The Arthritis, Diet and Activity Promotion Trial (ADAPT): design, rationale, and baseline results. Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the Arthritis, Diet, and Activity Promotion Trial. Exercise, self-efficacy, and mobility performance in overweight and obese older adults with knee osteoarthritis. Is increased joint loading detrimental to obese patients with knee osteoarthritis? A secondary data analysis from a randomized trial. Is serum leptin related to physical function and is it modifiable through weight loss and exercise in older adults with knee osteoarthritis? Effects of a modified shoe on knee load in people with and those without knee osteoarthritis. Effects of dietary intervention and quadriceps strengthening exercises on pain and function in overweight people with knee pain: randomised controlled trial Weight loss reduces knee-joint loads in overweight and obese older adults with knee osteoarthritis. Cost-effectiveness of exercise and diet in overweight and obese adults with knee osteoarthritis. Self-management for osteoarthritis of the knee: Does mode of delivery influence outcome? Intensive weight loss program improves physical function in older obese adults with knee osteoarthritis. The effects of hip muscle strengthening on knee load, pain, and function in people with knee osteoarthritis: a protocol for a randomised, single-blind controlled trial Effects of exercise adherence on physical function among overweight older adults with knee osteoarthritis. The independent and combined effects of intensive weight loss and exercise training on bone mineral density in overweight and obese older adults with osteoarthritis. Methotrexate for pain relief in knee osteoarthritis: an open-label study. Pain coping skills training and lifestyle behavioral weight management in patients with knee osteoarthritis: A randomized controlled study Weight changes and the risk of knee osteoarthritis requiring arthroplasty. Vitamin D supplementation in the management of knee osteoarthritis: study protocol for a randomized controlled trial Comparing two low-energy diets for the treatment of knee osteoarthritis symptoms in obese patients: a pragmatic randomized clinical trial. Does Transcutaneous Electrical Nerve Stimulation Improve the Physical Performance of People With Knee Osteoarthritis? Clinical efficacy and safety of glucosamine, chondroitin sulphate, their combination, celecoxib or placebo taken to treat osteoarthritis of the knee: 2-year results from GAIT The effectiveness of self‐management educational interventions for osteoarthritis of the knee Patient and provider interventions for managing osteoarthritis in primary care: protocols for two randomized controlled trials
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 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 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 investigate whether increased knee joint loading due to improved ambulatory function and walking speed following weight loss achieved over 16 weeks accelerates symptomatic and structural disease progression over a subsequent 1 year weight maintenance period in an obese population with knee osteoarthritis ( OA ) . METHODS Data from a prospect i ve study of weight loss in obese patients with knee OA ( the CARtilage in obese knee OsteoarThritis ( CAROT ) study ) were used to determine changes in knee joint compressive loadings ( model estimated ) during walking after a successful 16 week weight loss intervention . The participants were divided into ' Unloaders ' ( participants that reduced joint loads ) and ' Loaders ' ( participants that increased joint loads ) . The primary symptomatic outcome was changes in knee symptoms , measured with the Knee injury and Osteoarthritis Outcome Score ( KOOS ) question naire , during a subsequent 52 weeks weight maintenance period . The primary structural outcome was changes in tibiofemoral cartilage loss assessed semi-quantitatively ( Boston Leeds Knee Osteoarthritis Score ( BLOKS ) from MRI after the 52 weight maintenance period . RESULTS 157 participants ( 82 % of the CAROT cohort ) with medial and /or lateral knee OA were classified as Unloaders ( n = 100 ) or Loaders ( n = 57 ) . The groups showed similar significant changes in symptoms ( group difference : -2.4 KOOS points [ 95 % CI -6.8:1.9 ] ) and cartilage loss ( group difference : -0.06 BLOKS points [ 95 % CI -0.22:0.11 ) after 1 year , with no statistically significant differences between Loaders and Unloaders . CONCLUSION For obese patients undergoing a significant weight loss , increased knee joint loading for 1 year was not associated with accelerated symptomatic and structural disease progression compared to a similar weight loss group that had reduced ambulatory compressive knee joint loads . CLINICAL TRIALSGOV NCT00655941 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 evaluate the effects of a modified shoe that incorporates both lateral wedging and a variable-stiffness sole on knee joint loading in 3 population s : individuals with symptomatic and radiographic knee osteoarthritis ( OA ) , asymptomatic overweight individuals , and asymptomatic healthy weight individuals . METHODS Ninety participants ( 30 per group ) underwent a 3-dimensional gait analysis  across 3 test conditions : modified shoes , st and ard control shoes , and barefoot . For each condition , the first peak knee adduction moment ( KAM ) and knee flexion moment ( KFM ) ( both expressed as Nm/[body weight × height]% ) as well as the KAM impulse ( expressed as Nm.s/[body weight × height]% ) were determined . RESULTS The modified shoes significantly reduced the peak KAM as compared to the control shoes in both the OA ( P = 0.002 ) and the overweight ( P = 0.03 ) groups . In the OA group , there was no significant difference in peak KAM when walking in the modified shoe as compared to walking barefoot . In the overweight and the healthy weight groups , the peak KAM when walking in the modified shoe was significantly higher than that when walking barefoot ( P < 0.001 ) . Irrespective of group , the KAM impulse was significantly reduced when walking in the modified shoe as compared to the control shoe ( P < 0.001 ) and was significantly higher during both shoe conditions as compared to walking barefoot ( P < 0.001 ) . There was no change in the KFM between walking conditions for any group . CONCLUSION The findings illustrate that a shoe incorporating both a lateral wedge and a variable-stiffness sole can significantly reduce medial knee joint load . Further research examining the effects of these shoes on pain , function , and structural changes in the joint is warranted Objective To determine whether dietary intervention or knee strengthening exercise , or both , can reduce knee pain and improve knee function in overweight and obese adults in the community . Design Pragmatic factorial r and omised controlled trial . Setting Five general practice s in Nottingham . Participants 389 men and women aged 45 and over with a body mass index ( BMI ) of ≥28.0 and self reported knee pain . Interventions Participants were r and omised to dietary intervention plus quadriceps strengthening exercises ; dietary intervention alone ; quadriceps strengthening exercises alone ; advice leaflet only ( control group ) . Dietary intervention consisted of individualised healthy eating advice that would reduce normal intake by 2.5 MJ ( 600 kcal ) a day . Interventions were delivered at home visits over a two year period . Main outcome measures The primary outcome was severity of knee pain scored with the Western Ontario McMaster ( WOMAC ) osteoarthritis index at 6 , 12 , and 24 months . Secondary outcomes ( all at 24 months ) included WOMAC knee physical function and stiffness scores and selected domains on the SF-36 and the hospital anxiety and depression index . Results 289 ( 74 % ) participants completed the trial . There was a significant reduction in knee pain in the knee exercise groups compared with those in the non-exercise groups at 24 months ( percentage risk difference 11.61 , 95 % confidence interval 1.81 % to 21.41 % ) . The absolute effect size ( 0.25 ) was moderate . The number needed to treat to benefit from a ≥30 % improvement in knee pain at 24 months was 9 ( 5 to 55 ) . In those r and omised to knee exercise improvement in function was evident at 24 months ( mean difference −3.64 , −6.01 to −1.27 ) . The mean difference in weight loss at 24 months in the dietary intervention group compared with no dietary intervention was 2.95 kg ( 1.44 to 4.46 ) ; for exercise versus no exercise the difference was 0.43 kg ( −0.82 to 1.68 ) . This difference in weight loss was not associated with improvement in knee pain or function but was associated with a reduction in depression ( absolute effect size 0.19 ) . Conclusions A home based , self managed programme of simple knee strengthening exercises over a two year period can significantly reduce knee pain and improve knee function in overweight and obese people with knee pain . A moderate sustained weight loss is achievable with dietary intervention and is associated with reduced depression but is without apparent influence on pain or function . Trial registration Current Controlled Trials IS RCT N 93206785 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 PURPOSE The purpose of this study was to compare the cost-effectiveness of dietary and exercise interventions in overweight or obese elderly patients with knee osteoarthritis ( OA ) enrolled in the Arthritis , Diet , and Physical Activity Promotion Trial ( ADAPT ) . METHODS ADAPT was a single-blinded , controlled trial of 316 adults with knee OA , r and omized to one of four groups : Healthy Lifestyle Control group , Diet group , Exercise group , or Exercise and Diet group .  A cost analysis was performed from a payer perspective , incorporating those costs and benefits that would be realized by a managed care organization interested in maintaining the health and satisfaction of its enrollees while reducing unnecessary utilization of health care services . RESULTS The Diet intervention was most cost-effective for reducing weight , at $ 35 for each percentage point reduction in baseline body weight . The Exercise intervention was most cost-effective for improving mobility , costing $ 10 for each percentage point improvement in a 6-min walking distance and $ 9 for each percentage point improvement in the timed stair climbing task . The Exercise and Diet intervention was most cost-effective for improving self-reported function and symptoms of arthritis , costing $ 24 for each percentage point improvement in subjective function , $ 20 for each percentage point improvement in self-reported pain , and $ 56 for each percentage point improvement in self-reported stiffness . CONCLUSIONS The Exercise and Diet intervention consistently yielded the greatest improvements in weight , physical performance , and symptoms of knee OA . However , it was also the most expensive and was the most cost-effective approach only for the subjective outcomes of knee OA ( self-reported function , pain , and stiffness ) . Perceived function and symptoms of knee OA are likely to be stronger drivers of downstream health service utilization than weight , or objective performance measures and may be the most cost-effective in the long term Abstract Background Self-management has become increasingly popular in the management of chronic diseases . There are many different self-management models . Meta analyses of arthritis self-management have concluded that it is difficult to recommend any one program in preference to another due to inconsistencies in the study design s used to evaluate different programs . The Stanford Arthritis Self-Management Program ( ASMP ) , most commonly delivered by trained lay leaders , is a generic program widely used for people with rheumatological disorders . We have developed a more specific program expressly for people with osteoarthritis of the knee ( OAKP ) . It includes information design ed to be delivered by health professionals and results in improvements in pain , function and quality of life . Aim : To determine whether , for people with osteoarthritis ( OA ) of the knee , the OAKP implemented in a primary health care setting can achieve and maintain clinical ly meaningful improvements in more participants than ASMP delivered in the same environment . Methods / Design The effectiveness of the programs will be compared in a single-blind r and omized study . Participants : 146 participants with established OA knee will be recruited . Volunteers with coexistent inflammatory joint disease or serious co-morbidities will be excluded . Interventions : Participants will be r and omised into either  OAKP or ASMP groups and followed for 6 months . Measurements : Assessment s will be immediately before and after the intervention and at 6 months . Primary outcome measures will be WOMAC and SF-36 question naires and a VAS for pain . Secondary outcomes will include balance , tested using a timed single leg balance test and a timed step test and self-efficacy . Data will be analysed using repeated measures ANOVA . Discussion With an aging population the health care costs for people with arthritis are ever increasing . Although cost analysis is beyond the scope of this study , it is reasonable to expect that costs will be greater when health professionals deliver self-management programs as opposed to lay leaders . Consequently it is critical to examine the relative effectiveness of the primary care management strategies available for OA.Trial Registration This study is registered with the Australian New Zeal and Clinical Trials Registry : OBJECTIVE Physical function and body composition in older obese adults with knee osteoarthritis ( OA ) were examined after intensive weight loss . RESEARCH METHODS AND PROCEDURES Older obese adults ( n = 87 ; > or = 60 years ; BMI > or = 30.0 kg/m2 ) with symptomatic knee OA and difficulty with daily activities were recruited for a 6-month trial . Participants were r and omized into either a weight stable ( WS ) or weight loss ( WL ) program . Participants in WL ( 10 % weight loss goal ) were prescribed a 1000 kcal/d energy deficit diet with exercise 3 d/wk . WS participants attended health information sessions . Body composition and physical function ( Western Ontario and McMaster University Osteoarthritis Index , 6-minute walking distance , and stair climb time ) were assessed at baseline and 6 months . Statistical analysis included univariate analysis of covariance on 6-month measurements using baseline values as covariates . Associations between physical function and body composition were performed . RESULTS Body weight decreased 8.7 + /- 0.8 % in WL and 0.0 + /- 0.7 % in WS . Body fat and fat-free mass were lower for WL than WS at 6 months ( estimated means : fat = 38.1 + /- 0.4 % vs. 40.9 + /- 0.4 % , respectively ; fat-free mass = 56.7 + /- 0.4 vs. 58.8 + /- 0.4 kg , respectively ) . WL had better function than WS , with lower Western Ontario and McMaster University Osteoarthritis Index scores , greater 6-minute walk distance , and faster stair climb time ( p < 0.05 ) . Changes in function were associated with weight loss in the entire cohort . DISCUSSION An intensive weight loss intervention incorporating energy deficit diet and exercise training improves physical function in older obese adults with knee OA . Greater improvements in function were observed in those with the most weight loss Background Lower limb strengthening exercises are an important component of the treatment for knee osteoarthritis ( OA ) . Strengthening the hip abductor and adductor muscles may influence joint loading and /or OA-related symptoms , but no study has evaluated these hypotheses directly . The aim of this r and omised , single-blind controlled trial is to determine whether hip abductor and adductor muscle strengthening can reduce knee load and improve pain and physical function in people with medial compartment knee OA . Methods / Design 88 participants with painful , radiographically confirmed medial compartment knee OA and varus alignment will be recruited from the community and r and omly allocated to a hip strengthening or control group using concealed allocation stratified by disease severity . The hip strengthening group will perform 6 exercises to strengthen the hip abductor and adductor muscles at home 5 times per week for 12 weeks . They will consult with a physiotherapist on 7 occasions to be taught the exercises and progress exercise resistance . The control group will be requested to continue with their usual care . Blinded follow up assessment will be conducted at 12 weeks after r and omisation . The primary outcome measure is the change in the peak external knee adduction moment measured during walking . Question naires will assess changes in pain and physical function as well as overall perceived rating of change . An intention-to-treat analysis will be performed using linear regression modelling and adjusting for baseline outcome values and other demographic characteristics . Discussion Results from this trial will contribute to the evidence regarding the effect of hip strengthening on knee loads and symptoms in people with medial compartment knee OA . If shown to reduce the knee adduction moment , hip strengthening has the potential to slow disease progression . Trial Registration Australia New Zeal and Clinical Trials Registry 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 OBJECTIVE To determine the effects of dietary-induced weight loss ( D ) and weight loss plus exercise ( D + E ) compared to exercise alone ( E ) on bone mineral density ( BMD ) in older adults with knee osteoarthritis ( OA ) . DESIGN Data come from 284 older ( 66.0 ± 6.2 years ) , overweight/obese ( body mass index ( BMI ) 33.4 ± 3.7 kg/m2 ) , adults with knee OA enrolled in the Intensive Diet and Exercise for Arthritis ( IDEA ) study . Participants were r and omized to 18 months of walking and strength training ( E ; n = 95 ) , dietary-induced weight loss targeting 10 % of baseline weight ( D ; n = 88 ) or a combination of the two ( D + E ; n = 101 ) . Body weight and composition ( DXA ) , regional BMD , were obtained at baseline and 18 months . RESULTS E , D , and D + E groups lost 1.3 ± 4.5 kg , 9.1 ± 8.6 kg and 10.4 ± 8.0 kg , respectively ( P < 0.01 ) . Significant treatment effects were observed for BMD in both hip and femoral neck regions , with the D and D + E groups showing similar relative losses compared to E ( both P < 0.01 ) . Despite reduced BMD , fewer overall participants had T-scores indicative of osteoporosis after intervention ( 9 at 18 months vs 10 at baseline ) . Within the D and D + E groups , changes in hip and femoral neck , but not spine , BMD correlated positively with changes in body weight ( r = 0.21 and 0.54 respectively , both P ≤ 0.01 ) . CONCLUSIONS Weight loss via an intensive dietary intervention , with or without exercise , results in bone loss at the hip and femoral neck in overweight and obese , older adults with OA . Although the exercise intervention did not attenuate weight loss-associated reductions in BMD , classification of osteoporosis and osteopenia remained unchanged . CLINICAL TRIAL REGISTRATION NUMBER NCT00381290 OBJECTIVE Synovitis is very common in knee OA and associated with pain . This open-label study evaluated an anti-synovitis therapy , MTX , for pain relief in knee OA . METHODS Inclusion criteria included pain visual analogue scale ( VAS ) > 40/100 mm , ACR clinical criteria for knee OA and intolerance/inefficacy of NSAID and opioids . US at baseline and 24 weeks assessed effusion and synovial thickness . Patients received MTX up to 20 mg/week for 24 weeks . RESULTS Thirty participants were recruited ; mean age 64.5 years , median pain VAS 68 mm . At 24 weeks , 13/30 ( 43 % ) achieved ≥30 % reduction in pain VAS , 7 ( 23 % ) achieved ≥50 % reduction and 4 ( 13 % ) had worsened . Thirteen achieved Osteoarthritis Research Society International ( OARSI ) responder criteria . All had effusion/synovitis at baseline . There was no correlation between change in imaging and change in pain scores at 24 weeks . CONCLUSION This open-label trial suggests analgesic efficacy  for MTX in OA knee and suggests that a r and omized controlled trial is warranted . Trial Registration . Current controlled trials , http://www.controlled-trials.com/ , IS RCT N66676866 Summary Combined training in pain and weight management in overweight and obese OA patients result ed in improved pain and other outcomes compared to either training alone . ABSTRACT Overweight and obese patients with osteoarthritis ( OA ) experience more OA pain and disability than patients who are not overweight . This study examined the long‐term efficacy of a combined pain coping skills training ( PCST ) and lifestyle behavioral weight management ( BWM ) intervention in overweight and obese OA patients . Patients ( n = 232 ) were r and omized to a 6‐month program of : 1 ) PCST + BWM ;  2 ) PCST‐only ;  3 ) BWM‐only ; or 4 ) st and ard care control . Assessment s of pain , physical disability ( Arthritis Impact Measurement Scales [ AIMS ] physical disability , stiffness , activity , and gait ) , psychological disability ( AIMS psychological disability , pain catastrophizing , arthritis self‐efficacy , weight self‐efficacy ) , and body weight were collected at 4 time points ( pretreatment , posttreatment , and 6 months and 12 months after the completion of treatment ) . Patients r and omized to PCST + BWM demonstrated significantly better treatment outcomes ( average of all 3 posttreatment values ) in terms of pain , physical disability , stiffness , activity , weight self‐efficacy , and weight when compared to the other 3 conditions ( Ps < 0.05 ) . PCST + BWM also did significantly better than at least one of the other conditions ( ie , PCST‐only , BWM‐only , or st and ard care ) in terms of psychological disability , pain catastrophizing , and arthritis self‐efficacy . Interventions teaching overweight and obese OA patients pain coping skills and weight management simultaneously may provide the more comprehensive long‐term benefits 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 Background Osteoarthritis ( OA ) is a common health issue worldwide in the aging population who are also commonly deficient in vitamin D. Our previous study suggested that higher serum 25-(OH)D levels were associated with reduced knee cartilage loss , implying that vitamin D supplementation may prevent the progression of knee OA . The aim of the VItamin D Effects on OA ( VIDEO ) study is to compare , over a 2- year period , the effects of vitamin D supplementation versus placebo on knee structural changes , knee pain , and lower limb muscle strength in patients with symptomatic knee OA . Methods / design R and omised , placebo-controlled , and double-blind clinical trial aim ing to recruit 400 subjects ( 200 from Tasmania and 200 from Victoria ) with both symptomatic knee OA and vitamin D deficiency ( serum [ 25-(OH)D ] level of > 12.5 nmol/liter and < 60 nmol/liter ) . Participants will be r and omly allocated to vitamin D supplementation ( 50,000 IU compounded vitamin D3 capsule monthly ) or identical inert placebo group for 2 years . The primary endpoint is loss of knee cartilage volume measured by magnetic resonance imaging ( MRI ) and Western Ontario and McMaster Universities Index of OA ( WOMAC ) knee pain score . The secondary endpoints will be other knee structural changes , and lower limb muscle strength . Several other outcome measures including core muscle images and central blood pressure will be recorded . Linear and logistic regression will be used to compare changes between groups using univariable and multivariable modeling analyses . Both intention to treat and per protocol analyses will be utilized . Discussion The trial is design ed to test if vitamin D supplementation will reduce loss of knee cartilage volume , prevent the progression of other knee structural abnormalities , reduce knee pain and strengthen lower limb muscle strength , thus modify disease progression in knee OA.Trial registration Clinical Trials.gov identifier : NCT01176344 ; Australian New Zeal and Clinical Trials Registry : OBJECTIVES To evaluate in a prospect i ve , r and omized clinical trial ( RCT ) , symptom response among obese knee osteoarthritis ( OA ) patients following a feasible , intensive weight-loss program for 16 weeks . METHODS Eligible patients were obese [ body mass index ( BMI ) > 30 kg/m(2 ) ] ; > 50 years old , with primary knee OA . Participants were r and omized to either a very-low-energy diet ( VLED ) or a low-energy diet ( LED ) ( 415 kcal/day and 810 kcal/day , respectively ) , using commercially available formula foods - only for the first 8 weeks , managed by dieticians . The 8 weeks were followed by an additional 8-week period of a hypo-energetic diet consisting of normal food plus meal replacements ( 1200 kcal/day ) . The primary endpoint was the number of patients responding according to the Outcome Measures in Rheumatology Clinical Trials and Osteoarthritis Research Society International ( OMERACT-OARSI ) responder criterion . The statistical analysis was based on a non-responder intention-to-treat ( ITT ) population ( baseline observation carried forward ) . RESULTS One hundred and ninety two patients ( 155 ( 80.7 % ) females ) with a mean age 62.5 years [ st and ard deviation ( SD ) 6.4 ; range 50 - 78 years ] ; average BMI 37.3 ( SD 4.8 ) were included . At 16 weeks , similar proportions of the VLED and LED groups , 59 ( 61.5 % ) , and 63 ( 65.6 % ) patients , respectively , met the OMERACT-OARSI responder criteria , with no statistical significant difference between the groups ( P=0.55 ) . Combining the groups the pooled estimate was 64 % meeting the responder criteria [ 95 % confidence interval ( CI ) 57 % , 70 % ] . There was an overall reduction in pain , corresponding to an average pain reduction on the visual analogue scale ( VAS ) of 11.1 ( 95%CI 13.6 , 8.5 ) in the combined groups . At week 16 weight loss in the combined groups was 12.8 kg ( 95%CI : 11.84 - 13.66 ; P<0.001 ) . 71 % lost > or = 10 % body weight in both diet groups , with a pooled estimate of 74 % ( 95%CI : 68 - 80 % ) . CONCLUSION No clinical ly significant differences were found between the 415 kcal/day and 810 kcal/day diets . A 16-week formula-diet weight-loss program result ed in a fast and effective weight loss with very few adverse events result ing in a highly significant improvement in symptoms in overweight patients with knee OA Background : According to a recent meta analysis study , there is strong evidence to support the view that transcutaneous electrical nerve stimulation ( TENS ) is an effective treatment for managing osteoarthritis ( OA ) knee pain . However , there is limited evidence showing its effectiveness in improving physical function . This study examined whether TENS alone can improve physical function in terms of range of knee motion and the Timed-Up- and -Go Test . Methods : Subjects were r and omly allocated into 2 groups receiving TENS at 100 Hz or a placebo TENS . Outcome measures included : 1 ) visual analog scale for measuring the intensity of the present pain , 2 ) Timed-Up- and -Go Test , and 3 ) range of knee motion ( ROM ) . Repeated- measures analysis of variance and Pearson correlation were used for data analyses . Results : By day 10 , TENS produced a significantly greater increase in maximum knee ROM than the placebo group ( P = 0.033 ) . TENS also significantly increased the pain-limited knee ROM across sessions , but the between-group difference was short of significance ( P = 0.067 ) . The decrease in time in performing the Timed-Up- and -Go Test was also not significantly different between the 2 groups . A moderate correlation was observed between the reduction in pain scores and the improvement in the Timed-Up- and -Go Test . Conclusions : Our findings suggested that TENS did improve some of the physical parameters but over 10 days was unable to produce significant improvement in functional performance among people with knee OA . A larger-scale study with the assessment of other functional outcomes may be required to clarify if TENS could improve function in people with knee OA . Also , exercise can be considered to be an important adjunct treatment to TENS to improve function significantly Background Knee osteoarthritis ( OA ) is a major cause of pain and functional limitation in older adults , yet longer-term studies of medical treatment of OA are limited . Objective To evaluate the efficacy and safety of glucosamine and chondroitin sulphate ( CS ) , alone or in combination , as well as celecoxib and placebo on painful knee OA over 2 years . Methods A 24-month , double-blind , placebo-controlled study , conducted at nine sites in the US ancillary to the Glucosamine/chondroitin Arthritis Intervention Trial , enrolled 662 patients with knee OA who satisfied radiographic criteria ( Kellgren/Lawrence grade 2 or 3 changes and baseline joint space width of at least 2 mm ) . This subset continued to receive their r and omised treatment : glucosamine 500 mg three times daily , CS 400 mg three times daily , the combination of glucosamine and CS , celecoxib 200 mg daily , or placebo over 24 months . The primary outcome was a 20 % reduction in Western Ontario and McMaster University Osteoarthritis Index ( WOMAC ) pain over 24 months . Secondary outcomes included an Outcome Measures in Rheumatology/Osteoarthritis Research Society International response and change from baseline in WOMAC pain and function . Results Compared with placebo , the odds of achieving a 20 % reduction in WOMAC pain were celecoxib : 1.21 , glucosamine : 1.16 , combination glucosamine/CS : 0.83 and CS alone : 0.69 , and were not statistically significant . Conclusions Over 2 years , no treatment achieved a clinical ly important difference in WOMAC pain or function as compared with placebo . However , glucosamine and celecoxib showed beneficial but not significant trends . Adverse reactions were similar among treatment groups and serious adverse events were rare for all treatments Background Osteoarthritis ( OA ) is a common cause of pain and disability , and is the most common form of arthritis in the Western world . The most common joint to be affected is the knee . Pain and functional disability are common symptoms , which can lead to reduced quality of life and increase the risk of further morbidity . Current treatment aims to educate patients about the management of OA , reduce pain , improve function , decrease disability and reduce the progression of the disease . Education with clients has been described as a set of planned educational activities design ed to improve patients ' health behaviours and /or health status . The purpose of self‐education is to maintain or improve health , or , in some cases , to slow deterioration by increasing participant 's perception of self efficacy defined as an ability to control or manage various aspects of OA . To date , there is no systematic review of the literature undertaken to identify the effectiveness of self‐management educational activities for osteoarthritis of the knee . Objective The objective of this systematic review is to evaluate the effectiveness of  self‐management educational interventions on function and quality of life for adult subjects with OA of the knee . Search strategy A comprehensive search strategy was undertaken on data bases available from University of South Australia from their inception to January 2007 . Selection criteria R and omised controlled trials or clinical controlled trials were sought which evaluated any self management interventions for osteoarthritis knee . Critical appraisal of study quality was undertaken using Joanna Briggs Institute critical appraisal instruments . Data extraction was via the Joanna Briggs Institute st and ard data extraction form for evidence of effectiveness , and Review Manager Software was used to calculate comparative statistics . Results Thirteen trials were included in the review . Trials were clinical ly and method ologically heterogeneous . Pooled results indicate evidence of a beneficial effect from  self management strategies with reducing pain ( SMD ‐0.25 , 95%CI ‐0.36 to ‐0.13 , 11 trials 1379 participants ) . There was no effect on physical function ( SMD 0.13 , 95%CI ‐0.33 to ‐0.08 , eight trials , 1156 subjects ) . No beneficial effects were found from self management interventions with improving quality of life . We also found the exercise component of self management ( four trials ) demonstrated a benefit with reducing pain , improving function and quality of life . Exercise also offered a benefit over no exercise  . Overall method ological quality was moderate . Discussion Pooled results indicate evidence of a beneficial effect from self management strategies with reducing pain and improving function . Significant heterogeneity was found between trials . This was controlled for in the analysis but may be explained by heterogeneity in both the intervention and control group . The exercise component of self management programmes appears to contribute a significant benefit . Conclusion There is encouraging evidence of a small benefit from exercise in self management programs . Clear guidelines can not be provided for practice regarding the exercise content due to heterogeneity but overall benefit suggests this component should be emphasized and implemented in primary care self management programmes Background Osteoarthritis ( OA ) of the hip and knee are among the most common chronic conditions , result ing in substantial pain and functional limitations . Adequate management of OA requires a combination of medical and behavioral strategies . However , some recommended therapies are under-utilized in clinical setting s , and the majority of patients with hip and knee OA are overweight and physically inactive . Consequently , interventions at the provider-level and patient-level both have potential for improving outcomes . This manuscript describes two ongoing r and omized clinical trials being conducted in two different health care systems , examining patient-based and provider-based interventions for managing hip and knee OA in primary care . Methods / Design One study is being conducted within the Department of Veterans Affairs ( VA ) health care system and will compare a Combined Patient and Provider intervention relative to usual care  among n = 300 patients ( 10 from each of 30 primary care providers ) . Another study is being conducted within the Duke Primary Care Research Consortium and will compare Patient Only , Provider Only , and Combined ( Patient + Provider ) interventions relative to usual care  among n = 560 patients across 10 clinics . Participants in these studies have clinical and / or radiographic evidence of hip or knee osteoarthritis , are overweight , and do not meet current physical activity guidelines . The 12-month , telephone-based patient intervention focuses on physical activity , weight management , and cognitive behavioral pain management . The provider intervention involves provision of patient-specific recommendations for care ( e.g. , referral to physical therapy , knee brace , joint injection ) , based on evidence -based guidelines . Outcomes are collected at baseline , 6-months , and 12-months . The primary outcome is the Western Ontario and McMasters Universities Osteoarthritis Index ( self-reported pain , stiffness , and function ) , and secondary outcomes are the Short Physical Performance Test Protocol ( objective physical function ) and the Patient Health Question naire-8 ( depressive symptoms ) . Cost effectiveness of the interventions will also be assessed . Discussion Results of these two studies will further our underst and ing of the most effective strategies for improving hip and knee OA outcomes in primary care setting s . Trial registration NCT01130740 ( VA ) ; NCT 01435109 ( NIH
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 .
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 .