Could something as simple as a 20-minute bike ride improve the quality of platelet-rich plasma?

In this episode of Overtime with The Sports Docs, Drs. Ashley Bassett and Catherine Logan explore an intriguing laboratory study examining whether exercise performed immediately before a PRP blood draw can enhance the cellular composition of platelet-rich plasma.

As biologic therapies continue to expand throughout sports medicine, optimizing PRP has become increasingly important. While most discussions focus on centrifuge systems, platelet concentrations, leukocyte content, and injection techniques, this study introduces another potential variable: the patient.

The authors found that a brief bout of vigorous exercise significantly increased platelet concentrations and mobilized hematopoietic progenitor cells, raising the possibility that exercise could serve as a simple, low-cost strategy to optimize biologic treatments.

In This Episode, We Discuss:

•  The fundamentals of PRP and how it works 
•  Why PRP variability remains one of the biggest challenges in interpreting the literature 
•  Conditions with the strongest evidence supporting PRP: 
  •  Knee osteoarthritis 
  •  Lateral epicondylitis 
  •  Patellar tendinopathy 
  •  Plantar fasciitis 
•  The concept of exercise-mobilized PRP 
•  Differences between plasma-based and buffy coat PRP systems 
•  Whether higher platelet concentrations actually translate into improved clinical outcomes 
•  How this research may influence real-world PRP protocols 

Study Breakdown

Study Design: Prospective laboratory study

Participants:
20 healthy volunteers (ages 21–45 years)

Exercise Protocol:

•  5-minute warm-up 
•  20 minutes of cycling 
•  Target heart rate: 70–85% of predicted maximum 

Blood samples were obtained before and immediately after exercise and processed using two PRP systems:

• ACP System (plasma-based PRP) 
• Angel System (buffy coat PRP) 

Key Findings

Whole Blood Changes After Exercise

•  Platelet count increased approximately 22%
•  White blood cell count increased approximately 50%

ACP System

•  Platelet concentration increased from approximately: 
  • 457,000/µL → 562,000/µL

Angel System

•  Platelet concentration increased from approximately: 
  • 2.95 million/µL → 3.77 million/µL
•  PRP volume increased 
•  Hematopoietic progenitor cell concentrations increased significantly 

Why This Matters

The study suggests that patient physiology before blood collection may significantly influence the final biologic product.

A brief exercise session may:

•  Increase platelet yield 
•  Mobilize progenitor cells 
•  Potentially enhance biologic activity 
•  Provide a low-cost method to optimize PRP preparation 

For clinicians performing biologic injections, exercise may become another controllable variable alongside:

•  PRP preparation system 
•  Centrifuge settings 
•  Leukocyte concentration 
•  Injection technique 

Clinical Pearls

✔ PRP is not a single product. Composition varies substantially between systems.

✔ Patient factors may influence PRP quality just as much as centrifuge settings.

✔ Twenty minutes of exercise increased platelet concentrations in both PRP systems.

✔ Buffy coat systems demonstrated increased progenitor cell concentrations.

✔ The clinical significance of these changes remains unknown.

The Big Question

Does exercise-enhanced PRP actually improve patient outcomes?

This study demonstrates changes in laboratory measurements, but it does not tell us whether patients:

•  Heal faster 
•  Experience less pain 
•  Return to sport sooner 
•  Demonstrate better tendon or cartilage healing 

Future studies are needed to determine:

•  Optimal exercise type 
•  Ideal exercise intensity 
•  Timing before blood draw 
•  Which conditions benefit most 

Dr. Logan's Clinical Perspective

At the Joint Preservation Center, this study has prompted discussions about incorporating pre-injection exercise into PRP protocols. A simple 20-minute cycling session before blood collection may represent a practical strategy to optimize a patient's own biology before treatment.

While additional evidence is needed, this concept aligns with the broader goal of maximizing the effectiveness of biologic therapies through thoughtful patient preparation.

Take-Home Points

•  Exercise before PRP collection significantly increases platelet concentrations. 
•  Short bouts of exercise may mobilize progenitor cells. 
•  Patient physiology may influence PRP composition. 
•  Exercise represents a low-cost, non-pharmacologic optimization strategy. 
•  More research is needed to determine whether these laboratory changes improve clinical outcomes. 

Resources Mentioned

•  Episode #161: Platelet concentration and outcomes following PRP for lateral epicondylitis 
•  Recent Sports Docs episode with Dr. Arianna Gianakos discussing PRP for plantar fasciitis 

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Our Hosts:

Ashley Bassett, MD & Catherine Logan, MD, MBA / www.cosportsmedicine.com 

www.cloganmd.com