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From presidents to retirees, more than 17 million people over the age of 50 golf regularly. At the same time, knee osteoarthritis (OA), which causes swelling,pain and difficulty moving the joint, is one of the leading causes of disability in this age group. Although it may seem intuitive that golfers with OA should stay off their feet and ride in a golf cart, new research from the Shirley Ryan Ïã¸ÛÁùºÏ²Ê¼´Ê±¿ª½± 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 or inflammation.

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. Findings are being presented today at the Osteoarthritis Research Society International Annual Meeting in Liverpool, England.

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The health benefits of golf have decreased as the number of people who ride the course has increased by 53 percent. In the late 1980s, 45 percent of all rounds of gulf were played with a golf cart. By 2006, 69 percent of rounds were played with a cart. During this same time period, activity decreased among Americans, while obesity increased.

¡°Individuals with knee OA are often concerned about pain and may be more likely to use a golf cart,¡± said Prakash Jayabalan, M.D., Ph.D., physician scientist at the Shirley Ryan Ïã¸ÛÁùºÏ²Ê¼´Ê±¿ª½±, assistant professor at Northwestern University Feinberg School of Medicine and lead study author. ¡°However, through sophisticated blood-based biomarker analysis, this study has shown that golfers with knee OA do not need to be concerned about worsening their disease through walking the course; in fact, walking provides the best health benefit.¡±

The study, completed in partnership with the Glenview Park District Golf Course in Glenview, Ill., involved 15 participants¡ª10 of whom had knee osteoarthritis and five who were of similar age but did not have the disease. Participants played 18 holes ¡ª one round of golf ¡ª walking the course and, on a separate day, the same individuals played a round using a golf cart. The research team compared their heart rates to determine the intensity of exercise performed and also took blood samples during each round to measure markers of cartilage stress and inflammation.

The researchers found that, prior to starting either round, the golfers with knee OA 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 and, 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 OA 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.

Therefore, although walking the course offers the most significant health benefits, the study found that riding the course with a golf cart during a round¡ª and the requisite moderate walking that comes with it¡ª still brings cardiovascular benefits and helps to fulfil daily exercise guidelines.

¡°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.