Causal association between physical activity and knee osteoarthritis – a systematic review and dose-response meta‑analysis of cohort and mendelian randomization studies

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Details: Category: 2025, Volume 21; 19 November 2025; Hits: 121

Jie Zeng ^1ABCD , Elena Cherkashina ^*2ACD , Ilia Cherkashin ^*2,3ABCD , Artur Kruszewski ^4A,D , Chengcheng Cai ^5CD

¹ Police Command and Tactics Department, Hunan Police Academy, Changsha, China;
² School of Physical Education, Hainan Normal University, Haikou, Hainan Province, China
³ Institute of Physical Culture and Sports, North-Eastern Federal University, Yakutsk, Russia
⁴ Jozef Pilsudski University of Physical Education in Warsaw, Warsaw, Poland
⁵ College of Profession Tennis, Wuhan City Polytechnic, Wuhan, China
* Correspondence authors: Elena Cherkashina, Hainan Normal University, No. 99, Longkun South Road, Haikou City, Hainan Province,
China; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.; Ilia Cherkashin, Hainan Normal University, No. 99, Longkun South Road, Haikou City, Hainan
Province, China; North-Eastern Federal University, No. 58, Belinskogo street, Yakutsk City, Republic of Sakha, Russia e-mail:
Send to: I Cherkashin
Jie Zeng: https://orcid.org/0009-0006-5294-5171
Cherkashina Elena: https://orcid.org/0000-0002-3477-8801
Cherkashin Ilia: https://orcid.org/0000-0002-3015-3003
Kruszewski Artur: https://orcid.org/0000-0002-3930-7304
Chengcheng Cai: https://orcid.org/0009-0000-7961-5961

Abstract

Background and Study Aim: Previous studies have reported an association between physical activity (PA) and the occurrence
and progression of knee osteoarthritis (KOA). However, the existing evidence remains limited and of low-quality. This meta-
analysis aims to synthesize existing knowledge on the dose-response relationship between PA and the risk of KOA.
Material and Methods: This meta-analysis included 7 cohort studies and 7 mendelian randomization (MR) studies comprising
2840 cases of KOA, selected from three databases: PubMed, Web of Science, and CNKI up to April 4, 2024. In the qualified
studies, PA was primarily restricted and classified into exercise or sport, and the primary outcome indicators included the risk of
KOA.

Results: The categorical dose–relationship analysis from the MR study showed that moderate-to-vigorous physical activity
(MVPA), and light physical activity (LPA) are the protective factors for developing KOA (OR = 0.83, 95%CI: 0.73-0.94; OR = 0.71,
95%CI: 0.63,0.80). meeting WHO PA guidelines (≥10 Met/week) is not a significant factor for preventing KOA. The continuous
dose–relationship analysis showed that there was a significant nonlinear positive dose-response relationship between PA and the
risk of KOA. The linear model showed that the OR of KOA increased by 3% for every additional 4.5 met-h/week (OR = 1.03, 95%
CI 1.00-1.07).

Conclusions: The LPA and MVPA within a specific dose range were associated with a reduced risk of KOA, and high-dose PA
was associated with an increased risk of KOA. There was a significant nonlinear positive dose-response relationship between PA
and the risk of KOA. We underscore the necessity for future research endeavors to deeper into understanding how various types
of physical activity affect KOA risk and to devise effective preventive strategies and interventions aimed at mitigating the
occurrence of physical activity-associated KOA.

Keywords: joint pain, knee pain, MET, osteoarthritis patients

AMA

Arch Budo J Inn Agon. 2025, VOLUME 21, 2 of 2

Zeng J, Cherkashina E, Cherkashin I, Kruszewski A, Cai C. Causal association between physical activity
and knee osteoarthritis—a systematic review and dose-response meta-analysis of cohort and Mendelian
randomization studies. Arch Budo J Inn Agon. 2025;21.

APA

Zeng, J., Cherkashina, E., Cherkashin, I., Kruszewski, A., & Cai, C. (2025). Causal association between
physical activity and knee osteoarthritis—a systematic review and dose-response meta-analysis of cohort
and Mendelian randomization studies. Arch Budo Journal of Innovation and Agonology, 21.

Chicago
Zeng, Jie, Elena Cherkashina, Ilia Cherkashin, Artur Kruszewski, and Chengcheng Cai. 2025. "Causal
Association Between Physical Activity and Knee Osteoarthritis—A Systematic Review and Dose-Response
Meta-Analysis of Cohort and Mendelian Randomization Studies." Arch Budo Journal of Innovation and
Agonology 21.

Harvard

Zeng, J., Cherkashina, E., Cherkashin, I., Kruszewski, A. & Cai, C. (2025). Causal association between
physical activity and knee osteoarthritis—a systematic review and dose-response meta-analysis of cohort
and Mendelian randomization studies. Arch Budo Journal of Innovation and Agonology, 21.

MLA

Zeng, Jie, Elena Cherkashina, Ilia Cherkashin, Artur Kruszewski, and Chengcheng Cai. "Causal Association
Between Physical Activity and Knee Osteoarthritis—A Systematic Review and Dose-Response Meta-
Analysis of Cohort and Mendelian Randomization Studies." Arch Budo Journal of Innovation and
Agonology, vol. 21, 2025.

Vancouver

Zeng J, Cherkashina E, Cherkashin I, Kruszewski A, Cai C. Causal association between physical activity
and knee osteoarthritis—a systematic review and dose-response meta-analysis of cohort and Mendelian
randomization studies. Arch Budo J Inn Agon. 2025;21.

OUR POLICY

Mission of ARCHBUDO

The specific mission of the Archives of Budo 2023 is to strive for a breakthrough in public perception of a broad class of combat sports and martial arts as specific means of innovative agonology.