Is running good or bad for your joints? Study searches for a definitive answer

Published by Arthritis Research UK | Arthritis Today | Spring 2017 | No 172

The evidence that exercise can help to reduce the pain and stiffness caused by arthritis is overwhelming. This evidence isn't only gathered from robust scientific studies, but also directly from people of all ages who tell us how staying active has helped them to live well with arthritis.

However, the idea that certain types of exercise can be damaging to our joints, doing more harm than good, persists. This is particularly the case with running which, despite being a hugely popular pastime in the UK, continues to be the subject of conflicting reports in the media about its health benefits and risks.

Thousands of people of varying fitness levels enjoy 5km parkrun events every weekend and demand for places in longer races like the Great North Run and the London Marathon is highly competitive. But if running really is bad for your joints, are runners at greater risk of developing osteoarthritis in the future? And do the wider health benefits of running outweigh any risks?

Answering the question about running and arthritis

Researchers at the Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis in the University of Nottingham have embarked on a long-term study which aims to answer the questions about running and arthritis once and for all. Over the next 15 years the study will investigate the effects of recreational running on knee function and the development of joint pain and osteoarthritis over time.

Dr Kim Edwards, Associate Professor in Academic Orthopaedics, Trauma and Sports Medicine at the University of Nottingham, is leading the health of adults’ longitudinal observational (HALO) study. Her team’s first task was to conduct a systematic review of all published research exploring if there was any evidence of an association between running and knee osteoarthritis.

Dr Edwards says: "Surprisingly we found very few good-quality studies about this given the popularity of running around the world.

"Following our review, we concluded there's no clear evidence available anywhere in the world to either support or contradict the theory that running causes knee osteoarthritis. To be able to prove definitively that running isn't a risk factor for arthritis we therefore needed to conduct a long-term study like HALO."We concluded there's no clear evidence available anywhere in the world to either support or contradict the theory that running causes knee osteoarthritis."Dr Kim Edwards

"Collecting detailed information from a large group of people and then being able to watch what changes and develops over 15 years will give us the accurate picture we need to show how levels of physical activity affect our joints and our health.

“3,600 people from all over the UK have signed up to take part, the youngest is just 18 and the oldest is 81. We recruited lots of people from parkrun, other running events and triathlons, but we’ve also involved people we found via choirs and other non-sporting clubs to give us a real mix of participants, ranging from those who aren’t active at all to the very active.

"Some people will already be experiencing joint pain or have been diagnosed with osteoarthritis, while others won’t.”

Each participant was asked to complete three short questionnaires during 2016 which asked them to share information about their:

• background
• level and type of physical activity
• joint pain
• history of injury
• mood
• general health
• quality of life.

This will be followed up with another questionnaire later this year, then information will be gathered every three years until the end of the study.

Looking at how people move

In addition to analysing this data, the HALO researchers are also working on three sub-studies using volunteers drawn from the baseline group of participants. Investigator Richard Leech says: "We’re running a study working with a group of 300 volunteers; a mix of runners, triathletes and people who don’t do either of these activities.

"A team of physiotherapists will be looking at how each person moves via three assessments. Firstly, we’ll look at the joint itself, assessing how much it moves and the quality of that movement. Then we’ll conduct five timed tests covering everyday movements like walking, getting up from a chair and going up stairs to track how easy or difficult they are.

"Finally, we’ll ask the participants to take part in some tests usually associated with serious knee injuries which involve balance and hopping. The aim is to compare how people perform in these tests with the data gathered from the questionnaire and identify any interesting correlations."

Dr Edwards continues: "We’re also asking 150 people to complete detailed training diaries, either electronically or on paper, so we can get a better understanding of their day-to-day physical activity.

Exploring genetic factors

"The third sub-group study is looking at genetics. We’re inviting 600 people to give us blood samples so their genetic profile can be tested. Colleagues in Australia have identified an area of DNA they believe indicates if a person is at risk of injury and therefore of developing osteoarthritis. We’re replicating their study with people from the UK to find out if we get the same results.

"We’re incredibly grateful for all the time and energy our participants are giving us by taking part in our study. Without them we simply couldn’t do this type of research.

"We already know exercise relieves pain and reduces symptoms in most people with osteoarthritis. At the end of this study we want to be able to say definitively whether or not running causes osteoarthritis. We hope that providing robust evidence in this area will stop the mixed messages about exercise that are still out there and encourage more people to keep active and experience the wider health benefits that moving more brings.""It’s vital each person finds a sport or way of moving more that works for them, something they love doing."Dr Kim Edwards

"Running, like any type of physical activity, will improve heart health, can help to prevent some types of cancers, will lift your mood and help with depression, assist with weight management and reduce risk of type 2 diabetes. But knowing about all these benefits in theory won’t keep someone exercising if they don’t enjoy it. It’s vital each person finds a sport or way of moving more that works for them, something they love doing. If we can prove running isn’t harmful, we’ll be opening up wider access to a sport that’s accessible, low-cost and that so many people enjoy and get a lot out of."

Read our information on exercise and arthritis for advice on getting started and finding types of exercise to suit you.
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The Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis is led by Nottingham University Hospitals NHS Trust in collaboration with Arthritis Research UK and is a consortium of seven universities: Nottingham, Oxford, Southampton, Bath, Loughborough, Leeds and UCL.

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