Strength Training for ARthritis Trial (START)

Short Study Name (acronym): START


Long Name: Strength Training for ARthritis Trial


Investigators (list PI first):  Steven Messier, PhD

Funding Agency:  National Institutes of Health and Wake Forest University and WFU Health Sciences


 Funding Dates: 2011 - 2016


Research questions or aims:


This is an 18-month, high-intensity strength-training intervention for older adults with knee OA, focused on improving thigh composition. 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 inflammation, lower pain levels, and slow progression.


Participants (age ≥ 55 yrs; BMI ≥ 25 kg/m2 and ≤ 40 kg/m2 ) will be randomized to one of 3 groups: high-intensity strength training (75-90% 1RM); low-intensity strength training (30-40%1RM); or attention control. The study sample will consist of 372 ambulatory, community-dwelling persons with: (1) mild-to-moderate medial tibiofemoral OA (KL = 2-3); (2) knee varus malalignment (varus angle ≥ 2 degrees and ≤ 10 degrees); and (3) no participation in a formal strength-training program for more than 30 minutes per week within the past 6 months.


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; disease progression, measured by MRI; 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.

Target population: Older adults with Osteoarthritis, difficulty using knees or knee pain


Target # to enroll: 372


Target Dates of enrollment: No longer recruiting


Types of assessments and questionnaires:  medical examination, CT scan, DXA, SPPB, Leg press, 6 min Walk, blood work


Study Website (if applicable): none


Project Manager Contact Info:    Jovita Newman at, or 336-758-3969

Last Updated: 08-10-2015
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