Research articleLong Distance Running and Knee Osteoarthritis: A Prospective Study
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)
- et al.
Strategies for the prevention and management of osteoarthritis of the hip and knee
Best Pract Res Clin Rheumatol
(2007) An update on the pathogenesis and epidemiology of osteoarthritis
Radiol Clin North Am
(2004)- et al.
Aging, long-distance running, and the development of musculoskeletal disability: a controlled study
Am J Med
(1987) - et al.
Running, osteoarthritis, and bone density: initial 2-year longitudinal study
Am J Med
(1990) - et al.
Physical activity and self-reported, physician-diagnosed osteoarthritis: is physical activity a risk factor?
J Clin Epidemiol
(2000) - et al.
Level of physical activity and the risk of radiographic and symptomatic knee osteoarthritis of the elderly: the Framingham Study
Am J Med
(1999) Osteoarthritis: new insightsPart 1: the disease and its risk factors
Ann Intern Med
(2000)- et al.
Osteoarthritis of weight bearing joints of lower limbs in former elite male athletes
BMJ
(1994) - et al.
Knee osteoarthritis in former runners, soccer players, weight lifters, and shooters
Arthritis Rheum
(1995) - et al.
Premature osteoarthrosis in professional dancers
Clin J Sport Med
(1998)
The prevalence of knee osteoarthritis in the elderlyThe Framingham Osteoarthritis Study
Arthritis Rheum
Risk factors for incident radiographic knee osteoarthritis in the elderly: the Framingham Study
Arthritis Rheum
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
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