Effects of Intensive Diet and Exercise on Knee Joint Loads, Inflammation, and Clinical Outcomes Among Overweight and Obese Adults With Knee Osteoarthritis

Messier, Stephen P.; Mihalko, Shannon L.; Legault, Claudine; Miller, Gary D.; Nicklas, Barbara J.; DeVita, Paul; Beavers, Daniel P.; Hunter, David J.; Lyles, Mary F.; Eckstein, F.; Williamson, Jeff D.; Carr, Jeff; Guermazi, Ali; Loeser, Richard F.

doi:10.1001/jama.2013.277669

Cited by 635 publications

(810 citation statements)

References 51 publications

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“…In comparison to other exercise trials in patients with knee OA and comorbidity, we included patients with more severe comorbidity (10,12,13,49). Our study population had more activity limitations at baseline, had on average more pain, and had lower muscle strength in comparison to the baseline characteristics of patients in other exercise trials (10,12,13,49).…”

Section: Discussionmentioning

confidence: 99%

“…Our study population had more activity limitations at baseline, had on average more pain, and had lower muscle strength in comparison to the baseline characteristics of patients in other exercise trials (10,12,13,49). We selected patients if they had a severity score $2 for the comorbidity on the Cumulative Illness Rating Scale (23), indicating that the comorbidity had an impact on daily activities, and the patient was receiving regular care for the comorbid disease.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with unstable medical conditions, precluding safe participation in an exercise program, are excluded from clinical trials (10)(11)(12)(13), because of the high risk of comorbidity-induced adverse events. One study investigated the outcome of exercise therapy in a subgroup of patients with knee OA and comorbidity compared to patients without comorbidity (14).…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of Tailored Exercise Therapy on Physical Functioning in Patients With Knee Osteoarthritis and Comorbidity: A Randomized Controlled Trial

MSc

Leeden

Cheung

et al. 2017

Arthritis Care & Research

100

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Objective. To evaluate the efficacy on physical functioning and safety of tailored exercise therapy in patients with knee osteoarthritis (OA) and comorbidities. Methods. In a randomized controlled trial, 126 participants were included with a clinical diagnosis of knee OA and at least 1 of the following target comorbidities: coronary disease, heart failure, type 2 diabetes mellitus, chronic obstructive pulmonary disease, or obesity (body mass index ‡30 kg/m 2 ), with severity score ‡2 on the Cumulative Illness Rating Scale. The intervention group received a 20-week, individualized, comorbidity-adapted exercise program consisting of aerobic and strength training and training of daily activities. The control group received their current medical care for knee OA and were placed on a waiting list for exercise therapy. Primary outcome measures were the Western Ontario and McMaster Universities Osteoarthritis Index, subscale physical functioning (WOMAC-pf), and the 6-minute walk test (6MWT). Measurements were performed at baseline, after 20 weeks (directly posttreatment), and at 3 months posttreatment. Results. Statistically significant physical functioning differences over time were found between the intervention and control group (WOMAC: B 5 27.43 [95% confidence interval (95% CI) 29.99, 24.87], P < 0.001; and 6MWT: B 5 34.16 [95% CI 17.68, 50.64], P < 0.001) in favor of the intervention group. At 3 months followup, the mean improvements in the intervention group were 33% on the WOMAC scale and 15% on the 6MWT. These improvements are of clinical relevance. No serious adverse events occurred during the intervention. Conclusion. This is the first study showing that tailored exercise therapy is efficacious in improving physical functioning and safe in patients with knee OA and severe comorbidities.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Efficacy of Tailored Exercise Therapy on Physical Functioning in Patients With Knee Osteoarthritis and Comorbidity: A Randomized Controlled Trial

MSc

Leeden

Cheung

et al. 2017

Arthritis Care & Research

100

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“…In trials among subjects with and without established knee OA, weight loss was shown to have advantageous structure-modifying, systemic, and clinical effects (15)(16)(17)(18)(19)(20)(21). In a systematic review on the effects of weight loss on knee OA patients, a weight loss of at least 5% of body weight was indicated for symptomatic relief (22).…”

Section: Introductionmentioning

confidence: 99%

Prevention of Incident Knee Osteoarthritis by Moderate Weight Loss in Overweight and Obese Females

Runhaar

Vos

Middelkoop

et al. 2016

Arthritis Care & Research

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Objective. This study evaluated the effect of moderate weight loss on the incidence of knee osteoarthritis (OA) in middle-aged overweight and obese women, without clinical and radiologic knee OA at baseline. Methods. A total of 353 women (87%) with followup data available were selected from the Prevention of Knee Osteoarthritis in Overweight Females study, which evaluated the preventive effect of a diet and exercise intervention and of oral glucosamine sulfate on the incidence of knee OA. This was an exploratory proof-of-concept analysis, which compared the incidence of knee OA between women who reached the clinically relevant weight loss target of 5 kg or 5% of body weight after 30 months and those who did not reach this target. Results. The weight loss group showed a significantly lower incidence of knee OA according to the primary outcome measure, which was composed of the American College of Rheumatology criteria (clinical and radiographic), Kellgren/Lawrence grade ‡2, and joint space narrowing ‡1.0 mm (15% versus 20%; odds ratio 0.5, 95% confidence interval 0.3-0.9). Moreover, the weight loss also positively affected several health measures, such as blood glucose level, body fat percentage, and blood pressure. Conclusion. A reduction of ‡5 kg or 5% of body weight over a 30-month period reduces the risk for the onset of radiographic knee OA in middle-aged overweight and obese women. Because of the slow progression of the disease, a longer followup period will be necessary before the number of prevented cases of knee OA by moderate weight loss becomes clinically more relevant.

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“…29 Because of these potential adverse outcomes, clinicians may be reluctant to recommend weight loss in elders. 30 Losing trivial amounts of weight yet engaging in wellness and physical activities results in improved cardiovascular fitness, gait speed, short performance physical battery, and sixminute walk tests, [31][32][33] all measures that are likely more important to patient long-term health and quality of life 24 than weight loss. This suggests that a wellness rather than a 'weight-loss' strategy may be more beneficial for a senior's health.…”

Section: Management Differences In Older Vs Younger Adultsmentioning

confidence: 99%

Challenges with the Medicare Obesity Benefit: Practical Concerns & Proposed Solutions

2014

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Effects of Intensive Diet and Exercise on Knee Joint Loads, Inflammation, and Clinical Outcomes Among Overweight and Obese Adults With Knee Osteoarthritis

Cited by 635 publications

References 51 publications

Efficacy of Tailored Exercise Therapy on Physical Functioning in Patients With Knee Osteoarthritis and Comorbidity: A Randomized Controlled Trial

Efficacy of Tailored Exercise Therapy on Physical Functioning in Patients With Knee Osteoarthritis and Comorbidity: A Randomized Controlled Trial

Prevention of Incident Knee Osteoarthritis by Moderate Weight Loss in Overweight and Obese Females

Challenges with the Medicare Obesity Benefit: Practical Concerns & Proposed Solutions

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