Background/Purpose: The 16-week Plants for Joints (PFJ) multidisciplinary lifestyle Intervention, based on a whole-food plant-based diet, physical activity, and stress management, significantly reduced The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score compared to usual care in people with hip and/or knee osteoarthritis (OA) and metabolic syndrome in a randomized control trial (RCT) setting.^1,2 The aim of this study was to determine the long-term effectiveness of the PFJ intervention on pain, stiffness, and daily functioning in people with OA two years after the PFJ intervention.

Methods: People with knee and/or hip OA and metabolic syndrome were randomized to receive the PFJ intervention in addition to usual care, or the control group which received usual care. After this 16-week RCT period the control group also received the intervention. After completion of the intervention participants were followed up for two years with biannual visits and six adherence-promoting webinars per year. Changes in medication intensity between trial initiation and end of the extension study were classified as “increase”, “stable”, or “decrease”. Secondary outcomes included anthropometric and metabolic markers. The data of all participants from start of PFJ were combined to form one active treatment cohort. An intention-to-treat analysis with a linear mixed model was used to analyze changes over time.

Results: 44 (69%) of the 64 trial completers also completed the two-year follow-up. Overall, 84% of participants were female with a mean (SD) age of 63 (6) and baseline body mass index of 33 (5) kg/m². Two years after completing the PFJ intervention the improvement in WOMAC-total score after PFJ was maintained, and significantly lower compared to baseline: –9.1 (95% CI ­–12.8, ­–5.3; p < 0.0001; Figure 1). Furthermore, all components of the WOMAC improved significantly compared to baseline (Table 1). Results were similar in participants completing the two-year extension study vs. those that discontinued prematurely: mean WOMAC-total change during intervention completer: –11.7, dropout: –10.9; p = 0.6; mean change up to first year extension study completer: –8.5, dropout: –4.3; p = 0.7. Of the 19 participants who completed the extension study and used pain medication, 10 (53%) decreased or stopped, while 9 (47%) had increased pain medication. After the two-year follow-up period weight, waist circumference, and diastolic blood pressure remained significantly lower than baseline values, although there was no longer a significant difference in HbA1c, fasting blood glucose, and LDL cholesterol. Furthermore, of those who completed the follow-up and used lipid-lowering medication, 7 (44%) decreased, 6 (38%) remained stable, and 3 (19%) increased their lipid-lowering medication.

Conclusion: Significant improvements in pain, stiffness, and physical function observed after the PFJ intervention were maintained up to two years, indicating that intensive lifestyle modifications can be effective in the long term.

References:

1. Walrabenstein, Trials 2021
2. Walrabenstein, Osteoarthritis & Cartilage 2023

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/long-term-effectiveness-of-a-lifestyle-intervention-for-osteoarthritis-two-year-follow-up-after-the-plants-for-joints-randomized-clinical-trial/