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    Published on 8 June 2023

    Being overweight puts you at a higher risk of knee deterioration. Learn why maintaining a healthy body weight is important for your knees and overall health.
    Knee lifts into extension Bend your right knee and bring your thigh parallel to the water surface. Straighten your right knee forward and hold the position for a few seconds. Then lower your right leg down slowly, keeping your right knee straight. Repeat 10 times. Repeat with your left leg. Half squats Hold onto the side of the pool for balance. Bend both knees to lower your hips back into a half squat position with your back straight. Hold the position for a few seconds. Return to starting position. Repeat 10 times. Standing side leg lifts Keep both knees straight and lift your right leg out to the side. Lower the right leg slowly, keeping your knee straight. Repeat 10 times. Repeat with your left leg. How heavy is too heavy for your knees? If one’s BMI falls into either the overweight, obese, severely obese, or morbidly obese category, he or she would be at higher risk of knee deterioration. In the short run, this could lead to injury to the knee’s meniscus, cartilage or ligament, and in the long term, knee osteoarthritis. Severe knee osteoarthritis may lead to total knee replacement surgery “In western countries, a significant proportion of patients in need of total knee replacements exhibit obesity,” shared Adj Asst Prof Wang Lushun, Senior Consultant, Division of Hip & Knee Surgery, Department of Orthopaedic Surgery, Ng Teng Fong General Hospital (NTFGH). These patients are also at high-risk of complications such as higher rates of wound infection. “Obesity also reduces the lifespan of not just our native joints, but also of our replaced prosthetic joints (knee replacements).” Other common signs of deteriorating knee health include: 1. Pain in the knees during and after exercises that only get better with rest 2. Stiff knees especially after prolonged sitting or inactivity 3. Deformity in the legs (eg. bow leggedness) 4. Warmth and swelling in the knees Waist circumference is also often used and is a marker for health such as cardiovascular risks. “Given that the knees support a bulk of body weight, shaving off the kilograms significantly reduces pressure on the knee joints,” explained Adj Asst Prof Wang. NUHS’s weight management programme aims to help patients achieve a healthy weight range through the following method: Dietary management Exercise & Physical therapy Behaviour modification (lifestyle changes) Medical therapy Surgery On a regular basis, patients can also partake in “aerobic and resistance training programmes that are safe and effective treatments for knee osteoarthritis. This can be done three days a week, one hour per day,” suggested Adj Asst Prof Wang. “Aquatic aerobic exercises are safe as they are non-weight bearing or impact activities. I would routinely recommend these to patients,” he added. Aquatic aerobic exercises are highly recommended Exercising in water places less stress on the knees than land-based exercises due to the natural buoyancy of water, which helps to support the body’s weight. “Moving your body against the resistance in water not only helps strengthen muscles and improve cardiovascular endurance, but also burns more calories which may promote weight loss,” shared NTFGH Senior Physiotherapist Ms Faye Ng. Consider an appropriate pool depth. A deeper pool provides more resistance and greater buoyancy (more support of your body weight). The links between the deterioration of knee health and obesity are well established. According to local data gathered in 2015, the risk of total knee replacements increased by 27% with increasing levels of Body Mass Index (BMI). Based on a 2019/2020 local survey, among                             Singapore residents aged 18 to 74 years: 1 in 10 Singaporeans are obese Obesity  more common among males 20.7 high health risk based on BMI has •••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• According to local data gathered in 2015. Body Mass Index or BMI is calculated as:weight (kg) divided by (height (m) x height (m) Up to TKR patients are obese in western countries 50 % high risks of complications These patients are also at such as higher rates of wound infection by BMI = replacement (TKR) risk of total knee 27 % Losing weight can help to reduce pressure on the knee joints on the knees reduce 4x load of weight loss = 1kg Less 40kg load of weight loss = 10kg load that the knees need to support Therefore, Jogging on the spot Jog on the spot by lifting your right knee up and alternate with your left knee, swinging your arms as you do. Walking Walk across the pool, swinging your arms as you do. Single leg balance Lift your right foot off and maintain your balance against the resistance of the water. Hold the position for 15 to 20 seconds or as long as possible. Repeat with your left leg.
    “Stay hydrated and drink before and after your workout session to avoid dehydration. You may not
    notice that you are sweating with aquatic exercises,” Ms Ng added.

    “Stop and get out of the pool immediately if you experience any giddiness, breathlessness, pain, or other discomfort. Seek medical attention if required.” 

    Beyond affecting the knees, obesity also has been linked to a host of other ailments which include coronary heart disease, diabetes (type 2), high blood pressure, stroke, and cancer.

    Maintaining a healthy weight is key in not only caring for your knees but also your overall health.

    In consultation with Adj Asst Prof Wang Lushun, Senior Consultant, Division of Hip & Knee Surgery, Department of Orthopaedic Surgery, NTFGH & Consultant, Division of Hip & Knee Surgery, Department of Orthopaedic Surgery, JMC and Ms Faye Ng, Senior Physiotherapist, NTFGH.

    Download the full infographics here.

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