The topic about exercise and osteoarthritis is complex and controversial. Traditional teachings recommend that runners with osteoarthritis (OA) of the knee or hip should avoid running because it would exacerbate their conditions. What makes the topic so complex is that various in vitro, in invo, and clinical studies have suggested that exercise may prevent, cause, accelerate, or treat osteoarthritis. In general, studies done with runners have failed to demonstrate an increased risk for osteoarthritis of the knee and even suggest that running prevents the development of OA. Studies done with OA patients participating in exercise regimens is still a very complex matter. In this article we will discuss current medical literature about exercise and OA, the benefits of running as an OA preventative measure and what can your physician offer you in terms of training regimens that will suit your medical condition.
So What Do I Need to Know?
For runners who have been diagnosed with OA, here are 3 things that you should know:
1) Whether the direct effect of running is beneficial or detrimental to the health of weightbearing cartilage likely relates to the magnitude and duration of physical training. Compared with normal cartilage, studies have shown that cartilage from osteoarthritic tissue deforms more readily in response to the same load compared to normal cartilage, and more fluid is lost during the application of a given load. Overdoing your physical activity may exacerbate your OA symptoms and decrease your quality of life. Thus the focus of aerobic exercise is to improve mobility, reverse muscular atrophy, and increase bone minal density to prevent osteoporotic fractures.
2) Physical training capacity will be dependent upon the severity of your OA and should be tailored to improving the quality of life. The goals of exercise programs for patients with OA include reduction in pain and in functional impairment, protection of both involved and at-risk joints, and prevention of disability related to inactivity.
3) Exercise does not need to be intense in order to improve health and to avoid disability. Other options of exercise include Tai Chi. Two studies done Tufts University School of Medicine with OA patients practicing Tai Chi experienced a significant statistical decrease in pain scores.
For those who have NOT been diagnosed with OA, here are 3 things that you should know:
1) Running does not predispose you to OA. A prospective cohort study done by Stanford University School of Medicine in 2008 followed runners for over 18 years found no difference between the non-runners in the progression or the number of severe cases of knee OA. Long-distance running among healthy older individuals was not associated with accelerated OA. Another prospective study done by Saint Barnabas Medical Center found no evidence that running predisposes to OA of the lower extremities.
2) Running reduces the risk of requiring hip replacement surgery. A large follow-up study done by the Lawrence Berkeley National Laboratory using questionnaires completed by established cohorts of runners who ran ≥ 8 miles/week reported reduced risk for developing OA and requiring hip replacement surgery compared with those participating in other exercise. Multiple retrospective studies have found no evidence of premature damage of articular cartilage or increased risk for OA among long-distance runners.
3) Participating in races do not contribute to articular cartilage damage. A study done by the University of California San Francisco using MRI to evaluate the knees of long-distance runners report no significant damage to articular cartilage following a race and no major differences when images were compared to those of active non-runners.
So What are My Options?
Having OA is not an end-all to your physical wellbeing, but it does put focus your exercise goals towards symptomatic relief, joint protection, and disability prevention. Running can still be part of your regimen depending on your severity. However, incoporating resistance training with aerobic training may provide equal benefits in terms of reducing arthritis-related symptoms. Ultimately, several factors must be considered in creating your individualized exercise program that include the severity and specific manifestations of your disease and the frequent presence of severe deconditioning due to inactivity imposed by OA, and a good way to do so is to schedule an appointment with a sports medicine physician and create an exercise plan that is right for you.
Albert Hsia, MS-IV
Dr. David Carfagno, DO, CAQSM
- Fransen M, McConnell S. Land-based exercise for osteoarthritis of the knee: a metaanalysis of randomized controlled trials. J Rheumatol 2009; 36:1109.
- Minor MA. Exercise in the management of osteoarthritis of the knee and hip. Arthritis Care Res 1994; 7:198.
- Wang C, Schmid CH, Hibberd PL, et al. Tai Chi is effective in treating knee osteoarthritis: a randomized controlled trial. Arthritis Rheum 2009; 61:1545.
- Uthman OA, van der Windt DA, Jordan JL, et al. Exercise for lower limb osteoarthritis: systematic review incorporating trial sequential analysis and network meta-analysis. BMJ 2013; 347:f5555.
- Willick SE, Hansen PA. Running and osteoarthritis. Clin Sports Med 2010; 29:417.
- Williams PT. Effects of running and walking on osteoarthritis and hip replacement risk. Med Sci Sports Exerc 2013; 45:1292.
- Chakravarty EF, Hubert HB, Lingala VB, et al. Long distance running and knee osteoarthritis. A prospective study. Am J Prev Med 2008; 35:133.
- Panush RS, Hanson CS, Caldwell JR, et al. Is Running Associated with Osteoarthritis? An Eight-Year Follow-up Study. J Clin Rheumatol 1995; 1:35.
- Konradsen L, Hansen EM, Søndergaard L. Long distance running and osteoarthrosis. Am J Sports Med 1990; 18:379.
- Lane NE, Bloch DA, Jones HH, et al. Long-distance running, bone density, and osteoarthritis. JAMA 1986; 255:1147.
- Sohn RS, Micheli LJ. The effect of running on the pathogenesis of osteoarthritis of the hips and knees. Clin Orthop Relat Res 1985; :106.
- Stahl R, Luke A, Ma CB, et al. Prevalence of pathologic findings in asymptomatic knees of marathon runners before and after a competition in comparison with physically active subjects-a 3.0 T magnetic resonance imaging study. Skeletal Radiol 2008; 37:627.
- Schueller-Weidekamm C, Schueller G, Uffmann M, Bader TR. Does marathon running cause acute lesions of the knee? Evaluation with magnetic resonance imaging. Eur Radiol 2006; 16:2179.