintenance programs were effective after an initial 6-month weight-loss treatment, but the weight-focused program led to better long-term weight maintenance.

Participants in the weight-focused program reduced their fat consumption more significantly and maintained their weight loss better than those in the exercise-focused program, despite no differences in exercise participation or energy expenditure between the two groups.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of exercise-focused versus weight-focused maintenance programs on the management of obesity. Leermakers, EA., Perri, MG., Shigaki, CL., et al.[2019]

A systematic review of 18 randomized controlled trials found that combining diet and exercise leads to greater long-term weight loss compared to diet alone, with an average additional weight loss of 1.14 kg.

Both diet-only and diet-plus-exercise interventions resulted in some weight regain over time, highlighting the need for future research to develop strategies that promote sustained weight loss.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Long-term effectiveness of diet-plus-exercise interventions vs. diet-only interventions for weight loss: a meta-analysis. Wu, T., Gao, X., Chen, M., et al.[2009]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10746515/

The osteoarthritis prevention study (TOPS) - PMC This study will assess the efficacy and cost effectiveness of a dietary weight loss, exercise, and weight-loss maintenance program ... The weight- ...

2. nature.com nature.com/articles/s41430-025-01622-0

The effectiveness of dietary intervention in osteoarthritis ... Consistent with our findings, a meta-analysis revealed that a combination of diet and exercise treatments moderately reduced pain.

3. jamanetwork.com jamanetwork.com/journals/jama/fullarticle/2799405

Effect of Diet and Exercise on Knee Pain in Patients With ... Moderate (5%) to intensive (10%) weight loss in patients with knee OA and obesity achieved in previous academic center–based efficacy trials ...

4. jrheum.org jrheum.org/content/51/3/224

The Critical Role of Physical Activity and Weight ... In the Framingham Study, a weight loss of 5.1 kg (11.2 lbs) reduced women's risk of developing knee OA by 50% over 10 years. Further, prevention ...

5. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/40759020/

Efficacy of a Very-Low-Calorie Weight Loss Diet Plus ... Although VLCD plus exercise lost 8.5% more weight than exercise only, VLCD plus exercise was not more effective for change in hip pain severity ...

6. clinicaltrials.gov clinicaltrials.gov/study/NCT00979043

Study Details | NCT00979043 | The Arthritis, Diet, and ... The primary purpose of this study was to determine the effect of dietary weight-loss, exercise training, or a combination of both on physical function in ...

7. withpower.com withpower.com/trial/phase-osteoarthritis-6-2023-9c616

Diet and Exercise for Osteoarthritis Prevention (TOPS Trial) A combined dietary and exercise intervention led to significant weight loss in older obese adults with knee osteoarthritis, with the exercise and diet group ...