Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis - The arthritis, diet, and activity promotion trial
Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis - The arthritis, diet, and activity promotion trial
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DOI：
10.1002/art.20256
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发表时间：
2004-05-01
影响因子：
--
通讯作者：
Williamson, J
中科院分区：
文献类型：
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作者：
Messier, SP;Loeser, RF;Williamson, J
Objective.关节炎，饮食和活动促进试验（ADAPT）是一项随机，单盲临床试验，持续18个月，旨在确定长期运动和饮食减肥是否比常规护理更有效，无论是单独还是联合使用，在改善超重和肥胖的老年膝关节骨关节炎（OA）患者的身体功能，疼痛和活动能力。316名60岁及以上、体重指数大于或等于28 kg/m2、膝关节疼痛、膝关节OA影像学证据和自我报告身体残疾的社区超重和肥胖成年人被随机分为健康生活方式组（对照组）、单纯饮食组、单纯运动组和饮食加运动组。主要结局是自我报告的身体功能，采用西安大略和麦克马斯特大学骨关节炎指数（WOMAC）进行测量。次要结果包括体重减轻、6分钟步行距离、爬楼梯时间、WOMAC疼痛和僵硬评分以及关节间隙宽度。在316名随机参与者中，252名（80%）完成了研究。依从性如下：健康生活方式，73%;仅饮食，72%;仅运动，60%;饮食加运动，64%。在饮食加运动组中，观察到自我报告的身体功能（P < 0.05），6分钟步行距离（P < 0.05），爬楼梯时间（P < 0.05）和膝盖疼痛（P < 0.05）相对于健康生活方式组的显着改善。运动组6分钟步行距离明显改善（P < 0.05）。单纯节食组与健康生活方式组在任何功能或活动性指标上均无显著差异。与健康生活方式组（1.2%）相比，减肥组（饮食组，4.9%;饮食加运动组，5.7%）减掉了更多的体重（P < 0.05）。最后，两组间关节间隙宽度的变化无差异。与单独进行任何一种干预相比，适度减肥加适度运动相结合可更好地改善超重和肥胖老年膝关节OA患者自我报告的功能和疼痛指标以及运动性能指标。
Objective. The Arthritis, Diet, and Activity Promotion Trial (ADAPT) was a randomized, single-blind clinical trial lasting 18 months that was designed to determine whether long-term exercise and dietary weight loss are more effective, either separately or in combination, than usual care in improving physical function, pain, and mobility in older overweight and obese adults with knee osteoarthritis (OA).Methods. Three hundred sixteen community-dwelling overweight and obese adults ages 60 years and older, with a body mass index of greater than or equal to28 kg/m(2), knee pain, radiographic evidence of knee OA, and self-reported physical disability, were randomized into healthy lifestyle (control), diet only, exercise only, and diet plus exercise groups. The primary outcome was self-reported physical function as measured with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). secondary outcomes included weight loss, 6-minute walk distance, stair-climb time, WOMAC pain and stiffness scores, and joint space width.Results. Of the 316 randomized participants, 252 (80%) completed the study. Adherence was as follows: for healthy lifestyle, 73%; for diet only, 72%; for exercise only, 60%; and for diet plus exercise, 64%. In the diet plus exercise group, significant improvements in self-reported physical function (P < 0.05), 6-minute walk distance (P < 0.05), stair-climb time (P < 0.05), and knee pain (P < 0.05) relative to the healthy lifestyle group were observed. In the exercise group, a significant improvement in the 6-minute walk distance (P < 0.05) was observed. The diet-only group was not significantly different from the healthy lifestyle group for any of the functional or mobility measures. The weight-loss groups lost significantly (P < 0.05) more body weight (for diet, 4.9%; for diet plus exercise, 5.7%) than did the healthy lifestyle group (1.2%). Finally, changes in joint space width were not different between the groups.Conclusion. The combination of modest weight loss plus moderate exercise provides better overall improvements in self-reported measures of function and pain and in performance measures of mobility in older overweight and obese adults with knee OA compared with either intervention alone.