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Easing the pain of osteoarthritis.

Characterized by the breakdown of cartilage causing pain and stiffness, osteoarthritis can affect any joint in the body from the neck to toes, but it frequently surfaces in weight-bearing areas such as the knees, especially if a person is overweight.

Recently, a research team at Wake Forest University found that people with the condition experienced a significant improvement in physical function after participating in an 18-month program combining weight loss and exercise.

"If one has mild to moderate osteoarthritis, keep moving!" study author Dr. Stephen Messier, a professor and director of the J.B. Snow Biomechanics Laboratory and the Wake Forest University Runner's Clinic, told MU editors. "Our recommendation is that moderate weight loss and exercise should be the cornerstone of the standard of care that people receive."

In the ADAPT (Arthritis, Diet and Activity Promotion Trial) study, researchers found that individuals on an exercise and calorie-restricted regimen experienced a 24 percent improvement in physical function and reported significant improvements in knee pain--a decrease of more than 30 percent. ADAPT measured improvement in physical function, pain, and mobility in 252 randomized participants, all age 60 or older, who were overweight with a BMI of at least 28, sedentary, and had knee pain or knee osteoarthritis.

How can stressing painful joints be of benefit?

"Although ADAPT did not answer the question, there are a number of possible explanations," explains Dr. Messier. "One, muscles get stronger, and are therefore better able to absorb the shock normally absorbed by the bones. Two, the mechanics are better, so they are not putting stress where it shouldn't be. Three, we found that inflammation decreases. We think now that inflammatory biomarkers called cytokines--that degrade cartilage--decrease."

Study participants engaged in one hour of aerobic and weight training exercise three times weekly, and lost an average of 10 to 12 pounds. Beneficial effects were reported after six months and for an additional year.

"For 70-year-old patients with osteoarthritis, you can advise them that at age 72, they are going to be no worse off and perhaps a little better by following a diet-plus-exercise regimen," advises Dr. Messier. "From a public-health standpoint, that is a significant effect."

The research team is currently investigating whether glucosamine and chondroitin supplementation can help rebuild the articular cartilage lost in osteoarthritis.

"We are involved in a large pilot study, the Glucosamine/chondroitin and Training Exercise Study (GATES), to study the effect," Dr. Messier reports. "In this blinded trial, patients do not know whether they are getting the active drug or placebo, and neither do we. After six months we test them, then they start on an exercise program like that in the ADAPT program and continue to take their supplements.

Supplement manufacturers say that beneficial effects are usually apparent within six months of therapy. People who are allergic to shellfish are advised not to take the supplements. In addition, diabetics should be cautious, since the pills contain sugar.
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Publication:Medical Update
Geographic Code:1USA
Date:Jul 1, 2004
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