Gerontology department, Vrije Universiteit Brussel, Laarbeeklaan 103, BE-1090 Brussels, Belgium.
Frailty in Ageing (FRIA) research group, Vrije Universiteit Brussel, Laarbeeklaan 103, BE-1090 Brussels, Belgium.
Exerc Immunol Rev. 2023;29:22-53.
In the pathogenesis of knee osteoarthritis (KOA), inflammatory mediators play an important role. However, the precise underlying mechanism by which regular exercise therapy (ET) exert effects on the immune system in KOA patients is unknown.
The aim of this systematic review was to investigate the basal and acute effects of ET on inflammatory biomarkers and brain derived neurotrophic factor (BDNF) in KOA patients.
PubMed, Web Of Science and PEDro were systematically searched for appropriate studies. If possible, a meta-analysis was performed or an approximation of the effect size (ES) was calculated. Risk of bias was scored using the Cochrane ROB 2.0 or ROBINS-tools.
Twenty-one studies involving 1374 participants were included. Fifteen articles focused on basal exercise effects, four on acute effects, and two on both. Biomarker analysis (n=18) was performed in synovial fluid (n=4) or serum/plasma (n=17). A meta-analysis demonstrated that basal CRP was reduced in KOA patients 6-18 weeks weeks after ET (MD: -0.17;95%CI[-0.31;-0.03]), while IL-6 (MD: 0.21;95%CI[-0.44;0.85]), and TNF-α (MD: -0.57;95%CI[-1.47;0.32]), levels did not significantly change. Also, sTNFR1/2 did not change significantly after ET. For other biomarkers, insufficient data were available to perform a meta-analysis. Nevertheless, a low degree of evidence was found for a decrease in IL-6 (ES:-0.596 & -0.259 & -0.513), an increase in sTNFR1 (ES:2.325), a decrease in sTNFR2 (ES:-0.997) and an increase in BDNF (ES:1.412). Locally, intra-articular IL-10 (ES:9.163) increased, and IL1β (ES:-6.199) and TNF-α decreased (ES:-2.322) after ET. An acute exercise session elicited a myokine response (ES IL-6:0.314), and an increase in BDNF (no ES-data). No inflammatory effect (ES CRP:0.052; ES TNF-α:-0.019 & 0.081) following an acute bout of training was found. However, a single bout of exercise elicited a decrease in intra-articular IL-10 (no ES-data).
ET can induce circulatory and intra-articular anti-inflammatory effects in patients with KOA. The antiinflammatory properties have important implications for informing these patients and clinicians about the underlying effects of ET.
在膝骨关节炎（KOA）的发病机制中，炎症介质发挥着重要作用。然而，常规运动疗法（ET）对 KOA 患者免疫系统的影响的确切潜在机制尚不清楚。
本系统评价旨在研究 ET 对 KOA 患者炎症生物标志物和脑源性神经营养因子（BDNF）的基础和急性影响。
系统检索了 PubMed、Web Of Science 和 PEDro 以获取相关研究。如果可能，进行了荟萃分析或计算效应大小（ES）的近似值。使用 Cochrane ROB 2.0 或 ROBINS-tools 对偏倚风险进行评分。
共纳入 21 项研究，涉及 1374 名参与者。15 篇文章侧重于基础运动效果，4 篇文章侧重于急性效果，2 篇文章同时涉及基础和急性效果。对滑膜液（n=4）或血清/血浆（n=17）中的生物标志物进行了分析。荟萃分析显示，ET 后 6-18 周，KOA 患者的 CRP 降低（MD：-0.17；95%CI[-0.31；-0.03]），而 IL-6（MD：0.21；95%CI[-0.44；0.85]）和 TNF-α（MD：-0.57；95%CI[-1.47；0.32]）水平无显著变化。此外，ET 后 sTNFR1/2 无明显变化。对于其他生物标志物，由于数据不足，无法进行荟萃分析。然而，有低证据表明 IL-6（ES：-0.596 & -0.259 & -0.513）、sTNFR1（ES：2.325）增加、sTNFR2（ES：-0.997）减少和 BDNF（ES：1.412）增加。局部而言，ET 后 IL-10（ES：9.163）增加，IL1β（ES：-6.199）和 TNF-α（ES：-2.322）减少。单次运动训练可引起肌源性反应（ES IL-6：0.314），并增加 BDNF（无 ES 数据）。未发现急性运动后 CRP（ES：0.052）和 TNF-α（ES：-0.019 和 0.081）的炎症作用。然而，单次运动可导致关节内 IL-10 减少（无 ES 数据）。
ET 可诱导 KOA 患者循环和关节内抗炎作用。抗炎特性对于告知这些患者和临床医生 ET 的潜在作用具有重要意义。
