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Strenuous activity increases risk of knee osteoarthritis in low leg muscle mass
Last reviewed: 02.07.2025

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Weight bearing appears to be associated with the development of knee osteoarthritis (OA) in people with low lower limb muscle mass, according to a study published in JAMA Network Open.
Yahung Wu, MD, of the University Medical Center Rotterdam in the Netherlands, and colleagues conducted a prospective cohort study using data from the Rotterdam Study. They included participants who had X-ray measurements of their knees at baseline and follow-up.
They assessed the incidence of knee OA based on radiographs and the incidence of symptomatic knee OA based on radiographs and a knee pain questionnaire. Different types of physical activity and their association with radiographic knee OA were analyzed. A total of 5,003 subjects were included in the study.
The researchers found that the incidence of knee OA was 8.4% over a mean follow-up of 6.33 years. They also found that higher weight-bearing was associated with increased odds of knee OA, but not non-weight-bearing.
Furthermore, the association between weight bearing and incident knee OA was observed only among patients in the lower tertile of lower limb muscle mass index, but not in the middle or high tertile.
"Although we did not find an association between recreational physical activity and symptomatic knee OA, we did find that weight-bearing activity may increase the odds of radiographic knee OA, but only among those with a low lower limb muscle mass index," the authors write.
"While physical activity is known for its many health benefits, our study suggests the need for caution when engaging in weight-bearing activities."