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Effect of Energy Restriction and Exercise for Knee Osteoarthritis

Primary Purpose

Knee Osteoarthritis

Status
Recruiting
Phase
Not Applicable
Locations
United Kingdom
Study Type
Interventional
Intervention
Diet Only
Diet plus Exercise
Sponsored by
University of Bath
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Knee Osteoarthritis

Eligibility Criteria

45 Years - 69 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Male or post-menopausal females
  • Clinically diagnosed with knee Osteoarthritis including radiographic confirmation
  • Oxford Knee Score ≥20 to ≤35 for index knee
  • Aged 45-69 years
  • BMI ≥27.5kg/m2 to ≤40.0 kg/m2
  • Daily physical activity level <2.00

Exclusion Criteria:

  • Inability to undertake cycling exercise safely
  • Use of prescribed anti-inflammatory medication
  • Current smoker (or having quit <6months ago)
  • Has a diagnosis of diabetes or other metabolic disorder
  • Use of other medications that might interfere with study outcomes
  • Recent (within last 3 months) change in body mass of >5%
  • Currently engaged in an ongoing programme of physiotherapy treatment
  • Currently on waiting list or having had surgery for Osteoarthritis on the index knee (prior OA related surgery permitted on other knee as long as this is greater than 12 months prior to enrolment)
  • Having had major hip/knee surgery within preceding 12 months
  • Individuals with a blood pressure of greater than 180/110
  • Currently pregnant or intending to become pregnant during the study

Sites / Locations

  • University of BathRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Diet Only

Diet plus Exercise

Arm Description

Reduced calorie intake by 5000kcals per week over a 4 week period

Reduced calorie intake by 5000kcals per week over 4 weeks with the addition of five 30 minute exercise sessions per week on a cycle ergometer. The exercise in intensity will be progressive and perceptually based and monitored by the investigators.

Outcomes

Primary Outcome Measures

Change in hsCRP
Measured in mg/L via immunoassay

Secondary Outcome Measures

Other Systemic Biomarkers
Measured in pg/ml via electrochemiluminescence Interleukin-1 Beta Interleukin-1Receptor Antagonist Interleukin- 4 Interleukin- 6 Interleukin- 8 Interleukin- 10 Interleukin- 13 Interleukin-17A Interleukin-18 Tumor Necrosis Factor- alpha
The Knee Injury and Osteoarthritis Outcome Score (KOOS)
Pain, Symptoms, Activity of daily living, Sport/Rec, Quality of Life subscales. Each subscale has a minimum score of 0% and a maximum score of 100%, with lower values representing worse outcomes.
EQ-5D-5L Health Questionnaire
Mobility, Self-care, Usual activities, Pain/discomfort and Anxiety/depression. Each of the five dimensions comprising the EQ-5D descriptive system is divided into five levels of perceived problems: LEVEL 1: indicating no problem LEVEL 2: indicating slight problems LEVEL 3: indicating moderate problems LEVEL 4: indicating severe problems LEVEL 5: indicating unable to/extreme problems A unique health state is defined by combining one level from each of the five dimensions.
SF-36 Questionnaire
Physical functioning, Bodily pain, Role limitations due to physical health problems, Role limitations due to personal or emotional problems, Emotional well-being, Social functioning, Energy/fatigue, and General health perceptions. Scores for each domain range from 0 to 100, with a higher score defining a more favourable health state.
Visual Analogue Scale (VAS) Pain
0-10 scale Higher scores indicate worse pain
30-second chair stand test
Repetitions
40m fast paced walk
meters/second
Stair climb
seconds
Timed up and go test
seconds
Mechanical Detection Threshold
millinewtons (mN)
Pressure Pain Threshold
Newtons (N)
Body Mass Index
kg/m2
Hip and Waist Circumference
centimetres
Body Composition
Change in body composition via Dual Energy XX-Ray Absorptiometry scan
Markers of metabolic health
mmol/L Glucose Non-Esterified Fatty Acids Triglycerides Total cholesterol Low Density Lipoprotein Cholesterol High Density Lipoprotein Cholesterol

Full Information

First Posted
March 29, 2022
Last Updated
August 24, 2022
Sponsor
University of Bath
Collaborators
University of Oxford
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1. Study Identification

Unique Protocol Identification Number
NCT05518890
Brief Title
Effect of Energy Restriction and Exercise for Knee Osteoarthritis
Official Title
Effect of Short-term Negative Energy Balance With or Without Exercise on Systemic Biomarkers in Patients With Knee Osteoarthritis
Study Type
Interventional

2. Study Status

Record Verification Date
August 2022
Overall Recruitment Status
Recruiting
Study Start Date
January 1, 2022 (Actual)
Primary Completion Date
August 1, 2023 (Anticipated)
Study Completion Date
August 1, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Bath
Collaborators
University of Oxford

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
The investigators are looking at the effects of energy restriction, with or without exercise on markers of inflammation in individuals with knee osteoarthritis. There will be a 4 week 'wash-in' period where participants will maintain their normal lifestyle, followed by a 4 week 'intervention period' where participants will be randomised into either the diet alone group or the diet plus exercise group.
Detailed Description
Knee Osteoarthritis is a condition that causes pain, reduced physical function and quality of life. Long-term studies have shown that exercise and substantial weight loss can cause improvements in these factors. Individuals with knee Osteoarthritis might have changes in their joint that can be seen with x-ray images. However, this is not guaranteed, and imaging does not always detect changes that occur with interventions that cause improved symptoms. As a result, there is interest in biological markers (biomarkers) as another way of monitoring Osteoarthritis. These markers can be examined in biological tissues, with samples measured in blood easier to obtain than those taken from the fluid within the joint itself. Historically, Osteoarthritis was thought of as a disease caused by mechanical factors but we are now aware that inflammation also plays a part. Therefore, the investigators aim to test a short -term diet/exercise intervention that has been show to improve inflammation in other populations, in individuals with knee osteoarthritis. Importantly, this will allow the investigators to see if reducing food intake alone or doing this with regular exercise can improve outcomes without substantial weight loss. The investigators will ask individuals to participate in one of two groups where they will first be asked to continue their normal lifestyle for 4 weeks to check the stability of outcomes. The investigators will then ask individuals to either reduce their food intake by 5000 calories per week, or do this while also completing moderate intensity cycling exercise 5 times a week for 4 weeks. At the start and end of each period the investigators will collect a blood sample to assess markers of inflammation and disease related processes. The investigators will also conduct questionnaire measurements, tests of physical function and experimental pain and scan participants to establish body composition.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Knee Osteoarthritis

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
32 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Diet Only
Arm Type
Experimental
Arm Description
Reduced calorie intake by 5000kcals per week over a 4 week period
Arm Title
Diet plus Exercise
Arm Type
Experimental
Arm Description
Reduced calorie intake by 5000kcals per week over 4 weeks with the addition of five 30 minute exercise sessions per week on a cycle ergometer. The exercise in intensity will be progressive and perceptually based and monitored by the investigators.
Intervention Type
Other
Intervention Name(s)
Diet Only
Intervention Description
Participants caloric intake will be reduced by 5000kcal per week over 4 weeks
Intervention Type
Other
Intervention Name(s)
Diet plus Exercise
Intervention Description
Participants caloric intake will be reduced by 5000kcal per week over 4 weeks. Participants will also be asked to perform 5x30 minute cycling exercise sessions at home. Each week the intensity of exercise will be increased (week 1 = RPE 12, week 2 = RPE 13, week 3 = RPE 14, week 4 = RPE 15)
Primary Outcome Measure Information:
Title
Change in hsCRP
Description
Measured in mg/L via immunoassay
Time Frame
0, 4 and 8 weeks
Secondary Outcome Measure Information:
Title
Other Systemic Biomarkers
Description
Measured in pg/ml via electrochemiluminescence Interleukin-1 Beta Interleukin-1Receptor Antagonist Interleukin- 4 Interleukin- 6 Interleukin- 8 Interleukin- 10 Interleukin- 13 Interleukin-17A Interleukin-18 Tumor Necrosis Factor- alpha
Time Frame
0, 4 and 8 weeks
Title
The Knee Injury and Osteoarthritis Outcome Score (KOOS)
Description
Pain, Symptoms, Activity of daily living, Sport/Rec, Quality of Life subscales. Each subscale has a minimum score of 0% and a maximum score of 100%, with lower values representing worse outcomes.
Time Frame
0, 4 and 8 weeks
Title
EQ-5D-5L Health Questionnaire
Description
Mobility, Self-care, Usual activities, Pain/discomfort and Anxiety/depression. Each of the five dimensions comprising the EQ-5D descriptive system is divided into five levels of perceived problems: LEVEL 1: indicating no problem LEVEL 2: indicating slight problems LEVEL 3: indicating moderate problems LEVEL 4: indicating severe problems LEVEL 5: indicating unable to/extreme problems A unique health state is defined by combining one level from each of the five dimensions.
Time Frame
0, 4 and 8 weeks
Title
SF-36 Questionnaire
Description
Physical functioning, Bodily pain, Role limitations due to physical health problems, Role limitations due to personal or emotional problems, Emotional well-being, Social functioning, Energy/fatigue, and General health perceptions. Scores for each domain range from 0 to 100, with a higher score defining a more favourable health state.
Time Frame
0, 4 and 8 weeks
Title
Visual Analogue Scale (VAS) Pain
Description
0-10 scale Higher scores indicate worse pain
Time Frame
0, 4 and 8 weeks
Title
30-second chair stand test
Description
Repetitions
Time Frame
0, 4 and 8 weeks
Title
40m fast paced walk
Description
meters/second
Time Frame
0, 4 and 8 weeks
Title
Stair climb
Description
seconds
Time Frame
0, 4 and 8 weeks
Title
Timed up and go test
Description
seconds
Time Frame
0, 4 and 8 weeks
Title
Mechanical Detection Threshold
Description
millinewtons (mN)
Time Frame
0, 4 and 8 weeks
Title
Pressure Pain Threshold
Description
Newtons (N)
Time Frame
0, 4 and 8 weeks
Title
Body Mass Index
Description
kg/m2
Time Frame
0, 4 and 8 weeks
Title
Hip and Waist Circumference
Description
centimetres
Time Frame
0, 4 and 8 weeks
Title
Body Composition
Description
Change in body composition via Dual Energy XX-Ray Absorptiometry scan
Time Frame
0, 4 and 8 weeks
Title
Markers of metabolic health
Description
mmol/L Glucose Non-Esterified Fatty Acids Triglycerides Total cholesterol Low Density Lipoprotein Cholesterol High Density Lipoprotein Cholesterol
Time Frame
0, 4 and 8 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
45 Years
Maximum Age & Unit of Time
69 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or post-menopausal females Clinically diagnosed with knee Osteoarthritis including radiographic confirmation Oxford Knee Score ≥20 to ≤35 for index knee Aged 45-69 years BMI ≥27.5kg/m2 to ≤40.0 kg/m2 Daily physical activity level <2.00 Exclusion Criteria: Inability to undertake cycling exercise safely Use of prescribed anti-inflammatory medication Current smoker (or having quit <6months ago) Has a diagnosis of diabetes or other metabolic disorder Use of other medications that might interfere with study outcomes Recent (within last 3 months) change in body mass of >5% Currently engaged in an ongoing programme of physiotherapy treatment Currently on waiting list or having had surgery for Osteoarthritis on the index knee (prior OA related surgery permitted on other knee as long as this is greater than 12 months prior to enrolment) Having had major hip/knee surgery within preceding 12 months Individuals with a blood pressure of greater than 180/110 Currently pregnant or intending to become pregnant during the study
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Rachel L Deere, MSc
Phone
01225 385918
Email
r.deere@bath.ac.uk
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
James Bilzon, PhD
Organizational Affiliation
University of Bath
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Bath
City
Bath
ZIP/Postal Code
BA27AY
Country
United Kingdom
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Rachel Deere
Phone
01225 385918
Email
r.deere@bath.ac.uk

12. IPD Sharing Statement

Plan to Share IPD
No
IPD Sharing Plan Description
Anonymous individual data for all outcomes may be made available.

Learn more about this trial

Effect of Energy Restriction and Exercise for Knee Osteoarthritis

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