Chakravarty Eliza F, Hubert Helen B, Lingala Vijaya B, Zatarain Ernesto, Fries James F
Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California 94304, USA.
Am J Prev Med. 2008 Aug;35(2):133-8. doi: 10.1016/j.amepre.2008.03.032. Epub 2008 Jun 12.
Prior studies of the relationship of physical activity to osteoarthritis (OA) of the knee have shown mixed results. The objective of this study was to determine if differences in the progression of knee OA in middle- to older-aged runners exist when compared with healthy nonrunners over nearly 2 decades of serial radiographic observation.
Forty-five long-distance runners and 53 controls with a mean age of 58 (range 50-72) years in 1984 were studied through 2002 with serial knee radiographs. Radiographic scores were two-reader averages for Total Knee Score (TKS) by modified Kellgren & Lawrence methods. TKS progression and the number of knees with severe OA were compared between runners and controls. Multivariate regression analyses were performed to assess the relationship between runner versus control status and radiographic outcomes using age, gender, BMI, education, and initial radiographic and disability scores among covariates.
Most subjects showed little initial radiographic OA (6.7% of runners and 0 controls); however, by the end of the study runners did not have more prevalent OA (20 vs 32%, p =0.25) nor more cases of severe OA (2.2% vs 9.4%, p=0.21) than did controls. Regression models found higher initial BMI, initial radiographic damage, and greater time from initial radiograph to be associated with worse radiographic OA at the final assessment; no significant associations were seen with gender, education, previous knee injury, or mean exercise time.
Long-distance running among healthy older individuals was not associated with accelerated radiographic OA. These data raise the possibility that severe OA may not be more common among runners.
先前关于身体活动与膝关节骨关节炎（OA）关系的研究结果不一。本研究的目的是通过近20年的系列影像学观察，确定中年至老年跑步者与健康非跑步者相比，膝关节OA进展是否存在差异。
1984年对45名长跑运动员和53名平均年龄58岁（范围50 - 72岁）的对照者进行研究，直至2002年，期间拍摄系列膝关节X线片。影像学评分采用改良Kellgren & Lawrence方法，由两位阅片者对全膝关节评分（TKS）进行平均。比较跑步者和对照者的TKS进展以及重度OA膝关节的数量。进行多因素回归分析，以评估跑步者与对照者状态与影像学结果之间的关系，协变量包括年龄、性别、体重指数、教育程度以及初始影像学和残疾评分。
大多数受试者初始影像学OA较少（跑步者为6.7%，对照者为0）；然而，到研究结束时，跑步者的OA患病率（20%对32%，p = 0.25）和重度OA病例数（2.2%对9.4%，p = 0.21）均不比对照者多。回归模型发现，初始体重指数较高、初始影像学损伤以及从初始X线片到最后评估的时间较长与最终评估时更严重的影像学OA相关；未发现与性别、教育程度、既往膝关节损伤或平均运动时间有显著关联。
健康老年人长跑与影像学OA加速进展无关。这些数据提示重度OA在跑步者中可能并不更常见。
