Previous studies that have investigated the relationship between physical activity and osteoarthritis (OA) have shown mixed results (1-8). Elite sport participation and performing arts have been related to a higher lower-extremity joint OA risk, in particular in contact sports (1-3); conversely, there are fewer consensuses about the role of regular recreational noncontact training (4-5). Therefore the aim of this study was to determine if progression in the development of knee OA in middle-older aged runners happen when compared with healthy non-runners over almost 20 years of serial radiographic observation.
They studied forty-five long distance athletes and 53 controls with a mean age of 58 (range 50-72) with serial knee radiographs. Radiographic scores were recorded by two-reader averages for Total Knee Score (TKS) by reformed Kellgren and Lawrence methods. They compared TKS progression and the number of knees with severe OA between controls and athletes. A multivariate regression analyses was utilized to assess the association between runners versus control standing and radiographic results using BMI, age, education, gender and original radiographic and disability scores among covariates
At the start of the study little initial radiographic OA was shown in most subjects, however, as the study progressed the athletes did develop more prevalent OA, or more cases of severe OA than the controls. The final assessment regression models indicated higher initial BMI, radiographic damage and greater time for initial radiograph to be connected with worse radiographic OA. No significant relationship was seen with education, gender, mean exercise time or previous knee injury.
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Overall there was no association between long-distance running among healthy older individuals and accelerated radiographic OA. These results suggest that severe OA may not have a higher prevalence among runners. Therefore long-distance running or similar vigorous activities should not be discouraged for healthy older adults concerned with development of knee OA. However, much larger research needs to be conducted following hundreds to thousands of healthy older adults over several periods to determine if there is an association between long-distance running and modest decrease in prevalence or severity of radiographic OA (9).
The strength of this study is imbedded in the prospective observation study design, which utilized typical radiographic methods over almost 20 years of observation (10). This design was able to compare two groups that each provided substantial differences in independent variables of concern: long-distance running and other endurance activities while maintaining similarities in geographical location, education, and BMI. As the study progressed from first to subsequent radiographs there were relatively low dropout rates and these were similar between both-groups. Finally when examining the composite score of both knees and conservative worst-knee analysis comparable results were found.
Along with the strengths, there are also limitations to this study. Clinical symptoms were not analysed when radiographic OA was calculated. Previous studies have showed a relative lack of concordance amongst degree of radiographic impairment and indications (7, 9 & 11) It also must be acknowledged that this research may be subject to potential selection bias. All the athletes where healthy participants who had been running into at least the 60th year of life, predominant of which had been running for nearly 10 years prior to study entry. Therefore, these results may not be applicable/generalizable to people who begin running in their later years or have to stop running due to injuries or other reasons (10).
