Evidence mapPaperPMID 40511516Full record

SynthesisJournal of global health2025

Association between physical activity and knee osteoarthritis: a comprehensive systematic review and meta-analysis.

Xiaofeng Cui, Fangfang Xie, Jiahe Cui, Yukui Tian, Xue Bai, Lei Guo, Junchang Liu, Fei Yao

Abstract readSystematic ReviewMeta-Analysis
In one paragraph

Synthesis in Journal of global health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed.

  1. Observational
  2. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Xiaofeng Cui *The Fourth Clinical Medical College, Xinjiang Medical University, Urumqi, China.
Fangfang Xie *School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Jiahe CuiSchool of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Yukui TianThe Fourth Clinical Medical College, Xinjiang Medical University, Urumqi, China.
Xue BaiThe Fourth Clinical Medical College, Xinjiang Medical University, Urumqi, China.
Lei GuoThe Fourth Clinical Medical College, Xinjiang Medical University, Urumqi, China.
Junchang Liu
Fei YaoSchool of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Knee osteoarthritis (KOA), a debilitating chronic degenerative joint disease, substantially compromises patients' functional capacity and quality of life. Although physical activity (PA) has been recognised as a modifiable risk factor in the development of KOA, its potential protective role remains debated. To clarify this clinical uncertainty, we conducted a rigorous systematic review and meta-analysis to comprehensively assess the association between PA levels and the risk of incident KOA. Methods: We systematically searched PubMed, EMBASE, Cochrane Library, CINAHL, Web of Science databases for published observational studies on the association between PA and knee osteoarthritis. Following the PRISMA guidelines, we selected English literature from inception to publication on 21 September 2024, and assessed study quality according to the Newcastle-Ottawa scale. Our protocol is available on PROSPERO. Results: Our systematic screening identified 14 eligible observational studies (13 cohort studies and one case-control study) involving 507 696 participants with 27 412 incident cases of KOA. A pooled analysis comparing levels of PA intensity showed a 26% increased risk of knee OA for high PA compared with moderate PA (relative risk (RR) = 1.26; 95% CI = 1.17-1.37). In contrast, neither high PA (RR = 1.02; 95% CI = 0.84-1.23) nor moderate PA (RR = 0.94; 95% CI = 0.84-1.05) showed protective effects compared with low PA reference groups. Stratified analyses showed nonsignificant associations in cohort studies (RR = 1.06; 95% CI = 0.87-1.29) compared with case-control studies (RR = 0.41; 95% CI = 0.20-0.83). Notably, regional subgroup analyses showed comparable PA-related risks between European (RR = 1.01; 95% CI = 0.74-1.38) and North American populations (RR = 1.03; 95% CI = 0.81-1.31). Crucially, gender-stratified analyses demonstrated no significant differential risk in males (RR = 1.20; 95% CI = 0.54-2.70) vs. females (RR = 0.73; 95% CI = 0.29-1.82). Conclusions: This systematic review comprehensively demonstrated a dose-dependent relationship between physical activity intensity and the risk of knee osteoarthritis. Our meta-analysis showed that high PA levels significantly increased the risk of knee osteoarthritis compared with moderate PA. In addition, limited evidence suggested that exceeding international PA guidelines may increase the risk of osteoarthritis (RR = 1.18; 95% CI = 1.02-1.35). However, future studies need to be executed to further define the type of activity, optimal dose and duration required to effectively reduce the risk of knee osteoarthritis. Registration: PROSPERO: CRD42024600175.

Indexed as

ExerciseOsteoarthritis, KneeHumansRisk Factors

Identifiers

PMID40511516
PMCPMC12163862

What Socratic holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.