Heart Benefits May Outweigh Impact on Knee Osteoarthritis in Golfers Who Walk the Course

Newswise — Golfers with knee osteoarthritis who walk the golf course rather than riding in a cart experience increased joint inflammation, but gain significant cardiovascular benefits from the aerobic activity, according to a new study presented this week at the Association of Academic Physiatrists Annual Meeting in Puerto Rico.

Golf is a popular activity in the United States played by more than 17 million people each year. However, in 69% of rounds played in this country, golfers use a motorized cart to travel between holes rather than walking the course. This choice can have a negative impact on the potential health benefits of the sport. In addition, golfers with knee osteoarthritis (OA) may avoid walking because they believe they may make their joint pain and cartilage degradation worse. OA is one of the leading causes of disability for people 50 years of age or older.

To measure the effect of walking the course on cardiovascular and knee joint health, researchers at the Shirley Ryan Ability Lab and the Northwestern Feinberg School of Medicine in Chicago conducted a study of golfers with and without knee OA. The study used blood biomarker analysis to show that golfers who have knee OA do not need to worry about exacerbating their disease, and may gain heath benefits, by walking the course and skipping the cart.

“Our research group was recently invited to be part of a consortium of researchers that study the health benefits of golf through the World Golf Foundation. The impetus for the study stemmed from the fact that the majority of rounds of golf in the United States are now played with a golf cart, which has been suggested to affect the health benefits of the sport. We wanted to measure the effect of this in individuals with knee OA,” said Prakash Jayabalan, MD, PhD, Attending Physician and Clinician-Scientist in Sports Medicine at AbilityLab, and Assistant Professor at Northwestern University Feinberg School of Medicine. Dr. Jayabalan is a co-author of the study.

Participants in the study included 10 individuals with knee OA who each completed two 18-hole rounds of golf. In one round, they walked the course, and in the other, they used a golf cart. The study also included five healthy controls who played two 18-hole rounds of golf, but only walked the course.

The researchers measured golfers’ step count, heart rate, rating of perceived exertion (RPE) and pain score during the golf round. They also collected blood/serum samples at baseline, at the 9^th hole (the study’s midpoint), and at the 18^th hole (the study’s endpoint). Their samples were tested for OA biomarkers, or signs of inflammation.

They found that the golfers with OA who walked the course had significantly higher RPE, step count and duration of moderate/vigorous intensity activity (72.2% vs. 32.6% of the round). However, they had a slight but significant increase in pain. Both walking the course and riding in a cart walk for golf rounds did cause an increase in COMP, a cartilage breakdown marker, from the baseline of the study to the end of the round. The researchers also found that golfers’ Inflammatory markers significantly increased at the completion of the round when they walked the course, including TNF-α, IL-6 and IL-1β.  However, they found that MMP-3 and -13, two cartilage degradative enzymes, both increased significantly after walking or riding in a cart during rounds. These biomarker changes were not seen in the golfers without knee OA.

Although walking a golf course may cause an increase in inflammation, there is evidence of cartilage remodeling effects in knees whether golfers walk or take the cart, the researchers concluded. Golfers should consider their individual symptoms and follow their physicians’ guidance. This study has quantified the differences in these transportation modes for the first time.

“Walking exercise is commonly advocated for individuals with knee OA. Our study suggests that golf maybe a good prescription of walking exercise particularly if they walk the course as they get more health benefits,” said Dr. Jayabalan. “This study was specifically conducted in individuals with knee OA who play golf regularly. Our next step is to evaluate golf as an exercise intervention in individuals with knee OA who do not play golf regularly.”

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