Knee osteoarthritis is really very common. Particularly, as our population becomes more overweight and sedentary.
Patients will often ask about non-pharmacologic treatment (non-"drug" treatments), looking instead for a "natural" alternative.
Often, the elephant in the room is ignored.
Weight. Too much of it. Excess weight is the most obvious modifiable risk factor in knee osteoarthritis.
At the recent American College of Rheumatology Meeting (ACR 2011) in Chicago, results of the Intensive Diet and Exercise for Arthritis (IDEA) trial were presented. The IDEA trial was designed to test the hypothesis that intensive weight loss, either with or without exercise, would reduce pain and improve function in patients with knee osteoarthritis when compared with those patients who exercised but did not undergo dietary restriction.
454 overweight and obese patients, all older than 55 years, with symptoms related to their knee osteoarthritis were divided into 3 groups:
- Intensive Dietary restriction only
- Intensive Dietary restriction plus exercise
- Exercise only
The goal for the dietary restriction patients was a 10% reduction of baseline body weight. The exercise intervention consisted of low to moderate intensity walking as well as resistance training 3 times a week for 1 hour each time.
After 18 months, mean weight loss for the group on dietary restriction only was 8.9kg. When exercise was combined with dietary restriction, the mean weight loss was 10.6kg.
The exercise only group had much less mean weight loss, only 2kg.
Similarly, pain levels and walking speed (the measure used to assess mobility) improved most in the combination group with dietary restriction and exercise. On these measures, the exercise only group did also show benefit but again, this exercise only group did not do as well when compared to groups with dietary restriction.
The IDEA trial basically shows that weight loss, when combined with low to moderate intensity exercise, can lead to about 50% reductions in pain and to improved function.
The elephant in the room needs to be addressed.
It's something I expect doctors and allied health professionals have known for some time, but as a group, we tend to be poor in addressing this very important issue. We need to highlight how important weight loss is for our overweight patients with knee osteoarthritis.
In fact, we are doing these patients a disservice if we don't.
BJC Health's Connected Care approach emphasises the need for weight loss with knee osteoarthritis. It's good to see more and more evidence supporting this approach.
Are you addressing the elephant?