Discussion
Arthritis, knee pain, Osteoporosis, KOA
ARTHRITIS, RECRUITMENT, RECRUITMENT, OSTEOPOROSIS
This pilot demonstrates feasibility and lays the groundwork for a full-scale RCT that investigates the joint structural implications of a walking exercise program for KOA, though the recruitment approach could be improved. A subsequent full-scale RCT has the potential to build evidence about the clinical benefit of exercise therapy and help to debunk common misconceptions that exercise causes joint harm [The study demonstrates feasibility in terms of randomization, safety, retention, and adherence and presents improvements to the study design. Supervised outdoor walking allowed for individualized support and encouragement for participants, attributing to high patient satisfaction and symptomatic improvements. Group sizes were reduced to provide better individualized support and to ensure protocol adherence and safety. In addition, adding planned absences as an exclusion criterion helped to promote adherence to the program.Overall adherence to the walking program was 70.0%, which is higher than most comparable exercise studies [Recruitment was slower than anticipated, and the recruitment target could not be reached due to budgetary constraints. This could have been due to our institute recruiting for two KOA exercise trials simultaneously, and this will be considered when planning the implementation of a future large-scale trial. Recruitment in future studies could potentially benefit from an enhanced recruitment strategy, such as snowball sampling, engaging primary care practitioners, promotion through local organizations (e.g., Arthritis & Osteoporosis Tasmania), and by including more walk locations or using a multi-center design. The use of simple randomization resulted in an imbalance between the number of participants in each group, which could be prevented in a future trial by using block randomization [This pilot study investigated the direction and magnitude of changes in several exploratory outcomes. As this was a pilot study, no a priori power estimations were performed. Walking improved knee pain, function, and stiffness over 24 weeks, which supports the findings of previous RCTs [Physical performance and activity were assessor-blinded measures conducted to objectively examine changes in the ability to perform daily activities. Both the walking and control group showed improvements in OARSI performance measures over 24 weeks, which may have been due to a test learning effect [There were very small changes in MRI-based structural measures over 24 weeks in each group. Apart from a slight difference in meniscal extrusion score increases between the groups, there was no indication of detrimental effects related to the walking intervention. Meniscal extrusions increased by 23.5% in the walking group and 7.7% in the control group. This finding was based on a small number of participants (This study has several strengths. First, its design as a pilot RCT enabled a thorough investigation of the study design to improve the quality for a subsequent larger RCT. Second, the intervention was intensively supervised ensuring standardization of exercise and reducing self-report bias of exercise duration and frequency [