Have you ever been asked...Does running increase my risk for development of pain as I age?

Well, I must start my blog with a confession -  I found the research article I am about to share with you by reading the Feb 2006 issue of "Runner's World".  It is amazing where you will stumble onto good research...

The Runner's World article by Amby Burfoot (funny name for a Runner's World writer) starts with a common question we all receive in our clinics - will running over time increase my risk for pain when I am older?  She explains that this is a rather logical question based on our use of "mechanical" products.  She explains that it is intuitive to everyone from using mechanical systems (from cars to toothbrushes) the concept of wear-and-tear.  But, she goes on to point out that our bodies are "biomechanical" systems - "and those three little letters make all the difference."

The article cites the published article by Bruce et al:  "Aerobic exercise and its impact on musculoskeletal pain in older adults: a 14 year prospective longitudinal study"  in Arthritis Research and Therapy; September 2005.

Starting in 1984 they followed runners and non-runners that were > 50 years of age.  In the 14 year prospective study - they compared those that average > 26 miles/week to a set of controls that averaged 2 miles/week to measure the effects of aging on musculoskeletal pain.  These groups were selected so that if running did create cumulative trauma  - they would expect to see a 10-fold increase in pain by the > 26 mile/week group.  Overall they found the opposite, runners experienced a bout 25% less musculoskeletal pain than controls.

The article is attached  Download bruce_2005_arth_res_ther_running_oa.pdf .

One of the neat findings is the percent of complaints of musculoskeletal pain in those 60-80 years old.

Female Runners:  11.8%

Female Non-Runners:  70.6%

Male Runners:  17.6%

Male Non-Runners:  41.1%

So, although complaints of pain increases with age - no observed progressive increase in pain was noted by the runners.  So, although many of our patients fall somewhere between the 2 groups studied, there is now some clinical evidence that collaborates some of the biomechanical basic science literature that suggests that biomechanical systems require optimal loading to maintain health over time - or what we state in the clinic - "motion is lotion"

One side note - It is really exciting to see how open access journals are allowing research to trickle down faster to magazines meant for the general population...Very exciting!

Happy Running and Happy New Years!

Deydre

Comments

[John Childs]

Great post! The only problem is that you're not helping those of us looking to make excuses for why we didn't run a little more this past year than we should have. 2006 resolutions anyone?

Happy New Year!

John

[Charles Sheets]

A couple of comments. First off, Amby Burfoot is male, a long-time editor of Runner's World, and the winner of the 1968 Boston Marathon. As you pointed out, he does work hard to integrate research into the magazine as much as possible.
This reminds me of interview studies looking at the effect of stretching and running, which find that people who stretch have more injuries. This has led to advice not to stretch. But if you think about it, it's just as likely (if not more so) that people stretch because they have been injured - we're not sure of the exact relationship yet, but we're getting there. Tim Noakes goes into this in detail in his book the Lore of Running (highly recommended for anyone who deals with or is a distance runner). It's important to recognize the effect of self-selection here. Running is such a tough sport to endure mechanically, it's likely that anyone that is still running this consistently beyond age 50 has the biomechanics and desire for physical activity, which may not be present in less active folks. The higher-level runners were younger and leaner, but did not have a significantly lower level of arthritis than the others. People who self-limit themselves to two miles a week are more likely to have co-morbidities that would affect their general pain response.
I think the primary result we are seeing is that people who have the fortune to continue to be able to participate in aggressive activity will get results on multiple levels (physical and mental), which can be reflected in decreased pain, but not necessarily different mechanical outcomes, ie arthritis.

The only strong research that I can recall regarding endurance running and arthritis is that light to moderate hip arthritis (pooled Odds Ratio 1.25) may be found, as well as in knees with a history of ligamentous or meniscal injury.

Thanks for posting the article. Personally, I would consider it fantastic if we could convince even a small percentage of people to run two miles a week, as in this control group.

Charlie

[Douglas Dumas]

Deydre,

Great article, I an 40 and have been a runner since age 18. I find that I have more pain when I do not run. When I lay off of my training routine I feel stiff. When I return to normal activity I definitely feel looser.

Doug

[Britt Smith]

Deydre,
Interesting article demonstrating less pain with the runner group. This
information follows the NIH Consensus Conference on OA, which found that
moderate levels of running (undefined) created low or no risk for develop-
ment of OA. The characteristics of sports that did increase risk were
high intensity, acute, direct joint impact 'as a result of contact with
other participants, playing surfaces, or equipment' (e.g. football,
soccer), repetitive joint impact and torsional loads (e.g. baseball elbows,
soccer knees). Of course, OA and pain are not synonymous, but your
article supports the continued need to run. (I believe Rob had a blog a
while back about running and OA).
Happy New Years,
Britt
NIH Conference. Osteoarthritis: New insights, part 1: The disease and its
risk factors. Ann Intern Med.2000;133:635-646.
NIH Conference. Osteoarthritis: New insights, part 2: Treatment approaches.
Ann Intern Med.2000;133:726-737.
Felson DT. Risk factors for osteoarthritis. Clin Ortho & Related Res. 2004
427S:S16-S21.

[Deydre]

I think Charlie's comments are right on target!

By definition, there are a lot of limitations to this type of study design - and Charlie pointed out a few. Self-Selection tops the list.

Although the study design has limitations - overall it was well done! Further, Amby Burfoot's editorial on the research is a good example of patient/athlete education that is based in research.

Deydre

PS: Thanks for letting me know the history behind Amby Burfoot. What an amazing runner!

[Paul]

As the founding member of the obese asthmatic marathon runners club, I have a saying that goes something like this:

"Running does to your knees what sitting on the couch does to your buttocks. I'll stick with running."