A horseshoe is usually all the fells around a valley, the Lake District is basically made up of open ended valleys with the highest ground on ridges with multiple peaks usually getting higher towards the closed end of the valley. The advantage of a horseshoe is that you end up very close to your starting point so it's ideal for racing. The most famous of these are probably the Fairfield horseshoe, the Kentmere horseshoe and the Langdale horseshoe but there are others such as Wasdale and Ennerdale. Most of these have fell races and are in the championships. There are also " horseshoes " in many other places such as Scotland, Yorkshire and even the Isle of Wight.
Nope, I’ve been running *fast* up and down hills since I was a kid - and I am an almost-50-year-old competitive runner. My knees are great! You just need strong quads.