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Titolo:
Exercise and weight loss in obese older adults with knee osteoarthritis: Apreliminary study
Autore:
Messier, SP; Loeser, RF; Mitchell, MN; Valle, G; Morgan, TP; Rejeski, WJ; Ettinger, WH;
Indirizzi:
Wake Forest Univ, Sch Med, Dept Hlth & Exercise Sci, JB Snow Biomech Lab, Winston Salem, NC 27109 USA Wake Forest Univ Winston Salem NC USA 27109 , Winston Salem, NC 27109 USA Wake Forest Univ, Sch Med, Dept Internal Med, Winston Salem, NC 27109 USA Wake Forest Univ Winston Salem NC USA 27109 , Winston Salem, NC 27109 USA Wake Forest Univ, Sch Med, Dept Publ Hlth Sci, Winston Salem, NC 27109 USAWake Forest Univ Winston Salem NC USA 27109 , Winston Salem, NC 27109 USA
Titolo Testata:
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
fascicolo: 9, volume: 48, anno: 2000,
pagine: 1062 - 1072
SICI:
0002-8614(200009)48:9<1062:EAWLIO>2.0.ZU;2-X
Fonte:
ISI
Lingua:
ENG
Soggetto:
OSTEO-ARTHRITIS; NATIONAL-HEALTH; NHANES-I; CARTILAGE; MUSCLE; EPIDEMIOLOGY; ASSOCIATION; PERFORMANCE; PREVALENCE; DISABILITY;
Keywords:
disability; physical function; diet;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Social & Behavioral Sciences
Clinical Medicine
Citazioni:
43
Recensione:
Indirizzi per estratti:
Indirizzo: Messier, SP Wake Forest Univ, Sch Med, Dept Hlth & Exercise Sci, JB Snow Biomech Lab, Winston Salem, NC 27109 USA Wake Forest Univ Winston Salem NC USA 27109 lem, NC 27109 USA
Citazione:
S.P. Messier et al., "Exercise and weight loss in obese older adults with knee osteoarthritis: Apreliminary study", J AM GER SO, 48(9), 2000, pp. 1062-1072

Abstract

OBJECTIVE: The purposes of this pilot study were to determine if a combined dietary and exercise intervention would result in significant weight lossin older obese adults with knee osteoarthritis, and to compare the effectsof exercise plus dietary therapy with exercise alone on gait, strength, knee pain, biomarkers of cartilage degradation, and physical function. DESIGN: Single-blind, two-arm, randomized clinical trial conducted for 24 weeks. SETTING: A university health and exercise science center. PARTICIPANTS: Twenty-four community-dwelling obese older adults aged greater than or equal to 60 years, body mass index greater than or equal to 28, knee pain, radiographic evidence of knee osteoarthritis, and self-reported physical disability. INTERVENTION: Randomization into two groups: exercise and diet (E&D) and exercise alone (E). Exercise consisted of a combined weighs training and walking program for 1 hour three times per week. The dietary intervention included weekly sessions with a nutritionist utilizing cognitive-behavior modification to change dietary habits to reach a group goal of an average weightloss of 15 Ib (6.8 kg) over 6 months. MEASUREMENTS: All measurements were conducted at baseline and 3 and 6 months, except for synovial fluid analysis, which was obtained only at baselineand 6 months. In addition, weight was measured weekly in the E&D group. Physical disability and knee pain were measured by self-report and physical performance was measured using the 6-minute walk and stair climb tasks. Biomechanical testing included kinetic and kinematic analysis of gait and isokinetic strength testing. Synovial fluid was analyzed for levels of total proteoglycan, keratan sulfate, and interleukin-1 beta. RESULTS: Twenty-one of the 24 participants completed the study, with one dropout in the E&D group and two in the E group. The E&D group lost a mean of 18.8 Ib (8.5 kg) at 6 months compared with 4.0 Ib (1.8 kg) in the E group(P = .01). Significant improvements were noted in both groups in self-reported disability and knee pain intensity and frequency as well as in physical performance measures. However, no statistical differences were found between the two groups at 6 months in knee pain scores or self-reported performance measures of physical function. There was no difference in knee strength between the groups, with both groups showing modest improvements from baseline to 6 months. At 6 months, the E&D group had a significantly greater loading rate (P = .03) and maximum braking force (P = .01) during gait. There were no significant between-group differences in the other biomechanical measures. Synovial fluid samples were obtainable at both baseline and 6 months in eight participants (four per group). The level of keratan sulfate decreased similarly in both groups from an average baseline of 96.8 +/- 37.1 to 71.5 +/- 23 ng/mu g total proteoglycan. The level of IL-1 decreased from25.3 +/- 9.8 at baseline to 8.3 +/- 6.1 pg/mL. The decrease in IL-I correlated with the change in pain frequency (r = -0.77, P = .043). CONCLUSIONS: Weight loss can be achieved and sustained over a 6-month period in a cohort of older obese persons with osteoarthritis of the knee through a dietary and exercise intervention. Both exercise and combined weighs loss and exercise regimens lead to improvements in pain, disability, and performance. Moreover, the trends in the biomechanical data suggest that exercise combined with diet may have an additional benefit in improved gait compared with exercise alone. A larger study is indicated to determine if weight loss provides additional benefits to exercise alone in this patient population.

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Documento generato il 27/11/20 alle ore 07:06:09