Can Cycling Lower Your Risk Of Knee Arthritis?

Picture by Dennis Thong

I have written previously on what causes osteoarthritis (OA). Definitely not because of overuse nor a mechanical wear and tear process. Especially for those without any previous history of knee truma/ injury, there is very good evidence that OA is actually due to metabolic factors. Well, now a new study (Lo et al, 2024) suggests that cyclists are less likely to develop OA in their knees.

Lo et al (2024) studied 2600 older adults with and without knee OA using knee X-rays, subjective knee pain, and a questionnaire regarding their lifetime history of various physical activities during 4 periods of their lifes: 12 to 18 years old, 19 to 34, 35 to 49 and over 50. 

The study used 3 different outcomes. Persistent knee pain, OA based on X-rays (radiographic OA) and symptomatic OA (having both knee pain and radiographic OA. Note that what is seen on X-ray (OA knees) does not always correspond to pain. This means that some subjects had knee radiographic OA but NO pain.

Almost half the subjects reported some history of cycling and these subjects were less likely to have OA in their knees. How much less? Those with any history of cycling were 17 percent less likely to have knee pain, 9 percent less likely to have radiographic OA and 21 percent less likely to have both. 

Half of those who cycled reported only cycling regularly during one of the 4 age periods, usually the youngest age period from 12 to 18 years old.

Those who cycled during 1,2,3 or 4 of the periods studied reduced their risk of symptomatic OA (i.e. painful knees) by 17, 19, 28 and 43 percent. Meaning lifelong cyclists reduced their risk of symptomatic OA by nearly 50 percent.

The researchers also found that subjects with a history of swimming, strength training and running had lower rates of OA. This is consistent with previous evidence that running DOES NOT ruin your knees despite what every non runner and ex runner you know will insist running does.

You may love watching the beautiful game, but a history of playing the beautiful game (football) even just as a teenager bumped up knee OA risk by a factor of 2. This elevated risk remained even after adjusting for BMI, suggesting that the problem is likely related to acute knee injuries suffered while playing football. 

Picture by Dennis Thong

The researchers concluded that more cycling is associated with less knee pain and favorable to knee health and should be encouraged. 

If you have never cycled previously and would like to start, do note that almost half or the current or former cyclists in the study had radiographic evidence of OA. A quarter of them had symptomatic OA (painful knees). Is cycling better for OA once you do develop OA compared to say running? Is cycling capable of slowing its progression? Currently, we still do not know.

Those of you who have been always been cycling, you definitely have another reason to do so. 

Reference

Lo GH, Richard MJ, Kriska AM et al (2024). Bicyling Over A Lifetime Is Associated With Less Symptomatic Knee Osteoarthritis : Data From The Osteoarthritis Initiative. Med Sci Sp Ex. DOI: 10.1249/ MSS 0.0000000000003449

All pictures by Dennis Thong. Many thanks to Dennis and Eugene Phua for the pictures.

More Miles Does Not Mean Bad News For Your Knees

Singapore Stan Chart Marathon picture by RunSociety from Flickr

You will know someone who has had to rest from running because of an injury. And you will probably know someone who has been told by the doctor to quit running or their knees will wear out. Hence, it's easy to understand why so many people believe that running is not good for their knees.

I've written before that running does not wear out your knees.

I also disagreed with the author who wrote in the Straits Times (on 240516) on the above topic and I pointed out that there is no sound evidence at all that glucosamine helps with cartilage regeneration.

Here's further proof from a recently published article that didn't set out to study runners. In fact the authors that investigated this "Osteoarthritis Initiative" study had hypothesised that "a history of leisure running may increase the risk for knee knee symptoms and ROA (radiographic evidence of arthritis) even at lower levels."

Runners were grouped into low, middle and high groups if they had done at least 250, 800 or 2000 running workouts in their lifetime. All 2637 subjects in the study had high quality x-rays of their knees done and other methods of assessing knee symptoms.

Only two to five percent of the subjects described themselves as competitive runners showing that the findings are potentially more applicable to the general population compared to other studies.

Eight years after the study, subjects (56 percent female, average age of 64) were given a physical activity questionnaire. 29.5 percent indicated that they had participated in some running at some point in their lives.

The results were the exact opposite to what the researchers expected. This "forced" them to conclude that "A history of leisure running is not associated with increased odds of prevalent knee pain, ROA, or SOA (symptoms of arthritis). In fact, for knee pain, there was a dose-dependent inverse association with runners."

This meant that the people who ran the most had the least knee pain. This was true across all age groups and for running at any stage in one's life. The subjects that were still running had less knee pain (21.1 percent) than those who had quit running (25.3 percent), who had less pan than those who had never ran (29.6 percent).

So, most recent medical research continues to "exonerate" running as a cause of knee osteoarthrits. You now have more "ammunition" to show the naysayers who tell you to stop running or your knees will wear out.

Reference

Lo GH, Driban JB et al (2016). History Of Running With Higher Risk Of Sympyomatic Knee Osteoarthritis: A Cross-sectional Study From The Osteoarthritis Initiative. Arthritis Care and Research. DOI: 10.1002/act.22939.

Running Does Not Wear Out Your Knees

Picture by Cameron Drake on work done by Dr Noah Weiss

How many of you have had friends tell you that you'd better stop running as running causes your knee joints to wear out. I've had my fair share too.

Well, now you can tell all the naysayers that running (at any age) does not increase your risk of osteoarthritis (or wearing out of your joints), in fact they may even prevent the condition. This information was presented at the annual meeting of the American College of Rheumatology.

Researchers did a long term study on 2,683 subjects at four stages of their life : 12-18, 19-34, 35-49 and 50 and older. They were classified as a runner at that stage if they listed running as one of their three main activities.

X-rays of the knees were collected as well as subjects' reports of symptomatic pain. The knee x-rays were repeated again two years later. Analyses showed that 22.8 % of the participants who were runners had need osteoarthritis compared to 29.8 % who had never been a runner. And get this, average age of the participants was 64.7 years.

The authors concluded that "non-elite running at any time in life does not appear detrimental and may be protective" in regards to developing knee osteoarthritis.

Reference

http://acrannualmeeting.org/wp-content/uploads/2015/02/2014-ACR_ARHP-Annual-Meeting-Abstract-Supplement.pdf.