Long Distance Running and Knee Osteoarthritis

A Prospective Study


      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.


      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.


      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.


      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.
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        • Felson D.T.
        Osteoarthritis: new insights.
        Ann Intern Med. 2000; 133: 635-646
        • Bijlsma J.W.J.
        • Knahr K.
        Strategies for the prevention and management of osteoarthritis of the hip and knee.
        Best Pract Res Clin Rheumatol. 2007; 21: 59-76
        • Kujala U.M.
        • Kaprio J.
        • Sarna S.
        Osteoarthritis of weight bearing joints of lower limbs in former elite male athletes.
        BMJ. 1994; 308: 231-234
        • Kujala U.M.
        • Kettunen J.
        • Paananen H.
        • et al.
        Knee osteoarthritis in former runners, soccer players, weight lifters, and shooters.
        Arthritis Rheum. 1995; 38: 539-546
        • Teitz C.C.
        • Kilcoyne R.F.
        Premature osteoarthrosis in professional dancers.
        Clin J Sport Med. 1998; 8: 255-259
        • Felson D.T.
        • Naimark A.
        • Anderson J.
        • Kazis L.
        • Castelli W.
        • Meenan R.F.
        The prevalence of knee osteoarthritis in the elderly.
        Arthritis Rheum. 1987; 30: 914-918
        • Felson D.T.
        • Zhang Y.
        • Hannan M.T.
        • et al.
        Risk factors for incident radiographic knee osteoarthritis in the elderly: the Framingham Study.
        Arthritis Rheum. 1997; 40: 728-733
        • Felson D.T.
        An update on the pathogenesis and epidemiology of osteoarthritis.
        Radiol Clin North Am. 2004; 42: 1-9
        • Lane N.E.
        • Oehlert J.W.
        • Bloch D.A.
        • Fries J.F.
        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; 25: 334-341
        • Wang B.W.
        • Ramey D.R.
        • Schettler J.D.
        • Hubert H.B.
        • Fries J.F.
        Postponed development of disability in elderly runners: a 13-year longitudinal study.
        Arch Intern Med. 2002; 162: 2285-2294
        • Fries J.F.
        • Spitz P.
        • Kraines R.G.
        • Holman H.R.
        Measurement of patient outcome in arthritis.
        Arthritis Rheum. 1980; 23: 137-145
        • Bruce B.B.
        • Fries J.F.
        The Stanford Health Assessment Questionnaire: a review of its history, issues, progress, and documentation.
        J Rheumatol. 2003; 30: 167-178
        • The LRC Program Epidemiology Committee
        Plasma lipid distributions in selected North American populations: the Lipid Research Clinics Prevalence Study.
        Circulation. 1979; 60: 427-439
        • Lane N.E.
        • Bloch D.A.
        • Jones H.H.
        • Marshall W.H.
        • Wood P.D.
        • Fries J.F.
        Long distance running, bone density, and osteoarthritis.
        JAMA. 1986; 255: 1147-1151
        • Lane N.E.
        • Bloch D.A.
        • Wood P.D.
        • Fries J.F.
        Aging, long-distance running, and the development of musculoskeletal disability: a controlled study.
        Am J Med. 1987; 82: 772-780
        • Lane N.E.
        • Bloch D.A.
        • Hubert H.B.
        • Jones H.
        • Simpson U.
        • Fries J.F.
        Running, osteoarthritis, and bone density: initial 2-year longitudinal study.
        Am J Med. 1990; 88: 452-459
        • Davis H.S.
        • MacPherson K.
        • Merry H.R.
        • Wentzel C.
        • Rockwood K.
        Reliability and validity of questions about exercise in the Canadian Study of Health and Aging.
        Int Psychogeriatr. 2001; 13: 177-182
        • Altman R.D.
        • Fries J.F.
        • Bloch D.A.
        • et al.
        Radiographic assessment of progression in osteoarthritis.
        Arthritis Rheum. 1987; 30: 1214-1225
        • Altman R.
        • Hochberg M.C.
        • Murphy W.A.
        • Folfe F.
        • Lequesne M.
        Atlas of individual radiographic features in osteoarthritis.
        Osteoarthritis Cartilage. 1995; A (Sept): 3-70
        • Petersson I.F.
        • Boegard T.
        • Saxne T.
        • Silman A.J.
        • Svensson B.
        Radiographic osteoarthritis of the knee classified by the Ahlback and Kellgren & Lawrence systems for the tibiofemoral joint in people aged 35–54 years with chronic knee pain.
        Ann Rheum Dis. 1997; 56: 493-496
        • Panush R.S.
        • Schmidt C.
        • Caldwell J.R.
        • et al.
        Is running associated with degenerative joint disease?.
        JAMA. 1986; 255: 1152-1154
        • Cheng Y.
        • Macera C.A.
        • Davis D.R.
        • Ainsworth B.E.
        • Troped P.J.
        • Blair S.N.
        Physical activity and self-reported, physician-diagnosed osteoarthritis: is physical activity a risk factor?.
        J Clin Epidemiol. 2000; 53: 315-322
        • Hannan M.T.
        • Felson D.T.
        • Anderson J.J.
        • Maimark A.
        Habitual physical activity is not associated with knee osteoarthritis: the Framingham Study.
        J Rheumatol. 1993; 20: 704-709
        • Spector T.D.
        • Harris P.A.
        • Hart D.J.
        • et al.
        Risk of osteoarthritis associated with long-term weight bearing sports.
        Arthritis Rheum. 1996; 39: 988-995
        • McAlindon T.E.
        • Wilson W.F.
        • Aliabadi P.
        • Weissman B.
        • Felson D.T.
        Level of physical activity and the risk of radiographic and symptomatic knee osteoarthritis of the elderly: the Framingham Study.
        Am J Med. 1999; 106: 151-157
        • Szebenyi B.
        • Hollander A.P.
        • Dieppe P.
        • et al.
        Associations between pain, function, and radiographic features in osteoarthritis of the knee.
        Arthritis Rheum. 2006; 54: 230-235
        • Hannan M.T.
        • Felson D.T.
        • Pincus T.
        Analysis of the discordance between radiographic changes and knee pain in osteoarthritis of the knee.
        J Rheumatol. 2000; 27: 1513-1517