Patient case (clinical description): A 66-year-old woman comes to the office due to joint pain in the hands and periodic morning stiffness that lasts less than 15 minutes.  The pain is moderately severe and worsens with daily activity. The patient used Tylenol with minimal relief.  Past medical history is notable for hypertension and hypercholesteremia.  Physical examination shows firm nodules over the distal interphalangeal joints, bilaterally. The patient has pain in her knees as well. The knees are stiff in the morning for less than 30 minutes and become worse with climbing stairs. She has some sensation of bone friction during activity. X-ray shows narrowing of the joint space, subchondral bone sclerosis and osteophyte formation along the joints.

Patient's own account: I'm a 66-year-old woman and I went to my doctor's office because of a bloody joint pain in my hands that has been lasting for a while. The pain comes and go in the morning usually. I feel like a stiffness that last less than 15 minutes. The pain is moderately severe but it gets worse when I'm using my hands. I used Tylenol which helped a little. Apart from that, I suffer from hypertension and high cholesterol. The doctor made me notice that I have bumps around both of my hand joints. I also suffer from my knees and they are also stiff in the morning for around 30 min. It's even worse when I climb up the stairs! I also feel like my bones are rubbing against each other when I'm moving. The X-ray showed that I have narrow joint space, I have sclerosis, and abnormal growths of bone along my joints.

Clinical trial: Investigating the Effect of Interval Walking and Qigong on People With Knee Osteoarthritis: Pilot Study

Eligibility criteria:
Inclusion criteria are the following:

          1. 60-79 years of age and diagnosed with KOA by a physician or meet the ACR criteria (95%
             sensitivity, and 69% specificity) for KOA. The ACR criteria include experiencing
             almost daily knee pain and having at least 3 of these 6 criteria: (1) Age more than 50
             years old, (2) less than 30 minutes of morning stiffness, (3) increased warmth of the
             knee, (4) crepitus with flexion or extension, (5) joints' bony enlargement , and (6)
             tenderness of joint line with palpation, or subject must be diagnosed radiologically,
             with grade II or more according to the Kellgren and Lawrence rating scale.

          2. Frequent knee pain or aching on most of the preceding 30 days.

          3. An average of mild to moderate pain intensity level (5 to 75 mm on the 100 mm VAS) in
             the last 7 days

          4. Sedentary lifestyle assessed using 2011 Compendium of Physical Activities
             questionnaire. The subject is considered sedentary if engaging in exercise or physical
             activity with metabolic equivalents of task (MET) less than 4, not more than two
             times/week.

        Exclusion criteria:

          1. Unwilling to attend 3 sessions/week at Kirmayer Fitness Center

          2. Having other types of arthritis such as rheumatoid arthritis or gout

          3. Neurological disorders

          4. CVD including hypertension that prevent them from engaging in walking exercise

          5. Currently using beta blocker medication

          6. Underwent any lower limb surgery during the past 6 months

          7. A history of two or more incidents of fall during the last 6 months

          8. Current hip or spine pain that prevents them from engaging in walking exercise.
No condition on gender to be admitted to the trial.
No healthy subjects accepted to join the trial.
Subject must be at least 45 Years old.
Subject must be at most 79 Years

Eligibility (NLI label): Contradiction