Older patients with knee osteoarthritis (OA) who underwent a lengthy diet and train interventions reported much less pain and maintained some weight loss years after the program ended, according to a new study published in Arthritis Care & Research.
“These findings suggest that clinicians who deal with people with knee osteoarthritis have quite a lot of nonpharmacologic options that protect clinically vital results 3.5 years after the end of the treatment,” wrote lead author Stephen P. Messier, Ph.D., professor and director of the J.B. Snow Biomechanics Laboratory at Wake Forest University, Winston-Salem, N.C.
The study concerned patients with chubby or obesity aged 55 years or older who had been beforehand enrolled in the 1.5-year Intensive Diet and Exercise for Arthritis (IDEA) trial.
“You must keep in mind that it is 3.5 years after the IDEA trial ended,” Messier said in an interview. “There was no contact with them for that whole time; you’d count on, based mostly on the literature, that they’d revert to the place they had been before they started the trial. And positively, there was some regression, there was some weight regain. However, the vital part of the study is that even after 3.5 years, and even with some weight regain, there were some clinically vital results that lasted.”
“What we feel now could be that if we could prepare individuals higher for that point after they finish a weight loss intervention, from a psychological standpoint, it’ll make a real distinction,” he added. “We’re very good at helping people who have the confidence to lose weight. However, having the confidence to lose weight is completely different from having the confidence to keep up weight loss. If we can provide folks an intervention that has a psychological part, hopefully, we can enhance their confidence to keep up the weight loss that they attained.”
Of the 184 participants who were contacted for a follow-up go to, 94 consented to take part, 67% of whom were females and 88% of whom were White. A total of 27 participants had completed the diet and train intervention while another 35 completed the diet-only and 32 exercise-only interventions.
In the 3.5-year interval between the IDEA trial’s end and follow-up, body weight increased by 5.9 kg in the diet and exercise group (P < .0001) and by 3.1 kg in the diet-only group (P = .0006) but decreased in the exercise-only group by 1.0 kg (P = .25). Nevertheless, from baseline to 5-year follow-up, all teams noticed a discount in body weight. Average weight loss was –3.7 kg for the diet and exercise group (P = .0007), –5.8 kg for the diet group (P < .0001), and –2.9 kg for the train group (P = .003). Body mass index additionally decreased in all groups: by –1.2 kg/m2 in the diet and exercise group (P = .001), by –2.0 kg/m2 in the diet group (P < .0001), and by –1.0 kg/m2 in the exercise group (P = .004).
Pain – as measured by the Western Ontario and McMaster Universities Arthritis Index (WOMAC) score – was decreased in all groups throughout 5-year follow-up: –1.2 (P = .03) for the diet and train group, –1.5 (P = .001) for the diet-only group, and –1.6 (P = .0008) for the exercise-only group. WOMAC functions also considerably improved relative to baseline by 6.2 (P = .0001) in the diet and train group, by 6.1 (P < .0001) in the diet group, and by 3.7 (P = .01) in the exercise-only group.
Finding Time to Advise on Weight Loss, Train
“If exercise and weight loss had been simple, this nation would not be within the state we’re in,” Tuhina Neogi, MD, Ph.D., of Boston University, stated in an interview. “Shared decision-making and personalized medication are vital; sadly, for almost all of physicians – significantly main care physicians, the place a great deal of OA (osteoarthritis) management is undertaken – they do not have the time of their 20 minutes with a patient who has OA to counsel people towards a healthy weight and bodily exercise program after they’re additionally addressing widespread comorbidities seen in OA (osteoarthritis) akin to diabetes and heart disease.
“However as we all know,” she added, “while you do tackle weight loss and physical exercise, it has wide-ranging health advantages. This study offers to assist for using formal diet and train applications to attain vital and sturdy advantages for individuals with OA.”
Neogi did note one of many studies ‘ acknowledged limitations: Solely barely greater than half of the contacted participants returned for follow-up. Although the authors said that the people who returned were representative of both the pool of potential participants and the IDEA cohort as a complete, “we do not wish to make too many inferences when you do not have the entire study population obtainable,” she said. “The individuals who have agreed to come back again 3.5 years later for follow-up testing, possibly they’re a bit of extra health acutely aware, extra resilient. These individuals may be systematically completely different than the people who [did not return], although many of the elements weren’t statistically completely different between the teams.
“No matter constructive attributes they might have, although, we have to perceive extra about them,” she added. “We have to understand how they maintained the advantages they’d 3.5 years prior. That sort of understanding is vital to tell long-term strategies in OA (osteoarthritis) management.”
Messier highlighted an associated, ongoing study he is leading in which more than 800 chubby patients in North Carolina that suffer from knee pain are being led by diet and exercise interventions in a group setting. The objective is to duplicate the IDEA outcomes exterior of a clinical trial setting and present skeptical physicians that diet and exercise will be enacted and maintained on this subset of patients.
“I think we all know how efficient weight loss is, particularly when combined with exercise, in decreasing pain, bettering operate, bettering high quality of life in these patients,” he said. “The following step is to allow them to maintain those advantages for a long period after the intervention ends.”