Physical Activity Levels and Quality of Life Relate to
Collagen Turnover and Inflammation Changes After Running

NM, Driban JB, Barbe MF, Tierney R, Amin M, Sitler MR.J Orthop Res. 2016: ahead
of print

Take Home Message: Poor
scores on the Knee Osteoarthritis Outcome Score and Tegner Activity Scale may
be associated with elevated biomarker concentration levels that reflect collagen

the risk factors for early return to play following a musculoskeletal injury is
important due to the increased chance for developing chronic injuries or never
returning back to pre-injury activity levels. One potential solution to obtain
a more definitive gauge on readiness to return is to measure biochemical
markers (
biomarkers). Therefore, the
authors measured 22 athletes (11 with a history of ACL and/or meniscal surgery
and 11 healthy matched controls) blood serum before and after a 30-minute set paced run on a treadmill to assess if pre-exercise
patient-reported outcomes are related with biomarker changes of collagen
turnover, inflammation, and bone/cartilage degeneration. Specifically, the
authors measured 4 biomarkers important for collagen turnover: cartilage
oligomeric matrix protein (COMP), c-terminal cross linking telopeptide of type
II collagen (CTX-II), type II collagen fragments (CPII), CTX-II/CPII ratios.
They also measured one inflammatory biomarker (interleukin-1β) and one
biomarker of bone and cartilage degeneration (matrix metalloproteinase (MMP)-13).
The patient-reported measures were
Knee Osteoarthritis Outcomes Score (KOOS;
5 subscales for perceptions of pain, symptoms, knee health, and overall quality
of life) and
Tegner Activity Scale scores
(to assess activity level). Athletes with a history of knee injury reported
lower KOOS scores on all 5 subscales compared with healthy athletes. There were
no differences in biomarker concentration levels between groups. However, ACL
knee history patient’s pre-exercise quality of life score was negatively
associated with post exercise interleukin-1β. Similarly, ACL knee history
patient’s pre-exercise Tegner activity levels demonstrated a negative
correlation to post exercise CTX-II/CPII ration. No other relationships were
noted between pre and post exercise biomarkers and the patient-reported

authors found that measuring biomarker levels after an acute bout of running
revealed relationships between pre exercise knee-related quality of life and activity
levels. Each were negatively correlated; therefore, as quality of life and
activity levels decline the amount of proteins reflective of collagen
degradation and inflammation rose, which suggests that athletes with lower
activity levels and lower quality of life experienced greater increases in
collagen turnover and inflammation after only 30 minutes of running,
respectively. It would be interesting to see how athlete’s biomarkers would
respond after an intense game or a normal practice if 30 minutes of running
could cause a measurable association between reported outcome and concentration
level. It was also alarming to see that athletes with previous ACL or meniscal
injury reported lower KOOS scores on all 5 subscales within previously injured
group compared to controls; however, they were all cleared to return to play
and there was also no difference in activity level reported between groups. Currently,
medical professionals should be aware that pre-exercise self reported outcome
may be able to identify athletes at risk for abnormal biomarker responses and
lower quality of life that could lead to unhealthy changes in lifestyle

Questions for Discussion:
Do you use patient reported outcome measures to determine readiness to return
to play? Would you use biomarker data to help aid in your return to play decision-making?

Jane McDevitt, PhD
by: Stephen Thomas


Cattano NM, Driban JB, Barbe MF, Tierney R, Amin M, & Sitler MR (2016). Physical activity levels and quality of life relate to collagen turnover and inflammation changes after running. Journal of Orthopaedic Research PMID: 27035929