How Does Exercise, With and Without Diet, Improve Pain and Function in Knee Osteoarthritis? A Secondary Analysis of a Randomized Controlled Trial Exploring Potential Mediators of Effects

被引：13

作者：

Lawford, Belinda J. ^{[1
]}

Hinman, Rana S. ^{[1
]}

McManus, Fiona

Lamb, Karen E. ^{[1
]}

Egerton, Thorlene ^{[1
]}

Keating, Catherine ^{[2
]}

Brown, Courtney ^{[2
]}

Oliver, Kathryn ^{[1
]}

Bennell, Kim L. ^{[1
]}

机构：

[1] Univ Melbourne, Melbourne, Vic, Australia

[2] Medibank Private, Melbourne, Vic, Australia

来源：

ARTHRITIS CARE & RESEARCH | 2023年 / 75卷 / 11期

基金：

英国医学研究理事会;

关键词：

WEIGHT-LOSS; SELF-EFFICACY; HEALTH-STATUS; OBESE ADULTS; PATIENT; LIFE; ARTHRITIS; OUTCOMES; HIP; INTERVENTIONS;

D O I：

10.1002/acr.25140

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

ObjectiveTo explore the mediators of effects of two 6-month telehealth-delivered exercise programs, including exercise with and without weight-loss diet, on pain and function improvements in knee osteoarthritis (OA). MethodsSecondary analysis of 345 participants from a 3-arm randomized controlled trial of exercise (Exercise program) and exercise plus diet (Diet + Exercise program) versus information (Control program) was conducted. Outcomes were changes in pain (11-point numeric rating scale) and function (Western Ontario and McMaster Universities Osteoarthritis Index [score range 0-68]) at 12 months. Potential mediators were change at 6 months in attitudes toward self-management, fear of movement, arthritis self-efficacy, weight, physical activity, and willingness for knee surgery. For the Diet + Exercise program versus the Exercise program, only change in weight was evaluated. ResultsPossible mediators of the Exercise program versus the Control program included reduced fear of movement (accounting for -1.11 units [95% confidence interval (95% CI) -2.15, -0.07] improvement in function) and increased arthritis self-efficacy (-0.40 units [95% CI -0.75, -0.06] reduction in pain, -1.66 units [95% CI -3.04, -0.28] improvement in function). The Diet + Exercise program versus the Control program mediators included reduced fear of movement (-1.13 units [95% CI -2.17, -0.08] improvement in function), increased arthritis self-efficacy (-0.77 units [95% CI -1.26, -0.28] reduction in pain, -5.15 units [95% CI -7.34, -2.96] improvement in function), and weight loss (-1.20 units [95% CI -1.73, -0.68] reduction in pain, -5.79 units [95% CI -7.96, -3.63] improvement in function). Weight loss mediated the Diet + Exercise program versus the Exercise program (-0.89 units [95% CI -1.31, -0.47] reduction in pain, -4.02 units [95% CI -5.77, -2.26] improvement in function). ConclusionIncreased arthritis self-efficacy, reduced fear of movement, and weight loss may partially mediate telehealth-delivered exercise program effects, with and without diet, on pain and/or function in knee OA. Weight loss may partially mediate the effect of diet and exercise compared to exercise alone.

引用

页码：2316 / 2327

页数：12

共 57 条

[51] Mediation Analysis Allowing for Exposure-Mediator Interactions and Causal Interpretation: Theoretical Assumptions and Implementation With SAS and SPSS Macros [J].