Influence of Pain, Risk Factors and Functional Ability on Physical Activity Levels in Obese Women With Knee Osteoarthritis

Knee osteoarthritis (KOA) is among the most common causes of disability in women, and obesity has been identified as a major modifiable risk factor that can accelerate the progression of the disease. Increasing evidence suggests that the relationship between obesity, pain, functional impairment, and reduced physical activity is complex. These variables are often assessed separately. The purpose of this systematic review was to synthesize the current literature on the relationship between obesity-related variables, pain, functional ability, and physical activity in women with KOA.Methods:This systematic review was conducted according to the PRISMA 2020 guidelines. The search was performed on PubMed, Scopus, Web of Science, and the Cochrane Library, as well as Google Scholar and ScienceDirect, for studies published between 2017 and 2024. The inclusion criteria were set using the PICOS approach and included cross-sectional studies in women aged 40 years and older with KOA. The studies included in the review evaluated obesity markers (BMI or body composition), pain, functional capacity, and physical activity. Seven studies were included in this systematic review. The quality of the studies was assessed using the AXIS.Results:In all the studies included, higher BMI or higher fat mass was significantly associated with higher pain intensity, lower functional performance, and lower levels of physical activity. There was a dose-response relationship, where higher grades of obesity were associated with higher levels of clinical severity. Pain intensity, which is often measured using standardized tools such as VAS and WOMAC, was strongly associated with lower mobility and poorer functional performance on tests such as Timed Up and Go Test (TUG) and 6-Minute Walk Test (6MWT). Both higher BMI and pain-related fear were independent predictors of physical inactivity. However, higher skeletal muscle mass was associated with better functional performance. The quality of the studies included was moderate to high

MEDLINE · Meta-analysis · Obesity · Osteoarthritis · Physical activity · Risk factor · Systematic review · Lower Extremity Biomechanics and Pathologies · Osteoarthritis Treatment and Mechanisms · Total Knee Arthroplasty Outcomes