Diet, Exercise, or Both for Knee Osteoarthritis?

Information sourced from NEJM Journal Watch:

Diet, Exercise, or Both for Knee Osteoarthritis?

Diet and exercise together best achieve physiological and functional improvements.

Drug therapy often is ineffective for alleviating knee osteoarthritis (OA), and surgical treatment generally is not appropriate for mild-to-moderate cases, so lifestyle modifications still are the foundation of treatment. To assess the relative benefits of diet and exercise, researchers randomized 454 patients (mostly sedentary women; mean age, 66; mean body-mass index, 34 kg/m2) with mild-to-moderate knee OA to diet-induced weight loss, exercise, or both. The diet intervention was a combination of meal-replacement shakes and a low-fat diet plan designed to achieve calorie deficits of 800 to 1000 kcal daily. The exercise intervention consisted of thrice-weekly supervised 1-hour sessions of combined aerobic walking and strength training for 6 months, followed by a home-based program if participants wished.

At 18 months (completed by 88% of participants), mean weight loss was greater in the diet-plus-exercise and diet groups than in the exercise group (10.6 kg and 8.9 kg vs. 1.8 kg), as were reductions from baseline in interleukin-6 levels (a measure of inflammation). Diet-plus-exercise participants reported less pain and better function than did those in the diet-alone and exercise-alone groups.


When patients ask whether diet or exercise is better to help with the pain and functional effects of knee osteoarthritis, the answer is both. Exercise alone performed least well on almost all measures but appears to leverage the benefits of diet-induced weight loss. As with most trials of this nature, the structure and monitoring received by participants far exceed that generally available in most primary care practices.

Thomas L. Schwenk, MD reviewing Messier SP et al. JAMA 2013 Sep 25.


Messier SP et al. Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: The IDEA randomized clinical trial. JAMA 2013 Sep 25; 310:1263. [PubMed ® abstract]

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