Effects of Diet and Exercise on Knee Joint Loads & Inflammation

Knee osteoarthritis (OA), a common cause of chronic pain and disability, has biomechanical and inflammatory origins and is exacerbated by obesity. Osteoarthritis is the leading cause of chronic disability among older adults. Knee OA is the most frequent cause of mobility dependency and diminished quality of life, and obesity is a major risk factor for knee OA. Current treatments for knee OA are inadequate; of patients treated pharmacologically, only about half experience a 30% pain reduction, usually without improved function. The few studies of long-term weight loss in obese adults with knee OA showed equally modest improvements.

A single-blind, 18-month, randomized clinical trial at Wake Forest University between July 2006 and April 2011 to determine whether a ≥10% reduction in body weight induced by diet, with or without exercise, would improve mechanistic and clinical outcomes more than exercise alone. The diet and exercise interventions were center-based with options for the exercise groups to transition to a home-based program. Participants were 454 overweight and obese older community-dwelling adults (age ≥55 years with body mass index of 27-41) with pain and radiographic knee OA.

Interventions included: Intensive diet-induced weight loss plus exercise, intensive diet-induced weight loss, or exercise. Mechanistic primary outcomes: knee joint compressive force and plasma IL-6 levels; secondary clinical outcomes: self-reported pain (range, 0-20), function (range, 0-68), mobility, and health-related quality of life (range, 0-100). Among overweight and obese adults with knee OA, after 18 months, participants in the diet + exercise and diet groups had more weight loss and greater reductions in IL-6 levels than those in the exercise group; those in the diet group had greater reductions in knee compressive force than those in the exercise group.

Read the full study here: http://jama.jamanetwork.com/article.aspx?articleid=1741824

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