Intensive weight loss together with regular exercise did more to ease knee arthritis than exercise alone for overweight and obese adults in a new U.S. study.

Knee inflammation, pain and functioning all improved more among people who cut back on calories in addition to working out, researchers found.

The greatest benefits were seen among those who lost the most weight, and they tended to be the ones who combined diet and exercise.

“While both the exercise and the diet interventions separately were beneficial, the combination of the two was superior in virtually every outcome,” Stephen Messier, who led the study at Wake Forest University in Winston-Salem, North Carolina, said.

Extra weight is known to raise the risk of knee osteoarthritis, which happens when cartilage around the joint breaks down, causing inflammation, pain and stiffness.

One review found that being overweight doubles a person’s risk of knee osteoarthritis, and being obese quadruples it

For the new study, Messier and his colleagues wanted to see what effect losing weight through a strict diet program would have on arthritis symptoms.

They randomly assigned 454 overweight and obese adults with mild or moderate knee arthritis to 18 months of diet counseling, exercise or both.

For participants on the diet, the goal was to lose at least 10 percent of their starting weight. People replaced some meals with shakes and attended regular weight monitoring and nutrition sessions.

The exercise program involved one hour of physical activity three times per week, including aerobic walking and strength training.

By the end of the study, people assigned to both diet and exercise had lost an average of 23 pounds. That compared to almost 20 pounds in the diet-only group and four pounds among those who only exercised.

Compared to people in the exercise-only group, those who combined diet and exercise had less knee inflammation and pain and better functioning at 18 months.

For example, pain scores measured on a scale of 0 to 20, with higher scores indicating more pain, fell by 3.1 points in the diet plus exercise group and by 1.4 points in the exercise-alone group and about the same in the diet-alone group.

Likewise, on a 0-to-68 scale measuring knee function, people in the combined diet and exercise group improved by an average of 10.5 points, versus 4.7 points among those who only exercised.

People in the diet-alone and the diet plus exercise groups had about the same levels of knee inflammation – both lower than in the exercise-alone group.

“No one expects diet and exercise to have a huge impact” on osteoarthritis, Dr. Amanda Nelson, from the University of North Carolina at Chapel Hill’s Thurston Arthritis Research Center, said.

“The fact that most of the improvements were modest is what we would expect to see.”

Regardless of their group, participants who lost 10 percent of their body weight or more saw greater improvements in inflammation and other arthritis measures than those who dropped less weight, the researchers write in the Journal of the American Medical Association.

Messier told Reuters Health that exercise seems to have benefits for osteoarthritis independent of weight loss, so it should remain part of standard care.

Although not all patients may be able to find the same support provided in the study, many communities have YMCAs and other places people can go to get help with weight-loss and exercise goals, he noted.

Some people, Messier said, “just need help. If you have someone who is sedentary for most of their life … to just ask them, ‘Well, I think you need to lose a few pounds and exercise’ and then walk out the door, it’s not enough.”

Nelson, who wasn’t involved in the new research, told Reuters Health that people should also turn to family members and community groups for support, if possible.

Although a 10-percent weight loss continues to be the goal for overweight people with arthritis, even two pounds is better than nothing, she said.

“Patients should be encouraged that any weight loss is likely to be beneficial, and the more they can do the better,” Nelson said

Source: Reuters.com

Samantha Bradley holds her 1-year-old son, Adris, in Long Beach, Calif. Adris, born premature, required heart and eye surgery.

Samantha Bradley was only six months pregnant. She had already miscarried once. She knew she needed to get to an emergency room.

“I was in tears,” she said. “The only thing I could think was, ‘Get me to a hospital.’ ”

On vacation in Palm Springs, Bradley and her sister rushed to a nearby hospital. About 30 minutes later, Bradley gave birth to her son, Adris. The baby weighed just 1 pound, 8 ounces — a little more than a bag of coffee.

Adris would spend four months in the hospital, undergoing surgery to close a valve near his heart and eye surgery caused by a disease common in premature infants.

Black women like Bradley are 1½ times as likely as white women to give birth prematurely, and their babies are more than twice as likely to die before their first birthday.

Researchers once blamed a lack of prenatal care for the disparity. Now, research shows that the explanation is much more complex, rooted in the years before the women even get pregnant. Black women are more likely to be poor, have less education, lack health insurance and have chronic conditions such as diabetes and obesity.

“They are coming into the pregnancy at higher risk,” said Kay Johnson, who chairs the advisory committee on infant mortality for the U.S. Department of Health and Human Services. “By the time they see a doctor, seven months is too short to repair long-term adverse health.”

The leading causes of infant mortality are preterm birth and low birth weight. Even if premature children survive, they can face lifelong health or developmental problems.

The nation’s health care overhaul is expected to help close racial gaps by increasing access to preventive care, health insurance and family planning, Johnson said. The government also is investing in projects to reduce preterm birth and infant mortality.

“While there are all these medical risk factors, there are a whole bunch of other social risks,” said Erin Saleeby, director of women’s health programs for the Los Angeles County Department of Health Services. “The medical side of it will never be enough.”

Socioeconomics and medical care don’t fully explain why black women disproportionately lose their babies. Even black women who are highly educated are at higher risk than white women with less education.

That may be because of the cumulative effects of racism and stress, said Johnson, citing research on the subject.

Meridith Merchant, 42, a licensed psychologist who lives in Los Angeles, said she did all she was supposed to do during her pregnancy in 2005, eating well and attending all her prenatal appointments.

When she was 6½ months pregnant, her water broke. At Cedars-Sinai Medical Center, she gave birth to a girl, Nailah Asha, who weighed just 2 pounds.

Nailah spent five months in the neonatal intensive care unit, until she could eat and breathe on her own.

Merchant and her husband spent long hours at the hospital. Nailah was born with heart defects, and several weeks after her birth, she tested positive for Down syndrome.

She went home after five months but had trouble gaining weight. One day, Merchant was holding Nailah when her body went limp. Merchant called 911. Her daughter died at the hospital of an intestinal disorder. It was one day before her first birthday.

Every year, Merchant said, she commemorates Nailah’s birthday.

Source: http://www.timesdispatch.com/news