The Myth About Exercise

[ERCougar]

In response to several comments about the negative effects of running and the possibility of developing arthritis in the future, I did a quick internet search for articles linking moderate to high intensity running to the eventual development of hip and knee arthritis.

Here are a few of the better studies that I found on the subject, all from reputable, professional, peer-reviewed journals:

• A Danish study published in 1990 found that a group of athletes that ran 20 to 40 km per week for 30 years had an incidence of osteoarthritis that was no different from that of a comparison group.

• A study published in 1985 found that the incidence of osteoarthritis in a group of runners who competed between 1930 and 1960 was lower than a matched group of swimmers who competed at the same time.

• A 1996 longitudinal study (6 years) determined to assess whether long distance running was associated with increased musculoskeletal pain and disability. They found that high intensity running was not associated with increases in pain reports, and may even cause a decrease in pain ratings. They also found that vigorous physical activity is associated with greatly decreased levels of disability and with decreased mortality rates.

• A 1986 study found that runners with an average age of 60 who had run an average of three hours per week for 12 years did not have a greater prevalence of osteoarthritis than a comparison group.

• And finally, in the most definitive resource available, Runners World , an article from the August 2004 edition written by Amby Burfoot addressed this very question. He cites a 1984 longitudinal study which tracked pain and disability ratings in runners (n=565, run more than 26 miles per week) versus non-runners (n=301, run less than 2 miles per week), with all of the subjects being over the age of 50. The results of the study report that the runners group reported 25% less reports of pain as compared to the non-runners group over the 14 year period of study.

As a runner, I may be a bit biased in my analysis of the articles that I read. But anecdotally, in my personal experience, I cannot recall a single total joint replacement patient that is a former long distance runner. This comes from a sample size of several hundred post-op knee and hip patients. On the other hand, the majority of my post-op hip and knee replacement patients either are or were at one time classified as obese or morbidly obese.


I'll leave the cardiovascular risks and benefits of running to the MDs and DOs to dissect and discuss. But from an orthopedic standpoint, the conventional thought that long distance running causes pain and disability in later years appears to be unfounded as evidenced by my personal observations and a quick sampling of the available research in the area.

Take all of this for what its worth.

Great stuff, BG. I mentioned a while ago in another thread that there are sports medicine physicians who will argue that running is actually good for your knees, but this is a really nice collection of studies to bear that out (or at least that it's not harmful). And my experience with joint-replacement patients is identical.

[Jeff Lebowski]

Great responses, everyone. I love this board.

[Surfah]

Another point against exercise: People who are extreme, high-impact exercisers in their younger years often end up destroying their joints to the point that they are pretty disabled in their retirement years. I'm not sure the trade-off of extreme cardiovascular fitness in your 20s through 40s is worth needing knee and hip replacements and having very limited mobility in your 60s through 80s.

This happened with my mother. She has had a partial and a complete knee replacement in her knees. She also had her rotator cuff repaired. My dad too a college athlete has had his knee scoped. He's about to undergo surgery on his second shoulder having already had the other done. Rotator cuff injuries. My mom played tennis and golf and my dad played volleyball respectively. My mother also skied quite a bit, including mogul skiing which I am sure contributed to her knees falling apart. It's sad to see her quality of life go down. She's 52 years old. She's gained weight and is now in a catch 22 as really diet is the only thing she can manipulate since she can do little to no exercise. It kills her to not be able to do something active like she used. She usually tries anyway and ends up in bed the next day unable to move. She needs to have one of her knees replaced again as she can barely walk on it. The surgery was never really successful. But she had a pulmonary embolism after the surgery and nearly died and doesn't want to chance it again.

[cowboy]

Great responses, everyone. I love this board.

Amen. The Gym is as good as any fitness forum I've seen for the stuff that really interests me.

[happyone]

Her premise is waaaay off. The issue with overweight and obese is eating too much for your metabolism.....period. Exercise does increase food consumption to some degree, but the impact is offset by the calories burned while exercising. Now she is correct in one sense that you cannot lose weight by exercise alone. The calorie deficit made by exercise is typically not enough to elicit large weight loss, It takes a deficit of 4200 KCal to lose 1 pound of fat. You get that deficit by eating 1800 KCal instead of 2400.

If you want to look at it this way. Diet changes help you lose weight and exercise helps you maintain your weight loss. The database of people who have lost 30% of their initial bodyweight and maintained that loss over a years time, shows that they exercise and average of 60-90 minutes a day to help them maintain their weight.

That describes me.

[Jarid in Cedar]

This happened with my mother. She has had a partial and a complete knee replacement in her knees. She also had her rotator cuff repaired. My dad too a college athlete has had his knee scoped. He's about to undergo surgery on his second shoulder having already had the other done. Rotator cuff injuries. My mom played tennis and golf and my dad played volleyball respectively. My mother also skied quite a bit, including mogul skiing which I am sure contributed to her knees falling apart. It's sad to see her quality of life go down. She's 52 years old. She's gained weight and is now in a catch 22 as really diet is the only thing she can manipulate since she can do little to no exercise. It kills her to not be able to do something active like she used. She usually tries anyway and ends up in bed the next day unable to move. She needs to have one of her knees replaced again as she can barely walk on it. The surgery was never really successful. But she had a pulmonary embolism after the surgery and nearly died and doesn't want to chance it again.

She should look into swimming or water aerobics. Most towns have an "arthritis" class of water aerobics. It would help get her some exercise without the full effects of gravity. I give the name of our local instructor to everyone who has had a joint replacement.

[Pheidippides]

Amen. The Gym is as good as any fitness forum I've seen for the stuff that really interests me.

I can't tell you how much it's helped me over the last six months or so. Between the various people here there is an amazing store of knowledge here, and, what's more, a willingness to share it.

[CardiacCoug]

In response to several comments about the negative effects of running and the possibility of developing arthritis in the future, I did a quick internet search for articles linking moderate to high intensity running to the eventual development of hip and knee arthritis.

Here are a few of the better studies that I found on the subject, all from reputable, professional, peer-reviewed journals:

• A Danish study published in 1990 found that a group of athletes that ran 20 to 40 km per week for 30 years had an incidence of osteoarthritis that was no different from that of a comparison group.

• A study published in 1985 found that the incidence of osteoarthritis in a group of runners who competed between 1930 and 1960 was lower than a matched group of swimmers who competed at the same time.

• A 1996 longitudinal study (6 years) determined to assess whether long distance running was associated with increased musculoskeletal pain and disability. They found that high intensity running was not associated with increases in pain reports, and may even cause a decrease in pain ratings. They also found that vigorous physical activity is associated with greatly decreased levels of disability and with decreased mortality rates.

• A 1986 study found that runners with an average age of 60 who had run an average of three hours per week for 12 years did not have a greater prevalence of osteoarthritis than a comparison group.

• And finally, in the most definitive resource available, Runners World , an article from the August 2004 edition written by Amby Burfoot addressed this very question. He cites a 1984 longitudinal study which tracked pain and disability ratings in runners (n=565, run more than 26 miles per week) versus non-runners (n=301, run less than 2 miles per week), with all of the subjects being over the age of 50. The results of the study report that the runners group reported 25% less reports of pain as compared to the non-runners group over the 14 year period of study.

As a runner, I may be a bit biased in my analysis of the articles that I read. But anecdotally, in my personal experience, I cannot recall a single total joint replacement patient that is a former long distance runner. This comes from a sample size of several hundred post-op knee and hip patients. On the other hand, the majority of my post-op hip and knee replacement patients either are or were at one time classified as obese or morbidly obese.


I'll leave the cardiovascular risks and benefits of running to the MDs and DOs to dissect and discuss. But from an orthopedic standpoint, the conventional thought that long distance running causes pain and disability in later years appears to be unfounded as evidenced by my personal observations and a quick sampling of the available research in the area.

Take all of this for what its worth.

This is obviously far outside of my area of expertise. Thanks for those articles, BG. I learned something. But I believe there are a few studies that support the other side as well. A study of 2000+ Finnish competitive athletes from 1920-1965 showed twice as much risk of a hospital admission for osteoarthritis among former competitive athletes. You need to have population-wide studies like they can do in European countries with socialized medicine to really analyze these issues well. I'm not sure all of those studies you cited have too much validity.

http://www.bmj.com/cgi/content/abstract/308/6923/231

There are plenty of younger, very vigorous exercisers who end up needing joint replacement. My mother-in-law was a runner who needed a hip replacement in her 50s. I saw two 30-something patients during my residency who were marathon runners who had acute lumbar disk herniations requiring surgery (these are obviously anecdotal, rather than scientific observations ). This article is also very anecdotal and non-academic, but there are clearly some young exercisers who destroy their joints. Maybe most distance runners won't ever get into much serious trouble with their joints, but for those who start to develop joint problems, I think switching to lower impact exercise should definitely be considered:

http://www.tampabay.com/news/health/article994987.ece

I know that it is well-established that obesity is the major risk factor for osteoarthritis and need for joint replacement in this country. Most people getting joint replacements just wear out their joints by being too fat. But I think there is a happy medium between letting yourself get fat and out of shape and pounding on your knees, hips, and ankles for an hour a day.

There are an increasing number of cardiologists who think that marathon running may actually be detrimental to coronary arteries and to the risk of heart attack as well. Marathon runners have more coronary calcium than they would be predicted to have based on their Framingham risk score. I put a stent in a guy in Houston shortly after he finished a marathon last year and saw several thin, very physically fit distance runners with severe coronary artery disease (also an anecdotal observation).

http://www.medscape.com/viewarticle/579806_4

Anyway, these are interesting issues. Great discussion.

[ERCougar]

This is obviously far outside of my area of expertise. Thanks for those articles, BG. I learned something. But I believe there are a few studies that support the other side as well. A study of 2000+ Finnish competitive athletes from 1920-1965 showed twice as much risk of a hospital admission for osteoarthritis among former competitive athletes. You need to have population-wide studies like they can do in European countries with socialized medicine to really analyze these issues well. I'm not sure all of those studies you cited have too much validity.

http://www.bmj.com/cgi/content/abstract/308/6923/231

These are world-class athletes, so I'm not sure this really applies to any of us on the board. In fairness to you, that is what you've been arguing all along--that extreme participation in sports can be harmful--but no one's really disputing that. Like anything, exercise can be overdone. I've claimed from the beginning that marathons aren't good for you and I appreciate the studies you've cited to back that up, but none of us are career-marathoners--marathons seem to be used as a motivator for daily exercise. I still think moderate running and exercise (which really, is what all of us do here, except for Arch) is beneficial to joint health.

[Surfah]

These are world-class athletes, so I'm not sure this really applies to any of us on the board. In fairness to you, that is what you've been arguing all along--that extreme participation in sports can be harmful--but no one's really disputing that. Like anything, exercise can be overdone. I've claimed from the beginning that marathons aren't good for you and I appreciate the studies you've cited to back that up, but none of us are career-marathoners--marathons seem to be used as a motivator for daily exercise. I still think moderate running and exercise (which really, is what all of us do here, except for Arch) is beneficial to joint health.

But wasn't he arguing that anything more than 60 minutes of exercise is too much? I think a lot here push that when training for a marathon though they aren't career marathoners.

[CardiacCoug]

http://m.bbc.com/news/health-31095384

[ERCougar]

http://www.runnersworld.com/health/t...nning-too-much

Yes, the conclusion of the study (that "strenuous" jogging is as bad as being sedentary) is based on two deaths over more than a decade of follow-up. (Thank goodness a third person didn't die, or public health authorities would be banning jogging.)

[Donuthole]

http://www.runnersworld.com/health/t...nning-too-much

Didn't you slip and nearly die while running? You should probably just STFU and accept the science, bro.

[Joe Public]

http://www.runnersworld.com/health/t...nning-too-much

You beat me to it.

[Moliere]

Maybe Niku died