Lifestyle Adjustment - Scientific References

Reviewed by Greg Jaroszynski MD, FRCSC | Last updated May 2026

Weight Management and Obesity

Bliddal H, Leeds AR, Christensen R. Osteoarthritis, obesity and weight loss: evidence, hypotheses and horizons - a scoping review. Obes Rev. 2014;15(7):578-86. https://doi.org/10.1111/obr.12173
Christensen R, Bartels EM, Astrup A, Bliddal H. Effect of weight reduction in obese patients diagnosed with knee osteoarthritis: a systematic review and meta-analysis. Ann Rheum Dis. 2007;66(4):433-9. https://doi.org/10.1136/ard.2006.065904
Messier SP, Mihalko SL, Legault C, et al. Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: the IDEA randomized clinical trial. JAMA. 2013;310(12):1263-73. https://doi.org/10.1001/jama.2013.277669
Riddle DL, Stratford PW. Body weight changes and corresponding changes in pain and function in persons with symptomatic knee osteoarthritis: a cohort study. Arthritis Care Res (Hoboken). 2013;65(1):15-22. https://doi.org/10.1002/acr.21776

Fransen M, McConnell S, Harmer AR, et al. Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev. 2015;(1):CD004376. https://doi.org/10.1002/14651858.CD004376.pub3
Hinman RS, McTiernan A, Metcalf BR, Bennell KL. Balance impairments in individuals with symptomatic knee osteoarthritis: a comparison with matched controls using clinical tests. Rheumatology (Oxford). 2002;41(12):1388-94. https://doi.org/10.1093/rheumatology/41.12.1388
Juhl C, Christensen R, Roos EM, et al. Impact of exercise type and dose on pain and disability in knee osteoarthritis: a systematic review and meta-regression analysis of randomized controlled trials. Arthritis Rheumatol. 2014;66(3):622-36. https://doi.org/10.1002/art.38290
Roddy E, Zhang W, Doherty M, et al. Evidence-based recommendations for the role of exercise in the management of osteoarthritis of the hip or knee--the MOVE consensus. Rheumatology (Oxford). 2005;44(1):67-73. https://doi.org/10.1093/rheumatology/keh399

An B, Dai K, Zhu Z, et al. Baduanjin exercise for knee osteoarthritis: 6-month trial and 12-month follow-up. Ann Intern Med. 2021;174(8):1056-1064. https://doi.org/10.7326/M20-4793
Bennell KL, Hinman RS. A review of the clinical evidence for exercise in osteoarthritis of the hip and knee. J Sci Med Sport. 2011;14(1):4-9. https://doi.org/10.1016/j.jsams.2010.08.002
Latham NK, Bennett DA, Stretton CM, Anderson CS. Systematic review of progressive resistance strength training in older adults. J Gerontol A Biol Sci Med Sci. 2004;59(1):48-61. https://doi.org/10.1093/gerona/59.1.m48
Peterson MD, Rhea MR, Sen A, Gordon PM. Resistance exercise for muscular strength in older adults: a meta-analysis. Ageing Res Rev. 2010;9(3):226-37. https://doi.org/10.1016/j.arr.2010.03.004

Christensen R, Bartels EM, Astrup A, Bliddal H. Symptomatic efficacy of avocado-soybean unsaponifiables (ASU) in osteoarthritis (OA) patients: a meta-analysis of randomized controlled trials. Osteoarthritis Cartilage. 2008;16(4):399-408. https://doi.org/10.1016/j.joca.2007.06.014
Lu B, Driban JB, Duryea J, et al. Milk consumption and progression of medial tibiofemoral knee osteoarthritis: data from the Osteoarthritis Initiative. Arthritis Care Res (Hoboken). 2014;66(7):1146-51. https://doi.org/10.1002/acr.22276
McAlindon T, Jacques P, Zhang Y, et al. Do antioxidant micronutrients protect against the development and progression of knee osteoarthritis? Arthritis Rheum. 1996;39(4):648-56. https://doi.org/10.1002/art.1780390418
Veronese N, Stubbs B, Noale M, et al. Adherence to a Mediterranean diet is associated with lower incidence of frailty: A longitudinal cohort study. Clin Nutr. 2018;37(6 Pt A):2162-2168. https://doi.org/10.1016/j.clnu.2017.10.020

Brandt KD, Heilman DK, Slemenda C, et al. A comparison of lower extremity muscle strength, obesity, and depression scores in elderly subjects with knee pain with and without radiographic evidence of osteoarthritis. J Rheumatol. 2000;27(8):1937-46. https://pubmed.ncbi.nlm.nih.gov/10955337/
Jones A, Silva PG, Silva AC, et al. Impact of cane use on pain, function, general health and energy expenditure during gait in patients with knee osteoarthritis: a randomised controlled trial. Ann Rheum Dis. 2012;71(2):172-9. https://doi.org/10.1136/annrheumdis-2011-200024
Maly MR, Costigan PA, Olney SJ. Mechanical factors relate to pain in knee osteoarthritis. Clin Biomech (Bristol, Avon). 2008;23(6):796-805. https://doi.org/10.1016/j.clinbiomech.2008.02.012
Steultjens MP, Dekker J, Bijlsma JW. Coping, pain, and disability in osteoarthritis: a longitudinal study. J Rheumatol. 2001;28(11):2386-92. https://pubmed.ncbi.nlm.nih.gov/11708415/

Campbell CM, Buenaver LF, Finan P, et al. Sleep, pain catastrophizing, and central sensitization in knee osteoarthritis patients with and without insomnia. Arthritis Care Res (Hoboken). 2015;67(10):1387-96. https://doi.org/10.1002/acr.22609
Smith MT, Edwards RR, McCann UD, Haythornthwaite JA. The effects of sleep deprivation on pain inhibition and spontaneous pain in women. Sleep. 2007;30(4):494-505. https://doi.org/10.1093/sleep/30.4.494
Smith MT, Finan PH, Buenaver LF, et al. Cognitive-behavioral therapy for insomnia with osteoarthritis: a randomized controlled trial (NCT02001077). Sleep. 2021;44(6):zsab028. https://doi.org/10.1093/sleep/zsab028
Wilson AC, Palermo TM. Physical activity and function in adolescents with chronic pain: a controlled study. J Pain. 2012;13(6):541-8. https://doi.org/10.1016/j.jpain.2012.02.011

Hannan MT, Felson DT, Anderson JJ, et al. Habitual physical activity is not associated with knee osteoarthritis: the Framingham Study. J Rheumatol. 1993;20(4):704-9. https://pubmed.ncbi.nlm.nih.gov/8496861/
Haugen IK, Niu J, Aliabadi P, et al. The associations between smoking and knee osteoarthritis and knee joint pain: a cross-sectional study using data from the Osteoarthritis Initiative. Osteoarthritis Cartilage. 2012;20(10):1111-7. https://doi.org/10.1016/j.joca.2012.06.006
Muraki S, Akune T, Oka H, et al. Association of radiographic and symptomatic knee osteoarthritis with health-related quality of life in a population-based cohort study in Japan: the ROAD study. Osteoarthritis Cartilage. 2011;19(2):108-13. https://doi.org/10.1016/j.joca.2010.11.011
Sandmark H, Hogstedt C, Lewold S, Vingård E. Osteoarthrosis of the knee in men and women in association with overweight, smoking, and hormone therapy. Ann Rheum Dis. 1999;58(9):547-50. https://doi.org/10.1136/ard.58.9.547