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Strength Training for ARthritis Trial (START)

This study has been completed.
Sponsor:
ClinicalTrials.gov Identifier:
NCT01489462
First Posted: December 9, 2011
Last Update Posted: October 4, 2017
The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
Collaborator:
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Information provided by (Responsible Party):
Stephen P. Messier, Ph.D., Wake Forest University Health Sciences
  Purpose
The primary purpose of this study is to compare the effects of a high and low intensity strength training programs vs. a control group on knee pain and compressive joint forces.

Condition Intervention
Knee Osteoarthritis Behavioral: High Intensity Strength Training Behavioral: Low Intensity Strength Training Behavioral: Attention Control

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Strength Training for ARthritis Trial

Resource links provided by NLM:


Further study details as provided by Stephen P. Messier, Ph.D., Wake Forest University Health Sciences:

Primary Outcome Measures:
  • Pain [ Time Frame: Baseline, 6 months, 12 months, 18 months ]
    The investigators will measure short term (6 months) and long term (12 and 18 months) changes in pain.


Secondary Outcome Measures:
  • Knee Compressive Forces [ Time Frame: Baseline, 6 Months, 18 Months ]
    To compare the effects of 18 months of high-intensity strength training, low-intensity strength training, and attention control on knee-joint compressive forces during walking.

  • Function [ Time Frame: Baseline, 6 Months, 12 Months, 18 Months ]
    The investigators will measure short term (6 months) and long term (12 and 18 months) changes in function.

  • Mobility [ Time Frame: Baseline, 6 Months, 12 Months, 18 Months ]
    The investigators will measure short term (6 months) and long term (12 and 18 months) changes in mobility.

  • Inflammatory Markers [ Time Frame: Baseline, 6 Months, 18 Months ]
    The investigators will measure short term (6 months) and long term (18 months) changes in inflammatory markers.

  • Thigh Composition [ Time Frame: Baseline, 18 Months ]
    The investigators will measure short term (6 months) and long term (18 months) changes in thigh composition.


Enrollment: 375
Study Start Date: March 2012
Study Completion Date: September 2017
Primary Completion Date: September 2017 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: High Intensity Strength Training
The strength-training intervention will consist of 5-min warm-up, 40-min training, and 15-min cool-down. The 60-min sessions will be conducted 3 times/wk for 18 months. Every 2 weeks the load lifted will be adjusted so that the participants in this group are lifting 3 sets of each exercise at 75-90% of 1RM.
Behavioral: High Intensity Strength Training
The strength-training intervention will consist of 5-min warm-up, 40-min training, and 15-min cool-down. The 60-min sessions will be conducted 3 times/wk for 18 months. Every 2 weeks the load lifted will be adjusted so that the participants in this group are lifting 3 sets of each exercise at 75-90% of 1RM.
Experimental: Low Intensity Strength Training
The strength-training intervention will consist of 5-min warm-up, 40-min training, and 15-min cool-down. The 60-min sessions will be conducted 3 times/wk for 18 months. Every 2 weeks the load lifted will be adjusted so that the participants are lifting 3 sets of 15 repetitions at 30-40% of 1RM.
Behavioral: Low Intensity Strength Training
The strength-training intervention will consist of 5-min warm-up, 40-min training, and 15-min cool-down. The 60-min sessions will be conducted 3 times/wk for 18 months. Every 2 weeks the load lifted will be adjusted so that the participants are lifting 3 sets of 15 repetitions at 30-40% of 1RM.
Active Comparator: Attention Control
Participants in the control group will attend 60-min organized workshops 2 times/month for the first 6 months and then 1 time/month for months 7-18. Over the 18 months interactive presentations will cover such topics as foot care, nutrition, managing medication, and sleep practices, and experts will give wide-ranging lectures.
Behavioral: Attention Control
Participants in the control group will attend 60-min organized workshops 2 times/month for the first 6 months and then 1 time/month for months 7-18. Over the 18 months interactive presentations will cover such topics as foot care, nutrition, managing medication, and sleep practices, and experts will give wide-ranging lectures.

Detailed Description:

Muscle loss and fat gain contribute to the disability, pain, and morbidity associated with knee osteoarthritis (OA), and thigh muscle weakness is an independent and modifiable risk factor for it. However, while all published treatment guidelines, supported by Level-1 evidence, recommend muscle strengthening to combat sarcopenia and improve muscle quality in knee OA patients, previous strength-training studies either used intensities or loads below recommended levels or were generally short, lasting only 6 to 24 weeks. Consequently, they had low-to-modest effect sizes, could not detect changes in disease progression, did not address underlying OA mechanisms, and provided little lasting clinical benefit. The positive effects of long-term, structured exercise are known to persist even years after supervised treatment terminates.

The efficacy of high intensity strength training in improving OA symptoms, slowing progression, and affecting the underlying mechanisms has not been examined due to the unsubstantiated belief that it might exacerbate symptoms. Our preliminary data clearly show excellent tolerance for high-intensity strength training as well as reduced pain and increased function among older adults with knee OA. Similar studies in healthy older adults found improvements in thigh muscle mass and decreases in thigh fat mass with minimal alteration in total body weight after 16-18 weeks of training. We now propose an 18-month, high-intensity strength-training intervention for older adults with knee OA, focused on improving thigh composition (more muscle and less fat). We hypothesize that in addition to short-term clinical benefits, combining greater duration with high intensity will alter thigh composition sufficiently to attain long-term changes in knee-joint forces, decrease inflammatory cytokines, lower pain levels, and slow OA progression, which has yet to be convincingly demonstrated for any OA treatment. These are important benefits that are not achievable with shorter interventions.

Participants will be randomized to one of 3 groups: high-intensity strength training; low-intensity strength training; or attention control. The primary clinical aim is to compare the interventions' effects on knee pain, and the primary mechanistic aim is to compare their effects on knee-joint compressive forces during walking, a mechanism that affects the OA disease pathway. Secondary aims will compare intervention effects on additional clinical measures of disease severity (e.g., function, mobility); disease progression, measured by xray; thigh muscle and fat volume, measured by CT; components of thigh muscle function, including hip abductor strength and quadriceps strength, power, and proprioception; additional measures of knee-joint loading; and inflammatory and OA biomarkers.

  Eligibility

Information from the National Library of Medicine

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Ages Eligible for Study:   50 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Mild to Moderate Knee Osteoarthritis

Exclusion Criteria:

  • BMI ≥20 kg/m2 and ≤44.9 kg/m2
  • Knee varus malalignment
  • Participation in formal strength training for more than 30 min/week in the past 6 months.
  Contacts and Locations
Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01489462


Locations
United States, North Carolina
Wake Forest University
Winston-Salem, North Carolina, United States, 27109
Sponsors and Collaborators
Wake Forest University
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Investigators
Principal Investigator: Stephen P Messier, PhD Wake Forest University
  More Information

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Stephen P. Messier, Ph.D., Principal Investigator, Wake Forest University Health Sciences
ClinicalTrials.gov Identifier: NCT01489462     History of Changes
Other Study ID Numbers: R01AR059105 ( U.S. NIH Grant/Contract )
1R01AR059105-01A1 ( U.S. NIH Grant/Contract )
First Submitted: November 22, 2011
First Posted: December 9, 2011
Last Update Posted: October 4, 2017
Last Verified: October 2017

Keywords provided by Stephen P. Messier, Ph.D., Wake Forest University Health Sciences:
Arthritis
Osteoarthritis
Strength Training

Additional relevant MeSH terms:
Arthritis
Osteoarthritis
Osteoarthritis, Knee
Joint Diseases
Musculoskeletal Diseases
Rheumatic Diseases