Abstract
BACKGROUND—Physical activity is being recommended as an intervention for seemingly almost universal improvements to health. A potential concern with this recommendation for increased exercise is that some believe increased levels of activity may lead to increased incidence of osteoarthritis of the knee (knee OA), as a result of accelerated "wear and tear" of the major joints. OBJECTIVE—To investigate the hypothesis that the occurrence of knee OA may be related to the duration of participation in some forms of sport and active recreation. METHODS—The relation between habitual exercise, reported by a cross section of people surveyed in England, and self reported knee OA was investigated. Data were derived from the Allied Dunbar National Fitness Survey (1990-91). A matched retrospective case-control design was used and a new exposure classification system which categorised different grades of activities for different time periods for each subject's lifetime participation in regular physical activities was developed. Additional data on knee injuries sustained and bodily composition were also included in a multivariate analysis. RESULTS—From 4316 people originally interviewed, 216 eligible cases (66 men, 150 women) were identified (mean age 57.1). Each case was matched to four controls. When habitual sport/exercise participation were examined during a subject's life, only exposure to regular long walks and being physically active between the ages of 20 and 24 suggested any association with developing knee OA later in life. The only strong association found was a greatly increased risk of knee OA having previously sustained a knee injury (p<0.01, odds ratio 8.0 (95% confidence interval 2.0 to 32.0)). CONCLUSIONS—There was little evidence to suggest that increased levels of regular physical activity throughout life lead to an increased risk of knee OA later in life. Previous knee injury was associated with an increased risk of knee OA. Additionally, most injuries were caused through participation in physical activities. Hence, when deciding on participation in activities, it is worth taking the likelihood of joint injury into consideration, as the chance of injury is greater in some activities than others.
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- Altman R., Asch E., Bloch D., Bole G., Borenstein D., Brandt K., Christy W., Cooke T. D., Greenwald R., Hochberg M. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum. 1986 Aug;29(8):1039–1049. doi: 10.1002/art.1780290816. [DOI] [PubMed] [Google Scholar]
- Chamberlain M. A., Care G., Harfield B. Physiotherapy in osteoarthrosis of the knees. A controlled trial of hospital versus home exercises. Int Rehabil Med. 1982;4(2):101–106. doi: 10.3109/09638288209166889. [DOI] [PubMed] [Google Scholar]
- Cheng Y., Macera C. A., Davis D. R., Ainsworth B. E., Troped P. J., Blair S. N. Physical activity and self-reported, physician-diagnosed osteoarthritis: is physical activity a risk factor? J Clin Epidemiol. 2000 Mar 1;53(3):315–322. doi: 10.1016/s0895-4356(99)00168-7. [DOI] [PubMed] [Google Scholar]
- Cooper C., Coggon D. Physical activity and knee osteoarthritis. Lancet. 1999 Jun 26;353(9171):2177–2178. doi: 10.1016/S0140-6736(99)90094-6. [DOI] [PubMed] [Google Scholar]
- Ettinger W. H., Jr, Burns R., Messier S. P., Applegate W., Rejeski W. J., Morgan T., Shumaker S., Berry M. J., O'Toole M., Monu J. A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST). JAMA. 1997 Jan 1;277(1):25–31. [PubMed] [Google Scholar]
- Fisher N. M., Gresham G. E., Abrams M., Hicks J., Horrigan D., Pendergast D. R. Quantitative effects of physical therapy on muscular and functional performance in subjects with osteoarthritis of the knees. Arch Phys Med Rehabil. 1993 Aug;74(8):840–847. doi: 10.1016/0003-9993(93)90011-x. [DOI] [PubMed] [Google Scholar]
- Fisher N. M., Pendergast D. R., Gresham G. E., Calkins E. Muscle rehabilitation: its effect on muscular and functional performance of patients with knee osteoarthritis. Arch Phys Med Rehabil. 1991 May;72(6):367–374. [PubMed] [Google Scholar]
- Hadler N. M. Knee pain is the malady--not osteoarthritis. Ann Intern Med. 1992 Apr 1;116(7):598–599. doi: 10.7326/0003-4819-116-7-598. [DOI] [PubMed] [Google Scholar]
- Hannan M. T., Felson D. T., Anderson J. J., Naimark A. Habitual physical activity is not associated with knee osteoarthritis: the Framingham Study. J Rheumatol. 1993 Apr;20(4):704–709. [PubMed] [Google Scholar]
- Kujala U. M., Kaprio J., Sarna S. Osteoarthritis of weight bearing joints of lower limbs in former élite male athletes. BMJ. 1994 Jan 22;308(6923):231–234. doi: 10.1136/bmj.308.6923.231. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lane N. E. Exercise: a cause of osteoarthritis. J Rheumatol Suppl. 1995 Feb;43:3–6. [PubMed] [Google Scholar]
- Maetzel A., Mäkelä M., Hawker G., Bombardier C. Osteoarthritis of the hip and knee and mechanical occupational exposure--a systematic overview of the evidence. J Rheumatol. 1997 Aug;24(8):1599–1607. [PubMed] [Google Scholar]
- Marks R. The effect of isometric quadriceps strength training in mid-range for osteoarthritis of the knee. Arthritis Care Res. 1993 Mar;6(1):52–56. doi: 10.1002/art.1790060110. [DOI] [PubMed] [Google Scholar]
- McAlindon T. E., Wilson P. W., Aliabadi P., Weissman B., Felson D. T. Level of physical activity and the risk of radiographic and symptomatic knee osteoarthritis in the elderly: the Framingham study. Am J Med. 1999 Feb;106(2):151–157. doi: 10.1016/s0002-9343(98)00413-6. [DOI] [PubMed] [Google Scholar]
- O'Reilly S. C., Jones A., Muir K. R., Doherty M. Quadriceps weakness in knee osteoarthritis: the effect on pain and disability. Ann Rheum Dis. 1998 Oct;57(10):588–594. doi: 10.1136/ard.57.10.588. [DOI] [PMC free article] [PubMed] [Google Scholar]
- O'Reilly S. C., Muir K. R., Doherty M. Screening for pain in knee osteoarthritis: which question? Ann Rheum Dis. 1996 Dec;55(12):931–933. doi: 10.1136/ard.55.12.931. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pate R. R., Pratt M., Blair S. N., Haskell W. L., Macera C. A., Bouchard C., Buchner D., Ettinger W., Heath G. W., King A. C. Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA. 1995 Feb 1;273(5):402–407. doi: 10.1001/jama.273.5.402. [DOI] [PubMed] [Google Scholar]
- Spector T. D., Harris P. A., Hart D. J., Cicuttini F. M., Nandra D., Etherington J., Wolman R. L., Doyle D. V. Risk of osteoarthritis associated with long-term weight-bearing sports: a radiologic survey of the hips and knees in female ex-athletes and population controls. Arthritis Rheum. 1996 Jun;39(6):988–995. doi: 10.1002/art.1780390616. [DOI] [PubMed] [Google Scholar]
- Ury H. K. Efficiency of case-control studies with multiple controls per case: continuous or dichotomous data. Biometrics. 1975 Sep;31(3):643–649. [PubMed] [Google Scholar]
- Wacholder S., Silverman D. T., McLaughlin J. K., Mandel J. S. Selection of controls in case-control studies. III. Design options. Am J Epidemiol. 1992 May 1;135(9):1042–1050. doi: 10.1093/oxfordjournals.aje.a116398. [DOI] [PubMed] [Google Scholar]
- West R. R. Valuation of life in long run health care programmes. Br Med J (Clin Res Ed) 1985 Oct 19;291(6502):1139–1141. doi: 10.1136/bmj.291.6502.1139. [DOI] [PMC free article] [PubMed] [Google Scholar]
- White J. A., Wright V., Hudson A. M. Relationships between habitual physical activity and osteoarthrosis in ageing women. Public Health. 1993 Nov;107(6):459–470. doi: 10.1016/s0033-3506(05)80172-6. [DOI] [PubMed] [Google Scholar]