Relative Efficacy of Weight Management, Exercise, and Combined Treatment for Muscle Mass and Physical Sarcopenia Indices in Adults with Overweight or Obesity and Osteoarthritis: A Network Meta-Analysis of Randomized Controlled Trials.

Shu-Fen Chu,Chun-De Liao,Shih-Wei Huang,Hung-Chou Chen,Tsan-Hon Liou

doi:10.3390/nu13061992

Abstract

Aging and osteoarthritis are associated with high risk of muscle mass loss, which leads to physical disability; this loss can be effectively alleviated by diet (DI) and exercise (ET) interventions. This study investigated the relative effects of different types of diet, exercise, and combined treatment (DI+ET) on muscle mass and functional outcomes in individuals with obesity and lower-limb osteoarthritis. A comprehensive search of online databases was performed to identify randomized controlled trials (RCTs) examining the efficacy of DI, ET, and DI+ET in patients with obesity and lower-extremity osteoarthritis. The included RCTs were analyzed through network meta-analysis and risk-of-bias assessment. We finally included 34 RCTs with a median (range/total) Physiotherapy Evidence Database score of 6.5 (4–8/10). DI plus resistance ET, resistance ET alone, and aerobic ET alone were ranked as the most effective treatments for increasing muscle mass (standard mean difference (SMD) = 1.40), muscle strength (SMD = 1.93), and walking speed (SMD = 0.46). Our findings suggest that DI+ET is beneficial overall for muscle mass in overweight or obese adults with lower-limb osteoarthritis, especially those who are undergoing weight management.

Highlights

Osteoarthritis (OA) or degenerative arthritis is the most prevalent musculoskeletal disorder worldwide [1], with rapid increases in its prevalence after the sixth decade of lifespan and with a strong impact on the health of the aging population [2]
The final sample consisted of 34 randomized controlled trials (RCTs) [58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91], which were derived from 28 trials and were published between 2000 and 2020
The combined treatment regular multi-MR (RMMR) plus resistance exercise training (RET) was ranked as the optimal treatment for muscle mass (SMD = 1.44, 95% CI: 0.57–2.31, P score = 0.88) over the short-term follow-up duration, whereas RMMR-diet instruction and advisement (DIA) plus multicomponent exercise training (MET) (SMD = 0.50, 95% CI: 0.11–0.90, P score = 0.97) was ranked highest over the long-term follow-up (Figure 3 and Figure S1); only a single comparison was conducted in network meta-analysis (NMA) over medium-term follow-up, and the results showed that RMMR-DIA plus MET exerted a significant effect on muscle mass (SMD = 1.16, 95% CI: 0.86–1.47)

Summary

Introduction

Osteoarthritis (OA) or degenerative arthritis is the most prevalent musculoskeletal disorder worldwide [1], with rapid increases in its prevalence after the sixth decade of lifespan and with a strong impact on the health of the aging population [2]. Obesity and sarcopenia have become public health concerns in the older population, and sarcopenic obesity might synergistically increase the risk of physical disability [16,17]. Such compounding effects of sarcopenic obesity may affect OA [18] because obesity has become epidemic in the OA population [19] and sarcopenic obesity is closely associated with OA [20]. Because obesity exerts negative effects on physical function in obese individuals with OA [7,19,21] and a high percentage body fat (BF%) is significantly associated with sarcopenia [22], people with overweight or obesity and knee or hip OA have a high risk of physical disability due to sarcopenic obesity

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