OBJECTIVE: To evaluate whether a remotely delivered physical therapy exercise and education intervention with daily step goals increased moderate- to vigorous-intensity physical activity (MVPA) compared to a control. DESIGN: Assessor-blinded superiority randomized controlled trial with 2 parallel arms. METHODS: We included adults from the United States who met the National Institute for Health and Care Excellence osteoarthritis (OA) criteria. Participants were randomized to the intervention of five 45- to 60-minute video conferencing consultations with a physical therapist for strengthening exercises, step goals, and education over 12 weeks or a control of OA web-based resources. The primary outcome was change in MVPA over 12 weeks (measured with ActiGraph GT3X). The secondary and exploratory outcomes were changes in light-intensity physical activity, steps/day, treatment beliefs, pain, function in activities of daily living, function in sports and recreation, and quality of life over 12 and 24 weeks. RESULTS: Of 103 participants who were randomized, 88 had monitor data at baseline and 67 (76% of 88) had monitor data at 12 weeks. There were no between-group differences in MVPA change over 12 weeks (between-group difference, -1.8 min/day; 95% confidence interval -7.0 to 3.3), change in light-intensity physical activity, or steps/day. Pain and function improved more with the intervention group compared to the control. A greater number of intervention participants (n = 44) reported nonserious adverse events than the control group (n = 10). CONCLUSION: Incorporating daily step goals into a telehealth strength exercise and education program for people with knee OA did not increase MVPA..

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