From presidents to retirees, more than 17 million people over the age of 50 golf regularly. Knee osteoarthritis, which causes swelling, pain and difficulty moving the joint, is one of the leading causes of disability in this age group.
It may seem intuitive that golfers with knee osteoarthritis should
stay off their feet and ride in a golf cart. But new research from the
Shirley Ryan AbilityLab and Northwestern Medicine has found, for the
first time, that walking the course provides significantly higher health
benefits and is not associated with increased pain, cartilage breakdown
This study is the first comparing the health benefits of walking the
golf course versus using a cart, as well as the first to use a
blood-based biomarker analysis in knee osteoarthritis during a prolonged
sporting event. The findings will be presented April 28 at the
Osteoarthritis Research Society International Annual Meeting in
The health benefits of golf have decreased as the number of people
who ride the course has increased over the past 20 years. In the late
1980s, 45 percent of all rounds of golf were played with a golf cart. By
2006, 69 percent of rounds were played with a cart. During this same
time period, activity has decreased among Americans, while obesity has
"Individuals with knee osteoarthritis are often concerned about pain
and may be more likely to use a golf cart," said lead study author Dr.
Prakash Jayabalan, a physician scientist at the Shirley Ryan AbilityLab
and an assistant professor of physical medicine and rehabilitation at
Northwestern University Feinberg School of Medicine.
"However, through sophisticated blood-based biomarker analysis, this
study has shown that golfers with knee osteoarthritis do not need to be
concerned about worsening their disease through walking the course. In
fact, walking provides the best health benefit," Jayabalan said.
The study, completed in partnership with the Glenview Park District
Golf Course in Glenview, Illinois, involved 15 participants -- 10 who
had knee osteoarthritis and five who were of similar age but did not
have the disease. Participants played 18 holes (one round of golf)
walking the course and, on a separate day, the same individuals played a
round riding a golf cart. The research team compared their heart rates
to determine the intensity of exercise performed and took blood samples
during each round to measure markers of cartilage stress and
The researchers found that, prior to starting either round, the
golfers with knee osteoarthritis had an average pain score of 1.3 (on a
scale of 0-10). When they played the round walking the course, they had
an average 2.1-point increase in pain score. When they played the round
using the golf cart, they experienced on average a 1.5-point increase, a
difference that is not clinically significant.
The research team also measured blood-based biomarkers of cartilage
stress and inflammation. Although both methods of transportation caused
an increase in these markers (as would be expected with regular
walking), there was no difference between the rounds.
When walking the course, golfers with knee osteoarthritis spent more
than 60 percent of the round with heart rates in the moderate intensity
heart rate zone. When driving on a cart, golfers spent 30 percent of
the round in this range. While this figure is lower, it still fulfills
daily exercise recommendations.
Although walking the course offers the most significant health
benefits, the study found that riding the course with a golf cart during
a round -- and the requisite moderate walking that comes with it --
still offers cardiovascular benefits and helps fulfill daily exercise
"Bottom line: walking the course is significantly better than using a
golf cart, but using a golf cart is still better than not exercising at
all," said Jayabalan.