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Abstract

Objective

To investigate the effects of exercise training alone and in combination with kinesio taping on pain, functionality, and circulating cartilage oligomeric matrix protein (COMP), and matrix metalloproteinase (MMP)-1, and -3 at rest and immediately after walking exercise in knee osteoarthritis (OA).

Design

A total of 22 female patients diagnosed with knee OA were randomly divided into the exercise training (ET) or exercise training plus kinesio taping (ET + KT) groups. The patients in the ET performed exercise training for 6 weeks. The patients in the ET + KT group were applied with kinesio tape in addition to the exercise training for 6 weeks. In both groups, 20 minutes of walking exercise were performed before and after the interventions. The pain and functional status of the patients were assessed using visual analogue scale (VAS) and Western Ontario McMasters Osteoarthritis Index (WOMAC) before and after the intervention at rest, respectively. Blood samples were taken at rest and immediately after the walking exercise before and after the interventions for the analysis of COMP, MMP-1, and MMP-3 levels.

Results

In both groups, pain and functionality scores were significantly improved after the interventions (P < 0.05). COMP, MMP-1 and MMP-3 levels were higher immediately after walking exercise when compared with rest in both groups before and after the intervention (P < 0.05).

Conclusions

Exercise training and exercise training plus kinesio taping improved pain and physical function; however, the COMP, MMP-1, and MMP-3 levels did not change.

Keywords

knee osteoarthritis exercise kinesio taping COMP MMPs pain

Introduction

Osteoarthritis (OA) is a chronic, multifactorial, and degenerative disorder that mainly is seen in cartilage, subchondral bone, synovium, and muscles.^1,2 It is characterized by the loss of joint space, articular cartilage disorders, subchondral bone destruction, and synovial membrane thickening.^3,4 The knee is the most affected joint in OA, and knee OA patients experience inflammation, pain, stiffness, muscle atrophy, and functional disability.⁵ Physical disability caused by pain and loss of functional capacity in knee OA reduce life quality. Interestingly, women are more affected by knee OA than men.⁶ Although differences in knee anatomy, kinematics, previous knee injury, and hormonal influences have been shown to cause the disease,⁷ the true cause and underlying cellular and molecular mechanisms are still unclear. Current knee OA treatments aim to alleviate these symptoms by a variety of methods such as pharmacological, nonpharmacological, surgical, and nonsurgical interventions. Among the nonpharmacological modalities, exercise training and kinesio taping have gained popularity in recent years.⁸

There are no diagnostic tests that are routinely used to diagnose OA, but several biomarkers have been used to assess the severity of OA.⁹ One of the possible biomarkers of OA are the products of bone and cartilage degradation,^10,11 among which cartilage oligomeric matrix protein (COMP) and matrix metalloproteinases (MMPs) are the most studied biomarkers.¹² The fact that the levels of these markers are proportional to the degree of knee OA and that serum levels correlate with synovial fluid levels led to much work on them.^13-15

COMP is a noncollagen protein found primarily in articular cartilage,¹⁶ and plays a role for the maintenance of mature collagen network.¹⁷ Its level in synovial fluid correlates with serum level,¹⁸ and age, weight, and mechanical loading affect the serum COMP level in healthy individuals.¹⁹ In addition, an increase in serum COMP level has been reported in patients with knee OA,^19,20 and athletes after exercise.²¹ Furthermore, serum COMP level reflects the severity of the disease in the early stage of knee OA.²²

MMPs are a group of extracellular enzymes responsible for extracellular matrix (ECM) degradation.²³ MMP-3 is produced mainly in synovial tissue and cartilage and is responsible for cartilage matrix degradation and joint inflammation²⁴ and activates proMMPs 1, 7, 8, 9, and 13.²⁵ MMP-1, -8, and -13 are members of the collagenases that are responsible for the degradation of intact collagen type II which is the main component of the articular cartilage.²³ However, MMP-7 and MMP-9 play an important role in ECM homeostasis and in joint disc remodeling.²⁶ Studies have shown that synovial fluid and circulating levels of MMP-1 and MMP-3 are higher in knee OA than healthy individuals, and MMP-1 and MMP-3 reflect the progression of joint disease.^12,25,27,28

It is well known that exercise training improves strength, balance, range of motion, body coordination and reduces morbidity and pain in knee OA patients.^20-30 In addition to aerobic and resistance exercises in different modalities such as water exercises, walking, Tai Chi and yoga; quadriceps and hamstring strength exercises are also recommended regardless of the patient’s age, gender, body mass index, radiographic status, and baseline status.^31,32 In addition, circulating levels of COMP and MMPs have been reported to slightly decrease or not change in response to exercise training.^17,33-35 However, acute loading, such as walking exercise, has been shown to cause a marked increase in serum COMP and MMPs levels 15, 30, 45, and even 60 minutes after exercise, but had returned to baseline within 24 hours.^{17,25,28,29,33} Erhart-Hledik et al.³⁶ found that serum COMP levels increased after 30 minutes of walking exercise, and this amount of increase was closely related to the 5-year rate of cartilage loss in participants with knee OA.

Kinesio taping is an alternative taping method that reduces pain and edema, induces functional and proprioceptive stimulation, improves muscle activity, and prevents and treats sports injuries.^37,38 Number of studies^37,39-42 have examined the effects of kinesio taping on knee OA, but conflicting results have been obtained on pain and functionality. However, to our knowledge, no study has so far investigated the effects of kinesio taping on COMP, MMP-1, and MMP-3 levels in knee OA.

Since exercise training reverses knee OA-induced pain and functional impairment, we assumed that the combination of exercise training and kinesio taping may have a synergistic effect on knee OA symptoms and treatment. Therefore, the primary objective of this study was to investigate the effects exercise training alone and in combination with kinesio taping could have on pain, functionality, and circulating COMP, MMP-1, and MMP-3 levels at rest in patients with knee OA. Additionally, since acute loading causes an increase in serum COMP and MMPs levels after exercise, exercise training alone and in combination with kinesio taping may prevent this elevation after exercise. Thus, our secondary goal was to examine changes in circulating COMP, MMP-1, and MMP-3 concentrations after 20 minutes of walking exercise before and after interventions.

Methods

Subjects

Study Sample

This study was a randomized, double-centered study. Participants were selected from the patients who applied to Konya Numune Hospital Physical Medicine and Rehabilitation Department outpatient clinic between June 2016 and November 2016. All measurements were performed in Selçuk University Faculty of Medicine Division of Sports Physiology Laboratory.

The study was approved by the Ethics Committee of Selçuk University (approval no. 2016/101, 30/03/2016) and all experiments were carried out in accordance with the Helsinki Declaration. All participants were given written and verbal information about the purpose, procedures, and potential risks of the study, and signed informed consent forms were obtained.

Inclusion and Exclusion Criteria

Inclusion criteria were patients between the ages of 38 and 60 years, having a knee OA diagnosis according to the American College of Rheumatology,⁵ and Kellgren-Lawrence index II and III in class, and signing the informed consent form.

The exclusion criteria were rheumatoid arthritis, severe organ failure, previous joint replacement, osteoporosis, and diagnosis of any disease that could limit performance.

Study Design

Based on the inclusion and exclusion criteria 22 adult women were included in this study. The patients were randomly divided into the exercise training (ET, n = 11) and exercise training plus kinesio taping (ET + KT, n = 11) groups. Randomization was carried out using the sealed envelope method. In this method, an investigator gathered the 22 patients who met the inclusion criteria, and each patient was instructed to randomly select one of the sealed envelopes. There were 22 sealed envelopes, and 11 of these enveloped contained letter A, and 11 contained letter B. The patients in the group A performed exercise training for 6 weeks. The patients in the group B were applied kinesio taping in addition to the exercise training for 6 weeks. In both groups, 20-minute walking exercise was performed as an acute loading before and after the intervention ( Fig. 1 ).

Figure 1.

Flowchart of study design.

Interventions

Exercise Training Protocol

The exercise training consisted of 6 weeks of training with 3 days per week. This program was designed based on the recommendation of the American Geriatrics Society.⁴³ Each exercise session consisted of a total of 50-minute sessions of 10 minutes of warm-up, 20 minutes of resistance, 10 minutes of balance and stabilization, 5 minutes of lower limb stretching, and 5 minutes of cool-down exercises ( Table 1 ). All sessions were supervised by a trained physiotherapist (first author). The 20 minutes of walking exercise was done before and after the intervention at the participants’ own walking speed.

Table 1.

Summary and Timetable of the Exercise Program.

Duration (Minutes)	Step	Exercise	Description
10	Warm-up	Flexibility and mobility exercise	Exercising the hip, knee, and ankle joints while walking and sitting on the floor
20	Muscle strengthening	Isotonic exercise for the quadriceps muscles	In a supine position, using the resistance of ankle weights to raise the leg to 30° of hip flexion
		Isometric exercise for the quadriceps muscles	Raising the heel while sitting with the knees extended and contracting the quadriceps muscle as the knee pushes toward the mat
		Strengthening exercise for the hamstring muscles	In the prone position on the treatment table, the leg is bent toward the thigh from the extension and brought back to the table
		Isotonic exercise for the hip abduction muscles	Isometric hip abduction in the supine position using the resistance of the person’s own weight
		Side-lying isotonic exercise for the hip abduction muscles	In the side-lying position, the person performs isometric hip abduction using the resistance of their own weight
10	Balance and stabilizing	Walking forward	One foot is placed directly in front of the other (heel to toe) and they form a straight line, continuing to walk forward
		Walking backward	As above, stepping backward
		Side stepping	Stand with the feet together, one foot stepping forward and the back foot brought to the front, and then repeated in the opposite direction
		Toe walking	Walk forward on toes
		Heel walking	Walk forward on heels
5	Muscle stretching	Side-lying stretch for the quadriceps muscles	With the knees flexed in the side-lying position, one foot is pulled toward the back of the body and the quadriceps on the same side are stretched
5	Muscle stretching	Hamstring stretching	In the supine position, the hip joint is bent and fixed to its maximum range; The knee joint is then straightened as far as the shortened muscle allows
5	Cool-down	Slow walking

Kinesio Tape Application

Kinesio taping was applied 3 times per week over the study period of 6 weeks by the same experienced physiotherapist (first author). Before the kinesio taping, the skin surface was cleaned. Patients were positioned lying on their side, hip extended, and knee joint at 60° of flexion. The knee was taped with an I-shaped kinesio tape starting at the origin of the rectus femoris, and a Y-shaped kinesio tape proximal to the superior patellar border. The taping had no tension at its base, whereas the portion between the anchor and the superior patella was stretched ≈40% ( Fig. 2 ). After 48 hours, the kinesio tape was removed from the skin and each subject was examined for any skin sensitivity.

Figure 2.

Kinesio taping applications used in the study.

Collection and Storage of Blood Samples

Blood samples were obtained 24 hours after the last training session at rest and immediately after the 20 minutes of walking exercise before and after the interventions using a standard venipuncture at a constant room temperature ( Fig. 1 ). While blood samples were transferred to nonadditive tubes to obtain serum, they were transferred to EDTA (ethylenediaminetetraacetic acid)-coated tubes to obtain plasma. Samples were centrifuged at 5000 × g at 4 °C for 15 minutes and stored at −80 °C until time of analysis.

Outcome Measures

Knee-Related Pain and Health Status

Pain and physical function outcomes were evaluated at the beginning and at the end of the intervention period by the visual analogue scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), respectively.

Pain intensity was evaluated by the VAS. In this test, each subject was asked to state her perceived pain at rest, during activity, and during the night.⁴⁴ The WOMAC is a reliable and valid functionality test commonly used in patients with knee OA. This scale contains 24 items and is assigned into 3 subunits: pain, stiffness, and physical function and a Likert-type scale was used for scoring each item.⁴⁵

Biochemical Analysis

Serum COMP and plasma MMP-1 and MMP-3 levels were measured blood samples obtained at rest and following 20 minutes of walking exercise before and after the interventions. The serum COMP level was quantified via enzyme-linked immunosorbent assay (ELISA) according to the manufacturer’s instructions (Cat. no: 201-12-1487, Sunred Biological Technology, Shanghai, People’s Republic of China). The minimum detection level was about 0.283 ng/mL. Intra- and interassay coefficient of variation (CV) were 10.0% and 12.0%, respectively. The COMP level was expressed as ng/mL. Plasma MMP-1 level was measured using commercial ELISA kit (Cat. no: 201-12-0917, Sunred Biological Technology, Shanghai, People’s Republic of China), according to the producer’s recommendations. The minimum detection level was about 0.207 ng/mL. The MMP-1 level was expressed as ng/mL. Plasma MMP-3 level was analyzed using commercially available ELISA kit (Cat. no: BMS2014/2, Affymetrix, eBioscience, BenderMed Systems GmbH, Germany), according to the manufacturer’s recommendations. The minimum detection level was about 0.008 ng/mL. Intra- and interassay CV of the kit were 5.8% and 3.0%, respectively. The MMP-3 level was expressed as ng/mL.

Statistical Analysis

Statistical analysis was performed with SPSS v.22.0 for Windows (IBM Corp., Armonk, NY, USA). Data expressed as mean ± standard deviation (SD). The normality of the distribution of the data was evaluated by the Shapiro-Wilk test and statistical difference between the groups was analyzed by Student t test for parametric data and Mann-Whitney U test for nonparametric data. Intragroup comparisons were evaluated with paired t test for parametric data and Wilcoxon signed rank test for nonparametric data. A P value of less than 0.05 was considered statistically significant.

Results

Participants’ Characteristics

All participants completed the study, and there were no participants who could not complete the study. The mean age of the participants in the ET and ET + KT groups were 51.00 ± 3.69 and 48.18 ± 7.56 years, respectively, and there was no difference between the groups (P > 0.05). The baseline characteristics of the groups are shown in Table 2 . No statistically significant differences were found regarding weight, height or body mass index between the groups before and after the intervention (P > 0.05).

Table 2.

Baseline Characteristics of Participants in This Study.^a

Characteristic	Group	n	Before Intervention	After Intervention
Weight (kg)	ET	11	85.29 ± 14.30	83.40 ± 14.37
Weight (kg)	ET + KT	11	77.27 ± 7.01	76.74 ± 7.14
Height (cm)	ET	11	157.00 ± 5.00
Height (cm)	ET + KT	11	158.00 ± 8.00
BMI (kg/m²)	ET	11	34.76 ± 5.91	34.01 ± 6.04
BMI (kg/m²)	ET + KT	11	30.90 ± 3.17	30.69 ± 3.23

BMI, body mass index; ET, exercise training group, ET + KT, exercise training plus kinesio taping group.

Data are expressed as mean ± SD.

Changes in Pain and Functionality Scores

Intragroup comparison of the ET and ET + KT groups showed that the VAS and the WOMAC scores were lower after the intervention when compared with before the intervention in both groups (P < 0.05). However, there were no statistically significant differences between the groups before and after the intervention (P > 0.05) ( Table 3 ). These results indicate that there is no significant difference in pain and function following exercise training and exercise training plus kinesio taping.

Table 3.

Comparison of VAS and WOMAC Scores Between Groups.

	Group	n	Before Intervention	After Intervention
VAS (points)	ET	11	5.73 ± 0.79	2.82 ± 1.54*
VAS (points)	ET + KT	11	5.27 ± 1.35	3.55 ± 1.69*
WOMAC (points)	ET	11	47.27 ± 9.75	21.36 ± 13.11*
WOMAC (points)	ET + KT	11	41.18 ± 17.49	28.82 ± 13.05*

VAS, visual analogue scale; WOMAC, Western Ontario and McMaster Universities Osteoarthritis Index; ET, exercise training group; ET + KT, exercise training plus kinesio taping group.

Data are expressed as mean ± SD.

P < 0.05 compared with before intervention.

Changes of Biochemical Markers at Rest Before and After Interventions

Table 4 presents the circulating COMP, MMP-1, and MMP-3 levels before and after the interventions. There was no statistically significant difference between before and after the intervention in regarding the resting serum COMP and plasma MMP-1 levels in both groups (P > 0.05). In the ET group, plasma MMP-3 level was lower after the intervention than before the intervention (P < 0.05), but in the ET + KT group there was no statistically significant change between before and after the intervention at rest (P > 0.05). However, there was no statistically significant difference between the groups before and after the intervention periods (P > 0.05). These data indicate that neither exercise training alone nor exercise training plus kinesio taping affected circulating COMP, MMP-1, and MMP-3 levels at rest.

Table 4.

Effects of Exercise Training Alone or in Combination With Kinesio Taping on Biomarkers of the Knee OA.^a

	Group	n	Before Intervention			After Intervention
	Group	n	Rest	After Acute Loading	% Change From Rest	Rest	After Acute Loading	% Change From Rest
COMP (ng/mL)	ET	11	11.59 ± 1.80	13.08 ± 1.56^b	11.41 ± 7.90	11.13 ± 1.75	12.16 ± 1.83^c	10.40 ± 6.98
COMP (ng/mL)	ET + KT	11	11.67 ± 1.40	13.86 ± 2.04^b	12.04 ± 7.74	10.72 ± 1.61	12.55 ± 2.60^c	10.99 ± 7.17
MMP-1 (ng/mL)	ET	11	9.30 ± 2.19	11.30 ± 1.76^b	12.43 ± 9.74	9.85 ± 3.07	11.94 ± 2.06^c	13.22 ± 7.05
MMP-1 (ng/mL)	ET + KT	11	10.92 ± 1.65	13.08 ± 1.34^b	12.49 ± 9.10	9.15 ± 2.88	12.58 ± 1.87^c	15.43 ± 4.70
MMP-3 (ng/mL)	ET	11	5.08 ± 1.14	6.32 ± 1.00^b	12.08 ± 9.28	4.11 ± 1.07^b	5.23 ± 1.55^c	12.49 ± 7.22
MMP-3 (ng/mL)	ET + KT	11	4.51 ± 1.21	5.32 ± 1.07^b	12.42 ± 4.26	4.25 ± 0.88	5.07 ± 0.97^c	12.07 ± 4.49

OA, osteoarthritis; COMP, cartilage oligomeric matrix protein; MMP, matrix metalloproteinase, ET, exercise training group; ET + KT, exercise training plus kinesio taping group.

Data are expressed as mean ± SD.

P < 0.05 compared with before intervention rest.

P < 0.05 compared with after intervention rest.

Changes in COMP, MMP-1, and MMP-3 Levels in Response to Acute Loading Before and After Interventions

Circulating COMP, MMP-1, and MMP-3 levels were higher immediately after the 20 minutes of walking exercise than at rest in the ET and ET + KT groups before and after the intervention (P < 0.05). Before intervention, COMP concentrations in the ET and ET + KT groups were elevated by 11% and 12%, respectively. However, after the intervention, COMP levels in the ET and ET + KT groups were increased by 10% and 11%, respectively. Before the intervention, in both groups, MMP-1 and MMP-3 concentrations were increased by 12%. However, after the intervention, MMP-1 levels in the ET and ET + KT groups were elevated by 13% and 15%, respectively, and MMP-3 levels in both groups were increased by 12% ( Table 4 ). These data show that COMP, MMP-1, and MMP-3 levels increased in response to acute exercise, but neither exercise training alone nor exercise training plus kinesio taping affected COMP, MMP-1, and MMP-3 levels in response to acute exercise.

Discussion

In this study, we sought an answer to the question that does exercise training alone and in combination with kinesio taping improve pain, functionality and circulating COMP, MMP-1, and MMP-3 levels in patients with knee OA. The straight answer to this research question based on the results of the study is partially yes. Our results did not show a significant difference between exercise training and exercise training plus kinesio taping groups in terms of parameters of pain and functionality namely, VAS and WOMAC and circulating COMP, MMP-1, and MMP-3 levels. Despite that some changes occurred in pain, functionality, and biochemical markers with exercise training and exercise training plus kinesio taping, no difference was evident between the groups.

In this study, pain was assessed by VAS and functional status by WOMAC, and exercise training caused a decrease in VAS and WOMAC scores. Consistent with our findings, quadriceps strengthening exercises alone⁴⁶ or in combination with different exercise training protocols such as hamstring strengthening^47,48 and flexibility⁴⁹ exercise have been shown to be useful in improving pain and reducing functional performance limitations in patients with knee OA, as measured by VAS and WOMAC. In the present study VAS and WOMAC scores also decreased after the exercise training plus kinesio taping. There are conflicting findings regarding the effectiveness of kinesio taping on pain and functionality in knee OA. VAS and WOMAC scores have been reported to decrease^39,41,50,51 or not change⁴² in response to kinesio taping. These differences in results may be due to the evaluation time, duration of kinesio taping, differences in taping methods and characteristics of the patient group. In this study, we did not observe additional beneficial effect of kinesio taping on VAS and WOMAC scores. The possible explanation for the absence of any changes between the groups in this study may be due to the similar mechanism of action of exercise training and kinesio taping. During kinesio taping application, skin mobilization increases blood and lymph circulation and stimulates of cutaneous mechanoreceptors.³⁹ These mechanisms are also stimulated by exercise, and these factors are believed to directly affect pain perception and function.⁵²

One of the primary objectives of this study was to compare resting COMP level before and after interventions. In this study, exercise training and exercise training plus kinesio taping did not affect resting serum COMP level. There are conflicting findings suggesting that exercise training for 6 to 12 weeks increases^34,53 or does not affect^17,54 serum COMP levels in patients with knee OA. The differences between the results may be due to the type, duration, and intensity of exercise training programs and differences in patients’ characteristics. In this study, unchanged resting COMP levels in response to exercise training and exercise training plus kinesio taping suggest that these interventions are safe and do not cause any adverse changes on COMP turnover and cartilage metabolism. To our knowledge no study has so far investigated the effects of kinesio taping or exercise training plus kinesio taping on COMP level, and our study is the first in this regard. In this study, there was no difference between exercise training and exercise training plus kinesio taping groups, suggesting that kinesio taping did not have an additional effect on resting COMP level in these patients.

One of the secondary objectives of this study was to investigate the changes in circulating COMP level following acute loading in patients with knee OA. In this study, serum COMP level increased immediately after 20 minutes of walking exercise performed before and after the interventions. However, although the magnitude of the post-intervention increase was smaller, it was not statistically significant in either group. Consistent with our findings,^17,33,49 it has been reported in many studies that serum COMP levels increase in patients with knee OA after 30 minutes to 1 hour of walking exercise. In this study, possible reasons for the increase in serum COMP levels during exercise are mobilization of COMP from cartilage or other pressure loaded tissues, and modifications to the extra cartilage cycle of COMP. In addition, high levels of COMP in serum samples may indicate evidence of cartilage damage. In the present study, no difference between exercise training and exercise training plus kinesio taping groups, which suggests that kinesio taping has no additional effect on resting COMP level in patients with knee OA.

In the knee OA, mild to moderate inflammatory reactions may occur in the synovial membrane. During synovial inflammation, synoviocytes produce cartilage-disrupting enzymes such as MMPs that reduce cartilage volume.⁵⁵ In this study, although exercise training and exercise training plus kinesio taping did not affect resting MMP-1 levels, plasma MMP-3 levels were decreased in the exercise training group. In addition, MMP-1 and MMP-3 levels increased immediately after 20 minutes of walking exercise compared with resting levels before and after the interventions. Consistent with our findings, knee flexion-extension and isometric quadriceps exercises have been shown to reduce MMP-3 levels in synovial fluid in patients with knee OA.⁵² These data indicate that exercise training may prevent inflammatory reaction to chondrocytes and cartilage matrix, delay articular cartilage degeneration, and thus improve knee function. To the best of our knowledge, no studies have examined the effects of kinesio taping or exercise training plus kinesio taping on MMP-1 and MMP-3 levels at rest and after exercise in knee OA. Therefore, our study is a first in this regard. In this study, the lack of difference between exercise training and exercise training plus kinesio taping groups suggests that kinesio taping did not have additional effect on MMP-1 and MMP-3 levels in knee OA patients.

Although these results provide new information, this study has some limitations. First, biomarker concentrations were measured in serum and plasma samples representing systemic levels, not in knee synovial fluid. Second limitation is the absence of only kinesio taping group to better evaluate and compare the effectiveness of the interventions. Third, patients’ physical activity levels were not recorded before and during treatment. Fourth, in this study, we selected cartilage biomarkers that are considered potential biomarkers in knee OA, but other biomarkers such as pro- or anti-inflammatory cytokines can also provide us with useful information. Finally, muscle strength was not assessed before and after the intervention due to the technical difficulties.

This study has shown that exercise training and exercise training plus kinesio taping may improve pain and functionality independently of cartilage biomarkers such as COMP, MMP-1, and MMP-3. Exercise training and exercise training plus kinesio taping protocols have no detrimental effect on cartilage metabolism. However, acute exercise increases cartilage turnover and levels and activity of the proteolytic enzymes. As the clinical significance of the observed effects of the exercise training plus kinesio taping is questionable, more detailed future studies utilizing a longer period are required especially at the molecular level to explain the possible mechanism of actions.

Footnotes

Acknowledgments and Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Selçuk University Scientific Research and Project Committee (Grant No. 16202028).

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical Approval

The study was approved by the Ethics Committee of Selçuk University (approval no. 2016/101, 30/03/2016) and all experiments were carried out in accordance with the Helsinki Declaration.

Informed Consent

Signed informed consent forms were obtained from all participants.

ORCID iD

Muaz Belviranlı

References

Dieppe

. Developments in osteoarthritis. Rheumatology (Oxford). 2011 50(2):245-7. doi:10.1093/rheumatology/keq373

Man

Mologhianu

Osteoarthritis pathogenesis—a complex process that involves the entire joint. J Med Life. 2014;7(1_suppl):37-41.

Felson

Lawrence

Dieppe

Hirsch

Helmick

Jordan

, et al. Osteoarthritis: new insights. Part 1: the disease and its risk factors. Ann Intern Med. 2000;133(8):635-46. doi:10.7326/0003-4819-133-8-200010170-00016

Link

Steinbach

Ghosh

Ries

Lane

, et al. Osteoarthritis: MR imaging findings in different stages of disease and correlation with clinical findings. Radiology. 2003;226(2):373-81. doi:10.1148/radiol.2262012190

Altman

Asch

Bloch

Bole

Borenstein

Brandt

, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum. 1986;29(8):1039-49. doi:10.1002/art.1780290816

Kim

HA.

Molecular mechanisms of sex-related differences in arthritis and associated pain. Int J Mol Sci. 2020;21(21):7938. doi:10.3390/ijms21217938

Hame

Alexander

RA.

Knee osteoarthritis in women. Curr Rev Musculoskelet Med. 2013;6(2):182-7. doi:10.1007/s12178-013-9164-0

Fitzgerald

Hinman

Zeni

Jr Risberg

Snyder-Mackler

Bennell

KL.

OARSI Clinical Trials Recommendations: design and conduct of clinical trials of rehabilitation interventions for osteoarthritis. Osteoarthritis Cartilage. 2015;23(5):803-14. doi:10.1016/j.joca.2015.03.013

Mobasheri

Bay-Jensen

van Spil

Larkin

Levesque

MC.

Osteoarthritis Year in Review 2016: biomarkers (biochemical markers). Osteoarthritis Cartilage. 2017;25(2):199-208. doi:10.1016/j.joca.2016.12.016

10.

Abramson

Krasnokutsky

Biomarkers in osteoarthritis. Bull NYU Hosp Jt Dis. 2006;64(1-2):77-81.

11.

Mabey

Honsawek

Cytokines as biochemical markers for knee osteoarthritis. World J Orthop. 2015;6(1_suppl):95-105. doi:10.5312/wjo.v6.i1.95

12.

Hao

Zhang

Wang

Cartilage oligomeric matrix protein, C-terminal cross-linking telopeptide of type II collagen, and matrix metalloproteinase-3 as biomarkers for knee and hip osteoarthritis (OA) diagnosis: a systematic review and meta-analysis. Osteoarthritis Cartilage. 2019;27(5):726-736. doi:10.1016/j.joca.2018.10.009

13.

Chu

Wang

Dou

Zhao

Cartilage oligomeric matrix protein and matrix metalloproteinase-3 expression in the serum and joint fluid of a reversible osteoarthritis rabbit model. Genet Mol Res. 2015;14(4):14207-15. doi:10.4238/2015.November.13.4

14.

Georgiev

Ivanova

Kopchev

Velikova

Miloshov

Kurteva

, et al. Cartilage oligomeric protein, matrix metalloproteinase-3, and Coll2-1 as serum biomarkers in knee osteoarthritis: a cross-sectional study. Rheumatol Int. 2018;38(5):821-830. doi:10.1007/s00296-017-3887-y

15.

Plsikova Matejova

Spakova

Harvanova

Lacko

Filip

Sepitka

, et al. A preliminary study of combined detection of COMP, TIMP-1, and MMP-3 in synovial fluid: potential indicators of osteoarthritis progression. Cartilage. 2020. Epub Aug 4. doi:10.1177/1947603520946385

16.

Neidhart

Hauser

Paulsson

DiCesare

Michel

Häuselmann

HJ.

Small fragments of cartilage oligomeric matrix protein in synovial fluid and serum as markers for cartilage degradation. Br J Rheumatol. 1997;36(11):1151-60. doi:10.1093/rheumatology/36.11.1151

17.

Andersson

Thorstensson

Roos

Petersson

Heinegård

Saxne

Serum levels of cartilage oligomeric matrix protein (COMP) increase temporarily after physical exercise in patients with knee osteoarthritis. BMC Musculoskelet Disord. 2006;7:98. doi:10.1186/1471-2474-7-98

18.

Addison

Coleman

Feng

McDaniel

Kraus

VB.

Whole-body bone scintigraphy provides a measure of the total-body burden of osteoarthritis for the purpose of systemic biomarker validation. Arthritis Rheum. 2009;60(11):3366-73. doi:10.1002/art.24856

19.

Kluzek

Bay-Jensen

Judge

Karsdal

Shorthose

Spector

, et al. Serum cartilage oligomeric matrix protein and development of radiographic and painful knee osteoarthritis. A community-based cohort of middle-aged women. Biomarkers. 2015;20(8):557-64. doi:10.3109/1354750X.2015.1105498

20.

Hoch

Mattacola

Medina McKeon

Howard

Lattermann

Serum cartilage oligomeric matrix protein (sCOMP) is elevated in patients with knee osteoarthritis: a systematic review and meta-analysis. Osteoarthritis Cartilage. 2011;19(12):1396-404. doi:10.1016/j.joca.2011.09.005

21.

Neidhart

Müller-Ladner

Frey

Bosserhoff

Colombani

Frey-Rindova

, et al. Increased serum levels of non-collagenous matrix proteins (cartilage oligomeric matrix protein and melanoma inhibitory activity) in marathon runners. Osteoarthritis Cartilage. 2000;8(3):222-9. doi:10.1053/joca.1999.0293

22.

Zivanović

Rackov

Zivanović

Jevtić

Nikolić

Kocić

Cartilage oligomeric matrix protein - inflammation biomarker in knee osteoarthritis. Bosn J Basic Med Sci. 2011;11(1_suppl):27-32. doi:10.17305/bjbms.2011.2619

23.

Murphy

Knäuper

Atkinson

Butler

English

Hutton

, et al. Matrix metalloproteinases in arthritic disease. Arthritis Res. 2002;4(Suppl 3):S39-49. doi:10.1186/ar572

24.

Mazor

Lespessailles

Coursier

Daniellou

Best

Toumi

Mesenchymal stem-cell potential in cartilage repair: an update. J Cell Mol Med. 2014;18(12):2340-50. doi:10.1111/jcmm.12378

25.

Tchetverikov

Lohmander

Verzijl

Huizinga

TeKoppele

Hanemaaijer

, et al. MMP protein and activity levels in synovial fluid from patients with joint injury, inflammatory arthritis, and osteoarthritis. Ann Rheum Dis. 2005;64(5):694-8. doi:10.1136/ard.2004.022434

26.

Loreto

Leonardi

Musumeci

Pannone

Castorina

An ex vivo study on immunohistochemical localization of MMP-7 and MMP-9 in temporomandibular joint discs with internal derangement. Eur J Histochem. 2013;57:e12.

27.

Zeng

Chen

Song

Gao

CY.

High MMP-1, MMP-2, and MMP-9 protein levels in osteoarthritis. Genet Mol Res. 2015;14(4):14811-22. doi:10.4238/2015.November.18.46

28.

Roberts

Law

Thom

. The time course and mechanisms of change in biomarkers of joint metabolism in response to acute exercise and chronic training in physiologic and pathological conditions. Eur J Appl Physiol. 2019;119(11-12):2401-20. doi:10.1007/s00421-019-04232-4

29.

Mazor

Best

Cesaro

Lespessailles

Toumi

Osteoarthritis biomarker responses and cartilage adaptation to exercise: a review of animal and human models. Scand J Med Sci Sports. 2019;29(8):1072-82. doi:10.1111/sms.13435

30.

Chao

Jing

Xuehua

Peilei

Effect of systematic exercise rehabilitation on patients with knee osteoarthritis: a randomized controlled trial. Cartilage. 2020. Epub Feb 10. doi:10.1177/1947603520903443

31.

Al-Johani

Kachanathu

Ramadan Hafez

Al-Ahaideb

Algarni

Meshari Alroumi

, et al. Comparative study of hamstring and quadriceps strengthening treatments in the management of knee osteoarthritis. J Phys Ther Sci. 2014;26(6):817-20. doi:10.1589/jpts.26.817

32.

Ferreira

Duarte

Gonçalves

RS.

Non-pharmacological and non-surgical interventions to manage patients with knee osteoarthritis: an umbrella review. Acta Reumatol Port. 2018;43(3):182-200.

33.

Jayabalan

Gustafson

Sowa

Piva

Farrokhi

A stimulus-response framework to investigate the influence of continuous versus interval walking exercise on select serum biomarkers in knee osteoarthritis. Am J Phys Med Rehabil. 2019;98(4):287-291. doi:10.1097/PHM.0000000000001068

34.

Azukizawa

Ito

Hamamoto

Fujii

Morita

Okahata

, et al. The effects of well-rounded exercise program on systemic biomarkers related to cartilage metabolism. Cartilage. 2019;10(4):451-8. doi:10.1177/1947603518767998

35.

Bricca

Struglics

Larsson

Steultjens

Juhl

Roos

EM.

Impact of exercise therapy on molecular biomarkers related to cartilage and inflammation in individuals at risk of, or with established, knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. Arthritis Care Res (Hoboken). 2019;71(11):1504-15. doi:10.1002/acr.23786

36.

Erhart-Hledik

Favre

Asay

Smith

Giori

Mündermann

, et al. A relationship between mechanically-induced changes in serum cartilage oligomeric matrix protein (COMP) and changes in cartilage thickness after 5 years. Osteoarthritis Cartilage. 2012;20(11):1309-15. doi:10.1016/j.joca.2012.07.018

37.

Donec

Kubilius

The effectiveness of Kinesio Taping® for pain management in knee osteoarthritis: a randomized, double-blind, controlled clinical trial. Ther Adv Musculoskelet Dis. 2019;11:1759720X19869135. doi:10.1177/1759720X19869135

38.

Morris

Jones

Ryan

CG.

The clinical effects of Kinesio® Tex taping: a systematic review. Physiother Theory Pract. 2013;29(4):259-70. doi:10.3109/09593985.2012.731675

39.

Rahlf

Braumann

Zech

Kinesio Taping improves perceptions of pain and function of patient3s with knee osteoarthritis: a randomized, controlled trial. J Sport Rehabil. 2019;28(5):481-7. doi:10.1123/jsr.2017-0306

40.

Kocyigit

Turkmen

Acar

Guldane

Kose

Kuyucu

, et al. Kinesio taping or sham taping in knee osteoarthritis? A randomized, double-blind, sham-controlled trial. Complement Ther Clin Pract. 2015;21(4):262-7. doi:10.1016/j.ctcp.2015.10.001

41.

Kaya Mutlu

Mustafaoglu

Birinci

Razak Ozdincler

. Does Kinesio Taping of the knee improve pain and functionality in patients with knee osteoarthritis? A randomized controlled clinical trial. Am J Phys Med Rehabil. 2017;96(1_suppl):25-33. doi:10.1097/PHM.0000000000000520

42.

Wageck

Nunes

Bohlen

Santos

de Noronha

Kinesio Taping does not improve the symptoms or function of older people with knee osteoarthritis: a randomised trial. J Physiother. 2016;62(3):153-8. doi:10.1016/j.jphys.2016.05.012

43.

American Geriatrics Society Panel on Exercise and Osteoarthritis. Exercise prescription for older adults with osteoarthritis pain: consensus practice recommendations. A supplement to the AGS Clinical Practice Guidelines on the management of chronic pain in older adults. J Am Geriatr Soc. 2001;49(6):808-23. doi:10.1046/j.1532-5415.2001.00496.x

44.

Carlsson

. Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. Pain. 1983;16(1_suppl):87-101. doi:10.1016/0304-3959(83)90088-x

45.

Tüzün

Eker

Aytar

Daşkapan

Bayramoğlu

Acceptability, reliability, validity and responsiveness of the Turkish version of WOMAC osteoarthritis index. Osteoarthritis Cartilage. 2005;13(1_suppl):28-33. doi:10.1016/j.joca.2004.10.010

46.

Quilty

Tucker

Campbell

Dieppe

Physiotherapy, including quadriceps exercises and patellar taping, for knee osteoarthritis with predominant patello-femoral joint involvement: randomized controlled trial. J Rheumatol. 2003;30(6):1311-7.

47.

O’Reilly

Muir

Doherty

Effectiveness of home exercise on pain and disability from osteoarthritis of the knee: a randomised controlled trial. Ann Rheum Dis. 1999;58(1_suppl):15-9. doi:10.1136/ard.58.1.15

48.

Al-Johani

Kachanathu

Ramadan Hafez

Al-Ahaideb

Algarni

Meshari Alroumi

, et al. Comparative study of hamstring and quadriceps strengthening treatments in the management of knee osteoarthritis. J Phys Ther Sci. 2014;26(6):817-20. doi:10.1589/jpts.26.817

49.

Aguiar

Do Nascimento

De Miranda

Rocha

Teixeira

Scalzo

PL.

Effects of an exercise therapy protocol on inflammatory markers, perception of pain, and physical performance in individuals with knee osteoarthritis. Rheumatol Int. 2015;35(3):525-31. doi:10.1007/s00296-014-3148-2

50.

Anandkumar

Sudarshan

Nagpal

Efficacy of kinesio taping on isokinetic quadriceps torque in knee osteoarthritis: a double blinded randomized controlled study. Physiother Theory Pract. 2014;30(6):375-83. doi:10.3109/09593985.2014.896963

51.

Lee

The effects of kinesiology taping therapy on degenerative knee arthritis patients’ pain, function, and joint range of motion. J Phys Ther Sci. 2016;28(1_suppl):63-6. doi:10.1589/jpts.28.63

52.

Zhang

Liu

Zhi

Geng

Chen

Effects of exercise therapy on knee joint function and synovial fluid cytokine levels in patients with knee osteoarthritis. Mol Med Rep. 2013;7(1_suppl):183-6. doi:10.3892/mmr.2012.1168

53.

Hunt

Pollock

Kraus

Saxne

Peters

Huebner

, et al. Relationships amongst osteoarthritis biomarkers, dynamic knee joint load, and exercise: results from a randomized controlled pilot study. BMC Musculoskelet Disord. 2013;14:115. doi:10.1186/1471-2474-14-115

54.

Petersen

Saxne

Heinegard

Hansen

Holm

Koskinen

, et al. Glucosamine but not ibuprofen alters cartilage turnover in osteoarthritis patients in response to physical training. Osteoarthritis Cartilage. 2010;18(1_suppl):34-40. doi:10.1016/j.joca.2009.07.004

55.

Guilak

Fermor

Keefe

Kraus

Olson

Pisetsky

, et al. The role of biomechanics and inflammation in cartilage injury and repair. Clin Orthop Relat Res. 2004;(423):17-26. doi:10.1097/01.blo.0000131233.83640.91

Effects of Exercise Training Alone and in Combination With Kinesio Taping on Pain,Functionality,and Biomarkers Related to the Cartilage Metabolism in Knee Osteoarthritis

Abstract

Objective

Design

Results

Conclusions

Keywords

Introduction

Methods

Subjects

Study Sample

Inclusion and Exclusion Criteria

Study Design

Interventions

Exercise Training Protocol

Kinesio Tape Application

Collection and Storage of Blood Samples

Outcome Measures

Knee-Related Pain and Health Status

Biochemical Analysis

Statistical Analysis

Results

Participants’ Characteristics

Changes in Pain and Functionality Scores

Changes of Biochemical Markers at Rest Before and After Interventions

Changes in COMP, MMP-1, and MMP-3 Levels in Response to Acute Loading Before and After Interventions

Discussion

Footnotes

Acknowledgments and Funding

Declaration of Conflicting Interests

Ethical Approval

Informed Consent

ORCID iD

References