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Objective: We evaluated a behaviorally designed intervention utilizing gamification and social support to improve physical activity and reduce symptoms in patients with osteoarthritis of the knee (KOA)., Methods: Veterans with KOA, aged 40-80 years, were enrolled in this randomized controlled trial. Participants received a Fitbit and completed a 2- to 4-week baseline period. A Web-based platform administered biweekly surveys after randomization and tracked physical activity. Participants selected a daily step goal that was 33%, 40%, or 50% above their baseline. The intervention arm received game playing aspects and a social support partner to advance weekly step performance while the control arm only received weekly updates. The primary outcome was the change in steps per day averaged over 2-week intervals. We used mixed effects regression, adjusting for baseline step count. Secondary outcomes assessed the change in KOOS (Knee Injury and Osteoarthritis Outcome Score) over 32 weeks., Results: Thirty-one participants were included in the final analysis. Most participants were male (90.3%), Black (70.96%), had a mean (SD) age of 60 (13) years, and body mass index of 33.7 (5.9) kg/m2. Participants that received the intervention walked a total of 1119 (95% confidence interval: -562, 2799) more steps per day (p = 0.19). The effect was greatest in the first 6 months (1491 [-272, 3254], p = 0.10). Compared with controls, those that received the intervention had improvement over time in total KOOS (mean 2-week change +0.62 [0.031, 1.20] vs -0.38 [-1.04, 0.28], p = 0.02) and several subscales., Conclusions: This intervention demonstrated promise for promoting greater physical activity and improving symptoms in patients with KOA., Competing Interests: Conflicts of interest and sources of funding: Dr Baker would like to acknowledge funding through a Veterans Affairs Rehabilitation Research and Development (RR&D) SPiRE Award (I21 RX003157), an RR&D Merit Award (I01 RX003644), and Clinical Science Research and Development Career Merit Award (I01 CX001703). Dr Scanzello is supported by a Basic Laboratory Research and Development Merit Award (BX004912) and a RR&D Merit Award (RX003988). Dr Neogi is supported by a National Institutes of Health Mentoring Award (K24 AR070892). Dr Wysham is supported by a VA Career Development Award (CX002351). The contents of this work do not represent the views of the Department of the Veterans Affairs or the United States Government. The authors do not have any conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)