Strength Training for Arthritis Trial (START): design and rationale

Area of Science:

• Orthopedics
• Sports Medicine
• Gerontology

Background:

• Knee osteoarthritis (OA) is linked to muscle loss and fat gain, increasing disability and pain.
• Thigh muscle weakness is a modifiable risk factor for knee OA.
• Current guidelines recommend strength training, but optimal intensity and duration for OA are unclear.

Purpose of the Study:

• To evaluate the efficacy of high-intensity strength training (75-90% 1RM) compared to low-intensity training (30-40% 1RM) and healthy living education in older adults with knee OA.
• To determine the effects of these interventions on knee pain, knee-joint compressive forces, thigh composition, and OA progression.

Main Methods:

• An assessor-blind, randomized controlled trial involving 372 older adults (age ≥ 55) with mild-to-moderate medial tibiofemoral OA.
• Participants were randomized into high-intensity strength training, low-intensity strength training, or healthy living education groups.
• Primary outcomes included knee pain and knee-joint compressive forces; secondary outcomes included function, mobility, disease progression, thigh muscle/fat volume, strength, power, biomarkers, and quality of life.

Main Results:

• Reliability analyses showed high test-retest reliability for CT scans (ICC=0.99) and strength testing (ICC=0.93-0.99).
• Results will guide clinicians on optimal strength training for OA management.
• Assessing optimal strength training efficacy has potential for significant clinical impact.

Conclusions:

• High-intensity strength training shows promise for improving knee osteoarthritis symptoms and potentially slowing disease progression.
• This intervention may alter thigh composition, leading to reduced knee-joint forces and pain.
• Findings will provide crucial guidance for healthcare professionals managing OA complications.