Exercise + Weight Loss = Improved Arthritis

Overweight older adults with osteoarthritis (OA) of the knees will benefit from an exercise program combined with a weight-loss diet, according to study in Arthritis and Rheumatism (2004;50:1501–10). Given the frequent incidence of this disease and the common side effects of treatment, finding effective treatment alternatives without side effects is an important discovery.

A major cause of disability in older adults, OA is a disease characterized by progressive degeneration of the cartilage that lines the joints. The loss of this cartilage may be accompanied by pain, stiffness, swelling, decreased motion of the affected joints, and creaking of the joints (crepitus). Repetitive overuse of a particular joint may lead to OA development. Although OA can occur in any joint, the knees are most commonly affected and being overweight or obese increases the risk of developing OA of the knee.

Treatment for OA includes the use of pain relievers such as acetaminophen (Tylenol®), nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen (Aleve™), and cortisone shots into the joint. Acetaminophen can damage the liver when used to excess, naproxen and other NSAIDs can cause gastrointestinal irritation or ulcers, and cortisone shots can weaken ligaments and cartilage when used repeatedly. Surgery is generally reserved for severe cases that are unresponsive to other measures. Exercise is recommended to help strengthen the muscles around the joints, improve mobility, and decrease arthritis pain.

The new study examined the effect of diet and exercise on OA of the knee. Two hundred fifty-two overweight or obese people over age 60 with OA of the knee took part in the 18-month study. The participants had knee pain on most days that caused difficulty in performing daily living activities like climbing, bending, kneeling, and walking. The participants were randomly assigned to one of the following groups: (1) exercise, (2) dietary weight loss, (3) dietary weight loss and exercise, or (4) no treatment (control).

The exercise groups were prescribed three one-hour sessions per week that combined aerobic and weight training exercises, including walking, leg extensions, leg curls, and step-up exercises. The weight-loss diet was designed to produce and maintain an average weight loss of 5% of a person’s body weight. The control group received information about the benefits of weight loss and exercise for OA. The following were measured to assess the response to the different treatments: weight loss, physical function (including difficulty performing daily activities as described by the participants), mobility (how far the participants could walk in six minutes and timed stair climbing), pain, and x-rays of the knees to determine changes in the amount of space between the bones in the joint.

The diet-plus-exercise group had significantly greater improvements in physical function, mobility, and level of pain than the control group. The diet-plus-exercise group also experienced significantly more weight loss than the control group. There were no changes in any of the groups with respect to x-rays of the knees. All four groups tended to have improved function, but the diet-plus-exercise group had superior results to any of the other groups.

This is the first study to demonstrate the combined effects of exercise and weight loss on physical function, pain, and mobility in people with OA of the knee.

Kimberly Beauchamp, ND, received her bachelor’s degree from the University of Rhode Island and her Doctorate of Naturopathic Medicine from Bastyr University in Kenmore, WA. She is a co-founder and practicing physician at South County Naturopaths, Inc., in Wakefield, RI. Dr. Beauchamp teaches holistic medicine classes and provides consultations focusing on detoxification and whole-foods nutrition.

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