In order to gain the requisite skills to design and conduct clinical investigations regarding the interrelationship between exercise and osteoarthritis (OA), this application proposes that a physician with formal Rheumatology and Sports Medicine fellowship training engage in a five-year program of combining didactic lectures in Clinical Investigation with the conduction of an arthroscopically-based trial of the effect of exercise on the progression of knee OA. Specific emphasis will be placed upon the development of new outcome measures, large scale trial methodology and management, in addition to statistical data analysis. The proposed research study will investigate whether a weight-resistance exercise intervention yields slower progression of knee OA than a control group that receives only education regarding self-management techniques in knee osteoarthritis. A novel, arthroscopic outcome measure that assesses cartilage damage and synovial inflammation, the American College of Rheumatology Knee Arthroscopy Osteoarthritis Scale (ACR/KAOS), will serve as the primary outcome measure. A blinded observer trained in arthroscopy will score videotapes of arthroscopies performed on each patient prior to and following the assigned intervention using the ACR/KAOS. The rate of progression according to the ACR/KAOS will then be compared between those randomized to the exercise and education groups. The sensitivity to change of the ACR/KAOS will be compared to that of the gold-standard for knee OA disease progression, semiflexed (MTP) plain radiographs of the knee. The short-term goal will be to complete the courses required to achieve a Masters of Science degree in Clinical Investigation. The goals of this didactic portion of the program will be to gain knowledge of biostatistics, epidemiology, study design, and a detailed understanding of the moral and legal limitations to the inclusion of human subjects in clinical studies. In order to achieve this goal, the first year of the proposed plan would include participation in classes in the UCLA School of Public Health. Approximately 50% of the first year will be devoted to these classes, with the remaining 50% devoted to the conduction of the trial. This research plan will provide the training required to establish the principal investigator as an independent researcher in osteoarthritis. The long-term goal of the plan is to systematically apply the state of the art, aggressive training methods from sports medicine to those afflicted with OA and to monitor the impact through the use of comprehensive rheumatologic outcomes. Eventually, optimal exercise regimens will be sought for both primary and secondary prevention of OA at various joints and stages.
