Sports Medicine Research: In the Lab & In the Field: Born to Run? OA Doesn’t Need to Stop You (Sports Med Res)


Wednesday, July 25, 2018

Born to Run? OA Doesn’t Need to Stop You

Running Does Not Increase Symptoms or Structural Progression in People with Knee Osteoarthritis: Data from the Osteoarthritis Initiative

Lo GH, Musa SM, Driban JB, Kriska AM, McAlindon TE, Souza RB, Petersen NJ, Storti KL, Eaton CB, Hochberg MC, Jackson RD, Kwoh CK, Nevitt MC, & Suarez-Almazor ME.  Clinical Rheumatology. Published online May 4, 2018. DOI:10.1007/s10067-018-4121-3
Take Home Message: Running does not worsen symptoms or deterioration in patients with knee osteoarthritis.
Running is a very common form of physical activity. Many researchers have investigated whether running is good for someone with healthy knee joints, yet no one has investigated whether running is good for someone with knee osteoarthritis (OA).  Therefore, these authors analyzed 1203 adults with OA who had a definite bone spur (Kellgren Lawrence grade ≥ 2) in at least one of their knees from the Osteoarthritis Initiative dataset.The participants were over 50 years of age at study enrollment, with about 10% who self-identified running/jogging as one of their top 3 physical activity choices.  Nearly 70% of the runners were males, and about one-third of the runners were running for 6 to 10 years.  X-rays and pain from baseline were compared to their 48-month visit to determine if there was worsening of the knee OA.  Runners did not have worsening of OA on x-ray (progression of Kellgren Lawrence grade) or any progression to “new” frequent knee pain in comparison to non-runners.  Furthermore, runners were 1.5 times more likely to have resolution of frequent knee pain in comparison to non-runners.

These researchers were the first to look at the potential effect of running on knee health in adults who already have OA.  Running was not associated with knee OA worsening, and in fact, seemed to help improve knee pain. I wonder if the authors had looked at non-weightbearing physical activities like swimming, whether they would have found similar results.  It also would have been interesting to see if symptoms during or shortly after running may be better linked to OA progression.  But it seems that running may be an appropriate choice for physical activity among adults with OA, specifically males.  The authors cautioned that the percentage of female runners was so low that this generalization should be interpreted with caution.  It is important to note that most participants in this study had OA grades 2 and 3, with only a very small percentage having end-stage (grade 4) OA.  This may limit the findings to non-end stage OA as another research group reported that moderate-to-vigorous activity may exacerbate symptoms in individuals who have end-stage OA (grade 4).  It may have been interesting to see what the effect of length of running history had on knee OA diagnosis/progression.  About 25% of the participants just took up running in the last 5 years and about 18% had been running for more than 20 years.  Areas that could be looked at within these groups are age at enrollment/diagnosis, and then looking more particularly at the 13% of runners who reported they were competitive runners at one point.  The authors indicated that this subset of runners had generally higher Kellgren Lawrence grades of OA than the remainder of the study population.  Since elite-level long-distance running is associated with greater OA risk, the current findings should only be interpreted for recreational runners.  Ultimately, it appears that recreational running does not make knee OA worse, and can be an option for maintaining physical activity in adults with OA.

Questions for Discussion:  What physical activities do you recommend to individuals with “bad knees”?  Is there anything that your patients are telling you that they are feeling when running?

Written by: Nicole Cattano
Reviewed by: Stephen Thomas

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