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Nonpharmacologic interventions are the mainstay of OA management and should be tried first, followed by or in concert with medications to relieve pain when necessary. Nonpharmacologic therapies include weight management and exercises, braces and foot orthoses for patients suitable to these interventions, education, and use of assistive devices when required. Exercises have effects of similar magnitude on pain and function compared with NSAIDs. A combination of aerobic and strengthening exercises is usually indicated to address the whole spectrum of disability associated with OA, but optimal prescription should be individualized. Loss of at least 10 percent of body weight through a combination of diet and exercises has been associated with a 50 percent reduction in pain scores in overweight/obese patients with knee OA after 18 months . Weight loss can also be recommended for patients with hip OA, although there are no randomized trials assessing its impact on hip OA symptoms and may be beneficial for patients with OA in the hands, in view of its increased risk in patients with higher body mass index