Study finds increased cartilage tissue turnover in knee osteoarthritis patients after intensity exercise-training

According to a recent study published in Arthritis Research & Therapy, patients with knee osteoarthritis showed enhanced cartilage degradation and tissue turnover after a 3-month, exercise-related joint loading training program.

Christian S. Thudium and co-researchers conducted a secondary analysis of the VIDEX trial, a single-blinded, randomized controlled trial. The study involving 177 elderly patients with knee osteoarthritis has noted more cartilage degeneration in the high-intensity resistance supervised training group after a 3- and 6-month exercise-related joint loading program. Additionally, the researchers observed increased levels of human antibiotic resistance genes (huARGS) and C2M after training in both the high- and low-intensity groups. Compared to the low-intensity resistance training group, the high-intensity group increased huARGS levels after training (P=0.028) and at follow-up (P=0.003). Although the VIDEX trial found no differences in clinical outcomes between the high-intensity and low-intensity groups, these exploratory biomarker results show increased cartilage deterioration in the high-intensity group.

A randomized, crossover, exploratory clinical study conducted in 2021 reported changes in the biochemical markers of type II and VI collagen degradation following intense exercise in patients with knee osteoarthritis. The study included 20 subjects with knee osteoarthritis. Compared to resting and running, C2M levels tended to rise after cycling, and the type II collagen formation/degradation ratio tended to increase after cycling but not after running. After cycling and running, C6M levels tended to decline. Therefore, moderate-intensity exercise induces acute changes in the circulating levels of biochemical markers.

The increased serum levels of huARGS and C2M suggest changes in cartilage tissue turnover from the training program. However, it is essential to note that further research is needed to confirm this relationship and to determine the extent to which a training program can affect cartilage tissue turnover.


  1. Thudium CS, Engstrøm A, Bay-Jensen AC, Frederiksen P, Jansen N, De Zwart A, van der Leeden M, Dekker J, Lems W, Roorda L, van Spil WE. Cartilage tissue turnover increases with high-compared to low-intensity resistance training in patients with knee OA. Arthritis Research & Therapy. 2023 Dec;25(1):1-8.
  2. Bjerre-Bastos JJ, Nielsen HB, Andersen JR, Karsdal M, Bay-Jensen AC, Boesen M, Mackey AL, Byrjalsen I, Bihlet AR. Does moderate intensity impact exercise and non-impact exercise induce acute changes in collagen biochemical markers related to osteoarthritis?–An exploratory randomized cross-over trial. Osteoarthritis and Cartilage. 2021 Jul 1;29(7):986-94.