[Contribution of exercise and diet in the management of knee osteoarthritis in the obese].
OBJECTIVE
Our objective was to determine whether exercise and weight loss are more effective either separately or in combination, in improving pain and physical function in obese adults with moderate knee osteoarthritis (OA).


PATIENTS AND METHODS
Forty-five obese adults, with a body mass index greater than 35 kg/m2 or 30<or=BMI<35 associated to at least one cardiovascular risk factor, suffering from knee pain with evident radiographic signs of knee OA, were involved in our study. All patients were evaluated at baseline and at the end of the study. The assessment parameters were weight loss, the bioelectric impedance analysis, pain, six-minute walk distance, cardiovascular parameters, and muscular strength. The physical function was measured with the Womac and the Lequesne indexes. Patients were randomized into four groups, a control group (G1), exercise only group (G2), diet plus exercise group (G3) and diet only group (G4).


RESULTS
There was no difference between the four groups at baseline. Significant improvement of function (Womac) was noticed in groups performing exercise only (G2) (26%), diet plus exercise (G3) (37.89%) and diet only (G4) (18.34%). We also noticed an improvement in pain in G2 (p=0.04), G3 (p<0.001) and G4 (p=0.02). The improvement of quadriceps strength was noted only in G2 (p=0.01) et G3 (p=0.001) without any change in control group and diet only group (G4). The improvement of cardiovascular parameters was observed only in G2 and G3. Weight loss, decreased BMI and waist circumference was more important in diet plus exercise group (G3).


CONCLUSION
The combination of weight loss and exercise provide better improvements in physical function and pain in obese adults with knee OA compared with either intervention alone. Exercise used alone or associated to dietary provides better improvements in physical capacity and muscle strength.