medwireNews: A diet and exercise program delivered in community settings may improve some clinical outcomes for people with knee osteoarthritis (OA) and overweight or obesity, suggest findings from the WE-CAN pragmatic randomized controlled trial.
Stephen Messier (Wake Forest University, Winston-Salem, North Carolina, USA) told delegates at ACR Convergence 2022 in Philadelphia, Pennsylvania, USA, that clinical guidelines encourage diet and exercise in this patient population, but such interventions “have not been rigorously tested in community-based settings.”
To address this, the 18-month WE-CAN study compared a diet and exercise intervention – involving walking, weight training, and low-calorie meals or meal replacements – with a control intervention comprising face-to-face nutrition and health education meetings. These interventions were delivered in established community settings in urban and rural counties in North Carolina, including recreation centers, fitness centers, and facilities linked to religious buildings.
In all, 823 people (approximately 80% women) with an average age of around 65 years and BMI of 37 kg/m2 were included in the trial, 658 of whom attended the 18-month follow-up. The average WOMAC pain score at baseline was approximately 7.5 points.
Messier reported that participants in the diet and exercise group experienced a significantly greater improvement in WOMAC pain score from baseline to the 18-month follow-up than those in the control arm after adjustment for age, sex, BMI, and baseline values, with corresponding reductions of 32% versus 24%.
He said, however, that the between-group difference “was modest and of uncertain clinical importance,” and that the pain benefits seen in the control group could have been due to interactions with patients improving clinical outcomes.
Nevertheless, people in the diet and exercise group were significantly more likely than those in the control group to experience improvement in a number of secondary outcomes, including WOMAC function, 6-minute walk distance, and physical health-related quality of life. Participants in the intervention group also achieved a significantly greater reduction in bodyweight (8 vs 2 kg) and waist circumference (9 vs 4 cm).
The presenter concluded that community-based diet and exercise programs “may be a practical alternative to academic center-based programs for improving clinical outcomes in people with knee OA and overweight or obesity.”
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