title: The effects of weight reduction on the rehabilitation of patients with knee osteoarthritis and obesity. Obese, older adults with knee osteoarthritis: weight loss, exercise, and quality of life. North of England evidence based guidelines development project: methods of developing guidelines for efficient drug use in primary care Effects of exercise adherence on physical function among overweight older adults with knee osteoarthritis. Diet-induced weight loss, exercise, and chronic inflammation in older, obese adults: a randomized controlled clinical trial. Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the Arthritis, Diet, and Activity Promotion Trial. Six-week high-intensity exercise program for middle-aged patients with knee osteoarthritis: a randomized controlled trial [ISRCTN20244858] Is serum leptin related to physical function and is it modifiable through weight loss and exercise in older adults with knee osteoarthritis? Efficacy of physiotherapy management of knee joint osteoarthritis: a randomised, double blind, placebo controlled trial. A randomized controlled study of the Arthritis Self-Management Programme in the UK. The Influence of Surgically-Induced Weight Loss on the Knee Joint Exercise and weight loss in obese older adults with knee osteoarthritis: a preliminary study. Exercise, self-efficacy, and mobility performance in overweight and obese older adults with knee osteoarthritis. Weight loss reduces knee-joint loads in overweight and obese older adults with knee osteoarthritis. Weight loss: the treatment of choice for knee osteoarthritis? A randomized trial. Effect of weight loss and exercise on frailty in obese older adults. Determinants of high and low attendance to diet and exercise interventions among overweight and obese older adults. Results from the arthritis, diet, and activity promotion trial. The Arthritis, Diet and Activity Promotion Trial (ADAPT): design, rationale, and baseline results. The effect of energy restriction, walking, and exercise on lower extremity lean body mass in obese women with osteoarthritis of the knee Weight changes and the risk of knee osteoarthritis requiring arthroplasty.
abstract: OBJECTIVE To evaluate the effect of weight reduction on the rehabilitation of patients with knee osteoarthritis and obesity . METHODS A total of 126 patients with bilateral knee osteoarthritis and obesity were classified into 3 groups by their stages of osteoarthritis . Each group was divided into subgroups a , b , and c. The subjects in subgroup a received weight reduction treatment , those in subgroup b received weight reduction and electrotherapy modalities , and those in subgroup c received electrotherapy modalities to relieve pain . RESULTS Pain reduction , weight reduction , ambulation speed , and changes of Lequesne 's index were greater in patients in subgroups a and b than in subgroup c after treatment . Although the last pain scores in subgroup b were less than those in subgroup a , as measured by a visual analog scale ( VAS ) , there was no significant difference between their functional status . Significant pain relief ( VAS < 2 ) and an acceptable functional status ( Lequesne 's index < 7 ) were indicated when weight reduction was more than 15 % and 12 % , respectively , of the initial body weight of the individual . CONCLUSION Weight reduction was found to be a practical adjuvant treatment in the rehabilitation of patients with knee osteoarthritis This study examined the effects of dietary weight loss and exercise on the health-related quality of life ( HRQL ) of overweight and obese , older adults with knee osteoarthritis . A total of 316 older men and women with documented evidence of knee osteoarthritis were r and omly assigned to 1 of 4 18-month interventions : dietary weight loss , exercise , dietary weight loss and exercise , or healthy lifestyle control . Measures included the SF-36 Health Survey and satisfaction with body function and appearance . Results revealed that the combined diet and exercise intervention had the most consistent , positive effect on HRQL compared with the control group ; however , findings were restricted to measures of physical health or psychological outcomes that are related to the physical self Practice guidelines are valid if “ they lead to the health gains and costs predicted for them.”1 When implemented , valid guidelines lead to changes in clinical practice and improvements in outcomes for patients .2 - 5 Invalid guidelines , however , may lead to the use of ineffective interventions that waste re sources , or even to harm . Guidelines must offer recommendations for both effective and efficient care , and these have not previously been available in the United Kingdom . We have reported the development and content of guidelines for primary care in the United Kingdom based explicitly on evidence of effectiveness.6 - 9 Here , we present the methods used to develop evidence based guidelines on the use in primary care of four important groups of drugs — angiotensin converting enzyme inhibitors in patients with heart failure , choice of antidepressants , non-steroidal anti-inflammatory drugs in patients with osteoarthritis , and aspirin as an antithrombotic agent.10 - 13 Abridged versions of the guidelines on angiotensin converting enzyme inhibitors , aspirin , and non-steroidal anti-inflammatory drugs will be published in subsequent articles.14 - 16 # # # # Summary points Guideline development groups defined important clinical questions , produced search criteria , and drew up protocol s for systematic review and , where appropriate , meta- analysis Medline and Embase were search ed for systematic review s and meta-analyses , r and omised trials , quality of life studies , and economic studies Meta- analysis was used extensively by the group to answer specific clinical questions Statements on evidence were categorised in relation to study design , reflecting their susceptibility to bias Strength of recommendations was grade d according to the category of evidence and its applicability , economic issues , values of the guideline group and society , and the groups ' awareness of practical issues Recommendations cease to apply in December 1999 , by which time relevant results that may affect recommendations may be known Guideline development groups comprised three broad classes of members — relevant healthcare professionals ( up to five general practitioners ( all with OBJECTIVE To determine whether high exercise adherence improved physical function among older adults with knee osteoarthritis ( OA ) who were overweight or obese . METHODS Associations between  exercise adherence , changes in 6-minute walking distance in meters , and self-reported disability ( Western Ontario and McMaster Universities Osteoarthritis Index function subscale ) after 6 and 18 months were examined among an Arthritis , Diet , and Activity Promotion Trial sub sample ( n = 134 ) using multiple linear regression models . RESULTS Higher exercise adherence was associated with greater improvements in 6-minute walking distance after 6 and 18 months and in disability after 6 months . Pain and body mass index ( BMI ) contributed , to some extent , to explaining the link between exercise adherence  and changes in physical performance and self-reported disability . CONCLUSION Higher exercise adherence is associated with improved physical function in overweight and obese older adults with knee OA . This indicates that promoting adherence is clinical ly relevant when prescribing exercise regimens that also focus on decreasing pain and BMI BACKGROUND Persistent , low- grade inflammation is an independent predictor of several chronic diseases and all-cause mortality . OBJECTIVE The intention of this study was to determine the independent and combined effects of diet-induced weight loss and exercise on markers of chronic inflammation . DESIGN Three hundred sixteen community-dwelling , older ( > or = 60 y ) , overweight or obese [ body mass index ( in kg/m2 ) > or = 28 ] , sedentary men and women with radiographic evidence of knee osteoarthritis were r and omly assigned to four 18-mo treatments : healthy lifestyle control , diet-induced weight loss , exercise , and diet plus exercise . The exercise intervention consisted of combined weight training and walking for 1 h 3 times/wk . The weight-loss intervention consisted of a weekly session with a registered dietitian to provide education and support for lowering energy intake . RESULTS The diet-induced weight-loss intervention result ed in significantly greater reductions in concentrations of C-reactive protein ( P = 0.01 ) , interleukin 6 ( P = 0.009 ) , and soluble tumor necrosis factor alpha receptor 1 ( P = 0.007 ) than did no weight-loss treatment . Changes in soluble tumor necrosis factor alpha receptor 1 but not in C-reactive protein or interleukin 6 correlated with changes in body weight .  Exercise training did not have a significant effect on these inflammatory biomarkers , and there was no significant interaction between weight loss and exercise training . CONCLUSIONS These findings provide evidence from a r and omized controlled trial that a dietary intervention design ed to elicit weight loss reduces overall inflammation in older , obese persons . Additional studies are needed to assess the effects of different modes and intensities of exercise on inflammation OBJECTIVE The Arthritis , Diet , and Activity Promotion Trial ( ADAPT ) was a r and omized , single-blind clinical trial lasting 18 months that was design ed to determine whether long-term exercise and dietary weight loss are more effective , either separately or in combination , than usual care in improving physical function , pain , and mobility in older overweight and obese adults with knee osteoarthritis ( OA ) . METHODS Three hundred sixteen community-dwelling overweight and obese adults ages 60 years and older , with a body mass index of > or = 28 kg/m(2 ) , knee pain , radiographic evidence of knee OA , and self-reported physical disability , were r and omized into healthy lifestyle ( control ) , diet only , exercise only , and diet plus exercise groups . The primary outcome was self-reported physical function as measured with the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) . Secondary outcomes included weight loss , 6-minute walk distance , stair-climb time , WOMAC pain and stiffness scores , and joint space width . RESULTS Of the 316 r and omized participants , 252 ( 80 % ) completed the study .  Adherence was as follows : for healthy lifestyle , 73 % ; for diet only , 72 % ; for exercise only , 60 % ; and for diet plus exercise , 64 % . In the diet plus exercise group , significant improvements in self-reported physical function ( P < 0.05 ) , 6-minute walk distance ( P < 0.05 ) , stair-climb time ( P < 0.05 ) , and knee pain ( P < 0.05 ) relative to the healthy lifestyle group were observed . In the exercise group , a significant improvement in the 6-minute walk distance ( P < 0.05 ) was observed . The diet-only group was not significantly different from the healthy lifestyle group for any of the functional or mobility measures . The weight-loss groups lost significantly ( P < 0.05 ) more body weight ( for diet , 4.9 % ; for diet plus exercise , 5.7 % ) than did the healthy lifestyle group ( 1.2 % ) . Finally , changes in joint space width were not different between the groups . CONCLUSION The combination of modest weight loss plus moderate exercise provides better overall improvements in self-reported measures of function and pain and in performance measures of mobility in older overweight and obese adults with knee OA compared with either intervention alone Background Studies on exercise in knee osteoarthritis ( OA ) have focused on elderly subjects . Subjects in this study were middle-aged with symptomatic and definite radiographic knee osteoarthritis . The aim was to test the effects of a short-term , high-intensity exercise program on self-reported pain , function and quality of life . Methods Patients aged 36–65 , with OA grade III ( Kellgren & Lawrence ) were recruited . They had been referred for radiographic examination due to knee pain and had no history of major knee injury . They were r and omized to a twice weekly supervised one hour exercise intervention for six weeks , or to a non-intervention control group . Exercise was performed at ≥ 60 % of maximum heart rate ( HR max ) . The primary outcome measure was the Knee injury and Osteoarthritis Outcome Score ( KOOS ) . Follow-up occurred at 6 weeks and 6 months . Results Sixty-one subjects ( mean age 56 ( SD 6 ) , 51 % women , mean BMI 29.5 ( SD 4.8 ) ) were r and omly assigned to intervention ( n = 30 ) or control group ( n = 31 ) . No significant differences in the KOOS subscales assessing pain , other symptoms , or function in daily life or in sport and recreation were seen at any time point between exercisers and controls . In the exercise group , an improvement was seen at 6 weeks in the KOOS subscale quality of life compared to the control group ( mean change 4.0 vs. -0.7 , p = 0.05 ) . The difference between groups was still persistent at 6 months ( p = 0.02 ) . Conclusion A six-week high-intensive exercise program had no effect on pain or function in middle-aged patients with moderate to severe radiographic knee OA . Some effect was seen on quality of life in the exercise group compared to the control group OBJECTIVE : To determine the effect of weight loss and exercise interventions on serum leptin and to investigate the relationship of physical function and osteoarthritis ( OA ) severity with serum leptin in older overweight and obese adults with knee OA . In addition , the study examined if serum leptin predicts weight loss . DESIGN : Longitudinal , controlled clinical trial of weight loss and exercise interventions .SUBJECTS : Community dwelling , older , overweight and obese adults ( n=316 ; > 60 years of age ; body mass index ≥28.0 kg m−2 ) with symptomatic knee OA and self-reported difficulty in performing selected physical activities were recruited . INTERVENTIONS : Participants were r and omized into one of four groups for the 18-month study duration : Healthy Lifestyle Controls , Dietary Weight Loss ( Diet ) , Exercise Training ( Exercise ) , and a combination of Dietary Weight Loss and Exercise Training ( Diet+Exercise ) . The weight loss goal for the two Diet groups was 5 % from baseline at 18 months . Participants in the Exercise groups were trained for 3 days week−1 , 60 min day−1 . MEASUREMENTS : Body weight , body mass index , serum leptin , physical function , and OA severity were measured at baseline , 6 months , and 18 months . RESULTS : Diet and Diet+Exercise groups lost 5.3 and 6.1 % of their weight , respectively , at 18 months with the Exercise group losing 2.9 % . There was a significant main effect of weight loss on serum leptin with a decrease in serum leptin averaged across the 6- and 18-month time points for the Diet and Diet+Exercise groups compared to the other two groups ( β=0.245 ; P<0.01 ) . No main effect  for exercise training was observed . Serum leptin was related to self-reported physical function . In all participants , a mixed model analysis demonstrated that lower levels of baseline serum leptin predict larger weight loss ( β=−2.779 ; P=0.048 ) . CONCLUSION : Decreases in serum leptin may be one mechanism by which weight loss improves physical function and symptoms in OA patients OBJECTIVE To determine whether a multimodal physiotherapy programme including taping , exercises , and massage is effective for knee osteoarthritis  , and if benefits can be maintained with self management . METHODS R and omised , double blind , placebo controlled trial ; 140 community volunteers with knee osteoarthritis participated and 119 completed the trial .  Physiotherapy and placebo interventions were applied by 10 physiotherapists in private practice s for 12 weeks . Physiotherapy included exercise , massage , taping , and mobilisation , followed by 12 weeks of self management . Placebo was sham ultrasound and light application of a non-therapeutic gel , followed by no treatment . Primary outcomes were pain measured by visual analogue scale and patient global change . Secondary measures included WOMAC , knee pain scale , SF-36 , assessment of quality of life index , quadriceps strength , and balance test . RESULTS Using an intention to treat analysis , physiotherapy and placebo groups showed similar pain reductions at 12 weeks : -2.2 cm ( 95 % CI , -2.6 to -1.7 ) and -2.0 cm ( -2.5 to -1.5 ) , respectively . At 24 weeks , pain remained reduced from baseline in both groups : -2.1 ( -2.6 to -1.6 ) and -1.6 ( -2.2 to -1.0 ) , respectively . Global improvement was reported by 70 % of physiotherapy participants ( 51/73 ) at 12 weeks and by 59 % ( 43/73 ) at 24 weeks . Similarly , global improvement was reported by 72 % of placebo participants ( 48/67 ) at 12 weeks and by 49 % ( 33/67 ) at 24 weeks ( all p>0.05 ) . CONCLUSIONS The physiotherapy programme tested in this trial was no more effective than regular contact with a therapist at reducing pain and disability The objective of this study was to determine whether the Arthritis Self-Management Programme ( ASMP ) improves perceptions of control , health behaviours and health status , and changes use of health care re sources . The design was a pragmatic r and omized controlled study ; participants were allocated to ASMP ( Intervention Group ) or a 4-month waiting-list Control Group . The Intervention Group completed a 12-month follow-up . In total , 544 people with arthritis were recruited from the community--311 in the Intervention Group and 233 in the Control Group . Main outcome measures included : arthritis self-efficacy , health behaviours ( exercise , cognitive symptom management , diet and relaxation ) and health status ( pain , fatigue , anxiety , depression and positive affect ) . At 4 months follow-up , the ASMP had a significant effect on arthritis self-efficacy for other symptoms and pain subscales . Performance of a range of health behaviours ( cognitive symptom management , communication with physicians , dietary habit , exercise and relaxation ) was significantly greater among the Intervention Group . The Intervention Group were significantly less depressed and had greater positive mood . In addition , trends towards decreases on fatigue and anxiety were noted . Physical functioning , pain and GP visits remained stable at 4 months . A similar pattern of findings was found at 12 months follow-up for the Intervention Group . Furthermore , a significant improvement was found on pain and visits to GPs had decreased . Apart from a small improvement on physical functioning among the Intervention Group participants with osteoarthritis 12 months , all effects were independent of the type of arthritis . The findings suggest that the ASMP is effective in promoting improvements in perception of control , health behaviours and health status , when delivered in UK setting Background : The causal relationship between obesity and osteoarthritis ( OA ) of the knee is generally accepted . Weight loss has been shown to reduce the development of OA and improve the radiological parameters of existing disease . However , inducing weight reduction is difficult , and thus the number of patients studied has been small . We wished to determine the effects of surgically-induced weight loss on objective , radiological evidence of OA in the knee joint . Methods : 64 consecutive patients that were referred to the Bariatric Surgical Unit were enrolled in the study . The only exclusion criterion was the prior diagnosis of OA . Knee pain alone did not exclude patients from the study . The study was performed in a prospect i ve manner as a before-after trial . Radiographic data was evaluated by an independent radiologist not involved in the patient care or follow-up . Upright film of the knee was taken prior to surgery and 3 months following surgery .  Minimal medial joint space width ( JSW ) was measured by a digital image computer . In addition , patients were clinical ly assessed using the American Knee Society Score ( AKSS ) at these times . Results : 59 of 64 patients were available for followup . BMI decreased from 43.4 to 36.9 ( P<0.01 ) . The medial joint space increased from 4.6 mm to 5.25 mm ( P<0.001 ) . The AKSS improved from 78.5 points ( perfect function = 100 points ) to 90.69 points ( P<0.01 ) . Conclusion : Surgically-induced weight loss  is an effective , rapid and dependable means of reversing the radiological signs of early changes associated with OA OBJECTIVE The purpose s of this pilot study were to determine if a combined dietary and exercise intervention would result in significant weight loss in older obese adults with knee osteoarthritis , and to compare the effects of exercise plus dietary therapy with exercise alone on gait , strength , knee pain , biomarkers of cartilage degradation , and physical function . DESIGN Single-blind , two-arm , r and omized clinical trial conducted for 24 weeks . SETTING A university health and exercise science center . PARTICIPANTS Twenty-four community-dwelling obese older adults aged > or = 60 years , body mass index > or = 28 , knee pain , radiographic evidence of knee osteoarthritis , and self-reported physical disability . INTERVENTION R and omization into two groups : exercise and diet ( E&D ) and exercise alone ( E ) . Exercise consisted of a combined weight training and walking program for 1 hour three times per week . The dietary intervention included weekly sessions with a nutritionist utilizing cognitive-behavior modification to change dietary habits to reach a group goal of an average weight loss of 15 lb ( 6.8 kg ) over 6 months . MEASUREMENTS All measurements were conducted at baseline and 3 and 6 months , except for synovial fluid analysis , which was obtained only at baseline and 6 months . In addition , weight was measured weekly in the E&D group . Physical disability and knee pain were measured by self-report and physical performance was measured using the 6-minute walk and stair climb tasks . Biomechanical testing included kinetic and kinematic analysis of gait and isokinetic strength testing . Synovial fluid was analyzed for levels of total proteoglycan , keratan sulfate , and interleukin-1 beta . RESULTS Twenty-one of the 24 participants completed the study , with one dropout in the E&D group and two in the E group . The E&D group lost a mean of 18.8 lb ( 8.5 kg ) at 6 months compared with 4.0 lb ( 1.8 kg ) in the E group ( P = .01 ) . Significant improvements were noted in both groups in self-reported disability and knee pain intensity and frequency as well as in physical performance measures . However , no statistical differences were found between the two groups at 6 months in knee pain scores or self-reported performance measures of physical function . There was no difference in knee strength between the groups , with both groups showing modest improvements from baseline to 6 months . At 6 months , the E&D group had a significantly greater loading rate ( P = .03 ) and maximum braking force ( P = .01 ) during gait . There were no significant between-group differences in the other biomechanical measures . Synovial fluid sample s were obtainable at both baseline and 6 months in eight participants ( four per group ) . The level of keratan sulfate decreased similarly in both groups from an average baseline of 96.8 + /- 37.1 to 71.5 + /- 23 ng/microg total proteoglycan . The level of IL-1 decreased from 25.3 + /- 9.8 at baseline to 8.3 + /- 6.1 pg/mL. The decrease in IL-1 correlated with the change in pain frequency ( r = -0.77 , P = .043 ) . CONCLUSIONS Weight loss can be achieved and sustained over a 6-month period in a cohort of older obese persons with osteoarthritis of the knee through a dietary and exercise intervention . Both exercise and combined weight loss and exercise regimens lead to improvements in pain , disability , and performance . Moreover , the trends in the biomechanical data suggest that exercise combined with diet may have an additional benefit in improved gait compared with exercise alone . A larger study is indicated to determine if weight loss provides additional benefits to exercise alone in this patient population OBJECTIVE To examine changes in mobility-related self efficacy following exercise and dietary weight loss interventions in overweight and obese older adults with knee osteoarthritis ( OA ) , and to determine if self efficacy and pain mediate the effects of the interventions on mobility task performance . METHODS The Arthritis , Diet , and Activity Promotion Trial was an 18-month , single-blind , r and omized , controlled trial comparing the effects of exercise alone , dietary weight loss alone , a combination of exercise plus dietary weight loss , and a healthy lifestyle control intervention in the treatment of 316 overweight or obese older adults with symptomatic knee OA . Participants completed measures of stair-climb time and 6-minute walk distance , self efficacy for completing each mobility task , and self-reported pain at baseline , 6 months , and 18 months during the trial . RESULTS Mixed model analyses of covariance of baseline adjusted change in the outcomes demonstrated that the exercise + dietary weight loss intervention produced greater improvements in mobility-related self efficacy ( P = 0.0035 ) , stair climb ( P = 0.0249 ) and 6-minute walk performance ( P = 0.00031 ) , and pain ( P = 0.09 ) when compared with the healthy lifestyle control intervention . Mediation analyses revealed that self efficacy and pain served as partial mediators of the beneficial effect of exercise + dietary weight loss on stair-climb time . CONCLUSION Exercise + dietary weight loss results in improved mobility-related self efficacy ; changes in these task-specific control beliefs and self-reported pain serve as independent partial mediators of the beneficial effect of exercise + dietary weight loss on stair-climb performance OBJECTIVE To determine the relationship between change in body mass and knee-joint moments and forces during walking in overweight and obese older adults with knee osteoarthritis ( OA ) following an 18-month clinical trial of diet and exercise . METHODS Data were obtained from 142 sedentary , overweight , and obese older adults with self-reported disability and radiographic evidence of knee OA who underwent 3-dimensional gait analysis .  Gait kinetic outcome variables included peak knee-joint forces and peak internal knee-joint moments . Mixed regression models were created to predict followup kinetic values , using followup body mass as the primary explanatory variable . Baseline body mass was used as a covariate , and thus followup body mass was a surrogate measure for change in body mass ( i.e. , weight loss ) . RESULTS There was a significant direct association between followup body mass and peak followup values of compressive force ( P = 0.001 ) , result ant force ( P = 0.002 ) , abduction moment ( P = 0.03 ) , and medial rotation moment ( P = 0.02 ) . A weight reduction of 9.8 N ( 1 kg ) was associated with reductions of 40.6 N and 38.7 N in compressive and result ant forces , respectively . Thus , each weight-loss unit was associated with an approximately 4-unit reduction in knee-joint forces . In addition , a reduction in body weight of 9.8 N ( 1 kg ) was associated with a 1.4 % reduction ( 0.496 Nm ) in knee abduction moment . CONCLUSION Our results indicate that each pound of weight lost will result in a 4-fold reduction in the load exerted on the knee per step during daily activities . Accumulated over thous and s of steps per day , a reduction of this magnitude would appear to be clinical ly meaningful OBJECTIVE We wanted to assess the effect of rapid diet-induced weight loss on the function of obese , knee osteoarthritis ( OA ) patients . METHODS Eighty patients with knee OA , 89 % women ( n=71 ) , were recruited . Mean ( SD ) body-mass index ( BMI ) was 35.9 ( 5.1 ) kg/m(2 ) and age 62.6 ( 11.1 ) years . Patients were r and omized to either a low-energy diet ( LED 3.4MJ/day ) , or a control diet ( 5MJ/day ) . The LED group had weekly dietary sessions , whereas the control group was given a booklet describing weight loss practice s.  Changes in body weight and body composition were examined as independent predictors of changes in knee OA symptoms . Symptoms were monitored by the Western Ontario and McMaster Universities ' ( WOMAC ) OA index . RESULTS The LED and control group lost a mean ( SE ) of 11.1 (0.6)% and 4.3 (0.6)% , respectively , with a mean difference being 6.8 % ( 95 % confidence interval ( CI ) : 5.5 to 8.1 % ; P<0.0001 ) . The decrease in body fat percent was higher in the LED group , 2.2 % ( 1.5 to 3.0 % ; P<0.0001 ) . The total WOMAC index improved in the LED group ( P<0.0001 ) , but not in the control group ( P=0.12 ) , mean difference : -219.3 mm ( -369.2 to -69.4 mm ; P=0.005 ) . The ' Number Needed to Treat ( NNT ) ' to ensure an improvement in WOMAC>/=50 % was 3.4 ( 2.1 to 8.8 ) patients . Changes in total WOMAC index were best predicted by the reduction of body fat percent , with a 9.4 % ( 4.8 to 13.9 % ) improvement in WOMAC for each percent of body fat reduced ( P=0.0005 ) . CONCLUSIONS In our patients with knee OA , a weight reduction of 10 % improved function by 28 % . LED might be of advantage to control diet because of the rapidity of weight loss and a more significant loss of body fat BACKGROUND Obesity exacerbates the age-related decline in physical function and causes frailty in older persons . However , appropriate treatment for obese older persons is unknown . We evaluated the effects of weight loss and exercise therapy on physical function and body composition in obese older persons . METHODS We screened 40 obese older volunteers and eventually r and omized 27 frail obese older volunteers to treatment or control groups . Treatment consisted of 6 months of weekly behavioral therapy for weight loss in conjunction with exercise training 3 times per week . Physical function was evaluated with measurements of frailty ( Physical Performance Test , peak oxygen consumption , and Functional Status Question naire ) ; strength , gait , and balance tests ; body composition with dual-energy x-ray absorptiometry ; and quality of life using the Medical Outcomes Survey 36-Item Short-Form Health Survey . Results are reported as mean + /- SD . RESULTS Two subjects in the treatment group did not comply with the intervention , and 1 subject in the control group withdrew . Analyses included all 27 subjects originally r and omized to the treatment and control groups . The treatment group lost 8.4 % + /- 5.6 % of body weight , whereas weight did not change in the control group ( + 0.5 % + /- 2.8 % ; P<.001 ) . Compared with the control group , fat mass decreased ( -6.6 + /- 3.4 vs + 1.7 + /- 4.1 kg ; P<.001 ) , without a change in fat-free mass ( -1.2 + /- 2.1 vs -1.0 + /- 3.5 kg ; P = .75 ) in the treatment group . The Physical Performance Test score ( 2.6 + /- 2.5 vs 0.1 + /- 1.0 ; P = .001 ) , peak oxygen consumption ( 1.7 + /- 1.6 vs 0.3 + /- 1.1 mL/min per kilogram ; P = .02 ) , and Functional Status Question naire score ( 2.9 + /- 3.7 vs -0.2 + /- 3.9 ; P = .02 ) improved in treated subjects compared with control subjects . Treatment also improved strength , walking speed , obstacle course , 1-leg limb stance time , and health survey physical subscale scores ( all P<.05 ) . CONCLUSION These findings suggest that weight loss and exercise can ameliorate frailty in obese older adults . Trial Registration clinical trials.gov Identifier : NCT00146133 BACKGROUND Determinants of adherence to lifestyle regimens are ill understood . Attendance to intervention sessions is crucial for patients to acquire knowledge and skills regarding the core elements of an intervention . Therefore , we explored demographic , health-related , and social determinants of high and low attendance to diet and exercise sessions  among overweight and obese patients with knee osteoarthritis ( > or = 60 years ; N = 206 ) . METHODS The Arthritis , Diet , and Activity Promotion Trial was an 18-month r and omized controlled trial on the effectiveness of dietary weight loss and exercise interventions . We conducted chi-square and t-tests , and logistic regression analyses on categories of short- and long-term attendance to intervention sessions . RESULTS Over the 18-month duration of the study , 60.7 % ( + /- 28.5 ) of diet sessions , and 53.2 % ( + /- 29.0 ) of exercise sessions were attended . Not being married , low social participation , and single intervention r and omization predicted high attendance to diet sessions  during months 1 - 4 . Exercising at home , and single intervention r and omization predicted high attendance to exercise sessions during months 5 - 18 . High attendance to sessions early in the intervention was a significant determinant of high session attendance thereafter . CONCLUSIONS Offering people a choice where to exercise , and stimulating early intervention session attendance can be effective in improving long-term attendance to both interventions . Several determinants we found may be amenable to change to enhance intervention adherence of future r and omized controlled trials involving dietary weight loss and /or physical exercise Osteoarthritis ( OA ) of the knee leads to restrictions of physical activity and ability to perform activities of daily living . Obesity is a risk factor for knee OA and it appears to exacerbate knee pain and disability . The Arthritis , Diet , and Activity Promotion Trial ( ADAPT ) was developed to test the efficacy of lifestyle behavioral changes on physical function , pain , and disability in obese , sedentary older adults with knee OA . This controlled trial r and omized 316 sedentary overweight and obese older adults in a two-by-two factorial design into one of four 18-month duration intervention groups : Healthy Lifestyle Control ; Dietary Weight Loss ; Structured Exercise ; or Combined Exercise and Dietary Weight Loss . The weight-loss goal for the diet groups was a 5 % loss at 18 months . The intervention was modeled from principles derived from the group dynamics literature and social cognitive theory . Exercise training consisted of aerobic and strength training for 60 minutes , three times per week in a group and home-based setting . The primary outcome measure was self-report of physical function using the Western Ontario and McMaster University Osteoarthritis Index . Other measurements included timed stair climb , distance walked in 6 minutes , strength , gait , knee pain , health-related quality of life , knee radiographs , body weight , dietary intake , and cost-effectiveness of the interventions . We report baseline data stratified by level of overweight and obesity focusing on self-reported physical function and physical performance tasks . The results from ADAPT will provide approaches clinicians should recommend for behavioral therapies that effectively reduce the incidence of disability associated with knee OA Abstract Two hundred and twenty-eight Japanese women , aged 45–69 years , with osteoarthritis of the knee ( knee OA ) and a body mass index of greater than 26.4 self-selected one of the following interventions : ( 1 ) a nonsteroidal anti-inflammatory drug ( NSAID ) alone ( NA group ; n = 52 ) , ( 2 ) the NSAID with nonweight-bearing exercises ( NE ; n = 49 ) , ( 3 ) the NSAID combined with walking ( NW ; n = 35 ) , ( 4 ) an energy restriction diet plus the NSAID ( ND ; n = 29 ) , ( 5 ) the diet combined with the NSAID and strengthening exercises ( NDE ; n = 37 ) , or ( 6 ) the diet combined with the NSAID and walking ( NDW ; n = 26 ) . Body weight and lower extremity lean body mass ( L-LBM ) , assessed with segmental bioelectrical impedance , were measured at the outset and at 8 weeks in the six therapy groups . Interval changes in L-LBM and L-LBM per body weight ( L-LBM/weight ) were compared among the six groups at the conclusion . The Lequesne index can index of severity of osteoarthritis of the knee at the final assessment , compared with that at the initial assessment , was significantly decreased in the NE group , but not in the NW or the NA groups ( P = 0.023 ) . There was a significant increase in the L-LBM/weight in the NE group , but not in the NA or NW groups ( P = 0.002 between NE and NA ; P = 0.019 between NE and NW ) . There was a significant reduction in the Lequesne index in the NDE group in comparison with the ND and NDW groups ( P = 0.0001 between NDE and ND ; P = 0.0001 between NDE and NDW ) . There was a significant increase in L-LBM/weight in the NDE group , but not in the NDW or the ND groups ( P = 0.011 ) . Adjunctive therapy with nonweight-bearing lower extremity exercises appears to be more efficacious for prevention of lower extremity loss of muscle mass than adjunctive therapy with walking for obese women with knee OA OBJECTIVE To examine the effect of weight changes between 20 and 50 years of age on the risk of  severe knee osteoarthritis ( OA ) requiring arthroplasty . SUBJECTS AND METHODS Cases were 55 - 75 year old men and women ( n = 220 ) having had knee arthroplasty for primary osteoarthritis at the Kuopio University Hospital in 1992 - 93 . Controls ( n = 415 ) were r and omly selected from the population of Kuopio Province .  Weight at the age of 20 , 30 , 40 , and 50 years was collected retrospectively with a postal question naire . RESULTS After adjustment for age , sex , history of physical workload , recreational physical activity , and previous knee injury , weight gain result ing to a shift from normal body mass index ( BMI < or = 25 kg/m(2 ) ) to overweight ( BMI > 25 kg/m(2 ) ) was associated with a higher relative risk of knee OA requiring arthroplasty than persistent overweight from 20 - 50 years of age , compared with those with normal relative weight during the corresponding age period . The odds ratios ( OR ) were 3.07 ( 95 % confidence interval 1.87 to 5.05 ) for those with normal weight at the age of 20 years and overweight at two or three of the ages 30 , 40 or 50 years , 3.15 ( 1.85 to 5.36 ) for those with overweight from the age of 30 years , and 2.37 ( 1.21 to 4.62 ) for those with overweight from the age of 20 years , respectively . CONCLUSION In adult life , a shift from normal to overweight may carry a higher risk for knee OA requiring arthroplasty than does constant overweight
target: Clinical efficacy on pain reduction was present , although not predictable after weight loss .
  Meta-regression analysis indicated that physical disability of patients with knee OA and overweight diminished after a moderate weight reduction regime .
background: This review aims to assess by meta- analysis of r and omised controlled trials ( RCTs ) changes in pain and function when overweight patients with knee osteoarthritis ( OA ) achieve a weight loss .