Intensive Lifestyle Intervention Improves Physical Function Among Obese Adults With Knee Pain: Findings From the Look AHEAD Trial

Abstract

Lifestyle interventions have resulted in weight loss or improved physical fitness among individuals with obesity, which may lead to improved physical function. This prospective investigation involved participants in the Action for Health in Diabetes (Look AHEAD) trial who reported knee pain at baseline (n = 2,203). The purposes of this investigation were to determine whether an Intensive Lifestyle Intervention (ILI) condition resulted in improvement in self-reported physical function from baseline to 12 months vs. a Diabetes Support and Education (DSE) condition, and whether changes in weight or fitness mediated the effect of the ILI. Outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, stiffness, and physical function subscales, and WOMAC summary score. ILI participants exhibited greater adjusted mean weight loss (s.e.) vs. DSE participants (−9.02 kg (0.48) vs. −0.78 kg (0.49); P < 0.001)). ILI participants also demonstrated more favorable change in WOMAC summary scores vs. DSE participants (β (s.e.) = −1.81 (0.63); P = 0.004). Multiple regression mediation analyses revealed that weight loss was a mediator of the effect of the ILI intervention on change in WOMAC pain, function, and summary scores (P < 0.001). In separate analyses, increased fitness also mediated the effect of the ILI intervention upon WOMAC summary score (P < 0.001). The ILI condition resulted in significant improvement in physical function among overweight and obese adults with diabetes and knee pain. The ILI condition also resulted in significant weight loss and improved fitness, which are possible mechanisms through which the ILI condition improved physical function.

Association Among Depression, Physical Functioning, and Hearing and Vision Impairment in Adults With Diabetes

“…40 Physical therapy, regular participation in home or fitness center-based structured exercise programs, and lifestyle physical activity may also serve as effective strategies to improve physical functioning among adults with diabetes. [41][42][43] Based on our findings, clinicians should screen for physical functioning and depression in patients with diabetes and especially in those with hearing or vision impairments. Clinicians could use some of the described strategies in their practice to help prevent and improve depression symptoms, sensory impairment, and physical functioning.…”

EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis

“…For people with knee OA or knee pain, improvements were seen in pain, function and weight loss from diet interventions that included individual weight-loss goals, problem solving on how to reach these goals and follow-up visits to re-evaluate and discuss goals in combination with exercise 53 60. In obese patients, weight-loss programmes with explicit weight-loss goals showed a higher mean change in weight than programmes without explicit goals 65.…”

“…In patients with knee OA, the effectiveness of weight-loss programmes on body weight, pain and/or physical function was demonstrated in programmes delivered as weekly supervised sessions for a range of 8 weeks to 2 years 54 60 109–113. The effects on pain, function and weight loss from attending weight-loss programmes were small but significant (ES, 95% CI, pain 0.20, 0.00 to 0.39; physical function 0.23, 0.04 to 0.42; mean weight loss, 95% CI, 6.1 kg, 4.7 to 7.6) 109.…”

Nutritional Management of Type 2 Diabetes Mellitus and Obesity and Pharmacologic Therapies to Facilitate Weight Loss

“…77 Although weight loss was greater in the ILI group than in the support and education group throughout the study (8.6% vs 0.7% at 1 year; 6.0% vs 3.5% at study end), it did not reduce the rate of cardiovascular events. 78 However, ILI produced greater reductions in HbA 1c levels and greater initial reductions in sleep apnea, 79 urinary incontinence, 80 and depression, 81 and improvements in quality of life, 82 physical functioning, 83 and mobility. 84 The study will continue as an observational trial to identify longer-term effects of the intervention.…”