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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
  1. Asma S Alrushud1,2,
  2. Alison B Rushton1,3,
  3. Archontissa M Kanavaki1,3,
  4. Carolyn A Greig1,3
  1. 1School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
  2. 2Department of Health Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia
  3. 3MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, UK
  1. Correspondence to Asma S Alrushud; asa314{at}


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.

  • Exercise
  • diet
  • elderly
  • obesity
  • randomised controlled trials

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  • Contributors ASA led the review and contributed to all stages, including development of the search strategy, running the searches, assessing trials eligibility, data extraction and synthesis (including risk of bias and Grading of Recommendation, Assessment, Development and Evaluation analysis), and preparation of the manuscript. CAG and ABR provided expertise in systematic review methodology and risk of bias analysis. AMK assisted with assessment of eligibility of included studies and data extraction. All authors read and provided feedback on the preparation of this manuscript according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 checklist and approved the final manuscript.

  • Funding This review is a part of a PhD programme undertaken by ASA, and is fully funded by the King Saud University, Kingdom of Saudi Arabia, Riyadh and the Saudi Arabian Cultural Bureau, United Kingdom, London.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There are no additional unpublished data from the review.

  • Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with 'BMJ Publishing Group'. This only affected the full text version, not the PDF. We have since corrected these errors and the correct publishers have been inserted into the references.

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