Tai Chi for Knee OA Pain Management: a Mechanistic Study

Texas Tech University Health Sciences Center33 enrolled

Overview

This study is to determine how 8-week Tai Chi intervention alters plasma endocannabinoid and its receptors in monocytes/marcrophages, plasma oxylipinds, plasma brain-derived neurotrophic factor, brain white matter connectivity/efficiency, and functional/clinical outcomes in women with knee OA.

Knee osteoarthritis (OA) is one of the five leading causes of disability. Previous studies have shown that a mind-body moderate-intensity Tai Chi (TC) exercise (8-24 weeks) reduced pain and improved physical function for knee OA, when compared to a waiting list, attention control, usual physical activity, or physical therapy. However, TC's mechanisms of action regarding improvement of one's clinical condition and its functional outcomes in individuals with knee OA are poorly understood. This study is to determine how 8-week TC intervention alters plasma endocannabinoid and its receptors in monocytes/marcrophages, plasma oxylipinds, plasma brain-derived neurotrophic factor, brain white matter connectivity/efficiency, and functional/clinical outcomes in women with knee OA.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Knee Osteoarthritis Mind-body Exercise

Interventions

Tai chi exerciseBEHAVIORAL

24-form Yang style Tai Chi (60 min/session, 3 sessions/week) for 8 weeks

Eligibility

Sex: FEMALE

Medical Language ↔ Plain English

Inclusion Criteria: 1. Postmenopausal women. 2. WOMAC pain score ≥ 50 on at least 1 of the 5 questions in pain subscale (range of 0 to 100, with higher scores indicating greater pain. 3. English literacy. 4. Able to undergo an MRI scan 5. Diagnosed Have the following symptoms associated with knee OA based on American College of Rheumatology clinical classification criteria for osteoarthritis (Peat 2006). Pain in the knee. Need to at least 3 of the following: over 50 years of age, less than 30 minutes of morning stiffness, crepitus on active motion, bony tenderness, bony enlargement, or no palpable warmth of synovium. Exclusion Criteria: 1. Prior experience with mind-body practice (e.g. TC, Qi Gong, yoga, or acupuncture) or physical therapy programs for knee OA within the past 3 months. 2. Severe medical limitations (i.e., dementia, symptomatic heart or vascular disease, or recent stroke) precluding full participation. 3. Medical/neurologic or other systemic diseases affecting the musculoskeletal systems (i.e. polio/Parkinson's/multiple sclerosis, etc. in addition to cerebral vascular accident or stroke) and diabetes with peripheral neuropathy affecting their sensory/balance. 4. Intra-articular steroid injection or reconstructive surgery on most severely affected knee in the past three months. 5. Intra-articular hyaluronic acid injections on most severely affected knee in the past six months. 6. Inability to walk without an assistive device.

Locations (1)

Texas Tech University Health Sciences Center

Lubbock, Texas, United States

Outcomes

Primary Outcomes

endocannabinoid

plasma endocannabinoid levels

Time frame: Changes from bseline endocannabinoid levels at 8 weeks

oxylipins

plasma oxylipins levels

Time frame: Changes from baseline oxylipins levels at 8 weeks

Secondary Outcomes

endocannabinoid receptors expression

expression of endocannabinoids receptors on peripheral blood mononuclear cells using flow cytometry. Collect venous blood into evacuated tube containing lithium heparin and pour into a Leucosep tube prepared with Ficoll-Paque. Following sequential centrifugation steps, peripheral blood mononuclear cells will be collected and incubate with endotoxin (e.g. LPS or PMA) for 24 hours (Venable 2016). After incubation, PBMC will be collected and stained with cannabinoid receptors (CB1R and CB2R) and markers for monocytes/macrophages (CD14, etc).

Time frame: Changes from baseline the affinity of endocannabinoid receptor expression at 8 weeks

BDNF

plasma brain-derived neurotrophic factor levels using ELISA

Time frame: Changes from baseline BDNF levels at 8 weeks

white matter connectivity/efficiency of various fiber tracts in the brain

We will follow the protocol of Vachon-Presseau et al. 2006 to collect DTI data. DTI images will be acquired using echo planar imaging (72 x 2-mm thick axial slices; matrix size = 128 x 128; ﬁeld of view = 256 x 256mm2, resulting in a voxel size of 2 x 2 x 2mm). Images will have an isotropic distribution along 60 directions using a b-value of 1000s/mm2. For each set of diffusion-weighted data, eight volumes with no diffusion weighting will be acquired at equidistant points throughout the acquisition.

Time frame: Change from baselinewhite matter connectivity/efficiency of various fiber tracts in the brain at 8 weeks

Data from ClinicalTrials.gov

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