The Effects of Well-Rounded Exercise Program on Systemic Biomarkers Related to Cartilage Metabolism

Cartilage. 2019 Oct;10(4):451-458. doi: 10.1177/1947603518767998. Epub 2018 Apr 12.


Nonsurgical treatment such as exercise is the preferred method for management of knee osteoarthritis (OA). A combination of aerobic, muscle strengthening, and flexibility exercises is recommended for older adults. However, effects of the exercise intervention on cartilage metabolism remain unclear. This study used biomarkers to investigate the effects of well-rounded exercise program on cartilage metabolism in 42 women (mean age: 59 years). Participants started a weekly supervised exercise program and continued for 12 weeks. Before and after the program, we measured physical performance on the Timed Up-and-Go Test, 3-Minute Walk Test, and 30-Second Chair Stand Test. We collected serum and urine samples at the start of the program until 24 weeks and measured the concentrations of 4 biomarkers related to type II collagen metabolism: serum cartilage type II procollagen carboxy propeptide (sPIICP), urine C-terminal telopeptide of collagen type II (uCTX-II), urine cleavage of type II collagen by collagenases (uC2C), and serum cartilage oligomeric matrix protein (sCOMP). Participants were divided into pre-OA and OA groups based on X-ray findings. The pre-OA group showed significant increases and decreases in sPIICP and uCTX-II concentrations with improved physical performance, respectively. sCOMP concentrations significantly increased in both groups. The exercise also improved physical performance with no detrimental effect on type II collagen metabolism in the OA group. Thus, well-rounded exercise may not only improve physical capacity but also have beneficial effects on type II collagen metabolism, especially in people without radiological OA.

Keywords: articular cartilage; biomarker; exercise; osteoarthritis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Biomarkers / metabolism
  • Cartilage Oligomeric Matrix Protein / blood
  • Cartilage, Articular / metabolism*
  • Collagen Type II / metabolism
  • Exercise / physiology
  • Exercise Test / methods
  • Exercise Therapy / methods*
  • Female
  • Humans
  • Knee Joint / diagnostic imaging
  • Knee Joint / metabolism*
  • Middle Aged
  • Osteoarthritis, Knee / diagnostic imaging
  • Osteoarthritis, Knee / metabolism
  • Osteoarthritis, Knee / physiopathology
  • Osteoarthritis, Knee / rehabilitation*
  • Radiography
  • Severity of Illness Index


  • Biomarkers
  • COMP protein, human
  • Cartilage Oligomeric Matrix Protein
  • Collagen Type II