Cui Xiaofeng, Xie Fangfang, Cui Jiahe, Tian Yukui, Bai Xue, Guo Lei, Liu Junchang, Yao Fei
The Fourth Clinical Medical College, Xinjiang Medical University, Urumqi, China.
School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
J Glob Health. 2025 Jun 13;15:04173. doi: 10.7189/jogh.15.04173.
Knee osteoarthritis (KOA), a debilitating chronic degenerative joint disease, substantially compromises patients' functional capacity and quality of life. Although physical activity (PA) has been recognised as a modifiable risk factor in the development of KOA, its potential protective role remains debated. To clarify this clinical uncertainty, we conducted a rigorous systematic review and meta-analysis to comprehensively assess the association between PA levels and the risk of incident KOA.
We systematically searched PubMed, EMBASE, Cochrane Library, CINAHL, Web of Science databases for published observational studies on the association between PA and knee osteoarthritis. Following the PRISMA guidelines, we selected English literature from inception to publication on 21 September 2024, and assessed study quality according to the Newcastle-Ottawa scale. Our protocol is available on PROSPERO.
Our systematic screening identified 14 eligible observational studies (13 cohort studies and one case-control study) involving 507 696 participants with 27 412 incident cases of KOA. A pooled analysis comparing levels of PA intensity showed a 26% increased risk of knee OA for high PA compared with moderate PA (relative risk (RR) = 1.26; 95% CI = 1.17-1.37). In contrast, neither high PA (RR = 1.02; 95% CI = 0.84-1.23) nor moderate PA (RR = 0.94; 95% CI = 0.84-1.05) showed protective effects compared with low PA reference groups. Stratified analyses showed nonsignificant associations in cohort studies (RR = 1.06; 95% CI = 0.87-1.29) compared with case-control studies (RR = 0.41; 95% CI = 0.20-0.83). Notably, regional subgroup analyses showed comparable PA-related risks between European (RR = 1.01; 95% CI = 0.74-1.38) and North American populations (RR = 1.03; 95% CI = 0.81-1.31). Crucially, gender-stratified analyses demonstrated no significant differential risk in males (RR = 1.20; 95% CI = 0.54-2.70) vs. females (RR = 0.73; 95% CI = 0.29-1.82).
This systematic review comprehensively demonstrated a dose-dependent relationship between physical activity intensity and the risk of knee osteoarthritis. Our meta-analysis showed that high PA levels significantly increased the risk of knee osteoarthritis compared with moderate PA. In addition, limited evidence suggested that exceeding international PA guidelines may increase the risk of osteoarthritis (RR = 1.18; 95% CI = 1.02-1.35). However, future studies need to be executed to further define the type of activity, optimal dose and duration required to effectively reduce the risk of knee osteoarthritis.
PROSPERO: CRD42024600175.
膝关节骨关节炎（KOA）是一种使人衰弱的慢性退行性关节疾病，严重损害患者的功能能力和生活质量。尽管身体活动（PA）已被认为是KOA发病过程中一个可改变的风险因素，但其潜在的保护作用仍存在争议。为了澄清这一临床不确定性，我们进行了一项严格的系统评价和荟萃分析，以全面评估PA水平与KOA发病风险之间的关联。
我们系统检索了PubMed、EMBASE、Cochrane图书馆、CINAHL、Web of Science数据库，以查找已发表的关于PA与膝关节骨关节炎之间关联的观察性研究。按照PRISMA指南，我们选择了从创刊到2024年9月21日发表的英文文献，并根据纽卡斯尔-渥太华量表评估研究质量。我们的方案可在PROSPERO上获取。
我们的系统筛选确定了14项符合条件的观察性研究（13项队列研究和1项病例对照研究），涉及507696名参与者，其中有27412例KOA发病病例。一项比较PA强度水平的汇总分析显示，与中等强度PA相比，高强度PA患膝骨关节炎的风险增加了26%（相对风险（RR）=1.26；95%置信区间（CI）=1.17-1.37）。相比之下，与低强度PA参照组相比，高强度PA（RR=1.02；95%CI=0.84-1.23）和中等强度PA（RR=0.94；95%CI=0.84-1.05）均未显示出保护作用。分层分析显示，与病例对照研究（RR=0.41；95%CI=0.20-0.83）相比，队列研究中的关联不显著（RR=1.06；95%CI=0.87-1.29）。值得注意的是，区域亚组分析显示，欧洲人群（RR=1.01；95%CI=0.74-1.38）和北美人群（RR=1.03；95%CI=0.81-1.31）之间与PA相关的风险相当。至关重要的是，按性别分层分析显示，男性（RR=1.20；95%CI=0.54-2.70）与女性（RR=0.73；95%CI=0.29-1.82）之间的风险无显著差异。
这项系统评价全面证明了身体活动强度与膝关节骨关节炎风险之间存在剂量依赖关系。我们的荟萃分析表明，与中等强度PA相比，高强度PA显著增加了患膝骨关节炎的风险。此外，有限的证据表明，超过国际PA指南的标准可能会增加骨关节炎的风险（RR=1.18；95%CI=1.02-1.35）。然而，未来需要开展进一步研究，以进一步明确有效降低膝关节骨关节炎风险所需的活动类型、最佳剂量和持续时间。
PROSPERO：CRD42024600175
