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ObjectiveThe aim of the study was to compare the acute effects of walking the golf course versus using a golf cart during a round of golf on biological markers of joint disease, joint pain, and cardiovascular parameters in individuals with knee osteoarthritis.MethodsParticipants with knee OA (n = 10) older than 50 yrs were recruited for this crossover designed study in which they completed two 18-hole rounds of golf: (1) walking the course and (2) using a golf cart. Five control participants (n = 5) performed the walking condition only. Step count, heart rate, rating of perceived exertion and pain using the Numeric Pain Rating Scale were measured during the round. Serum was collected at baseline, 9th hole (halfway), and 18th hole (completion) and tested for biomarkers associated with tissue turnover (cartilage oligomeric matrix protein), inflammation (tumor necrosis factor α, interleukin 1β, interleukin 6), and degradative enzyme production (matrix metalloproteinase 3, matrix metalloproteinase 13).ResultsIn knee OA participants, walking the course was associated with significantly higher step count and duration of moderate/vigorous physical activity (72.2% vs. 32.6% of the round) but did lead to a significant increase in knee joint pain (P < 0.05). Both conditions caused cartilage oligomeric matrix protein and matrix metalloproteinase 13 concentration increases from baseline to completion (P < 0.05), but inflammatory markers (tumor necrosis factor α, interleukin 6, and interleukin 1β, P < 0.05) only increased when walking the course. Biomarker concentrations did not increase in control participants.ConclusionsWalking the course optimizes the duration of moderate/vigorous activity during a round of golf, but the golf cart is a beneficial option in those with exacerbated joint pain and inflammation that would otherwise limit participation.

The nonoperative practitioner managing individuals with cartilage defects should use a patient-centered, multifaceted approach that aims to individualize treatment to provide optimal benefit. These include addressing modifiable risk factors for disease progression and instituting interventions such as weight loss, nutrition, physical activity, and potentially regenerative medicine strategies. This review will focus on these nonoperative treatment strategies with a focus on when treatments are necessary, who will benefit from these approaches, why they are specifically appropriate, and, finally, how these treatments directly modify the structure of a patient's cartilage and resulting symptoms.

Background Biomarkers have potential to identify early signs of joint disease. This study compared joint pain and function in adolescents and young adults with CP compared to individuals without. Methods Cross-sectional study compared individuals with CP(n = 20), aged 13-30 with Gross Motor Function Classification System (GMFCS) I-III and age-matched individuals without CP(n = 20). Knee and hip joint pain measured using Numeric Pain Rating Scale (NPRS) and Knee injury and Osteoarthritis Outcome Score (KOOS) and Hip dysfunction and Osteoarthritis Outcome Score (HOOS) surveys. Objective strength and function were also measured. Biomarkers for tissue turnover (serum COMP, urinary CTX-II) and cartilage degradation (serum MMP-1, MMP-3) were measured in blood and urinary samples. Findings Individuals with CP had increased knee and hip joint pain, reduced leg strength, reduced walking and standing speeds, and ability to carry out activities of daily living(p < 0.005) compared to controls. They also had higher serum MMP-1(p < 0.001) and urinary CTX-II levels(p < 0.05). Individuals with CP who were GMFCS I and II demonstrated reduced hip joint pain(p = 0.02) and higher MMP-1 levels (p = 0.02) compared to GMFCS III. Interpretation Individuals with CP with less severe mobility deficits had higher MMP-1 levels likely due to more prolonged exposure to abnormal joint loading forces but experienced less joint pain.