• Asma S Alrushud, Alison B Rushton, Archontissa M Kanavaki, and Carolyn A Greig.
• School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.
• BMJ Open. 2017 Jun 8; 7 (6): e014537.

BackgroundDespite the clinical recommendation of exercise and diet for people with knee osteoarthritis (OA), there are no systematic reviews synthesising the effectiveness of combining physical activity and dietary restriction interventions on the musculoskeletal function of overweight and obese older adults with knee OA.ObjectiveTo evaluate the effectiveness of combined physical activity and dietary restriction programmes on body weight, body mass index (BMI) and the musculoskeletal function of overweight and obese older adults with knee OA.Information SourcesA detailed search strategy was applied to key electronic databases (Ovid, Embase, Web of Science andCumulative Index to Nursing and Allied Health Literature (CINAHL)) for randomised controlled trials (RCTs) published in English prior to 15 January 2017.ParticipantsParticipants with BMI ≥25 kg/m2, aged ≥55 years of age and with radiographic evidence of knee OA.InterventionsPhysical activity plus dietary restriction programmes with usual care or exercise as the comparators.Outcome MeasuresPrimary outcome measures were body weight, BMI or musculoskeletal function. Secondary outcome measures were pain and quality of life.ResultsOne pilot and two definitive trials with n=794 participants were included. Two articles reporting additional data and outcome measures for one of the RCTs were identified. All included RCTs had an unclear risk of bias. Meta-analysis was only possible to evaluate mobility (6 min walk test) at 6 months and the pooled random effect 15.05 (95% CI -11.77 to 41.87) across two trials with n=155 participants did not support the combined intervention programme. Narrative synthesis showed clear differences in favour of a reduced body weight and an increased 6 min walk in the intervention group compared with control groups.ConclusionThe quality of evidence of benefit of combining exercise and dietary interventions in older overweight/obese adults with knee OA is unclear.Trail Registration NumberCRD42015019088 and ISRCTN, ISRCTN12906938.© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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