Participants followed a diet program, an exercise program that involved aerobic and resistance-exercise, a diet plus exercise intervention, or usual care. The researchers found that participants following the diet plus exercise program experienced significant improvements in self-reported physical function, 6-min walk distance, stair climb time, and knee pain compared to those in the usual care group. Exercise alone improved 6-min walk distance while dieting alone

did not result in greater functional improvement than usual care. Present findings support prior reports indicating that weight loss and exercise training provided therapeutic benefit for women with knee OA. In this regard, the circuit style resistance-training program and weight loss program used in this study promoted significant reductions in body mass (-2.4%), VS-4718 solubility dmso fat mass (-6%), and body fat (-3.5%) while increasing symptom-limited peak VO2 (5%), upper body 1RM Autophagy inhibitor strength (12%), upper body muscular endurance (20%), isokinetic knee extension and flexion peak torque (12-46%), step up and over knee function (8-15%), and forward lunge knee function (7-20%). These changes

were accompanied by significant improvements in total cholesterol (-8%), low-density lipoproteins (-12%), HOMAIR (-17%), and leptin (-30%) values. Interestingly, reductions in serum leptin levels have been reported to be associated with improved physical function in find more patients with OA [48]. Participants also reported less perceptions of pain (-53%), joint stiffness (-44%), and limitations in physical function (-49%) on the WOMAC index as well as a 59% reduction in VAS pain ratings. These findings provide

additional evidence that patients with knee OA may experience significant improvements in markers of health, fitness, functional capacity, and perceptions of pain when following a weight loss and exercise program that includes resistance-training. However, present findings add to our understanding of how different types of diets and concomitant dietary supplementation with a GCM affect weight loss, training adaptations, functional capacity, and/or perceptions of pain in women with knee OA. In this regard, a number of studies have indicated that replacing carbohydrate with protein while following a hypo-energetic diet promotes greater fat loss [14, 15, 19, 49]. The rationale Oxymatrine has been that there are thermogenic advantages in metabolizing protein compared to carbohydrate and that a higher amount of protein in the diet can help maintain fat free mass during weight loss thereby helping minimize reductions in resting energy expenditure that is often associated with weight loss [14, 16]. Our previous research examining the efficacy of the exercise and diet program used in this study provides some support to this theory [20, 21, 23]. Therefore, we hypothesized that women with knee OA may experience greater weight loss and therapeutic benefits from following a higher protein diet.