The influence of dietary energy restriction and exercise on features of knee osteoarthritis in humans

: (Alternative Format Thesis)

Abstract

Knee Osteoarthritis (OA) is one of the leading causes of disability worldwide, with approximately one in five adults over 45 years of age diagnosed in the UK. Knee OA is characterised by acute and chronic pain, increased systemic inflammation and reductions in physical functioning and quality of life. There is currently no cure for knee OA however the first line of treatment recommended for symptom management is weight management and exercise. Despite this, there is still a need for specific guidelines and a greater understanding around how exercise and weight management can help with symptoms and potentially delay disease progression. The aim of this thesis was to determine the effects of energy restriction and exercise on features of knee OA. In Chapter 3, a systematic review of the available literature concluded that acute exercise, and exercise training may have a beneficial effect on pain sensitisation in individuals with knee OA, however the current evidence base is weak and requires more high quality RCTs to add to the existing evidence. In Chapter 4, we found that a single bout of upper body aerobic exercise was more beneficial than lower body aerobic exercise in reducing acute pain flares commonly experienced following a single bout of exercise in individuals with chronic knee pain and knee OA. In Chapter 5, the protocol of a randomised controlled trial to determine the effects of energy restriction, with or without exercise on several features of knee OA, including a range of systemic inflammatory biomarkers, knee pain and pain sensitisation, functional outcomes, and general health is described. Finally, in Chapter 6, the preliminary results showed that four weeks of dietary energy restriction combined with aerobic exercise equivalent to general physical activity guidelines, produced a clinically significant reduction in symptomatic pain in comparison to dietary energy restriction alone. Further, dietary energy restriction plus exercise were more beneficial than dietary energy restriction alone in improving functionality, and reductions in several pro-inflammatory markers were seen in the dietary energy restriction plus exercise group but not in the dietary energy restriction alone group, although no interaction effects were found. This thesis has shown that a single bout of upper body exercise may serve as an effective exercise alternative to prevent acute pain flares commonly experienced following exercise in this population, and that short term dietary energy restriction combined with aerobic exercise training is beneficial in reducing symptomatic pain and may prove beneficial in reducing systemic inflammation, in comparison to dietary energy restriction alone.

Date of Award	28 Jun 2023
Original language	English
Awarding Institution	University of Bath
Supervisor	James Bilzon (Supervisor), Enhad Chowdhury (Supervisor) & Dylan Thompson (Supervisor)