Kosin Med J.  2021 Dec;36(2):125-135. 10.7180/kmj.2021.36.2.125.

Association of Weight Change and Physical Activity with Knee Pain and Health-Related Quality of Life in East Asian Women Aged 50 Years and Older with Knee Osteoarthritis: A Population-Based Study

• KMID: 2524649
• DOI: http://doi.org/10.7180/kmj.2021.36.2.125

Abstract

bjectives: This study aimed to investigate the association of self-reported weight change and physical activity with the level of knee pain and health-related quality of life in East Asian women with knee osteoarthritis using population-based data.
Methods
A total of 564 women (mean age, 68.2 years, standard deviation, 8.9 years) aged 50 years or older with knee osteoarthritis (Kellgren-Lawrence (K-L) grade ≥ 2) were included in the data analyses from the fifth Korea National Health and Nutrition Examination Survey. Data regarding the radiographic grade, self-reported weight change during the past year, physical activity, level of knee pain, and health-related quality of life (EuroQOL five- dimension (EQ-5D) index) were collected. Multiple regression analysis was performed to identify factors significantly associated with the level of knee pain and health-related quality of life in subgroups according to the body mass index (BMI) range (≤ 22.5, between 22.6 and 27.5, and > 27.5 kg/m ² ).
Results
In the whole group, the level of knee pain was significantly associated with K-L grade (P < 0.001), and EQ-5D was negatively associated with age (P < 0.001), the level of knee pain (P < 0.001), and weekly hours of vigorous-intensity activity (P = 0.026). In the subgroup analysis, weight gain showed significant association with the level of knee pain only in women with 22.5 kg/m² < BMI ≤ 27.5 kg/m² (P = 0.006). Weight gain showed significant association with EQ-5D in women with BMI ≤ 22.5 kg/m²(P = 0.047) whereas weekly hours of moderate-intensity activity was negatively associated with EQ-5D in women with BMI > 27.5 kg/m² .
Conclusions
The association of weight change and physical activity with knee pain and health-related quality of life might be different according to BMI ranges. Well-designed interventions to improve both knee pain and health-related quality of life need to be investigated in future studies that would strictly control physical activity, diet, and weight changes.

Keyword

Health-related quality of life; Knee pain; Osteoarthritis; Physical activity Weight change

Figure

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  Fig. 1 Flow diagram of the inclusion and exclusion criteria for the Korea National Health and Nutrition Examination Survey (KNHNES). A total of 564 women aged 50 years or older were included.

Reference

1. Bindawas SM, Vennu V, Auais M. Health-related quality of life in older adults with bilateral knee pain and back pain: data from the Osteoarthritis Initiative. Rheumatol Int. 2015; 35:2095–101.

2. Kiadaliri AA, Lamm CJ, de Verdier MG, Engstrom G, Turkiewicz A, Lohmander LS, et al. Association of knee pain and different definitions of knee osteoarthritis with health-related quality of life: a population-based cohort study in southern. Sweden Health Qual Life Outcomes. 2016; 14:121.

3. Bartley EJ, King CD, Sibille KT, Cruz-Almeida Y, Riley JL 3rd, Glover TL, et al. Enhanced Pain Sensitivity Among Individuals With Symptomatic Knee Osteoarthritis: Potential Sex Differences in Central Sensitization. Arthritis Care Res (Hoboken). 2016; 68:472–80.

4. Dieppe PA, Lohmander LS. Pathogenesis and management of pain in osteoarthritis. Lancet. 2005; 365:965–73.

5. Aree-Ue S, Kongsombun U, Roopsawang I, Youngcharoen P. Path model of factors influencing health-related quality of life among older people with knee osteoarthritis. Nurs Health Sci. 2019.

6. Felson DT. Obesity and vocational and avocational overload of the joint as risk factors for osteoarthritis. J Rheumatol Suppl. 2004; 70:2–5.

7. Nteeba J, Ortinau LC, Perfield JW 2nd, Keating AF. Diet-induced obesity alters immune cell infiltration and expression of inflammatory cytokine genes in mouse ovarian and peri-ovarian adipose depot tissues. Mol Reprod Dev. 2013; 80:948–58.

8. Rakotoarivelo V, Lacraz G, Mayhue M, Brown C, Rottembourg D, Fradette J, et al. Inflammatory Cytokine Profiles in Visceral and Subcutaneous Adipose Tissues of Obese Patients Undergoing Bariatric Surgery Reveal Lack of Correlation With Obesity or Diabetes. EBioMedicine. 2018; 30:237–47.

9. Coggon D, Reading I, Croft P, McLaren M, Barrett D, Cooper C. Knee osteoarthritis and obesity. Int J Obes Relat Metab Disord. 2001; 25:622–7.

10. Isla Pera P, Ferrer MC, Nunez Juarez M, Nunez Juarez E, Macia Soler L, Lopez Matheu C, et al. Obesity, knee osteoarthritis, and polypathology: factors favoring weight loss in older people. Patient Prefer Adherence. 2016; 10:957–65.

11. Lee R, Kean WF. Obesity and knee osteoarthritis. Inflammopharmacology. 2012; 20:53–8.

12. Marks R. Obesity profiles with knee osteoarthritis: correlation with pain, disability, disease progression. Obesity (Silver Spring). 2007; 15:1867–74.

13. Salih S, Sutton P. Obesity, knee osteoarthritis and knee arthroplasty: a review. BMC Sports Sci Med Rehabil. 2013; 5:25.

14. Zheng H, Chen C. Body mass index and risk of knee osteoarthritis: systematic review and meta-analysis of prospective studies. BMJ Open. 2015; 5:e007568.

15. Bliddal H, Leeds AR, Christensen R. Osteoarthritis, obesity and weight loss: evidence, hypotheses and horizons – a scoping review. Obes Rev. 2014; 15:578–86.

16. Bedson J, Croft PR. The discordance between clinical and radiographic knee osteoarthritis: a systematic search and summary of the literature. BMC Musculoskelet Disord. 2008; 9:116.

17. Spector TD, Hart DJ, Byrne J, Harris PA, Dacre JE, Doyle DV. Definition of osteoarthritis of the knee for epidemiological studies. Ann Rheum Dis. 1993; 52:790–4.

18. Lee KM, Kang SB, Chung CY, Park MS, Kang DW, Chang CB. Factors associated with knee pain in 5148 women aged 50 years and older: A population-based study. PLoS One. 2018; 13:e0192478.

19. Lee S, Kim SJ. Efficacy and safety of ChondroT on knee-osteoarthritis: Protocol for a 8-week, randomized, double-blind, placebo-controlled, multicenter therapeutic exploratory clinical trial. Medicine (Baltimore). 2018; 97:e0170.

20. Chun MY. Validity and reliability of korean version of international physical activity questionnaire short form in the elderly. Korean J Fam Med. 2012; 33:144–51.

21. Bilbao A, Garcia-Perez L, Arenaza JC, Garcia I, Ariza-Cardiel G, Trujillo-Martin E, et al. Psychometric properties of the EQ-5D-5L in patients with hip or knee osteoarthritis: reliability, validity and responsiveness. Qual Life Res. 2018; 27:2897–908.

22. Conner-Spady BL, Marshall DA, Bohm E, Dunbar MJ, Loucks L, Al Khudairy A, et al. Reliability and validity of the EQ-5D-5L compared to the EQ-5D-3L in patients with osteoarthritis referred for hip and knee replacement. Qual Life Res. 2015; 24:1775–84.

23. WHO Expert Consultation. Appropriate Body-Mass Index for Asian Populations and Its Implications for Policy and Intervention Strategies. Lancet. 2004; 363:157–63.

24. McVinnie DS. Obesity and pain. Br J Pain. 2013; 7:163–70.

25. Goulston LM, Kiran A, Javaid MK, Soni A, White KM, Hart DJ, et al. Does obesity predict knee pain over fourteen years in women, independently of radiographic changes? Arthritis Care Res (Hoboken). 2011; 63:1398–406.

26. Fuglestad PT, Jeffery RW, Sherwood NE. Lifestyle patterns associated with diet, physical activity, body mass index and amount of recent weight loss in a sample of successful weight losers. Int J Behav Nutr Phys Act. 2012; 9:79.

27. Raynor HA, Jeffery RW, Phelan S, Hill JO, Wing RR. Amount of food group variety consumed in the diet and long-term weight loss maintenance. Obes Res. 2005; 13:883–90.

28. Whatley JE, Gillespie WJ, Honig J, Walsh MJ, Blackburn AL, Blackburn GL. Does the amount of endurance exercise in combination with weight training and a very-low-energy diet affect resting metabolic rate and body composition? Am J Clin Nutr. 1994; 59:1088–92.

29. Field AE, Aneja P, Rosner B. The validity of self-reported weight change among adolescents and young adults. Obesity. 2007; 15:2357–64.

30. Villanueva EV. The validity of self-reported weight in US adults: a population based cross-sectional study. BMC Public Health. 2001; 1:11.