Weight & Lifestyle Management for Knee Osteoarthritis
Information on healthy eating, pain management and sleep routines to live well with osteoarthritis.
Learning how to live well with knee osteoarthritis is very important part of your treatment. This can include weight management and healthy eating, recognising patterns in your pain, learning how to deal with flare-ups and improving your sleep routine. This page is broken up into two sections as follows:
Weight Management
lifestyle management
Weight Management
Weight management forms a crucial part of the core recommended treatments for people with knee osteoarthritis. Weight management refers to the steady maintenance of your weight (i.e., not fluctuating between weight gain and weight loss). For some people, the goal will be to reduce weight, for others the goal will be to maintain their current weight, or their healthiest weight.
Listen to Dietician Prof Audrey Tierney talk about how weight management and osteoarthritis are linked in this video.
How does living with overweight or obesity contribute to knee pain?
People who are living with overweight or obesity are 2 to 4 times more likely to develop knee osteoarthritis. Carrying extra weight increases the risk of knee pain in two main ways:
Increased pressure on the joints
Extra weight results in higher loads through the joint, especially on the inner side of the knee.
Higher inflammation
Excess stored fat (adipose tissue) may lead to the release of inflammatory markers in the body. This inflammation may cause more cartilage breakdown in our joints and changes to the underlying bone. Excess fat stored around the waist (visceral adipose tissue) can be harmful and more likely to have negative health effects.
Can losing weight slow down the progression of knee osteoarthritis?
Yes, losing weight can slow down the progression of osteoarthritis. By reducing the pressure on the knee joints and lowering inflammation levels in the body, weight loss can protect the cartilage and joint tissues from further changes. Weight loss will not however reverse existing osteoarthritis. That’s why it’s important to focus (or seek help if necessary) on avoiding gradual weight gain, maintaining your current weight, or losing weight (read more about this below).
How much weight do I need to lose to reduce knee pain?
Losing 5 to 10% of your body weight can significantly reduce knee pain and improve your ability to function in everyday life. If you weigh 90 kilograms this equates to losing between 4.5 to 9 kilos in weight. (If you weigh 15 stone this would mean losing between 10.5 pounds and 21 pounds). A dose-response relationship exists between weight loss and symptoms, meaning a small amount of weight loss should bring a small reduction in knee pain, with greater weight loss bringing greater improvements.
What if I can’t lose weight?
It is not all about pounds on the scales. Improving the quality of your diet will also help with lowering inflammation levels in the body. Ensuring you are eating to the recommended national dietary guidelines and eating a more ‘anti-inflammatory’ diet has been shown to be beneficial. Eating lots of wholegrains, fruits and vegetables and less foods high in salt, sugar and fat is often a good place to start. Regular exercise also helps in reducing the amount of excess fat that can affect the joints and inflammation. Improving overall diet quality and increasing regular exercise can improve your symptoms even if there is no or little weight loss. There is more information on why weight loss is so challenging in the Read More section at the bottom of the page.
Your best weight is the weight you can achieve while living the healthiest life you can truly enjoy.
Dr. Yoni Freedhoff, Obesity Medicine Clinician
What type of exercise is recommended for weight management and will not worsen knee pain?
A wide range of exercise is safe and will not worsen knee pain in people who are overweight or living with obesity. The key with any new exercise or physical activity is to start small and build up gradually- you are much less likely to aggravate symptoms with this approach. The focus of exercise should be to promote fitness, overall health and general well-being, not to burn calories.
Aerobic exercise, such as walking, cycling or rowing has been found to be beneficial for knee pain in people who are overweight or living with obesity.
Strength training, in the gym or at home, is also recommended.
Both types of exercise are effective at reducing fat stored around the waistline.
Exercise alone typically accounts for a small amount of weight loss, and it should be combined with dietary changes and/or medical interventions for obesity.
What types of diets and food plans for knee osteoarthritis have been tested?
No diet has been proven by research to cure any type of arthritis. Be cautious of special diets or supplements that make these claims.
The best diet for osteoarthritis is a healthy, balanced one to maintain your general health and prevent other medical problems. Following an eating plan, as promoted by national healthy eating guidelines is generally recommended. This includes plenty servings of fruits and vegetables, wholemeal foods and lean proteins.
There are no specific foods or drinks that you need to avoid if you have osteoarthritis. However, high levels of alcohol intake and ultra-processed foods (high in fat, sugar and salt) may lead to an increase in inflammation.
Some studies suggest that eating a Mediterranean diet can reduce inflammation in people with osteoarthritis. The Mediterranean diet is largely a plant-based diet which is high in wholegrains, fruits and vegetables, fish, legumes and pulses, with olive oil the main source of added fat.
A registered dietitian can support you with weight management and to make dietary changes to improve the overall quality of your diet.
Do supplements help with osteoarthritis?
There is no strong evidence to suggest that supplements alone will help with clinical improvements in osteoarthritis. Supplements that are available on the market that commonly claim to help with joint pain include glucosamine, chondroitin and turmeric but be aware as these claims are often overstated. If taking supplements, they should be alongside healthy eating and should not replace a food or whole food group. Always speak to your GP or pharmacist if you are unsure.
What about new weight loss medications?
GLP-1 (glucagon-like peptide-1) receptor agonists, traditionally used in managing type 2 diabetes and obesity, may offer benefits for patients with knee osteoarthritis. These drugs help regulate blood sugar and appetite can result in significant weight loss. While it is not specifically approved for treating osteoarthritis, a recent research trial investigated one of these medicines, semaglutide (known as Ozempic or Wegovy, just launched in Ireland), for people with knee pain due to osteoarthritis who had obesity or a body mass index ≥30. Semaglutide given by injection once-weekly resulted in significant weight loss and a large reduction in knee pain compared to a placebo (inactive or sham injection).
While semaglutide may offer benefits, caution is advised with these medications. No long term studies have tested their effects in people with knee osteoarthritis. Gastrointestinal issues (e.g., nausea, diarrhoea, vomiting and constipation) are commonly reported side effects. There are also concerns about the potential for malnutrition if food intake is greatly reduced. Anywhere between 20% and 30% of the total weight loss can come from losing muscle mass, which is problematic in the long-term or if the medication is halted as you are left with a slower metabolism (read more below about rapid weight loss). It’s therefore essential to use it under the guidance of a healthcare professional as part of a broader treatment plan that ensures that protein / nutrient intake is adequate and strengthening exercise is included to prevent muscle loss.
Why is rapid weight loss not recommended if you have knee pain?
When people lose weight quickly, approximately 20-30% of the weight lost can be muscle (this will vary depending on factors like diet, exercise, and individual metabolism). If people regain this weight in the future (which often happens after rapid weight loss), it is likely they will regain fat, not muscle mass. Generally, a slower approach is recommended, about 1-2lbs (approximately 0.5-1.0kg) a week. This way, the weight is more likely to stay off.
What is weight creep and why is preventing it important for knee pain?
- Even with weight loss we can’t reverse osteoarthritic changes to joint structure. That’s why preventing weight gain in the first place is an important focus.
- Weight maintenance is more realistic and manageable than weight loss.
- Making small lifestyle changes now may help to maintain your current weight and reduce further gain, which will help prevent further joint changes.
- Research shows not everyone can manage their weight through lifestyle changes alone. Some people need assistance from a healthcare provider and possibly medication or other interventions. Contact your healthcare provider if you need assistance.
During our middle-age we tend to accumulate weight slowly. On average, at a rate of 0.5–1 kg per year (1–2lbs), meaning over a decade we can gain 5 to 10kg. For those already living with overweight, it’s important to stop any further weight gain.
To stop gradual weight gain, consider small lifestyle changes such as eating a more balanced healthy diet, as outlined above, and eating less foods that are high in fat, sugar and salt. Even walking an extra 10 minutes a day creates a small energy deficit that can successfully slow or prevent weight gain.
A Modern Understanding of Obesity
Want to know more about how our understanding of obesity and weight management has advanced?
Obesity is now recognised as a complex and chronic disease. It can last for a lifetime and often will require ongoing management. Viewing it like other chronic conditions (e.g blood pressure and diabetes) means the focus should be on control rather than cure. Obesity results from a complex interplay between genetic, environmental, behavioural, and social factors. The idea that obesity is caused by lack of willpower, or bad choices is an outdated one.
Factors affecting weight management
Why is weight loss so difficult?
When weight is lost, the body goes into starvation mode. Feelings of hunger increase, feelings of fullness are supressed and the metabolism slows down. All these are the body’s attempt to maintain a higher body weight. According to research, roughly 90 percent of people who lose a lot of weight will eventually regain almost all of it. People do not regain weight because they lack willpower. Instead, powerful biological responses counter act their best efforts and promote weight regain. This is why help and support from health professionals is needed to address weight that is impacted on health.
The “Tug-of War” of Weight Management
When weight is lost the body fights to put the weight back on
Is obesity treatable?
The treatment of obesity focuses on overall health, not just weight reduction. Some key principles of obesity management are:
1. Obesity management is more than just reducing numbers on a scale.
Treating obesity is not about a simple cure. It is about improving overall health and well-being over the long term. Even a modest reduction in body weight can lead to significant improvements in health.
2. An important part of obesity management is identifying and addressing root causes for weight gain.
Identifying and removing barriers or road blocks that are holding you back is key to making positive, successful health improvements.
3. Every individual defines success differently.
Success may mean having more energy, improving your self-esteem, preventing further weight gain or improving overall health. Whatever your ideal “success” may be, use it to help guide and motivate you.
4. Work towards your “best” weight.
When setting expectations for a weight management plan, it is important to set realistic and achievable goals that work within a lifestyle that you still enjoy. Don’t pressurise yourself to set a timeline for specific weight loss, or exercising excessively. Instead, focus on making healthy and enjoyable behavioural changes that will improve your overall quality of life!
Links to useful websites
Lived Experience of Managing Weight with Knee Osteoarthritis
Listen to Matthew’s experience of weight management and how this has helped his knee pain.
Listen to Patricia-Anne’s experience of managing weight.
IRISH RESOURCES FOR WEIGHT MANAGEMENT
Read more about how you think and approach weight loss in the HSE’s “Talking about weight – A guide to developing healthy habits”.
If you want more information on adopting a sustainable approach to healthy eating, head over to the “Healthy Eating” section of the Safefood website by clicking here.
There is also a Safefood 12-Week Weight Loss Programme for people with a BMI of between 25 and 30.
The Irish Coalition for People with Obesity (ICPO) is a volunteer-led organisation that provides or directs people to education, support and raises awareness for people living with overweight or obesity across Ireland.
Find a registered dietician in your region to support you with a healthy eating plan.
Lifestyle Management
Education and self-management forms a crucial part of the core recommended treatments for people with knee osteoarthritis. Education and self-management should be provided to all people with knee osteoarthritis alongside exercise and weight management.
What is Self-Management?
Self-management is defined as the tasks that individuals must undertake to live well with one or more chronic conditions. These tasks include having the confidence to deal with medical management, role management, and emotional management of their conditions.
To effectively self-manage a condition, people need to learn about their condition and the best ways to overcome barriers and obstacles that the condition creates. Therefore, some people with knee osteoarthritis can use information from this website, or seek assistance from a health professional (for example your doctor or physiotherapist) to help them improve their own strategies in managing their condition. Self-management does not mean that you are on your own! It means that you have been empowered with the education to help to keep your symptoms at bay. Learning how to do this is a continuous process that is shared by you, your family, healthcare team and other people with osteoarthritis.
Self-management includes things like healthy eating (see weight management), exercise and getting a good night’s sleep in order to improve the quality of your day-to-day life.
How can I identify what I need to know or learn?
This is an individual question and it takes a little thought from yourself (reflection) and maybe a little guidance from a health professional.
What are the best ways to manage symptoms if I have a flare-up?
A ‘flare-up’ means that you are experiencing a temporary increase in your knee osteoarthritis symptoms (for example pain or stiffness). The good news is that symptom flare-ups usually improve quickly and are not normally associated with doing any ‘damage’ to your knee joint.
Flare-ups of symptoms are a normal part of osteoarthritis. Luckily, these episodes are usually only short lived and nothing serious.
Why did it happen? It may have been something specific (e.g., tried a new activity, did more walking than usual) or it could be for an unknown reason. Either way, follow these simple steps that you can take to manage your flare-up and assist you to return to normal functional level.
What should I do?
Don't panic
People can worry that they have created new ‘damage’ to their knees, however as you know from the ‘understanding osteoarthritis‘ pages, pain does not always equal damage.
If there has not been any recent excessive trauma to the knee then it is most likely that you have just pushed your knee movements in a different way, or slightly more than normal.
Being worried, anxious, or stressed is known to increase the amount of pain someone feels, therefore it’s really important to remain calm and optimally manage your flare up.
Consider methods to reduce your pain in the short term
There are a number of ways you can try to reduce your knee pain levels.
a. As mentioned in the previous section – stay calm – it is unlikely that you will have created damage to your knee.
b. Try to modify your activity temporarily – for example if you have just walked to your local shops, consider stopping temporarily to rest, or consider other transport options to help you get home and reduce the amount that you have to continue to walk.
c. Use heat or ice – this can be a useful way to control your pain without using medications. People often ask which is better – heat or ice? However, either heat or ice can be useful and it is a personal preference as to which is best. Regardless of which you choose, ensure that there is a barrier between the hot/cold pack and the skin and avoid heating/cooling for longer than 10 minutes every 2 hours. Also – make sure that you monitor the area that you are applying the hot/cold pack to, to ensure that you are not causing any irritation to the skin or burns.
d. Consider temporarily taking pain medications that you have previously been prescribed, or visit your Doctor/Pharmacist for further advise to help you get through the flare up period. Remember that medications are the second level of the treatment pyramid and that you can move up AND down the pyramid. Therefore, when the pain has settled you will likely be able to reduce their intake/return to your normal levels.
e. If you still need further help then you could consider seeking further help from a physiotherapist. They may be able to provide guidance specific to your situation or offer assistive devices or treatments to help control your symptoms and get you back to doing the things you were doing.
Use your knee as much as possible
It’s important to not completely stop using your knee/leg. Consider temporarily modifying your activity to reduce symptoms.
For example if you have just walked to your local shops, consider stopping temporarily to rest, or consider other transport options to help you get home and reduce the amount that you have to continue to walk.
Learn from the episode and plan
See if you can understand why you got a flare-up? Was it just because you used your leg much more than normal? If so, consider how you can gradually build yourself up to be able to tolerate the activity in the future by setting small progressive goals.
If your symptoms do not appear to be improving with any of the advice above then seek advice from your doctor.
Sleep and Osteoarthritis
Why is sleep important for joint pain?
Sleep is anti-inflammatory!
It is as essential to our health as food and water and is important to a number of brain functions, including how nerve cells communicate with each other. We sleep for a third of our lives and there are many restorative processes going on during sleep that are needed to stay healthy.
Over 80% of people with arthritis have trouble sleeping. With achy, stiff and sometimes swollen joints, getting comfy, dozing off and staying asleep while in pain due to osteoarthritis can be tough and affect our quality of life. Many people blame their restless nights on pain however, evidence indicates that the relationship can works both ways i.e. poor sleep can make your joint pain worse, and even increase the likelihood that it can affect not just your physical health, but also your mental and emotional health. So while pain can certainly contribute to sleep problems, the more we learn about sleep, pain and inflammation, the more we find the relationships are likely to work both ways.
Listen to expert sleep researcher and physiotherapist, Dr Séan McKenna
Tips for better sleep
Stick to a sleep schedule
Go to bed and get up at the same time every day, including weekends. Being consistent reinforces your body’s sleep-wake cycle.
Examples of ways to be more physically active might be walking instead of driving, taking the stairs instead of the elevator.
Pay attention to what you eat and drink
Don’t go to bed hungry or stuffed. In particular, avoid heavy or large meals within a couple of hours of bedtime. Discomfort might keep you up.
Examples of ways to increase your exercise may include going to a muscle strength class.
Create a restful environment
Keep your room cool, dark and quiet. Exposure to blue light in the evenings might make it more challenging to fall asleep i.e. TV/iPad/Smart phone in the bedroom.
Include physical activity in your daily routine
Regular physical activity can promote better sleep. However, avoid being active too close to bedtime.
Manage your mental and emotional health
Try to resolve your worries or concerns before bedtime. Jot down what’s on your mind and then set it aside for tomorrow.
Listen to expert sleep researcher and physiotherapist, Dr Séan McKenna
Lived Experience of Managing Symptoms of Knee Osteoarthritis
Listen to Matthew’s experience of being diagnosed with knee osteoarthritis.
Listen to Matthew’s experience of modifying activities for knee osteoarthritis.
Listen to Patricia-Anne’s experience of taking control of her symptoms.
IRISH RESOURCES FOR EDUCATION AND SELF-MANAGEMENT
Apart from exploring all of the information on jointpain.ie, there are some additional education and self-management programmes for osteoarthritis available in Ireland.
The GLA:D Ireland programme (Good Life with osteoArthritis Denmark) is an example of a group exercise and education programme for hip and knee osteoarthritis that is led by physiotherapists and available in healthcare and community settings all around Ireland (and the world). The programme includes two hour-long sessions dedicated to education about osteoarthritis.
Click here to see where GLA:D is available and how to get referred.
The Arthritis Ireland “Living Well with Arthritis” course is led by trained leaders, who either have the condition themselves or are healthcare professionals. It consists of six weekly sessions, each 2.5 hours long, and is offered free of charge. Each group has about 18 participants and is delivered both online and within the community.
Click here for more information.
Other resources can be found here.