title: Effect of weight maintenance on symptoms of knee osteoarthritis in obese patients: a twelve-month randomized controlled trial.
abstract: OBJECTIVE
  To compare results of obese patients with knee osteoarthritis (OA) who, after an intensive weight loss regimen, received 1 year of either dietary support (D), a knee-exercise program (E), or "no attention" (C; control group).
  
  
  METHODS
  We conducted a randomized, 2-phase, parallel-group trial. A total of 192 obese participants with knee OA were enrolled; the mean age was 62.5 years and 81% were women with a mean entry weight of 103.2 kg. In phase 1, all participants were randomly assigned to 1 of 3 groups and began a dietary regimen of 400-810 and 1,250 kcal/day for 16 weeks (2 8-week phases) to achieve a major weight loss. Phase 2 consisted of 52 weeks' maintenance in either group D, E, or C. Outcomes were changes from randomization in pain on a 100-mm visual analog scale, weight, and response according to the Outcome Measures in Rheumatology-Osteoarthritis Research Society International criteria.
  
  
  RESULTS
  Mean weight loss for phase 1 was 12.8 kg. After 1 year on maintenance therapy, the D group sustained a lower weight (11.0 kg, 95% confidence interval [95% CI] 9.0, 12.8 kg) than those in the E (6.2, 95% CI 4.4, 8.1 kg) and C (8.2, 95% CI 6.4, 10.1 kg) groups (P = 0.002 by analysis of covariance [ANCOVA]). Adherence was low in the E group. All groups had statistically significant pain reduction (D: 6.1; E: 5.6; and C: 5.5 mm) with no difference between groups (P = 0.98 by ANCOVA). In each group 32 (50%), 26 (41%), and 33 (52%) participants responded to treatment in the D, E, and C groups, respectively, with no statistically significant difference in the number of responders (P = 0.41).
  
  
  CONCLUSIONS
  A significant weight reduction with a 1-year maintenance program improves knee OA symptoms irrespective of maintenance program.
authors.affiliation: The Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region of Copenhagen, Denmark.
authors.forename: Robin
authors.initials: R
authors.lastname: Christensen
authors.forename: Marius
authors.initials: M
authors.lastname: Henriksen
authors.forename: Anthony R
authors.initials: AR
authors.lastname: Leeds
authors.forename: Henrik
authors.initials: H
authors.lastname: Gudbergsen
authors.forename: Pia
authors.initials: P
authors.lastname: Christensen
authors.forename: Tina J
authors.initials: TJ
authors.lastname: Sørensen
authors.forename: Else M
authors.initials: EM
authors.lastname: Bartels
authors.forename: Birgit F
authors.initials: BF
authors.lastname: Riecke
authors.forename: Jens
authors.initials: J
authors.lastname: Aaboe
authors.forename: Rikke
authors.initials: R
authors.lastname: Frederiksen
authors.forename: Mikael
authors.initials: M
authors.lastname: Boesen
authors.forename: L Stefan
authors.initials: LS
authors.lastname: Lohmander
authors.forename: Arne
authors.initials: A
authors.lastname: Astrup
authors.forename: Henning
authors.initials: H
authors.lastname: Bliddal
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001696:Biomechanical Phenomena; D031204:Caloric Restriction; D003718:Denmark; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D020370:Osteoarthritis, Knee / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D010147:Pain Measurement; D010349:Patient Compliance; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss