The Benefits of Bicycling on Knee Arthritis and Pain

Bicycling, whether outdoors or in a spinning class, may help prevent knee arthritis and pain. A recent analysis of data from over 2,600 individuals in their 60s revealed that those who had biked at any point in their lives were 17% less likely to develop knee pain and 21% less likely to develop arthritis-related knee pain. These findings were published earlier this month in *Medicine & Science in Sports & Exercise*.

Insights from an Observational Study

“Based on our observational study, bicycling over a lifetime is associated with better knee health, including less knee pain and less damage to the joint,” stated Dr. Grace Lo, the study’s lead author and chief of rheumatology at the Michael E. DeBakey VA Medical Center in Houston. “The more periods of time in life a person spent bicycling, the less likely they were to experience knee pain and signs of osteoarthritis.” Dr. Lo, who also serves as an associate professor of medicine at Baylor College of Medicine, added a personal note: “The findings from the study make me feel pretty good about making my kids ride their bikes regularly, and I will continue to encourage that activity. I am also glad that I bike whenever I get the chance.”

Bicycling Strengthens Knee Muscles

Individuals with knee arthritis are often advised to keep their joints moving, though the best activity has been unclear. This new study suggests that biking may strengthen the muscles around the knees without causing the jarring impact on the joints associated with activities like running. Dr. Lo and her colleagues focused on a subset of volunteers from the Osteoarthritis Initiative, a multicenter observational study that recruited participants aged 45 to 79, some with knee arthritis and some without.

Eight years into the original study, participants filled out a questionnaire about their leisure physical activity during four life periods: ages 12 to 18, 19 to 34, 35 to 49, and 50 and older. Over half had consistently cycled at some point in their lives.

Understanding Biking's Protective Benefits

While the study’s data cannot definitively explain why biking might be protective, Dr. Lo suspects that individuals who biked between ages 12 and 18 built up their quadriceps muscles, which may have continued to provide benefits even if they did not bike regularly thereafter. Biking’s non-jarring nature likely contributes to its benefits. “We know that non-weight-bearing activities are less likely to cause pain,” Lo explained. “That’s probably a reason why people experience less pain when bicycling compared to other activities.”

Expert Opinions and Recommendations

“This is a significant study,” remarked Dr. Andrew Gregory, an associate professor of orthopedics, neurosurgery, and pediatrics at the Vanderbilt University Medical Center in Nashville. He noted that activities involving knee movement help maintain cartilage health. “Movement of the joint is crucial because it drives nutrients into the cartilage,” he said, adding that this part of the knee has no blood supply of its own.

Dr. Gregory highlighted that biking strengthens the glutes, which support the hips and knees and help with side-to-side motion, whereas running primarily works muscles in a straight line. Without strong side muscles, the knees are more vulnerable to injury.

Practical Cycling Advice

The study does not specify how often individuals should bicycle, but general recommendations for physical activity can be applied. Dr. Christine Peoples, a clinical associate professor of medicine in the division of rheumatology at the University of Pittsburgh, advises, “If you’re not active now, start slow and cycle two to three times a week, pedaling slowly and at a low intensity. Make sure you’re on a bike with a supportive seat position. Then you can gradually increase the intensity.”

Study Limitations and Further Research

Dr. Scott Barbuto, an assistant professor of rehabilitation and regenerative medicine at the Columbia University Vagelos College of Physicians and Surgeons, noted that while the study is promising, it is retrospective, meaning causality cannot be confirmed. “When a study is retrospective, causality cannot be established,” he said. Prospective trials, where participants are randomly assigned to bike or not bike, are not feasible due to the long time it takes for arthritis to develop.

Mechanisms of Biking's Benefits

Biking may benefit the knees by stimulating the production of factors that limit inflammation and by strengthening the leg muscles that support the knees without the impact stress associated with running. Physical therapy for an arthritic knee includes exercises to strengthen the muscles around the joint, underscoring the importance of muscle support in managing knee health.