Participation in some sports,not running,increases risk of knee and hip osteoarthritis

Songning Zhang

Biomechanics/Sports Medicine Laboratory,Department of Kinesiology,Recreation and Sport Studies,University of Tennessee,Knoxville,TN 37996,USA

Research highlight

Participation in some sports,not running,increases risk of knee and hip osteoarthritis

Songning Zhang

Biomechanics/Sports Medicine Laboratory,Department of Kinesiology,Recreation and Sport Studies,University of Tennessee,Knoxville,TN 37996,USA

Arthritis is the leading cause of disability in older adults in the United States.1Osteoarthritis(OA)is the most common form of arthritis,and knee and hip the most affected joints. Some of the common risk factors are associated with knee and hip OA including age,body weight,past joint injuries,and sport participation.Participation in strenuous sports increases the risks of injuries.However,it is not clear if participation in different sports presents different risks for OA.2For example, it is well known that running increases the risk for knee injuries,but it remains unknown if running is associated w ith an increased risk of knee or hip OA.A recent study has shed some light on this issue.3

Using self-reported physician diagnosed OA data in a follow-up survey of 74,752 runners(7.1± 1.8 years of running)of the fi rst and second National Runner’s Health Study and 14,625 walkers(5.7±1.2 years of walking)of the National Walker’s Health Study,the author found that compared to running＜1.8 MET-h/day where 1 MET is the energy expended sitting at rest(3.5 m L O2/kg/min),the risk for OA decreased by 18.1%,16.1%,and 15.6%for running between 1.8—3.6,3.6—5.4,and≥5.4 MET-h/day,respectively.3The rates of reduction of hip replacement(an end-stage treatmentofhip OA)were 35.1%,50.4%,and 38.5%,respectively. These data,combined with the body mass index(BM I)data of the runners,suggest that running reduced OA and hip replacementrisk partially due to the lower BM Iassociated w ith runners.Furthermore,the study showed that increased running speed,distance,or years of running did not increase OA risk, butseemed to increase risk ofhip replacement.The resultsalso demonstrated that running presents no increased risk for OA compared to walking.The author argued that running may decrease OA more than walking due to the larger percentage of runners(89.5%)who exceeded 1.8 MET-h/day compared to walkers(52.8%).However,the study did not report jointspecific OA in the runners.This prospective cohort study has a large sample size,exceeding the number of surveyed runners 10 times compared to the number of runners surveyed in all previous cross-sectional running studies combined.3

OA risks associated w ith participation in other vigorous sports are not clearly evidenced and consistent in the literature.A recent systematic review and meta-analysis on the effects of sport activities on OA predictions(hip,knee,and ankle)provide some new insight.4The review,which initially identified 1294 studies and included 43 qualified studies according to a pre-defined set of criteria,included studies that had a large variation in the number of participants(16—8000) and duration of the study period(30 months—40 years). Regarding the relationship between OA and sportactivity,12 papers met the inclusion criteria,including two retrospective cohort studies,two case series studies,seven case—control studies,and one cross-sectional study.Either radiographic or magnetic resonance imaging was used to define OA in most of the studies;questionnaire,physician diagnosis,and selfreported pain and disability were also used in some of the studies.Itwas reported thatparticipation in team sports was a risk factor for knee OA onset prior to 45 years of age.5One study identified participation in soccer as a risk factor for knee OA6while another study did not identify it as a risk factor.7Females had an increased risk of developing knee OA compared to males when participating in gymnastics or Kung Fu.8A case—control study showed that an increased risk of developing knee OA was associated w ith participation in soccer,ice hockey,and tennis,but not in track and field, skiing,and orienteering.9However,after adjustment for knee injury and other covariates,no increased risk was found.One study found no association between general sportactivity and an increased risk of hip OA.10It was found that participation in soccer was a risk factor for hip OA.Participation ingymnastics by women was related to an increased risk for hip OA,while for men,participation in gymnastics,running, Kung Fu,and soccer was not associated w ith an increased risk of hip OA.6,8One study examined the relationship between the amount of sport participation and the risk of hip OA11and found that high and medium exposure to sports prior to the age of 50 increased the odds ratios for hip OA, compared to low exposure to sport participation.The authors commented that recall bias of previous sport exposure time, intensity of activity,level of play,and other related factors may have influenced the results,as these were rarely measured in the literature.4According to the authors,4the strength of this systematic review includes the search of 12 separate databases using a tested strategy,consistency of results,large sample sizes,and varying populations and countries.

In summary,the study on running and walking suggests that recreational running does not increase the risk for knee OA and hip replacement(end-stage hip OA).3These systematic reviews on the relationship between OA risk and sport activities improve our understanding of how OA might be caused by participation in differentsports.4However,the relationship between knee and hip OA in sport participants who never suffered joint injuries remains unclear.

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Received 9 March 2014;accepted 10 March 2014

E-mail address:szhang@utk.edu

Peer review under responsibility of Shanghai University of Sport

2095-2546/$-see front matter CopyrightⒸ2014,Shanghai University of Sport.Production and hosting by Elsevier B.V.A ll rights reserved. http://dx.doi.org/10.1016/j.jshs.2014.03.001