The Editorial Executive Committee welcomes letters, which should be less than 250 words. Before a decision to publish is made, letters which refer to a published article may be sent to the author for a response. Any letter may be sent to an expert for comment. When letters are published, they are usually accompanied in the same issue by their responses or comments. The Committee screens out discourteous, inaccurate or libellous statements. The letters are sub-edited before publication. Authors are required to declare any conflicts of interest. The Committee's decision on publication is final.

Letter to the Editor

Editor, – In the article 'Prescribing exercise for diabetes' (Aust Prescr 2007;30:130-3), the author adequately takes into account cardiovascular and neurological concerns when advising, for example, jogging or running. However, relative adult weight gain (weight gain compared to weight on reaching maximum height and general maturity) is seemingly not addressed other than in very general terms.

Patients may be at risk of considerable irreversible weight-bearing joint damage if this issue is neglected, since even prolonged walks in obese individuals could result in aggravated ankle, knee and hip degeneration due to the load-bearing involved.

If 'losing a pound results in a four-pound reduction in knee-joint load for each step'1, then surely adding weight might also potentially damage the weight-bearing joints in a fourfold manner as well.

Ted Arnold
Medical officer
Executive Health Management

Author's comments

Ms Bronwyn Penny, author of the article, comments:

I appreciate Dr Arnold's opinion and am in complete agreement regarding excessive joint loading in obese individuals who may be involved in significant weight-bearing activities.

In this situation, very obese patients may benefit from undergoing initial weight loss coupled with lower limb resistance training to increase lower limb strength and improve mobility before undertaking weight-bearing aerobic modalities.2


  1. Messier SP, Gutekunst DJ, Davis C, De Vita P. Weight loss reduces knee-joint loads in overweight and obese older adults with knee osteoarthritis. Arthritis Rheum 2005;52:2026-32.
  2. Jakicic JM, Otto AD. Physical activity considerations for the treatment and prevention of obesity. Am J Clin Nutr 2005;82(1 Suppl):S226-9.