Date Published: October 1, 2018
Publisher: Public Library of Science
Author(s): Jean-Francois Esculier, Natasha M. Krowchuk, Linda C. Li, Jack E. Taunton, Michael A. Hunt, Jean-Philippe Regnaux.
To evaluate the perceptions of the general public and healthcare practitioners (HCP) in Canada about the relationship between running and knee joint health, and to explore HCP`s usual recommendations to runners with knee osteoarthritis (KOA).
Non-runners and runners (with and without KOA) and HCP completed an online survey regarding the safety of running for knee joint health. HCP also provided information related to usual clinical recommendations. Proportions of agreement were compared between non-runners and runners.
A total of 114 non-runners, 388 runners and 329 HCP completed the survey. Overall, running was perceived as detrimental for the knee joint by 13.1% of the general public, while 25.9% were uncertain. More uncertainty was reported regarding frequent (33.9%) and long-distance (43.6%) running. Statistical analyses revealed greater proportions of non-runners perceiving running negatively compared with runners. Overall, 48.4% believed that running in the presence of KOA would lead to disease progression, while 53.1% believed running would lead to premature arthroplasty. In HCP, 8.2%, 9.1% and 22.2% perceived that running in general, running frequently, or running long-distances are risk factors for KOA, respectively. 37.1% and 2.7% of HCP typically recommended patients with KOA to modify their running training or to quit running, respectively.
High rates of uncertainty among the general public and HCP in Canada outline the need for further studies about running and knee joint health. Filling knowledge gaps will help inform knowledge translation strategies to better orientate the general public and HCP about the safety of running for knee joint health.
Knee osteoarthritis (KOA) is a leading cause of long-term disability in Canada and across the world, resulting in chronic pain and activity limitations, and eventually decreased quality of life . This condition also bears significant economic burden due to treatments, loss of productivity and indirect healthcare costs . KOA is thought to develop because of a variety of risk factors including advancing age, obesity, previous trauma and genetics . Regular physical activity can help in reducing the incidence of KOA and its economic burden, in part because of its beneficial effects on weight control [3, 4]. In addition, physical activity and exercise have been widely recognized as essential components of clinical management of people with KOA [5, 6]. Nevertheless, adherence to recommendations in the population largely depends on perceptions about the benefits of specific types of physical activity as well as on barriers to participation.
This study is the first to provide data on how the general public and HCP perceive running with respect to knee joint health, as well as their perceptions of the appropriateness of running in individuals with pre-existing KOA. Even though regular physical activity is strongly advocated for the prevention and management of KOA, beliefs specifically about running do not reflect such certainty and are in line with the current state of evidence. While people who run (both in the general public and HCP) were more positive to the effects of running on knee joint health, there was no clear direction overall to definitively state whether people in our survey perceived running as safe for knee joint health or not. Indeed, one of the most interesting findings is the relatively high proportion of respondents who were uncertain about running being appropriate or not for knee joint health.
In conclusion, the general public and HCP in Canada reported high rates of uncertainty regarding running as a risk factor to develop KOA, and about the appropriateness of running with pre-existing KOA. Considering efforts to provide recommendations of meaningful regular physical activity to promote knee joint health, results from this study emphasize the need for additional research specifically investigating running, as well as the development of future knowledge translation strategies to the general public and HCP. High-quality prospective studies are warranted both in cohorts of individuals with and without KOA. Importantly, caution must be taken to monitor detailed training parameters such as frequency, speed and distance, so that clearer recommendations can be issued on optimal dosage for knee joint health and tailored to individual patients with KOA.