Nutrition and movement for self-efficacy in osteoarthritis

Introduction Osteoarthritis (OA) is a major problem for both the individual patient and society, and it is one of the leading causes of impaired function worldwide. Due to ongoing demographic changes, the incidence of OA is expected to increase significantly in the years to come, which emphasizes the magnitude of this disorder and stresses the need for a paradigm shift towards early treatment. Physical activity and exercise represent important and effective components of early treatment and are therefore highly recommended as a first line treatment of OA. Good Life with osteoArhtritis in Denmark (GLA:D®) represents an evidence-based treatment plan for knee and hip OA consisting of patient education and neuromuscular exercises. Studies have shown that GLA:D is feasible and effective in reducing pain and improving function and quality of life. OA has long been considered as the sole consequence of any process leading to increased pressure on one particular joint or fragility of cartilage matrix. Progress in molecular biology in the 1990s has profoundly modified this paradigm. Low-grade inflammation induced by the metabolic syndrome, innate immunity and inflammation are some of the more recent arguments in favour of the inflammatory theory of OA. Due to the connection of metabolic inflammation and dietary pattern, nutrition plays a significant role in inflammation-related diseases. A Western-diet, characterized on the one hand by a high intake of fat, cholesterol, protein, sugar, salt, processed and ‘fast foods’– especially meat - and on the other hand by a low amount of plant-based foods, including fresh fruits and vegetables, legumes, seeds and nuts, evokes a state of metaflammation (= chronic metabolic inflammation). Therefore, antiinflammatory lifestyle changes should be ‘first-line’ interventions in the management of OA and holds the promise of increasing a patient’s inflammatory threshold, reducing rate of diseases progression, reducing weight, and maximizing health by minimizing a patient’s risk or manifestation of other lifestyle-related conditions. The New Nordic Diet (= NND) was developed in the early 2000ies by experts in the field of nutrition, gastronomy, environmental issues, food culture and sensory science, focus on the principles health, gastronomic potential as well as sustainability. The fundamental guidelines are firstly, more calories from plant foods and fewer from meat, secondly, more foods from the sea and the lakes and thirdly, Fachhochschule St. Pölten GmbH, Matthias Corvinus-Straße 15, 3100 St. Pölten, T: +43 (2742) 313 228, F: +43 (2742) 313 228-339, E: csc@fhstp.ac.at, I: www.fhstp.ac.at more foods from the wild countryside. These principles and guidelines can be applied in any region including Austria. Furthermore, the NND focus on regional products, which are also part of typical Austrian cuisine. Especially vegetables and fruits (e.g. roots, cabbage, legumes, apples, pears or berries), cereals (e.g. whole grain rye, oats or barley), lake fish and rapeseed oil, correspond highly with Austrian needs. To our knowledge, no study has examined the influence of NND on the progression of OA nor exist an Austrian adaption of the NND. Hence, the aims of the study are: 1. To evaluate the effect of a nutrition program combined with an evidence-based training program on quality of life in patients with mild to moderate knee OA 2. To evaluate the effect of a nutrition promgram combined with an evidence-based training program on symptoms, inflammation status and joint function in patients with mild to moderate knee OA 3. To implement an evidence-based training program for patients with knee osteoarthritis in Austria and to present the results Material & Methods - Randomized controlled clinical trial including 60 participants - Two groups o Intervention group: Nutrition program and GLAD o Control group: GLAD - Outcome measurement (Baseline, T1 6 weeks, T2 3 month, T3 6 month, T4 12 month) o Biochemi