Investigating the Mind and Body in Arthritis Research

A professor and director of Health and Exercise Science at Wake Forest University, Shannon Mihalko, PhD, is a principal investigator for the Wake Forest site of The Osteoarthritis Prevention Study (TOPS) and lead behavioral scientist on the coordinating center. While weight loss and exercise have been found to be some of the most effective treatments for osteoarthritis (OA) in weight-bearing joints, like knees, TOPS, funded in part by the Arthritis Foundation, is examining whether weight loss and exercise can help prevent OA from developing in the first place.

Tell us about your background.  

I received my undergraduate degree from Wake Forest University and my masters’ and PhD degrees from the University of Illinois at Champaign-Urbana. My first master’s was in kinesiology, followed by my doctorate in kinesiology with an emphasis in exercise and health psychology. I went on to get a second master’s degree in community health with a concentration in epidemiology. I am a professor in the Department of Health and Exercise Science (HES) at Wake Forest University, and I also hold a joint appointment in the Department of Social Sciences and Health Policy within the Division of Public Health Sciences at Wake Forest University School of Medicine. I teach Health Psychology, Epidemiology, and am the director of the HES Honors Research Program.

What drew you to the field of science and research, and arthritis research in particular?

I was first drawn to the field of exercise science to better understand strength training and how to promote the importance of muscle and strength development in women, and in particular, older women. Although I was interested in the physiology, I kept asking why more females weren’t engaging in this behavior; at that time the importance of strength training for women was not well understood. These conversations kept coming back to motivation and self-confidence and that led me to a course in health psychology and the theoretical frameworks for predicting behavior change. In that course I realized my true passion was in behavioral psychology, with an emphasis on physical activity and eventually, dietary behaviors in older adults. Combined with my interest in women’s health, I was fortunate to join two parallel research teams working with chronic conditions that affect predominantly women, breast cancer and knee osteoarthritis. My role on these teams has grown over the years, and as the lead behavioral scientist, I hope to develop programs grounded in a social cognitive framework that build self-efficacy and prevent chronic psychological stress to maximize adherence to these health behaviors over a lifetime.  

Could you describe what you do with TOPS? 

I am the principal investigator for the Wake Forest site as well as the lead behavioral scientist on the coordinating center. As an investigator on TOPS, I led the development of the diet and exercise as well as the healthy living interventions with an eye on strategies to promote adherence and retention. I work closely with our lead interventionist, Monica Love, to deliver behavioral training for interventionists at all sites in TOPS and with our project manager, Jovita Newman, to oversee the study activities at Wake Forest University. 

Do you expect TOPS to affect patients either directly or indirectly? 

Both! Participants in the study will benefit directly through engagement in interventions that support healthy behaviors, while the lessons we learn about what works, what sustains engagement and how to reduce barriers will have broader impact. Indirectly, our findings will help inform future interventions and guidelines, ultimately reaching more women and improving outcomes over time.

What are you excited about in OA?  What should patients be excited about?  

I am encouraged by the shift toward understanding that knee osteoarthritis not just as a “wear and tear” disease, but as a condition influenced by lifestyle behaviors and psychosocial factors. For people who live with knee OA, this means there are more tools within their control — including physical activity, dietary behaviors and stress management — that can meaningfully improve symptoms and quality of life. For individuals trying to prevent the onset of knee OA, I think there is excitement for the growing recognition that behavioral interventions matter and that programs like TOPS are designed to support making and maintaining these changes over a lifetime. 

What else would you like to share about your involvement with arthritis research?

What has been most rewarding is working with dedicated teams that bring together expertise in medicine, physiology and nutrition, behavioral science, and community engagement. Arthritis research has given me the opportunity to focus on interventions that are both evidence-based and theoretically driven, while also practical for everyday life. It is important to me that the work we do translates into real strategies and a shift in thinking that help individuals live with less pain, greater mobility and improved overall well-being.