Development of a Mind Body Program to Reduce Knee Pain in Obese Osteoarthritis Patients with Comorbid Depression

Symptomatic knee osteoarthritis (OA) is the most common joint disorder in the U.S and a leading cause of disability. Depression and obesity are highly comorbid among knee OA patients, and the combination of obesity and depression is associated with decreased physical activity, higher pain and disability, and more rapid cartilage degradation. Depression, obesity and OA exacerbate one another and share a common pathophysiology involving systemic inflammation and pro-inflammatory cytokines, reflecting a complex mind-body interaction. Current treatments for knee OA offer little to no benefit over a placebo, and do not emphasize mind-body practices or physical activity to target the underlying pathophysiology. Interventions to lessen depressive symptoms and increase physical activity offer the ability to target biological, mechanical and psychological mechanisms of OA progression in this high-risk subset. Our long-term goal is to conduct a phased R33/R61 proposal to evaluate the mechanisms by which the 3RP delivered via telehealth, and adapted for patients with depression, obesity and knee OA (3RP-OA) and to target increased in physical activity improves subjective knee health (e.g., knee pain, physical function, and biomarkers of cartilage breakdown). Our guiding hypothesis is that the synergistic interaction between mindfulness, adaptive thinking, positive psychology and healthy living skills of the 3RP adapted for the needs of OA patients and to target increased physical activity reduces pro-inflammatory cytokine expression while also promoting optimal mechanical loading of the cartilage will slow the progression of symptomatic knee OA. Toward this goal, this R34 proposal aims to 1) adapt the 3RP for the needs of knee OA patients with depression (PHQ-9.10) and obesity (BMI.30 kg/m2) with a focus of increasing physical activity; and 2) establish the feasibility, credibility and acceptability of the programs and research procedures.