J.B. Snow Biomechanics Laboratory, Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC 27109, USA.
Osteoarthritis Cartilage. 2011 Mar;19(3):272-80. doi: 10.1016/j.joca.2010.11.010. Epub 2010 Dec 4.
The aim of this study was to examine the effects of high weight loss on knee joint loads during walking in participants with knee osteoarthritis (OA).
Data were obtained from a subset of participants enrolled in the Arthritis, Diet, and Activity Promotion Trial (ADAPT). Complete baseline and 18-month follow-up data were obtained on 76 sedentary, overweight or obese older adults with radiographic knee OA. Three-dimensional gait analysis was used to calculate knee joint forces and moments. The cohort was divided into high (>5%), low (<5%), and no (0% or gain) weight loss groups.
From baseline body weight, the high weight loss group lost an average of 10.2%, the low weight loss group lost an average of 2.7%, and the no weight loss group gained 1.5%. Adjusted 18-month outcome data revealed lower maximum knee compressive forces with greater weight loss (P=0.05). The difference in compressive forces between the high weight loss and no weight loss groups was due primarily to lower hamstring forces (P=0.04). Quadriceps forces were similar between the groups at 18-month follow-up. There was no difference between the groups in 18-month joint space width or Kellgren-Lawrence scores.
These results suggest that a 10% weight loss in an overweight and obese osteoarthritic population elicits positive changes in the mechanical pathway to knee OA by having lower knee joint compressive loads during walking compared to low and no weight loss groups. The difference in compressive forces was due, in large part, to reductions in hamstring co-contraction during the initial portion of the stance phase.
本研究旨在探讨膝关节骨关节炎（OA）患者在行走过程中高体重减轻对膝关节负荷的影响。
数据来自关节炎、饮食和活动促进试验（ADAPT）中纳入的部分参与者。对 76 名超重或肥胖的、有影像学膝关节 OA 的、久坐的老年成年人进行了基线和 18 个月的随访，获得了完整的基线和 18 个月的随访数据。采用三维步态分析来计算膝关节的力和力矩。该队列分为高（>5%）、低（<5%）和无（0%或增加）体重减轻组。
从基线体重来看，高体重减轻组平均减轻了 10.2%，低体重减轻组平均减轻了 2.7%，无体重减轻组体重增加了 1.5%。调整后的 18 个月的结果数据显示，体重减轻越多，最大膝关节压缩力越低（P=0.05）。高体重减轻组和无体重减轻组之间的压缩力差异主要归因于腘绳肌力较低（P=0.04）。18 个月时，两组股四头肌的力量相似。18 个月时，组间关节间隙宽度或 Kellgren-Lawrence 评分无差异。
这些结果表明，超重和肥胖的骨关节炎人群减轻 10%的体重会通过降低行走时膝关节的压缩负荷，从而对膝关节 OA 的力学途径产生积极的影响，与低体重减轻和无体重减轻组相比。压缩力的差异主要归因于初始站立阶段腘绳肌协同收缩的减少。
