Given the recent anxiety about using pain-killing drugs, osteoarthritis sufferers are looking for other ways to get some relief. Exercise and weight loss are known to be helpful in treating the condition, and combining both treatments is even better than either alone . . .

Exercise and Weight Loss Help Osteoarthritis

Summarized by Robert W. Griffith, MD
June 3, 2005

Introduction

With the withdrawal of Vioxx^® and Bextra^® and the questions raised about the safety of Celebrex^® as well as the other NSAID drugs, more and more patients are looking for alternative ways to relieve their arthritis pain. Doctors have long recommended their overweight knee osteoarthritis patients to lose weight to take some of the strain off their joints. Now a study has been reported showing that weight loss combined with moderate exercise produces better results than either measure alone. It's published in the journal Arthritis and Rheumatology, and we summarize it here.

What was done

The Arthritis, Diet and Activity Promotion Trial (ADAPT) was done at Wake Forest University, North Carolina, USA. There were 316 volunteers with knee osteoarthritis, who were overweight or obese, and over 60. They had to have knee pain and some degree of disability to be included in the study.

The participants were divided randomly into 4 groups:

• Exercise 3 days a week (15' aerobic and15' strength training, followed by 15' aerobics and a 15' cool-down)
• Dietary weight-loss program (counting calories to achieve and maintain a 5% weight loss over 18 months)
• Exercise-plus-diet (the two regimes above, combined)
• Talks and advice on a healthy lifestyle - the control group

Full exams were scheduled at baseline, six months later, and after 18 months. The chief measurement was self-reported physical function, using a well-recognized scale (the WOMAC¹). Other measures were weight loss, distance walked in 6 minutes, stair-climbing time, pain and stiffness scores, and X-ray measurement of the joint width.

What was found

Eighty percent of the participants completed the 18-month study. At the end of the study, all the groups showed some improvement in the various measurements. Here are the changes that were significant:

• In the diet-plus-exercise group, there was significant improvement in physical function, 6-minute walking distance, stair-climbing, and knee pain. Pain decreased 30% from baseline. Weight loss amounted to about 6% of starting weight, on average.
• In the exercise group, there was significant improvement in the 6-minute walking distance.
• The diet group lost 5% of their starting weight, on average.
• The control group (lifestyle advice) lost 1.2% of their starting weight during the study.

What these results mean

Combining moderate exercise with modest weight loss by counting calories produced greater benefit than either of the two methods alone. Although this result is not surprising, it should encourage those osteoarthritic patients who are wary of exercising (because they fear it may be painful); the end-result is clearly worth the effort. As an added benefit, eating a healthful diet and exercising reduces the risk of cancer and cardiovascular disease, so there are obviously good 'side-effects' to the best regime found in this study. Better than the side-effects of some drugs!

Source

• Exercise and weight loss in overweight and obese older adults with knee osteoarthritis: The arthritis, diet and activity promotion trial. SP. Messier, RF. Loeser, GD. Miller,  et al., Arthritis & Rheumatism, 2004, vol. 50, pp. 1501--1510

Footnotes
1. The Western Ontario and McMaster Universities Osteoarthritis Index

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