Does Not Increase Symptoms or Structural Progression in People with Knee
Osteoarthritis: Data from the Osteoarthritis Initiative
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
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?
by: Nicole Cattano
by: Stephen Thomas