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Many middle-aged and older people question whether participation in sports or intense exercise programs increases the risk of developing osteoarthritis or accelerates degeneration of joints with minimal osteoarthritis. Although articular cartilage undergoes significant age-related changes in chondrocyte function and matrix composition, the available evidence does not show that moderate exercise by middle-aged and older people increases their risk of developing osteoarthritis; also, carefully selected sports and exercise programs can improve strength and mobility in older people and people with mild and moderate osteoarthritis. Sports and exercise programs that subject joints to repetitive high levels of impact and torsional loading can increase the risk of joint injury and degeneration. Individuals with abnormal joint anatomy or alignment, previous significant joint injury, joint instability, disturbances of joint or muscle innervation, or inadequate muscle strength probably have increased risk of degenerative joint disease from exercise that subjects their joints to loads greater than those that result from normal activities of daily living, especially activities that involve repetitive impact or torsion. These individuals and people with early osteoarthritis can benefit from regular exercise, but they should have a careful evaluation of their joint structure and function before participating in sports or intense exercise programs. In most instances, they would be best advised to select physical activities that maintain joint motion and muscle strength with minimal impact or torsional loading, thereby gaining improved general health and mobility with minimal increased risk of osteoarthritis.