***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: To assess whether joint pain or radiographic osteoarthritis ( ROA ) of the knee and h and is associated with all-cause and disease-specific mortality in middle-aged women . Methods Four subgroups from the prospect i ve community-based Chingford Cohort Study were identified based on presence/absence of pain and ROA at baseline : ( Pain−/ROA− ; Pain+/ROA− ; Pain−/ROA+ ; Pain+/ROA+ ) . Pain was defined as side-specific pain in the preceding month , while side-specific ROA was defined as Kellgren – Lawrence grade ≥2 . All-cause , cardiovascular disease ( CVD ) and cancer-related mortality over the 23-year follow-up was based on information collected by the Office for National Statistics . Associations between subgroups and all-cause/cause-specific mortality were assessed using Cox regression , adjusting for age , body mass index , typical cardiovascular risk factors , occupation , past physical activity , existing CVD disease , glucose levels and medication use . Results 821 and 808 women were included for knee and h and analyses , respectively . Compared with the knee Pain−/ROA− group , the Pain+/ROA− group had an increased risk of CVD-specific mortality ( HR 2.93 ( 95 % CI 1.47 to 5.85 ) ) , while the knee Pain+/ROA+ group had an increased HR of 1.97 ( 95 % CI 1.23 to 3.17 ) for all-cause and 3.57 ( 95 % CI 1.53 to 8.34 ) for CVD-specific mortality . We found no association between h and OA and mortality . Conclusion We found a significantly increased risk of all-cause and CVD-specific mortality in women experiencing knee pain with or without ROA but not ROA alone . No relationship was found between h and OA and mortality risk . This suggests that knee pain , more than structural changes of OA is the main driver of excess mortality in patients with OA BACKGROUND Previous studies showed that knee osteoarthritis ( OA ) is associated with increased mortality in Caucasians . While prevalence of knee OA is higher in Chinese than in Caucasians , no study has examined whether knee OA increases mortality in Chinese population . METHODS Between 8/2005 - 10/2005 1025 residents aged ≥50 years were recruited in r and omly selected rural communities in Wuchuan , China . Subjects completed a home interview and had weight-bearing posteroanterior semiflexed view of radiographs at tibiofemoral joints and skyline view of radiographs at patellofemoral joints , and were followed until end of 2013 . A knee was defined as having radiographic osteoarthritis ( ROA ) if either Kellgren/Lawrence ( KL ) score at tibiofemoral joint ≥2 or presence of OA at patellofemoral joint based on OARSI criteria . Symptomatic knee osteoarthritis ( SxOA ) was defined if both pain ( i.e. , knee pain occurred on most days in past month ) and ROA were present at the same knee . We examined the relation of knee SxOA and knee ROA to the all-cause mortality , respectively , using Cox-proportional hazard models adjusting for potential confounders . RESULTS Over the follow-up period 99 subjects  died . The mortality rates were 32.6 ( 95 % confidence interval ( CI ) : 19.6 - 54.0 ) and 10.9 ( 95 % CI : 8.8 - 13.5 ) per 1000 person-years among subjects with and without SxOA , respectively . Multivariable adjusted hazard ratio of all-cause mortality for knee SxOA was 1.9 ( 95 % CI : 1.0 - 3.5 ) . However , no such association was observed for knee ROA ( hazard ratio = 1.2 , 95 % CI : 0.7 - 1.9 ) . CONCLUSIONS Knee SxOA was associated with an increased risk of all-cause mortality among the residents in the rural areas of China BACKGROUND Obesity exacerbates the age-related decline in physical function and causes frailty in older persons . However , appropriate treatment for obese older persons is unknown . We evaluated the effects of weight loss and exercise therapy on physical function and body composition in obese older persons . METHODS We screened 40 obese older volunteers and eventually r and omized 27 frail obese older volunteers to treatment or control groups . Treatment consisted of 6 months of weekly behavioral therapy for weight loss in conjunction with exercise training 3 times per week . Physical function was evaluated with measurements of frailty ( Physical Performance Test , peak oxygen consumption , and Functional Status Question naire ) ; strength , gait , and balance tests ; body composition with dual-energy x-ray absorptiometry ; and quality of life using the Medical Outcomes Survey 36-Item Short-Form Health Survey . Results are reported as mean + /- SD . RESULTS Two subjects in the treatment group did not comply with the intervention , and 1 subject in the control group withdrew . Analyses included all 27 subjects originally r and omized to the treatment and control groups . The treatment group lost 8.4 % + /- 5.6 % of body weight , whereas weight did not change in the control group ( + 0.5 % + /- 2.8 % ; P<.001 ) . Compared with the control group , fat mass decreased ( -6.6 + /- 3.4 vs + 1.7 + /- 4.1 kg ; P<.001 ) , without a change in fat-free mass ( -1.2 + /- 2.1 vs -1.0 + /- 3.5 kg ; P = .75 ) in the treatment group . The Physical Performance Test score ( 2.6 + /- 2.5 vs 0.1 + /- 1.0 ; P = .001 ) , peak oxygen consumption ( 1.7 + /- 1.6 vs 0.3 + /- 1.1 mL/min per kilogram ; P = .02 ) , and Functional Status Question naire score ( 2.9 + /- 3.7 vs -0.2 + /- 3.9 ; P = .02 ) improved in treated subjects compared with control subjects . Treatment also improved strength , walking speed , obstacle course , 1-leg limb stance time , and health survey physical subscale scores ( all P<.05 ) . CONCLUSION These findings suggest that weight loss and exercise can ameliorate frailty in obese older adults . Trial Registration clinical trials.gov Identifier : NCT00146133 OBJECTIVE To vali date the ability of the American College of Rheumatology ( ACR ) clinical classification criteria and the ACR clinical plus radiographic classification criteria for osteoarthritis of the knee to predict articular cartilage damage . METHODS Ninety subjects with knee osteoarthritis ( OA ) who were enrolled in a prospect i ve study determining the therapeutic efficacy of arthroscopic irrigation  were characterized as to whether they fulfilled the ACR clinical classification criteria or the ACR clinical plus radiographic classification criteria . Ten rheumatoid arthritis ( RA ) patients were included as controls .  Cartilage damage was defined using the ACR/Knee Arthroscopy Osteoarthritis Scale ( ACR/KAOS ) system , which is a vali date d outcome instrument for knee OA based on arthroscopic visualization . Mean values of the damage scores in each group were calculated and compared by t-test to determine statistical significance between the 3 groups . RESULTS The mean ACR/KAOS score for the 10 RA patients was 1.8 [ SD 1.22 ; range 0 to 4 ] . Of the 90 OA patients who underwent arthroscopy , only 73 patients had sufficient videotape to make an accurate assessment by the blinded assessor . The mean ACR/KAOS score for the 6 OA patients who fulfilled only the ACR clinical classification was 17.4 [ SD 11.3 ; range 5 to 34.3 ] and the mean ACR/KAOS score for the 67 patients who fulfilled the ACR clinical plus radiographic classification criteria was 42.0 [ SD 29.1 ; range 5.1 to 118.4 ] . These differences were statistically significant ( RA versus OA clinical P=0.02 ; RA versus OA clinical + radiographic P < or=0.01 ) . Nonparametric multivariate analysis did not reveal significant correlations between ACR/KAOS scores and WOMAC global scores ( r=0.11 , P=0.39 ) , patient VAS ( r=0.29 , P=0.022 ) , and age ( r=0.29 , P=0.08 ) . CONCLUSIONS The ACR clinical and clinical plus radiographic criteria for OA of the knee accurately predict cartilage damage as assessed by arthroscopy . Furthermore , the ACR clinical classification criteria identify OA patients with cartilage damage before any radiographic change , while the ACR clinical plus radiographic classification criteria identify OA patients with more severe cartilage damage . RELEVANCE The ACR classification criteria correlates well with articular cartilage damage in patients with OA 
    Output:
    
People with OA are at increased risk of death due to CVD .
The relationship with overall mortality is less clear and may be moderated by the presence of h and OA