A pilot randomized controlled trial evaluating outdoor community walking for knee osteoarthritis: walk.
Study Goal
To determine the feasibility of a randomized controlled trial examining outdoor walking's effects on knee osteoarthritis clinical outcomes and MRI structural changes.
Results Summary
The walking group showed clinically important improvements in symptoms (e.g., reduced knee pain) compared to usual care, with 70% program adherence and 70.8% retention. The study identified recruitment challenges but supported the feasibility of a full-scale RCT.
Population
Adults with knee osteoarthritis (mean age 66 years, 60% female).
Effective Dosage
3 days/week walking.
Duration
24 weeks.
Interactions
None mentioned.
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
outdoor walking program (plus usual care) | decrease | self-reported knee osteoarthritis symptoms | KOA participants | - | resulted in large improvements | #1 |
outdoor walking program (plus usual care) | decrease | symptoms | walking group | - | experienced clinically important improvements | #2 |
outdoor walking program (plus usual care) | decrease | visual analogue scale (VAS) knee pain | walking group | -38.7 mm [95% CI -47.1 to -30.3] | change | #3 |
usual care | increase | visual analogue scale (VAS) knee pain | usual care group | 4.3 mm [-4.9 to 13.4] | change | #4 |
outdoor walking program (plus usual care) | increase | mild adverse events | walking group | - | had a higher number | #5 |
OBJECTIVES: To determine the feasibility of a randomized controlled trial (RCT) examining outdoor walking on knee osteoarthritis (KOA) clinical outcomes and magnetic resonance imaging (MRI) structural changes. METHOD: This was a 24-week parallel two-arm pilot RCT in Tasmania, Australia. KOA participants were randomized to either a walking plus usual care group or a usual care control group. The walking group trained 3 days/week. The primary outcome was feasibility assessed by changes being required to the study design, recruitment, randomization, program adherence, safety, and retention. Exploratory outcomes were changes in symptoms, physical performance/activity, and MRI measures. RESULTS: Forty participants (mean age 66 years (SD 1.4) and 60% female) were randomized to walking (n = 24) or usual care (n = 16). Simple randomization resulted in a difference in numbers randomized to the two groups. During the study, class sizes were reduced from 10 to 8 participants to improve supervision, and exclusion criteria were added to facilitate program adherence. In the walking group, total program adherence was 70.0% and retention 70.8% at 24 weeks. The walking group had a higher number of mild adverse events and experienced clinically important improvements in symptoms (e.g., visual analogue scale (VAS) knee pain change in the walking group: - 38.7 mm [95% CI - 47.1 to - 30.3] versus usual care group: 4.3 mm [- 4.9 to 13.4]). CONCLUSIONS: This study supports the feasibility of a full-scale RCT given acceptable adherence, retention, randomization, and safety, and recruitment challenges have been identified. Large symptomatic benefits support the clinical usefulness of a subsequent trial. TRIAL REGISTRATION NUMBER: 12618001097235. Key Points • This pilot study is the first to investigate the effects of an outdoor walking program on knee osteoarthritis clinical outcomes and MRI joint structure, and it indicates that a full-scale RCT is feasible. • The outdoor walking program (plus usual care) resulted in large improvements in self-reported knee osteoarthritis symptoms compared to usual care alone. • The study identified recruitment challenges, and the manuscript explores these in more details and provides recommendations for future studies.