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Diet, Exercise, and Knee Osteoarthritis

The link between obesity and knee osteoarthritis is well-established in the literature and makes perfect sense when considering forces incurred at the knee joint during weight-bearing activity.  It is a classic cycle that far too many people face.  An obese individual has knee pain and are told they must exercise in order to lose weight to allow for less pressure on the knee.  Attempts at exercise, however, oftentimes exacerbates their knee pain which can increase frustration and decrease compliance.  This frustration builds and many times, the individual gives up and remains sedentary.

The problem with this approach is that it is incomplete.  Diet (and compliance to proper eating habits) must be included in any attempt to lose weight!  Most people know the importance of good eating habits, however, few know what this looks like.  We live in times of great abundance, which is both a blessing and a curse, as most of these nutritional options are not at all nutritional.  There is no shortage of advice and dietary plans out there.  Much of this advice is overblown, far more complicated than they must be, and thereby much too confusing and difficult to comply with.  Without diving too deep into nutrition, lets just say that REAL foods (meaning natural, whole foods from good sources), in correct quantities, is enough to make a huge difference in one’s health and weight loss efforts (although there is so much more to this equation including stress, sleep, activity levels, etc.).  With that said, there are plenty of dietary plans that do incorporate supplements or meal replacements and are proven to be effective at aiding in weight loss.  Sometimes these plans may kick start the process for someone who is really struggling.

A randomized clinical trial in the Journal of American Medical Association (JAMA) titled “Effects of Intensive Diet and Exercise on Knee Joint Loads, Inflammation, and Clinical Outcomes Among Overweight and Obese Adults with Knee Osteoarthritis” reveals the importance of diet in addition to exercise in the targeted study population, and highlights that exercise alone did not yield as good of results as exercise AND dietary interventions.  This 18-month study was performed at Wake Forest University and included ambulatory, community dwelling adults, 55 years and older, with osteoarthritis (OA) of the knee.  Participants were split into a diet group, an exercise group, and a diet + exercise group.  Dietary interventions included two low-carb, low-fat, 25-gram protein meal-replacement shakes per day (using Lean Shake; GNC) followed by a third meal of 500-750 kcal, low in fat, and high in vegetables.  Calorie distribution goals were consistent with the Dietary Reference Intakes for Energy and Macronutrients.  Upon follow-up, fewer meal replacements were consumed.  Exercise regimen consisted of 1 hour on 3 days a week for 18 months.  Exercise programming utilized “aerobic walking (15 minutes), strength training (20 minutes), a second aerobic phase (15 minutes), and a cool down (10 minutes)”.  The diet + exercise group combined both interventions.

Findings of this study revealed greater weight loss, reduced inflammatory markers (Plasma IL-6 levels), improved mobility, and greater reductions in knee compressive force in the diet and diet + exercise groups than those in the exercise only group.  This serves as an important reminder of the importance of diet in not only losing weight, but also in a reduction in inflammation which could theoretically affect pain, edema, and as a result, overall healing.  The understanding between diet and systemic inflammation is becoming more widely appreciated and can understandably have large effects on one’s healing.

As the saying goes, we truly are what we eat, and losing weight in a healthy way, for the purpose of being healthier, can have many benefits across all systems of the body. It is important to consider assessing your lifestyle as a whole when creating a strategy for weight loss.  To stay healthy, we must remain active, and a large part of remaining active (and experiencing less discomfort) comes down to maintaining a healthy weight.

Matt Vetter, PT, CSCS

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Messier SP, Mihalko SL, Legault C, 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;310(12):1263–1273. doi:10.1001/jama.2013.277669


Omaha Physical Therapy Institute provides specialized care for individuals with knee pain, osteoarthritis, and those that have undergone a total knee replacement.  Call today to set up your appointment and get back to doing the things you love!

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