Research article
Long Distance Running and Knee Osteoarthritis: A Prospective Study

https://doi.org/10.1016/j.amepre.2008.03.032Get rights and content

Background

Prior studies of the relationship of physical activity to osteoarthritis (OA) of the knee have shown mixed results. The objective of this study was to determine if differences in the progression of knee OA in middle- to older-aged runners exist when compared with healthy nonrunners over nearly 2 decades of serial radiographic observation.

Methods

Forty-five long-distance runners and 53 controls with a mean age of 58 (range 50–72) years in 1984 were studied through 2002 with serial knee radiographs. Radiographic scores were two-reader averages for Total Knee Score (TKS) by modified Kellgren & Lawrence methods. TKS progression and the number of knees with severe OA were compared between runners and controls. Multivariate regression analyses were performed to assess the relationship between runner versus control status and radiographic outcomes using age, gender, BMI, education, and initial radiographic and disability scores among covariates.

Results

Most subjects showed little initial radiographic OA (6.7% of runners and 0 controls); however, by the end of the study runners did not have more prevalent OA (20 vs 32%, p =0.25) nor more cases of severe OA (2.2% vs 9.4%, p=0.21) than did controls. Regression models found higher initial BMI, initial radiographic damage, and greater time from initial radiograph to be associated with worse radiographic OA at the final assessment; no significant associations were seen with gender, education, previous knee injury, or mean exercise time.

Conclusions

Long-distance running among healthy older individuals was not associated with accelerated radiographic OA. These data raise the possibility that severe OA may not be more common among runners.

Introduction

Osteoarthritis (OA) is the most common form of arthritis and contributes substantially to disability among older adults.1, 2 The relationship of physical activity to the development and progression of OA of the knee has been examined in the past with mixed results. Participation in sports and the performing arts at the elite level has been associated with increased risks of OA of lower-extremity joints, especially in contact sports3, 4, 5; however, there is less consensus about the role of habitual recreational noncontact exercise.6, 7 Data suggest that long-distance running may not be associated with increased progression of knee OA in the absence of knee injury, obesity, proprioceptive deficit, or poor muscle tone.2, 8 A prospective longitudinal study of long-distance runners and a similarly aged group of controls is ongoing, with results suggesting that overall disability levels in runners increase with age at 25% of the rate of more sedentary controls.9, 10 Disability was measured using the Health Assessment Questionnaire Disability Index (HAQ-DI), a self-reported instrument assessing functional ability in eight areas: rising, dressing and grooming, hygiene, eating, walking, reach, grip, and activities of independent living.11, 12

This study examined radiographic knee OA by serial radiographs taken between 1984 and 2002 in long-distance runners aged ≥50 years compared with a similarly matched control group from the community. When the study was designed in 1984, there was concern that running was likely to accelerate OA due to repetitive trauma to the joints. Consistent with this, our original hypothesis was that long-distance runners would develop more prevalent and more severe OA than a similarly aged control population. Herein, the radiographic outcomes are reported of the observational study of runners and controls followed for up to 18 years.

Section snippets

Subjects and Data Collection

The nationwide Fifty-Plus Runners Association provided access to a group of long-distance runners aged ≥50 years; most had been running for over a decade. The control group was drawn from a random sample from the Stanford University Lipid Research Clinics Prevalence Study, begun in 1972.13 In January 1984, study descriptors were sent to approximately 1500 subjects from these two groups. Based on positive responses to the study descriptors, a cohort of 538 runners and 423 controls were assembled

Study Population

Of the 113 participants in the radiographic study, 98 (45 runners and 53 controls) had at least two sets of radiographs. Drop-out rates did not differ appreciably between runners (6/51) and controls (9/62) despite nearly 2 decades of follow-up. Subjects who had died (1/51 runners, 3/62 controls) or those who did not return for subsequent radiographs tended to be an average of 5 years older, but have fewer previous knee injuries, and lower total knee scores than those with at least two sets of

Discussion

We had originally hypothesized that long-distance running may be associated with increased incidence and severity of OA when compared to a similar cohort of nonrunners. However, the results are not consistent with this hypothesis. In this analysis, long-distance running was not associated with accelerated incidence or severity of radiographic OA. Over the prolonged period of observation (mean 11.7 years) and despite more prevalent OA and worse radiographic scores at the baseline, runners did

References (27)

  • D.T. Felson et al.

    The prevalence of knee osteoarthritis in the elderlyThe Framingham Osteoarthritis Study

    Arthritis Rheum

    (1987)
  • D.T. Felson et al.

    Risk factors for incident radiographic knee osteoarthritis in the elderly: the Framingham Study

    Arthritis Rheum

    (1997)
  • N.E. Lane et al.

    The relationship of running to osteoarthritis of the knee and hip and bone mineral density of the lumbar spine: a 9-year longitudinal study

    J Rheumatol

    (1998)
  • Cited by (108)

    • Hip fractures in cyclist – a six-year cohort study at a single large volume trauma centre

      2021, Injury
      Citation Excerpt :

      Due to the decreased functional demand on the lower limbs compared with running, cycling is a good way to maintain cardiovascular strength [1]. Many patients in this category are likely to have an element of early osteoarthritis which can exacerbate pain during running and which can be averted when cycling is used as an option to maintain fitness [2,3]. Cycling is not without its hazards.

    View all citing articles on Scopus
    View full text