A case-control study to investigate the relation between low and moderate levels of physical activity and osteoarthritis of the knee using data collected as part of the Allied Dunbar National Fitness Survey
Open accessAbstract
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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Risk of injury increases with obesity, volume of exercise, and participation in vigorous exercise such as competitive sports, whereas higher fitness, supervision, stretching exercises, protective equipment such as bike helmets, and well-designed environments protect against injury.
“Risk of injury increases with obesity, 51 volume of exercise, 50 and participation in vigorous exercise such as competitive sports, 54 whereas higher fitness, 50 supervision, stretching exercises, protective equipment such as bike helmets, and well-designed environments protect against injury.”
From Exercise and Physical Activity in the Prevention and Treatment of Atherosclerotic Cardiovascular Disease: A Statement From the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity) (2003) · cites this paper as [51]
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Experimental — accuracy not yet measuredThe most common risk of physical activity in adults is musculoskeletal injury.
“The most common risk of physical activity in adults is musculoskeletal injury.50,51”
From Exercise and Physical Activity in the Prevention and Treatment of Atherosclerotic Cardiovascular Disease: A Statement From the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity) (2003) · cites this paper as [51]
The Discussion says sports and physical activity increase the risk of knee injury, and the Abstract says most reported injuries occurred during physical activities. Neither passage compares musculoskeletal injury with other risks of physical activity or establishes that it is the most common risk in adults. (LLM, conf=0.86)
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Cites
Altman, R., Asch, E., Bloch, D., Bole, G., Borenstein, D., Brandt, K., Christy, W., Cooke, T. D., Greenwald, R., Hochberg, M., et al. (1986) · Arthritis & Rheumatism · doi:10.1002/art.1780290816 · Cited by 6,777 · see citing works
Physical Activity and Health: A Report of the Surgeon General
(1995) · PsycEXTRA Dataset · doi:10.1037/e525162010-001 · Cited by 5,488 · see citing works
Selection of Controls in Case-Control Studies
Wacholder, S., McLaughlin, J. K., Silverman, D. T., & Mandel, J. S. (1992) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a116396 · Cited by 998 · see citing works
Ettinger, W. H. (1997) · JAMA · doi:10.1001/jama.1997.03540250033028 · Cited by 947 · see citing works
Physical activity, fitness, and health: consensus statement
(1993) · Choice Reviews Online · doi:10.5860/choice.31-0344 · Cited by 881 · see citing works
Physical Activity, Fitness, and Health
(2012) · doi:10.5040/9781718209107.part-001 · Cited by 742 · see citing works
Quadriceps weakness in knee osteoarthritis: the effect on pain and disability
O’Reilly, S., Jones, A. C., Muir, K. R., & Doherty, M. (1998) · Annals of the Rheumatic Diseases · doi:10.1136/ard.57.10.588 · Cited by 534 · see citing works
Self-citationSelection of Controls in Case-Control Studies: III. Design Options
Wacholder, S., Silverman, D. T., McLaughlin, J. K., & Mandel, J. S. (1992) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a116398 · Cited by 444 · see citing works
Spector, T. D., Harris, P. A., Hart, D. J., Cicuttini, F., Nandra, D., Etherington, J., Wolman, R., & Doyle, D. (1996) · Arthritis & Rheumatism · doi:10.1002/art.1780390616 · Cited by 385 · see citing works
&NA; (1996) · Journal of Occupational and Environmental Medicine · doi:10.1097/00043764-199606000-00005 · Cited by 367 · see citing works
Osteoarthritis of weight bearing joints of lower limbs in former elite male athletes
Kujala, U. M., Kaprio, J. A., & Sarno, S. (1994) · BMJ · doi:10.1136/bmj.308.6923.231 · Cited by 304 · see citing works
McAlindon, T. E., Wilson, P. W. F., Aliabadi, P., Weissman, B., & Felson, D. T. (1999) · The American Journal of Medicine · doi:10.1016/s0002-9343(98)00413-6 · Cited by 269 · see citing works
Fisher, N. M., Pendergast, D. R., Gresham, G. E., et al. (1991) · PubMed · Cited by 268 · see citing works
Efficiency of Case-Control Studies with Multiple Controls Per Case: Continuous or Dichotomous Data
Ury, H. K. (1975) · Biometrics · doi:10.2307/2529548 · Cited by 249 · see citing works
Physical activity and self-reported, physician-diagnosed osteoarthritis
Cheng, Y. J., Macera, C. A., Davis, D. R., Ainsworth, B. E., Troped, P. J., & Blair, S. N. (2000) · Journal of Clinical Epidemiology · doi:10.1016/s0895-4356(99)00168-7 · Cited by 200 · see citing works
Maetzel, A., Mākelä, M., HAWKER, G. A., et al. (1997) · PubMed · Cited by 167 · see citing works
Knee Pain Is the Malady—Not Osteoarthritis
Hadler, N. M. (1992) · Annals of Internal Medicine · doi:10.7326/0003-4819-116-7-598 · Cited by 164 · see citing works
Fisher, N. M., Gresham, G. E., Abrams, M., et al. (1993) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/0003-9993(93)90011-x · Cited by 153 · see citing works
Screening for pain in knee osteoarthritis: which question?
O’Reilly, S., Muir, K., & Doherty, M. (1996) · Annals of the Rheumatic Diseases · doi:10.1136/ard.55.12.931 · Cited by 137 · see citing works
Self-citationPhysiotherapy in osteoarthrosis of the knees: A Controlled Trial of Hospital Versus Home Exercises
Chamberlain, M. A., Care, G., & Harfield, B. (1982) · International Rehabilitation Medicine · doi:10.3109/09638288209166889 · Cited by 127 · see citing works
Habitual physical activity is not associated with knee osteoarthritis: the Framingham Study.
Hannan, M. T., Felson, D. T., Anderson, J. J., & Naimark, A. (1993) · PubMed · Cited by 117 · see citing works
Relationships between habitual physical activity and osteoarthrosis in ageing women
White, J. A., Wright, V. A., & Hudson, A. M. (1993) · Public Health · doi:10.1016/s0033-3506(05)80172-6 · Cited by 69 · see citing works
Exercise: a cause of osteoarthritis.
Lane, N. E. (1995) · PubMed · Cited by 54 · see citing works
The effect of isometric quadriceps strength training in mid‐range for osteoarthritis of the knee
Marks, R. (1993) · Arthritis & Rheumatism · doi:10.1002/art.1790060110 · Cited by 40 · see citing works
Physical activity and knee osteoarthritis
Cooper, C. C., & Coggon, D. (1999) · The Lancet · doi:10.1016/s0140-6736(99)90094-6 · Cited by 29 · see citing works
Valuation of life in long run health care programmes.
West, R. (1985) · BMJ · doi:10.1136/bmj.291.6502.1139 · Cited by 6 · see citing works
Valuation of life in long run health care programmes
Henderson, J. (1985) · BMJ · doi:10.1136/bmj.291.6508.1578 · Cited by 2 · see citing works
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Thompson, P. D., Buchner, D., Piña, I. L., Balady, G. J., Williams, M. A., Marcus, B. H., Berra, K., Blair, S. N., Costa, F., Franklin, B., et al. (2003) · Circulation · doi:10.1161/01.cir.0000075572.40158.77 · Cited by 2,132 · see citing works
Exercise for the treatment of depression and anxiety
Carek, P. J., Laibstain, S. E., & Carek, S. M. (2011) · The International Journal of Psychiatry in Medicine · doi:10.2190/pm.41.1.c · Cited by 797 · see citing works
- Authors
- Sutton, A. J., Muir, K. R., Mockett, S., & Fentem, P.
- Affiliations
- University of Nottingham (GB)
- Corresponding author
- Sutton, A J
- ORCID
- Venue
- Annals of the Rheumatic Diseases
- Publisher
- Elsevier BV
- Published
- 2001-08
- Volume
- 60
- Issue
- 8
- Pages
- 756-764
- ISSN
- 0003-4967 (ISSN-L)
- OpenAlex
- W2148355214
- Cited by
- 101
- References
- 29
- Citations by year
- 2025: 2 · 2024: 1 · 2023: 2 · 2022: 3 · 2021: 2 · 2019: 2 · 2018: 1 · 2016: 2 · 2015: 5 · 2014: 6 · 2013: 16 · 2012: 5
- FWCI
- 2.41
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Annals of the Rheumatic Diseases (publishedVersion)
- PubMed (publishedVersion)
- Leicester Research Archive (University of Leicester) (submittedVersion)
- Topics
- Health Sciences › Medicine › Rheumatology › Osteoarthritis Treatment and Mechanisms
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Physical Sciences › Engineering › Biomedical Engineering › Lower Extremity Biomechanics and Pathologies
- Keywords
- knee osteoarthritis, physical activity, sports participation, knee injury, Long Walk, lifelong physical activity
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Athletic Injuries, Bicycling, Body Composition, Cross-Sectional Studies, Female, Humans, Knee Injuries, Male, Middle Aged, Risk Factors, Exercise, Body Mass Index, Multivariate Analysis, Logistic Models, Case-Control Studies, Walking, Osteoarthritis, Knee
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