Tools for Practice

#266 Exercise-induced osteoarthritis: Running into problems?

Does running increase the risk of developing osteoarthritis?

Based on low-quality observational data, running likely does not increase the risk of developing osteoarthritis, except possibly in elite athletes. Additionally, recreational running may be associated with lowering the risk of knee osteoarthritis. Exercise is one of the most effective treatments for reducing osteoarthritic pain. 

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Systematic review of 17 observational studies (including 7 cohort), 114829 patients. Compared “competitive runners” (professional/elite or represent their country at international competition), recreational runners, and controls:1 
  • Overall prevalence knee/hip osteoarthritis: 
    • ~4% (all runners) versus 10% (control) (statistical significance not reported). 
    • Separating runners by intensity of activity: 
      • ~4% in recreational runners statistically lower than 13% in competitive runners. 
      • ~4% in recreational runners not statistically different than 10% in controls.
  • Hip osteoarthritis: no difference. 
    • Exception: one survey study found increased risk in 141 elite runners/cross-country skiers.2 
  • Knee osteoarthritis: 
    • Recreational running lowered risk of knee osteoarthritis: 
      • 32% versus 38% control. 
    • Competitive running versus control: no difference. 
  • Largest cohort study, 16961 participants, followed for 11 years:3 
    • No association in men >50 years old, or women of any age. 
      • Exception: Men <50 years old who run/walk >30km/week had an increased risk of self-reported knee/hip osteoarthritis compared to sedentary controls (adjusted hazard ratio 2.4). 
  • Limitations: controls likely not completely sedentary, inclusion of case-control and cross-sectional studies, most cohort studies small (<100 participants), “diagnosis” of osteoarthritis variable (examples: relied solely on radiographs or patient recall). 
Systematic review, all types of runners, 15 observational studies:4 
  • Lower risk of knee surgery due to osteoarthritis (3 case-control studies) in runners compared to non-runners: Odds Ratio=0.46 (statistically different). 
  • There is only a weak correlation between x-ray findings and osteoarthritis symptoms.5 
  • Knee injuries are associated with development of knee osteoarthritis, and some sports may be more prone to injury.6 
  • Exercise (any type) is one of the most effective treatments for osteoarthritis pain.7 

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  • Adam Keough MD CCFP (SEM)
  • Adrienne J Lindblad BSP ACPR PharmD
  • Joey Ton PharmD

1. Allentorn-Geli E, Samuelsson K, Musahl V, et al. J Orthop Sports Phys Ther. 2017; 47(6):373-90.

2. Kettunen J, Kujala UM, Kaprio J, et al. Am J Sports Med. 2001; 29(1):2-8.

3. Cheng Y, Macera CA, Davis DR, et al. J Clin Epidemiol. 2000 Mar 1; 53(3):315-22.

4. Timmins KA, Leech RD, Batt ME, et al. Am J Sports Med. 2016; 45(6):1447-1457.

5. Lin DCM, Reichmann WM, Gossec L, et al. Osteoarthritis Cartilage. 2011;19(5):543-9.

6. Thelin N, Holmberg S, Thelin A. Scand J Med Sci Sports. 2006; 16:329-33.

7. Ton J, Perry D, Thomas B, et al. Can Fam Physician. 2020 Mar; 66(3):e89-98.

Authors do not have any conflicts of interest to declare.