Pilot study of duloxetine plus aerobic exercise for pain and depressive symptoms in knee osteoarthritis.
9 affiliations
- 1Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
- 2Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
- 3Geriatric Research Education and Clinical Center, VA Maryland Health Care System, Baltimore, MD, USA.
- 4Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA.
- 5Institute of Gerontology, Wayne State University, Detroit, MI, USA.
- 6Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, USA.
- 7Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- 8Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
- 9Mental Health Clinical Center, VA Maryland Health Care System, Baltimore, MD, USA.
Abstract
Objective
Pain and depressive symptoms are common in knee osteoarthritis (KOA), and their co-occurrence creates bidirectional effects that complicate treatment, as intervening on one does not necessarily improve the other. This single-group pilot study evaluated the feasibility of a 12-week supervised hybrid aerobic exercise program plus duloxetine targeting pain, depressive symptoms and physical function.Methods
Between May 2023 and March 2025, participants with symptomatic KOA and mild-severe depressive symptoms were recruited from the University of Maryland Medical System, the VA Maryland Health Care System and the Baltimore metropolitan area. The intervention combined a hybrid walking program (two home-based and one supervised session per week) with duloxetine, initiated at 30 mg and titrated to 60 mg. Clinical outcomes were collected at baseline and 12 weeks and included structured assessments and physical performance tests.Results
The recruitment target was 20 participants; 34 enrolled, 21 initiated treatment and 17 completed the protocol. Knee Injury and Osteoarthritis Outcome Score pain scores increased by 14.2 points (95% CI 6.5, 21.9), indicating less pain, while Hamilton Depression Rating Scale scores decreased by 5.5 points (95% CI -9.0, -2.0), implying a reduction in depressive symptoms. Physical function improved as measured by changes in the 6-min walk test [130 ft (95% CI 56.7, 204.1)], 20-m gait speed [0.08 m/s (95% CI 0.004, 0.154)] and chair stands [1.8 repetitions (95% CI 0.7, 2.8)].Conclusion
This study demonstrates feasibility and preliminary efficacy signals for an exercise-pharmacologic protocol and underscores the need for larger randomized clinical trials.Clinical trial registration
https://clinicaltrials.gov/, NCT04111627.
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BibTeX
@article{rathbun2026pilot,
title = {{Pilot study of duloxetine plus aerobic exercise for pain and depressive symptoms in knee osteoarthritis.}},
author = {Alan M Rathbun and Alice S Ryan and Yu Dong and Brock A Beamer and Mark Luborsky and Michelle D Shardell and Justine Golden and Claudia M Campbell and Grace H Lo and Jason E Peer and Marc C Hochberg},
journal = {Rheumatology advances in practice},
year = {2026},
month = oct,
doi = {10.1093/rap/rkag116},
url = {https://europepmc.org/article/MED/42936867},
note = {CC BY},
}
RIS
TY - JOUR
TI - Pilot study of duloxetine plus aerobic exercise for pain and depressive symptoms in knee osteoarthritis.
AU - Alan M Rathbun
AU - Alice S Ryan
AU - Yu Dong
AU - Brock A Beamer
AU - Mark Luborsky
AU - Michelle D Shardell
AU - Justine Golden
AU - Claudia M Campbell
AU - Grace H Lo
AU - Jason E Peer
AU - Marc C Hochberg
PY - 2026
DA - 2026/10/06
JO - Rheumatology advances in practice
DO - 10.1093/rap/rkag116
UR - https://europepmc.org/article/MED/42936867
AB - Objective Pain and depressive symptoms are common in knee osteoarthritis (KOA), and their co-occurrence creates bidirectional effects that complicate treatment, as intervening on one does not necessarily improve the other. This single-group pilot study evaluated the feasibility of a 12-week supervised hybrid aerobic exercise program plus duloxetine targeting pain, depressive symptoms and physical function.Methods Between May 2023 and March 2025, participants with symptomatic KOA and mild-severe depressive symptoms were recruited from the University of Maryland Medical System, the VA Maryland Health Care System and the Baltimore metropolitan area. The intervention combined a hybrid walking program (two home-based and one supervised session per week) with duloxetine, initiated at 30 mg and titrated to 60 mg. Clinical outcomes were collected at baseline and 12 weeks and included structured assessments and physical performance tests.Results The recruitment target was 20 participants; 34 enrolled, 21 initiated treatment and 17 completed the protocol. Knee Injury and Osteoarthritis Outcome Score pain scores increased by 14.2 points (95% CI 6.5, 21.9), indicating less pain, while Hamilton Depression Rating Scale scores decreased by 5.5 points (95% CI -9.0, -2.0), implying a reduction in depressive symptoms. Physical function improved as measured by changes in the 6-min walk test [130 ft (95% CI 56.7, 204.1)], 20-m gait speed [0.08 m/s (95% CI 0.004, 0.154)] and chair stands [1.8 repetitions (95% CI 0.7, 2.8)].Conclusion This study demonstrates feasibility and preliminary efficacy signals for an exercise-pharmacologic protocol and underscores the need for larger randomized clinical trials.Clinical trial registration https://clinicaltrials.gov/, NCT04111627.
SN - 2514-1775
ER -