Effect of physical activity and dietary restriction interventions on weight loss and the musculoskeletal function of overweight and obese older adults with knee osteoarthritis: a systematic review and mixed method data synthesis.
BACKGROUND
Despite the clinical recommendation of exercise and diet for people with knee osteoarthritis (OA), there are no systematic reviews synthesising the effectiveness of combining physical activity and dietary restriction interventions on the musculoskeletal function of overweight and obese older adults with knee OA.


OBJECTIVE
To evaluate the effectiveness of combined physical activity and dietary restriction programmes on body weight, body mass index (BMI) and the musculoskeletal function of overweight and obese older adults with knee OA.


INFORMATION SOURCES
A detailed search strategy was applied to key electronic databases (Ovid, Embase, Web of Science andCumulative Index to Nursing and Allied Health Literature (CINAHL)) for randomised controlled trials (RCTs) published in English prior to 15 January 2017.


PARTICIPANTS
Participants with BMI ≥25 kg/m2, aged ≥55 years of age and with radiographic evidence of knee OA.


INTERVENTIONS
Physical activity plus dietary restriction programmes with usual care or exercise as the comparators.


OUTCOME MEASURES
Primary outcome measures were body weight, BMI or musculoskeletal function. Secondary outcome measures were pain and quality of life.


RESULTS
One pilot and two definitive trials with n=794 participants were included. Two articles reporting additional data and outcome measures for one of the RCTs were identified. All included RCTs had an unclear risk of bias. Meta-analysis was only possible to evaluate mobility (6 min walk test) at 6 months and the pooled random effect 15.05 (95% CI -11.77 to 41.87) across two trials with n=155 participants did not support the combined intervention programme. Narrative synthesis showed clear differences in favour of a reduced body weight and an increased 6 min walk in the intervention group compared with control groups.


CONCLUSION
The quality of evidence of benefit of combining exercise and dietary interventions in older overweight/obese adults with knee OA is unclear.


TRAIL REGISTRATION NUMBER
CRD42015019088 and ISRCTN, ISRCTN12906938.
['Alrushud|Asma S|AS|', 'Rushton|Alison B|AB|', 'Kanavaki|Archontissa M|AM|', 'Greig|Carolyn A|CA|']
D000368:Aged D018771:Arthralgia D015992:Body Mass Index D001835:Body Weight D004038:Diet, Reducing D015444:Exercise D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D053580:Muscle Strength D009765:Obesity D020370:Osteoarthritis, Knee D050177:Overweight D011788:Quality of Life D016059:Range of Motion, Articular D015431:Weight Loss
obesity Exercise diet randomised controlled trials elderly