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Running and the Development of Disability with Age

James F. Fries, MD; Gurkirpal Singh, MD; Dianne Morfeld, BA; Helen B. Hubert, PhD; Nancy E. Lane, MD; and Byron W. Brown, PhD
[+] Article, Author, and Disclosure Information

From Stanford University School of Medicine, Stanford, California. Requests for Reprints: James F. Fries, MD, 1000 Welch Road, Suite 203, Palo Alto, CA 94304-1808. Grant Support: By grant AR20610-16 from the National Institutes of Health to the Stanford Arthritis Center.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1994;121(7):502-509. doi:10.7326/0003-4819-121-7-199410010-00005
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Objective: To determine, by longitudinal study, whether regular vigorous running activity is associated with accelerated, unchanged, or postponed development of disability with increasing age.

Study Design: 8-year prospective, longitudinal study with yearly assessments.

Participants: 451 members of a runners' club and 330 community controls who were initially 50 to 72 years old (also characterized as “ever-runners” [n = 534] and “never-runners” [n = 247], respectively).

Measurements: The dependent variable was disability as assessed by the Health Assessment Questionnaire and separately validated in these participant cohorts. Covariates included age, sex, body mass index, comorbid conditions, education level, smoking history, alcohol intake, mean blood pressure, initial disability level, family history of arthritis, and radiologic evidence of osteoarthritis of the knee in a subsample.

Results: Initially, the runners were leaner, reported joint symptoms less frequently, took fewer medications, had fewer medical problems, and had fewer instances of and less severity of disability, suggesting either that the average previous 12 years of running had improved health or that self-selection bias was present. After 8 years of longitudinal study, the differences in initial disability levels (0.026 compared with 0.079; P < 0.001) had steadily increased to 0.071 for runners compared with 0.242 for controls (P < 0.001). The difference was consistent for men and women. The rate of development of disability was several times lower in the runners' club members than in community controls; this difference persisted after adjusting for age, sex, body mass, baseline disability, smoking history, history of arthritis, or other comorbid conditions (slopes of progression of disability for the years 1984 to 1992, after adjusting for covariates: men in the runners' club, 0.004 (SE, 0.002); community controls, 0.012 (SE, 0.002); women in the runners' club, 0.009 (SE, 0.005); community controls, 0.027 (SE, 0.004); P < 0.002 for both sets of comparisons). In addition to differences in disability, there were significant differences in mortality between the runners' club members (1.49%) and community controls (7.09%) (P < 0.001). These differences remained significant after adjusting for age, sex, body mass, comorbid conditions, education level, smoking history, alcohol intake, and mean blood pressure (P < 0.002, conditional risk ratio for community controls compared with the runners, 4.27; 95% CI, 1.78 to 10.26).

Conclusions: Older persons who engage in vigorous running and other aerobic activities have lower mortality and slower development of disability than do members of the general population. This association is probably related to increased aerobic activity, strength, fitness, and increased organ reserve rather than to an effect of postponed osteoarthritis development.




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Figure 1.
Progression of disability over time. Top.PBottom.

Runners' club members compared with community controls. Data from all patients and all data points were compared with data from continuing 1992 participants (completers). Bars represent 95% confidence limits. No significant differences existed between those completing 8 years of the study (1992 participants) and data including all data points, but significant differences between runners' club participants and community controls were observed at all time points ( < 0.01). Ever-runners compared with never-runners. Similar differences, significant at all time points, are seen when ever-runners, those who have ever run for 1 month or more, were compared with never-runners. Bars represent 95% confidence limits (1992 participants).

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Figure 2.
Progression of disability over time by sex.P

Runners' club compared with community controls. Disability progression is less in the runners' club members. Significant differences were noted for men and women, with the effects more pronounced in women ( < 0.05). Bars represent 95% confidence limits (1992 participants).

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Figure 3.
Disability levels by age.P

The figure presents a cross-sectional analysis of disability in runner's club, community control, and all participants in 1992. Differences between runner's club members and community controls are significant ( < 0.05) at all ages except for the youngest and the oldest. Bars represent 95% confidence limits.

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Figure 4.
Survival analysis.Table 4

Kaplan-Meier survival curves are presented for runners' club members and for community controls. Bars represent 95% confidence limits. These curves present the crude mortality data; shows data adjusted for relevant covariates.

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