For more than two decades, we have seen, and still see, patients with sedentary lifestyles because of knee pain. In many of these people, this subsequent inactivity has also lead to weight gain. When these people visit us, they come for knee pain treatments and some also come with the idea that if we can solve their knee pain, they can lose weight and get back to their favorite activities. In many cases we can do that. However, it can be a much easier job if we can also help and convince the patient that weight loss during our treatments would be of great benefit as well.
We know, weight loss and activity are challenges for these people. We know of their frustration and pain. What I hope to show you in this article is that it does not take a lot of weight loss to provide a lot of pain relief. I am hoping to show you that it may not be as hard as you think.
A lot of science, a lot of numbers. A little weight loss, a little activity, a lot of pain relief and better health
There is a connection between obesity and knee pain. There is a connection between obesity, inactivity and knee replacement. Knee replacement, as I demonstrated in my article Knee replacement does not help you lose weight, is not the answer for many who want to resume an active lifestyle based on the idea that the knee replacement will help them lose weight.
Reduce knee pain, reduce weight, increase quality of life
In July 2019, research in the journal Arthritis care and research (1) offered some sobering numbers.
- Half of the 14 million persons in the US with knee osteoarthritis are not physically active, this, despite evidence that physical activity is associated with improved health.
- Among these sufferers more than half (7.5 million people) lost years of quality of life due to inactivity or insufficient physical activity relative to activity over their remaining lifetimes.
The research concludes: “Physical inactivity leads to substantial Quality Adjusted Years of Life of losses in the US knee osteoarthritis population. Increasing activity level in even a fraction of this population may have considerable collateral health benefits, potentially averting cases of cancer, cardiovascular disease, and diabetes.”
So here researchers tell us that something common sense has been telling everyone all along:
- If you can get patients with knee osteoarthritis a little more activity. they will have less pain, better quality of life and reduce their cancer, cardiovascular, diabetes risks.
The lead researcher of this study, Elena Losina, Ph.D. Has been providing information like this for years. She lead a 2011 study in the Annals of Internal Medicine that examined people between the ages of 50 and 84 and estimated how many years of quality-adjusted life-years they lost due to obesity and knee osteoarthritis, and, what health benefits these people they could achieve if they lost weight.
- If you were not obese and between the ages of 50 – 84, knee pain from osteoarthritis would rob almost two good years of quality of life from you (that is not quality of life measure) – For patients with both osteoarthritis knee pain and obesity 3.5 years of quality life lost.
What these two studies show us is that little has changed in almost a decade of research. If your knee is hurting, little has probably changed for you as well except the continued knee degenerative disease.
It does not take much weight loss to improve your quality of life
We are going to look at some studies which suggest the benefits of weight loss by percentage of body weight. While some research suggests the more the weight loss the better, other researchers suggests small amounts of weight loss can also have significant beneficial impact.
In November 2018 in the aforementioned journal Arthritis care and research, (3) a team of investigators tested patients to help determine the effect of weight loss on clinical and mechanistic outcomes in overweight and obese adults with knee osteoarthritis. The people in the study were broken up into four groups
People who lost:
- 5% of their body weight over 18 months (1 pound for every 20 pounds they weighed)
- 5-10% of their body weight over 18 months (1 – 2 pounds for every 20 pounds they weighed),
- 10-20% of their body weight over 18 months (2 – 4 pounds for every 20 pounds they weighed),
- 20% of their body weight over 18 months (4 pounds for every 20 pounds they weighed. This would be the equivalent of 4o pounds of weight loss on a 200 pound body – this is very significant weight loss).
- There were significant dose responses to weight loss for pain, function, 6-minute walk distances, physical and mental health-related quality of life, knee joint compressive force, and interleukin-6 (INFLAMMATION).
- Greater weight loss resulted in superior outcomes with greater quality of life improvements.
What is quality of life improvements? What is your reward for losing weight?
Doctors in Brazil published research (4) which divided elderly patients with osteoarthritis into two groups and tested their abilities to perform basic tasks.
Group 1: patients considered obese
Group 2: patients considered non-obese
- The obese group showed a worst performance in the TUG test. A test where the amount of time a patient takes to get up from a chair, walk 10 feet and then walk back and sit in the chair.
- The obese group also showed a worse performance in brisk walking speed and the 6 minute walk test.
The following activities were difficult to perform and caused a more severe pain in the obese group:
- “housework chores”,
- “going down stairs”,
- “bending to floor”
- “getting up from bed”
- “rising from a chair”
- “standing” and
- “getting on/off toilet”
You probably did not need a research study to point out these challenges to you. What this research probably tells you is that there are people out there who have the same challenges you do.If you need more reasons why a little weight loss and a little physical activity can help you “get on and off a toilet,” and reward you with other health benefits please see my article: Weight loss can protect you from knee replacement if you are motivated.
A Little Weight Loss Plus Exercise Helps You Walk Faster
There is a new study,(4) October 31, 2019, lead by the Wake Forest University School of Medicine that examined The Intensive Diet and Exercise for Arthritis (IDEA) program. This was an 18-month randomized controlled trial that enrolled 454 overweight and obese older adults with symptomatic and radiographic knee osteoarthritis and tested for impact of exercise and diet separately and together on these people’s knee pain.
- Some in the group Participants were randomized to either exercise, intensive diet-induced weight loss, or intensive diet-induced weight loss plus exercise interventions.
- These researchers had previously reported that the clinical benefits of intensive diet-induced weight loss + exercise interventions were significantly greater than with either intervention alone (e.g., greater pain reduction, and better function, mobility, and health-related quality of life).
Now in this study, the researchers tested the hypothesis that intensive diet-induced weight loss plus exercise interventions has greater overall benefit on gait mechanics compared to either intervention alone.
The intensive diet-induced weight loss plus exercise interventions group walked significantly faster at 18-month follow-up than Exercise group alone.
Most people who come into our office know they are overweight and know they need to lose weight.But they are also plagued by knee instability problems like those mentioned by the study patients above. Stem cell therapy addresses the knee weakness and knee instability immediately. A good diet plan can address the weight loss simultaneously to the stem cell treatments. In many patients we get that jump start of weight loss and reduced pain quickly, enough to help many create the “momentum and motivation,” they need to heal their problems.
Will stem cell therapy help me?
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1 Losina E, Silva G, Smith KC, Collins JE, Hunter DJ, Shrestha S, Messier SP, Yelin EH, Suter LG, Paltiel AD, Katz JN. Quality-Adjusted Life-Years Lost Due to Physical Inactivity in the United States Osteoarthritis Population. Arthritis Care Res (Hoboken). 2019 Jul 26. doi: 10.1002/acr.24035.
2 Losina E, Walensky RP, Reichmann WM. Impact of obesity and knee osteoarthritis on morbidity and mortality in older Americans. Ann Intern Med. 2011 Feb 15;154(4):217-26.
3 Messier SP, Resnik AE, Beavers DP, Mihalko SL, Miller GD, Nicklas BJ, DeVita P, Hunter DJ, Lyles MF, Eckstein F, Guermazi A. Intentional Weight Loss in Overweight and Obese Patients With Knee Osteoarthritis: Is More Better?. Arthritis care & research. 2018 Nov;70(11):1569-75.