1. In this randomized controlled trial, community-based diet and exercise education led to improvement in osteoarthritis associated pain score.

2. Community-based diet and exercise regimen was more effective in lowering mean body weight and mean waist circumstance compared to attention control group.  

Evidence Rating Level: 1 (Excellent)

Osteoarthritis (OA) is the most common cause of mobility and disability amongst the elderly. Since patients with OA live with symptoms for an average of 26.1 years, optimizing treatment of OA can have a significant impact on quality of life for this population. Although obesity has been identified as a modifiable risk factor for OA, the effectiveness of diet and exercise on relieving pain in OA has not been demonstrated in community-based settings.

This randomized control trial conducted in the United States consisted of 823 patients who were 50 years or older (77% women), had knee OA, and were overweight (classified as a body mass index ≥ 27). Patients with symptomatic coronary artery disease, type 1 diabetes, and active cancer were excluded. 414 patients were randomized to the intervention group, where they received in-person dietary counseling, provision of meal replacement supplements, and 60-minute group exercise sessions 3 days per week for 18 months. 409 patients were randomized to the control group and received in-person nutrition and health education, five times total. The primary outcome was self-reported Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) knee pain score. Secondary outcomes measured included body weight, waist circumference, WOMAC function score, pain medication use, and quality of life score.

At the 18-month follow up, the intervention group had a statistically significant improvement in knee pain compared to the control group. Although it is unclear if the observed difference in knee pain score is of clinical importance, more patients in the intervention group achieved a clinically meaningful improvement in pain score compared to the control group. There were also significant improvements in secondary outcomes including body weight and function score in the intervention group. However, since nutritional supplements and gym access were provided as part of the trial protocol, the feasibility of replicating this study and providing such interventions as a part of osteoarthritis care is unclear.

Click to read the study in JAMA Network 

Image: PD

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