الفهرس 
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Abstract
The best way to manage osteoarthritis is by educating patients about the disease and making helpful lifestyle changes. One of the best lifestyle choices for easing osteoarthritis symptoms is maintaining a healthy diet (Szoeke, 2006 & WHO,2013). Learning how specific foods influence the inflammatory process is the best strategy for containing it and reducing long-term disease risks through using anti-inflammatory diet (Weli,2012). In the current study the researcher applied inflammatory diet and exercises as a modifiable risk factors.
Anti-inflammatory diet focuses on creating anti-inflammatory prostaglandins instead of pro-inflammatory prostaglandins to regulate the body’s inflammatory response, through ingesting healthy fats. The diet emphasizes whole foods, such as whole grains, fruits, vegetables, nuts, seeds and fish containing omega-3 fatty acids, have an anti-inflammatory effect on joints. Using mono-unsaturated fats obtained from olive oil. Also, replacing solid oil at room temperature containing hydrogenated vegetable oils and trans-fats as from fried food,processed and fast foods which cause inflammation (Hossain et al.,2007 & weil,2012).
Other essential components of anti-inflammatory diet are pure water, ginger, cinnamon, turmeric, and green tea instead of sugary drinks. As they have ameliorative properties. Maintaining a healthy weight and practicing exercise specific for each affected joint with daily walking for at least half hour are helpful for reducing OA pain and symptoms (Weli,2012).
The aim of this study was to assess the effect of using anti-Inflammatory diet program on the osteoarthritis among obese women through the following objectives:
1. Assess the dietary habits related to obesity and osteoarthritis pre- post the nutritional program.
2. Assess the acuity of the symptoms among the participant women osteoarthritis pre- post the nutritional program.
3. Assess the joint mobility among the participant women osteoarthritis pre- post the nutritional program.
Study design:
A quasi-experimental design with pre-post test was used to achieve the aim of the study.
Settings:
This study was initially conducted at the physical therapy and orthopedic clinics of Tala central hospital and participant were followed by home visits. The data collection phase was completed between The data collection phase was completed between 1st January 2015 till the end of December 2015.
Sample The participants were purposive sample of 60 obese women diagnosed with osteoarthritis. The instruments used in this study: It was consisted of two main tools:
I -An interviewing questionnaire for assessing the following:
E. Socio demographic data included 3 items about age, occupation and educational level.
F. Types of the affected joint: they included knee, hip, neck or hand. First: in case of osteoarthritis of knee or hip, Second, in case of osteoarthritis of neck. Third , in case of osteoarthritis of hand:
G. Symptoms and activities of daily living.
H. The current knowledge and practice about anti-inflammatory diet and the eating pattern.
I. Tool II- Bio-physiologic measurements tool for assessing body mass index and waist circumference The main findings of this study summarized in the following:
The prominent age was 40- ˂45 years old representing 40 % of the diet only group and 36.7 % of the diet and exercise group.
There was significant improvement about anti-inflammatory diet knowledge after implementing the program between diet only group and the diet and exercise.
There was significant improvement between the two groups regarding practice including all items of eating patterns.
The study showed improvement in the mean scores of body mass index and waist circumference after the program of both groups, revealing significantly more improvement for the diet and exercise group. Regarding knee joint, It showed more significant improvement for diet and exercise group regarding, pain degree, acuity of symptoms, most of activities of daily living.
In respect to hip joint, the result indicated more significant improvement for the diet and exercise group than the diet only group regarding the degree of pain after the intervention. Also, there was more significant improvement for diet and exercise group regarding all the symptoms and most activities. In relation to hand joint, there was insignificant improvement of frequency and duration of pain. As the frequency of pain improved more for diet and exercise group although duration of pain improved more for diet only group. This result reflected variability among participants’ responses. It showed more improvement for diet and exercise group regarding all activities of daily living after the intervention, indicating a significant difference concerning opening a new jar, preparing bed and carrying objects.
In respect to neck OA, the current study indicated that diet and exercise group significantly more improved than diet only group regarding personal care and lifting after the intervention, but insignificantly regarding work.
In conclusion, the findings of the current study revealed a significant improvement in knowledge about anti-inflammatory diet after implementing the program. Educating women about anti-inflammatory diet was crucial as there were significant positive modifications of dietary patterns. The effect on body mass index and waist circumference was more in diet and exercise group than diet only group. Combining specified exercises was more effective on decreasing the acuity of pain, symptoms and consequently activities of daily living and mobility of joints. Generally, anti-Inflammatory diet program including anti-inflammatory exercises was more effective palliative care for osteoarthritis clinically. The suggested recommendations were:
Improve knowledge that maximizing consumption of anti-inflammatory diet starting from infancy for community citizens.
Societal changes associated with development of supportive policies such as health, agriculture, environment, food processing, marketing and education, individually and at the community level.
o At the individual level; limit energy intake from total fat and sugar. Increase consumption of fruits and vegetables as well as legumes, whole grains and nuts. Support regular activity practice at outpatient clinics.
o At the community level; reduce the fat, sugar and salt content of processed food. Practice responsible social marketing for individuals with co-morbid cases and elderly. Establish and strengthen initiatives for the surveillance, prevention and management of obesity. Anti-inflammatory diet is basically palliative for caring of osteoarthritic patients but as a restorative one it needs other further studies.