Managing Diet & Exercise Schedules using Professional Help for Treating Knee Osteoarthritis in Obese/Overweight Individuals

Exercising under the Guidance of an Expert Brings About Greater Results

Think Beyond Symptom Management

Age doesn’t seem to be a bar these days for health conditions and problems to hit a person. Advancements in science and technology may have improved our longevity but the quality of our lives are getting worse day by day-heart attacks hit individuals in mid-30s, diabetes loves young children, blood pressure has taken center seat in young adults and knee problems have ruined the quality of life of millions of people.

Osteoarthritis
Osteoarthritis (OA) is the most common chronic condition of the joints establishing itself as a rapidly growing cause of disability in the world. Though both the sexes are at a risk, the number of cases of osteoarthritis in women is almost double that of the male sex. It can affect anyone of any age group but its mostly people above the age of 65 who face the wraths of it. It’s been projected that more than 130 million people will suffer from OA by 2050. The knee is primarily the largest joint that’s affected by the disease whose major risk factors include obesity, age, joint injury, joint overuse, weak thigh muscles and genes. Statistics show that at least one in every 12 individuals above the age of 60 have hand OA & one in every second person will develop OA during his/her life.
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Obesity is a modifiable risk factor for OA and research even tells that obesity, diabetes and metabolic syndrome (MetS) directly influence the development of the condition. Haven’t we also heard our physician instantly recommending us to lose weight when we complain about knee pain? Weight plays a definite role in knee pain as our entire body weight is imposed on the knee for support and this causes rapid wear and tear of the body part. Presently, there are no varied treatment options available for OA and pain is confined mostly with symptom management or in worse cases, using total joint replacement when the joint is damaged beyond repair. Reputed arthritis societies and organizations recommend practicing regular physical activity and healthy diet to lose weight in obese/overweight patients as a combat measure against OA but what are the provisions set up in clinical settings for such treatments?

Treating OA in Obese Patients through Diet & Exercise in Clinical Settings
Obesity can both cause and worsen OA but the good thing is that it can be modified and controlled. We do have research material showing that weight reduction is a great strategic treatment option for OA. Understanding the condition and realizing that exercise intervention can help to reduce pain thereby enabling better mobility is also clearly proved through various studies.

A study brought in 181 patients whose BMI was above 30 and suffered from severe knee osteoarthritis. Only 112 candidates (others quit due to health reasons and inability to attend sessions regularly) completed the program and their average age was around 57 years. The program was for a duration of 4 months during which 2 exercises and one dietary intervention sessions were organized every week. Each of the patient’s weight was measured and they were categorized based on their weight, age and initial OKS score. Oxford knee score (OKS), 30 second sit to stand (30s s-s), 6 minute walk test (6MWT) and EQ5Dquality of life were assessed during the study period. Patients with weight ranges between 100 and 110 and OKS score between 10 and 20 benefitted the most out of the program but it was seen that all the 112 participants who successfully completed the study displayed significant improvements in their physical abilities. This clearly shows that when the condition is tackled in obese people with diet and exercise interventions by professionals there are great opportunities for better treatment.

Various studies have established the strong connection between obesity and knee arthritis. They show that people with a BMI greater than 30 are at a 5-time risk of knee OA. In adults above the age of 60, mean knee strength in obese males is 65% of body weight compared to 77% for controls while it is 50% of body weight for obese females compared to 62% for non-obese females. Muscle weakness is predominant among older adults and is a common reason for fall. Death due to such falls are also high in number. Various studies linking diet interventions in obese patients with knee OA have come to successful conclusions: A pilot study achieved 9% weight loss over 6 months in obese older adults with knee OA with the help of a partial meal-replacement plan and behavioral strategies; another study used an intensive low-energy diet to achieve 11% weight loss in 8 weeks. When obese patients lose weight there is an active reduction in the disability level and losing around 10% of the body weight results in greater potential advantages. Findings of various trials and meta-analyses of weight reduction strategies in obese/overweight individual are tabulated below:

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Trial	No. of Participants	Intervention	Mean Weight Reduction	​Outcome
CAROT	177	16 weeks energy-restricted diet, no exercise but weekly contact with RDN	13.2%	30% reduction in pain, 4% increase in walking speed
IDEA	454	18 months energy-restricted diet, 60 min of exercise thrice a week. Weekly contact with RDN first six months & biweekly during last 6 months	11.4%	45% reduction in pain, 10% increase in walking speed & 15% increase in walking distance
Meta analysis of 4 Randomized Controlled Trials	454	6 weeks to 18 months	6.1%	Disability showed great improvements when weight loss  was >5%

A reduction in body weight affects OA by reducing the load on the knee. By combining calorie restrictions with calorie distribution (45-60% from carbs, 15-20% from proteins and <30% from fats) we attain greater benefits. Studies show that pain, physical function and walking distance improve by 26%, 31% and 15% with aerobic walking exercise. Patients feel that it is their doctor’s responsibility to guide them towards weight loss if needed. A recent study shows that only 42% obese individuals who visited their GP over a 1-year period were advised to lose weight. Only a very small percentage of physicians take the pain to write down a prescription for physical activity promotion programs (15%). But when their intervention is involved in obese patients with knee OA results are surely positive.

Diet & Exercise-Related Interventions
Meta-analyses shows that a combination of strengthening, flexibility and aerobic exercise are likelier to improve function and reduce pain. Many studies promote a majority of these dietary interventions for maximized benefits:

1. Aim to reduce at least 10% of body weight initially in obese/overweight patients and bring BMI levels below 30. Avoid extreme diet regulations while promoting moderate energy restrictions along with strength training and aerobic exercises
2. Cholesterol-lowering diet advisable with patients with high cholesterol levels. Ensure increased intake of fiber, soy and nuts
3. Eat foods rich in vitamin A, C and E to meet adequate levels needed. Always try to achieve the levels via diet before jumping onto supplements
4. Pump in vitamin D by using oily fish, eggs, vitamin D-fortified milk, cereals and sunshine. Maintaining a healthy BMI range within 25 prevents the withdrawal of vitamin D levels from the adipose tissue.
5. Consume more of greens such as kale, Brussels sprouts, spinach and broccoli
6. Reduce intake of total and saturated fat as they are associated with increased knee joint space-width loss while increasing the consumption of mono- and polyunsaturated fatty acids as they regulate inflammation.
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We have studies showing that knee pain reduces by as much as 50% after appreciable weight loss (by as much as 10%). Never do the mistake of either following a low-calorie diet or exercising. Only when exercise and diet are followed together can we achieve successful weight loss measures. These lifestyle interventions must be sustained to prevent regain of lost weight.
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References
Exercise professional led physical activity and diet in obese individuals with knee osteoarthritis: https://journals.lww.com/acsm-essr/Pages/viewallmostpopulararticles.aspx

Diet & exercise for obese adults with knee osteoarthritis: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3444812/

Role of diet & nutrition in treating osteoarthritis: https://academic.oup.com/rheumatology/article/57/suppl_4/iv61/4975692

​Update on the treatment of osteoarthritis in obese patients: https://www.tandfonline.com/doi/full/10.1517/14656566.2016.1165208