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Open Access Highly Accessed Research article

Effect of leisure time physical activity on severe knee or hip osteoarthritis leading to total joint replacement: a population-based prospective cohort study

Eva Ageberg127*, Gunnar Engström34, Maria Gerhardsson de Verdier3, Jan Rollof3, Ewa M Roos5 and L Stefan Lohmander156

Author Affiliations

1 Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden

2 Department of Health Sciences, Lund University, Lund, Sweden

3 AstraZeneca R&D, Lund, Molndal, Sweden

4 Epidemiology Research Group, Clinical Sciences, Malmö, Lund University, Lund, Sweden

5 Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark

6 Department of Orthopedics and Traumatology, University of Southern Denmark, Odense, Denmark

7 Department of Health Sciences, Lund University, PO Box 157, SE-221 00, Lund, Sweden

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BMC Musculoskeletal Disorders 2012, 13:73  doi:10.1186/1471-2474-13-73

Published: 17 May 2012

Abstract

Background

Studies on leisure time physical activity as risk factor or protective factor for knee or hip osteoarthritis (OA) show divergent results. Longitudinal prospective studies are needed to clarify the association of physical activity with future OA. The aim was to explore in a prospective population-based cohort study the influence of leisure time physical activity on severe knee or hip OA, defined as knee or hip replacement due to OA.

Methods

Leisure time physical activity was reported by 28320 participants (mean age 58 years (SD 7.6), 60% women) at baseline. An overall leisure time physical activity score, taking both duration and intensity of physical activities into account, was created. The most commonly reported activities were also used for analysis. The incidence of knee or hip replacement due to OA over 11 years was monitored by linkage with the Swedish hospital discharge register. Cox’s proportional hazards model (crude and adjusted for potential confounding factors) was used to assess the incidence of total joint replacement, or osteotomy (knee), in separate analyses of leisure time physical activity.

Results

There was no significant overall association between leisure time physical activity and risk for knee or hip replacement due to OA over the 11-year observation time. For women only, the adjusted RR (95% CI) for hip replacement was 0.66 (0.48, 0.89) (fourth vs. first quartile), indicating a lower risk of hip replacement in those with the highest compared with the lowest physical activity. The most commonly reported activities were walking, bicycling, using stairs, and gardening. Walking was associated with a lower risk of hip replacement (adjusted RR 0.76 (95% CI 0.61, 0.94), specifically for women (adjusted RR 0.75 (95% CI 0.57, 0.98)).

Conclusions

In this population-based study of middle-aged men and women, leisure time physical activity showed no consistent overall relationship with incidence of severe knee or hip OA, defined as joint replacement due to OA, over 11 years. For women, higher leisure time physical activity may have a protective role for the incidence of hip replacement. Walking may have a protective role for hip replacement, specifically for women.

Keywords:
Osteoarthritis; Arthroplasty; Exercise; Workload; Risk factors