A friend says she doesn’t do any strenuous exercise in order to keep her hip and knee joints like new for old age. She doesn’t want to get arthritis and plans on going to the grave with “all her original parts.”
I give her credit for being amusing, but does her plan have any merit? Does exercise contribute to arthritis? And does anyone care what you go to the grave with?
When the time comes, the replacement parts I’m buried with will be the least of my worries.
It would seem like exercise does contribute to arthritis. We all know the former football player with a “bad knee” from those years in high school or college. One of the most famous medical studies of all time actually looked at exercise and arthritis, but most people don’t know it.
The Framingham study started in 1948 in Framingham, Massachusetts. This longitudinal study of just around 5,200 residents is most well known for its observations on heart disease and stroke. This study showed the risks of cigarette smoking, high cholesterol, high blood pressure and obesity. This landmark study is still going today and one of the things being followed is exercise and its effects. The participants reported exercise and injuries, and even had knee X-rays at the beginning of the study and then later points.
Over the decades, some of the group developed knee arthritis. There was no link between exercise (specifically jogging and walking) and arthritis in both symptoms and radiologic findings on follow-up X-rays. Jogging wasn’t worse than walking. Obesity was found to be a risk factor for arthritis, but the more active overweight subjects didn’t get arthritis any more than more slender active patients.
What about the flip side — is strenuous exercise actually good for joints? An Australian study of about 300 adults found the participants who did the most vigorous weight-bearing (not swimming) exercise had the thickest knee cartilage with one exception — those who had injuries.
Taking it another step forward, another study of more than 430 avid runners found no evidence that running caused arthritis throughout 20 years of observation. What they did find was that the runners had less musculoskeletal disabilities than the non-runners. And the runners had a mortality rate 39% lower than the non-runners. These studies have been repeated with college athletes and have not found exercise, even strenuous repetitive exercise, as a risk factor.
So, why is there so much knee arthritis? Injuries. Old injuries have been found to be a leading cause of joint arthritis. Getting back to the old football player, it was the trauma — the sprains or cartilage tears or even fractures — that contribute to arthritis. Another problem is age. Cartilage loses its ability to heal as you get older.
Your parents might be part of the problem. People inherit the growth pattern of their parents, this includes minor abnormalities in how bones are shaped and how they can lead to arthritis. Being female, women unfortunately are more likely to develop arthritis as they get older.
Lastly, as previously mentioned, being overweight adds a disproportionate amount of pressure on the knees. Every extra pound of weight adds 3 pounds of weight to the knees.
Once you have arthritis is when you switch to the exercises that improve muscle strength without significant weight impact. Walking and swimming are great, and even yoga and tai chi help with balance and flexibility.
So is my friend right? Probably not. Not exercising does not seem to help and another study found that weakness of the leg muscles around the knee seems to be its own risk for arthritis. The cardiovascular and other musculoskeletal benefits of exercise outweigh the risk for arthritis as long as you do it safely.
Having all your original parts in the grave doesn’t seem worth it if you never really live. Take a hike — there’s a whole world out there.
Dr. Salvatore Iaquinta is a head and neck surgeon at Kaiser Permanente San Rafael and the author of “The Year They Tried To Kill Me.” He takes you on the Highway to Health every fourth Monday.