Trouble with stairs linked to earlier death in knee OA

4 minute read

Stair climbing behaviours are a quick and easy way to flag poor health outcomes at an early stage, research suggests.

People with knee OA who reported difficulties with stair climbing are almost twice as likely to die within the 13-year follow-up as those with no difficulties, say researchers. 

Meanwhile, those who climbed at least seven flights of stairs per week reduced the risk of all-cause mortality by over a third when compared with people who climbed two or fewer flights per week. 

“Changes in stair climbing, driven by pain, are often one of the first reported limitations for those with knee OA,” wrote the authors in the Journal of Rheumatology

“Stair climbing, like walking speed, challenges several body systems, such as the cardiovascular and muscular systems. 

“These findings highlight that trouble with stair climbing and/or infrequent stair use may serve as important early risk factors of future poor health outcomes in OA,” they wrote, adding that it “would give clinicians ample time to monitor, treat, or refer the patient for intervention to prevent or delay negative health outcomes”. 

The US researchers used data from the Osteoarthritis Initiative, which included almost 5000 adults with or at high risk of knee OA. They looked at self-reported difficulties with stair climbing and stair climbing frequency, and likelihood of death from any cause within the 13-year follow-up. Almost 7% of the group died within the study time frame. 

Results were adjusted for potential confounders including age, gender, BMI, race, radiographic OA, pain and comorbidities. 

Around 14% of those who said they were “limited a lot” by stair climbing died, more than double that in the “not limited at all” group, at just over 6%, with an adjusted hazard ratio of 1.84. 

In terms of stair climbing frequency, those who climbed seven or more flights of stairs per week were 38% less likely to die over the follow-up period than those in the group who climbed zero to two flights of stairs per week. 

“We found that both difficulty with stair climbing and less frequent stair climbing were related with greater all-cause mortality hazard over 13 years in adults with or at high risk for knee OA,” wrote the authors. 

The authors noted that the ability to climb stairs required contributions from the cardiovascular system, the musculoskeletal system, the visual and vestibular systems, and coordination of upper and lower body motor systems. Difficulties with stair climbing may therefore indicate a problem in one or more of these systems. 

While slow walking speed and difficulty with walking have also been shown to predict all-cause mortality in older adults, including those with knee OA, it can be difficult to assess in a typical consultation. 

The advantage of using stair climbing as an indicator of potential problems, said the authors, was that it showed up earlier and could be readily assessed with some brief questions.  

Questions addressing stair climbing in the Osteoarthritis Initiative dataset included: “Does your health now limit you in climbing several flights of stairs?”, with patients able to answer a lot, a little or not at all; and “During the past seven days, how many flights of stairs have you climbed up?”, with patients able to answer less than one, one-two, three-four, five-six and more than six. 

“Stair climbing behaviours are simple for patients to recall and relatively quick for clinicians to collect,” the authors pointed out. 

“Changes to stair climbing may occur early in the course of knee OA and are often the first reported limitation, potentially serving as an early indicator for future decline.  

“Therefore, these data would give clinicians ample time to monitor, treat, or refer the patient for intervention to prevent or delay negative health outcomes.” 

The Journal of Rheumatology 2024, online 1 April 

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