Diet and exercise programme: a successful OA strategy in a community-based setting

In a community-based setting, an adaptation of diet and an exercise programme led to modest improvements in pain in obese patients with osteoarthritis (OA). Remarkably, patients were able to lose 8% of body weight and had significant improvements in a couple of secondary outcomes.

Weight loss and exercise programmes have been shown to be effective in academic, centre-based trials under highly controlled conditions. “However, these interventions have not been rigorously tested in community-based settings,” said Prof. Stephen Messier (Wake Forest University, NC, USA) [1]. Therefore, the primary aim of his study was to determine whether adaptation to a diet and an exercise programme resulted in a statistically significant reduction in pain, compared with a control group.

Thus, 823 patients with OA were randomised and allocated to a diet and exercise group (n=414) or a control group (n=409). The primary outcome was the between-group difference in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) knee pain at the 18-month follow-up. The exercise programme consisted of 15 minutes of walking and 20 minutes of weight training, followed by another 15 minutes of walking. Patients were advised to practice 3 times a week for 18 months. In addition, they received recipes to compose a reduced-calorie diet of their choice with the option to include a nutritional powder to make low-calorie shakes as meal replacements. The control group received nutrition and health education in 5 1-hour face-to-face meetings over the 18 months and informational packets or phone sessions.

The baseline characteristics of both groups were comparable, with a median age of 64 years, a female predominance, and a BMI of 36.7.

Patients in the intervention group achieved a significantly lower WOMAC pain score after 6 and 18 months. At the end of the follow-up period, the WOMAC pain score was reduced by 32% in the intervention group compared with 24% in the control group (P=0.02). Moreover, patients in the intervention group were 20% more likely to attain a 2-point improvement in the WOMAC pain score (considered clinically meaningful) than the control group.

A remarkable success of the diet and exercise programme was noted regarding weight loss: Patients in the intervention group lost 8 kg, which is an 8% weight loss compared with only 2 kg in the control group (P>0.01). The former group also improved WOMAC function: They had a 36% better function compared with 22% in the control group (P<0.001). The intervention also led to a significantly higher mean 6-minute walking distance and a better health-related quality of life.

Prof. Messier concluded that a community-based exercise programme and dietary advice led to a statistically significant albeit modest reduction in pain. In addition, the remarkable weight loss seen in the intervention group can have important additional health benefits.

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   1. Messier S, et al. Effectiveness of Intensive Diet and Exercise on Knee Pain Among Communities with Knee Osteoarthritis, Overweight, and Obesity: The WE-CAN Pragmatic Randomized Clinical Trial. 1675, ACR Convergence 2022, 10–14 November, Philadelphia, USA.

 

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Posted on 1 December, 20221 December, 2022