The benefits of dealing with obesity in patients with knee osteoarthritis
Knee osteoarthritis (OA), or the wearing away of cartilage between bones, and obesity are directly related to each other. Obese patients are more likely to incur knee OA due to excessive pressure on the joints of the knee, and those who already suffer from it are at a higher risk of further damaging the area. For this reason, increasing physical activity at a modest level and losing weight reduce the risk of knee OA and improve the lives of those with the disease. Despite this known fact, only 46.4% of recently surveyed obese adults with OA were instructed to lose weight by their doctor. Seizing the opportunity to explain these proven benefits of weight loss, a study was conducted that breaks down all components of the strategy.
Due to the fact that there is currently no known cure for knee OA, most treatment instead focuses on improving patients' functional health and quality of life. According to the Journal's reports, in several randomized trials of patients with knee OA, more physical activity resulted in modest but significant improvements in pain and health-related quality of life. An increase in physical activity, along with a decrease in consumption of calories, also leads to a reduction of weight, and may even strengthen muscles around the knee, which can lead to greater stability in that region. In addition, knee OA patients that underwent a combination of exercise and dietary intervention experienced greater results than those who underwent either of the two individually, with the combination turning out an average weight loss of about 6% of body weight after 18 months. A more intensive program using both components resulted in a 10% body weight loss.
Though the facts clearly point out the proven benefits of physical activity, there is limited research on the most appropriate forms of physical activity to use, as less than 20 randomized controlled studies exist on the topic. Findings in this study showed that prescribing moderate amounts of physical activity in multiple short sessions is more likely to lead to improvements in pain and function than excessively long training sessions. Strengthening exercises for the lower extremities have also been proven effective, and one recommendation is to perform both aerobic and strengthening exercises in the same session. A session following this format could include a 15-minute walk, then a series of strength-training exercises, followed by another 15-minute walk and finally a 5-minute cool-down walk with some stretching. One central belief to keep in mind with these exercises is that total energy expended is more important than intensity, and regular walking sessions at a level of 5 or 6 on the intensity scale are most effective.
A major difficulty in assigning these plans is the fact that due to patients' conditions, which are usually riddled with pain and fatigue, they may lack the motivation to undergo these life adjustments in dieting and physical activity. Studies show that as each patient's confidence increases and they notice improvements, the more likely they'll be to continue the lifestyle modifications, making it imperative that physicians guide their patients along and inform them of their successes. Furthermore, each treatment plan assigned by a physician should assess the severity of each patient's weight problem, his or her motivation level and the existing risk factors for chronic disease. The patient's degree of readiness and need to initiate weight loss should also be considered. According to the levels of treatment suggested in this study, patients will be placed in one of four categories, and the particular regimen will be appropriate to each group. A major guideline when dealing with patients in the middle of treatment plans is to promote realistic expectations. Modest weight loss (5-10% of total body weight) has been proven to lead to a significant reduction in the risk of disability and improvements in physical function and quality of life, so patients following treatment plans should shoot for goals similar to these rather than setting the bar too high.
Obesity should be regarded as a chronic health problem that requires lifelong guidance from health care providers. Physicians must acknowledge obesity's direct relationship to knee OA, and changes in dietary behaviors and physical activity should be encouraged to all obese patients with the purpose of losing weight and limiting the chances of knee OA arising or worsening. The compliance of physicians to inform their patients of the inherent risks of obesity on the knee and to prescribe measures to lose weight and manage obesity is key in dealing with this important issue.
-As reported in the Nov. '09 issue of The Journal of Musculoskeletal Medicine
-Summarized by Greg Gargiulo
