Abstract
BackgroundKnee pain is common with obesity and weight gain being important risk factors. Previous clinical trials have focused on overweight or obese adults with knee pain and osteoarthritis and demonstrated modest effects of intense weight loss programs on reducing knee pain despite very significant weight loss. There has been no lifestyle intervention that targets community-based adults to test its effect on prevention of knee pain. We aimed to determine the effect of a simple low-intensity self-management lifestyle intervention (HeLP-her), proven in randomised controlled trials to improve lifestyle and prevent weight gain, on knee pain in community-based young to middle-aged rural women.MethodsA 1-year pragmatic, cluster randomised controlled trial was conducted in 649 community-based women (aged 18–50 years) to receive either the HeLP-her program (consisting of one group session, monthly SMS text messages, one phone coaching session, and a program manual) or one general women’s health education session. Secondary analyses were performed in 390 women who had knee pain measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline and 12-month follow-up. “Any knee pain” was defined as a WOMAC pain score ≥ 1. Knee pain worsening was defined as an increase in WOMAC pain score over 12 months.ResultsThirty-five percent of women had “any knee pain” at baseline. The risk of knee pain worsening did not differ between the intervention and control groups over 12 months. For women with any knee pain at baseline, those in the intervention arm had a lower risk of knee pain worsening compared with those in the control arm (OR 0.37, 95% CI 0.14–1.01, p = 0.05), with a stronger effect observed in women with body mass index ≥ 25 kg/m2 (OR 0.28, 95% CI 0.09–0.87, p = 0.03).ConclusionsIn community-based young to middle-aged women, a simple low-intensity lifestyle program reduced the risk of knee pain worsening in those with any knee pain at baseline, particularly in those overweight or obese. Pragmatic lifestyle programs such as HeLP-her may represent a feasible lifestyle intervention to reduce the burden of knee pain in the community.Trial registrationACTRN12612000115831, registered 24 January 2012.
Highlights
Knee pain is common with obesity and weight gain being important risk factors
Given the steady weight gain that is occurring in many countries and the role of weight gain in the development and worsening of knee pain, community interventions aimed at weight loss or preventing weight gain may have a role in reducing the prevalence and burden of knee pain
A total of 649 women were recruited for the original study, of whom 525 (81%) women had complete data for age, Body mass index (BMI), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and were included in the current knee pain substudy
Summary
Knee pain is common with obesity and weight gain being important risk factors. There has been no lifestyle intervention that targets community-based adults to test its effect on prevention of knee pain. We aimed to determine the effect of a simple low-intensity self-management lifestyle intervention (HeLP-her), proven in randomised controlled trials to improve lifestyle and prevent weight gain, on knee pain in community-based young to middle-aged rural women. We have shown in community-based adults that moderate weight gain (5%) was associated with development and worsening of knee pain [6]. Given the steady weight gain that is occurring in many countries and the role of weight gain in the development and worsening of knee pain, community interventions aimed at weight loss or preventing weight gain may have a role in reducing the prevalence and burden of knee pain. Early intervention for the prevention and treatment of knee pain is important, as an episode of knee pain predicts future recurrence [10]
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