Improving Walking Quality and Quantity in Osteoarthritis (IWALQQ-OA)

People with knee osteoarthritis have low levels of physical activity, especially walking
activity. They also walk with abnormal walking biomechanics that are associated with greater
knee loading. Therefore, it is important to increase the levels of walking activity in people
with knee osteoarthritis, but also change their walking patterns to reduce knee loading.

This study will last 12 months and participants will be randomized into 2 groups. For the
first 6-months, half of the participants will attend sessions at a community location that
include training in mindful walking technique. The other half will meet for the same
frequency and duration at a community location for education on osteoarthritis and its
management (focusing on symptom management, importance of physical activity, weight
management, etc.). Both groups will also receive a wrist-worn activity monitor and a
smartphone application that they will use throughout the study. After 6-months all
participants will be allowed to practice on their own.

All participants will complete gait analysis, knee MRI, questionnaires, physical function
assessment at baseline and at 6-months. All participants will also complete questionnaires at
3,9, and 12 months. Weekly physical activity and knee pain data will be collected using the
mobile health technology for 12- months.

Inclusion Criteria:

- age 50-80 years

- BMI ≤40 kg/m2

- Knee pain on most days in one or both knees

- Knee pain score ≥ 4 during last week

- Predominantly medial knee pain

- Predominantly medial knee radiographic osteoarthritis with or without radiographic
patellofemoral osteoarthritis

- • Radiographic tibiofemoral Kellgren-Lawrence grade 2 or 3 in painful knee(s)

- Knee stiffness on waking up in the morning that lasts < 30 minutes

- Ability to ambulate for a minimum of 20 minutes, without any assistive device

- Available for the study duration

- Own a smartphone

- Can speak and understand English

Exclusion Criteria:

- Kellgren-Lawrence grade of 4 in both knees or Kellgren-Lawrence grade of 4 in the more
symptomatic knee

- Contraindications to exercise

- Using orthotics for knee pain such as knee braces, wedge insoles

- Knee injection in previous 6-months

- Currently receiving physical therapy for knee pain

- Planning major treatment for knee pain (e.g., physical therapy, surgery) in next 6
months

- Self-reported joint diseases like rheumatoid arthritis, psoriatic arthritis,
ankylosing spondylitis, gout, etc.

- Self-reported total joint replacement in any lower extremity joint

- Self-reported neurological conditions like stroke, Parkinson's disease, etc.

- Self-reported muscular disease like muscle dystrophy

- Self-reported musculoskeletal or neurologic conditions that affect gait.

- Contraindications to MRI (e.g. metal implanted in body, claustrophobia, pregnancy).