Effects of Exercise Intensity on Musculoskeletal Injury Healing and Functional Recovery in College Students
Main Article Content
Abstract
This randomized controlled trial examines how exercise intensity affects musculoskeletal injury healing and functional recovery in college students. A total of 140 undergraduates with confirmed Grade I or II musculoskeletal injuries were randomly assigned to low-intensity exercise, moderate-intensity exercise, high-intensity exercise, or conventional physical therapy. All participants completed a 12-week intervention, with outcomes assessed through biological markers of healing, objective functional performance, pain perception, and health-related quality of life. The results show that moderate-intensity exercise at 55%–70% HRmax produced the most favorable outcomes across inflammatory markers, isokinetic peak torque, joint range of motion, dynamic balance, VAS pain ratings, and SF-36 subscales. Highintensity loading was associated with inflammatory rebound and higher re-injury risk during early recovery, while conventional therapy produced the weakest overall improvement. The findings provide evidence-based guidance for campus rehabilitation programs and support future integration of biomedical sensing and signal analysis into individualized exercise monitoring.
Downloads
Article Details

This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
References
R. Blazev, K. M. Ashwood, K. D. Ashwood, et al., “Exercise metabolism and adaptation in skeletal muscle,” Nature Reviews Molecular Cell Biology, vol. 24, no. 9, pp. 607-632, 2023, doi: 10.1038/s41580-023-00606-x.
C. Jibao, Z. Ren, F. Ye, et al., “Molecular mechanisms of exercise contributing to tissue regeneration,” Signal Transduction and Targeted Therapy, vol. 7, no. 1, 2022, doi: 10.1038/s41392-022-01233-2.
Z. Natalia, H. Genevieve, A. N. Patsalis, et al., “The role of innate and adaptive immune cells in skeletal muscle regeneration,” International Journal of Molecular Sciences, vol. 22, no. 6, pp. 3265, 2021, doi: 10.3390/ijms22063265.
P. Georgiana and C. Bénédicte, “Inflammation during post-injury skeletal muscle regeneration,” Seminars in Cell & Developmental Biology, vol. 119, pp. 32-38, 2021, doi: 10.1016/j.semcdb.2021.05.031.
T. Huiyin and Y. L. Long, “Inflammation balance in skeletal muscle damage and repair,” Frontiers in Immunology, vol. 14, Art. no. 1133355, 2023, doi: 10.3389/fimmu.2023.1133355.
L. A. M. Araujo and R. T. Vitor, “From skeletal muscle damage and regeneration to the hypertrophy induced by exercise: What is the role of different macrophages subsets? American Journal of Physiology-Regulatory, Integrative and Comparative Physiology,” 2021; 322(1), doi: 10.1152/ajpregu.00038.2021.
K. A. Reezigt, J. S. Swanenburg, B. John, et al., “Higher intensity exercise reduces disability more than lower intensity exercise in adults with chronic low back pain: A systematic review and meta-analysis,” Musculoskeletal Care, vol. 21, no. 3, pp. 611-622, 2023, doi: 10.1002/msc.1734.
J. H. Hollingworth, A. M. Williams, G. A. Cooke, et al., “If exercise is medicine, why don’t we know the dose? An overview of systematic reviews assessing reporting quality of exercise interventions in health and disease,” British Journal of Sports Medicine, vol. 56, no. 12, 2022, doi: 10.1136/bjsports-2021-104977.
C. L. D. H. Rodriguez, R. M. J. Belmonte, R. C. Luis, et al., “The role of physical exercise in chronic musculoskeletal pain: best medicine - a narrative review,” Healthcare, vol. 12, no. 2, 2024, doi: 10.3390/healthcare12020242.
R. Ivarsson, M. J. Casamichana, G. C. Castellano, et al., “Role of sports psychology and sports nutrition in return to play from musculoskeletal injuries in professional soccer: an interdisciplinary approach,” European Journal of Sport Science, vol. 21, no. 7, pp. 1-10, 2020, doi: 10.1080/17461391.2020.1792558.
M. Nirav, D. C. Singleton, J. H. Thomas, et al., “Incidence and prevalence of hamstring injuries in field-based team sports: a systematic review and meta-analysis of 5952 injuries from over 7 million exposure hours,” British Journal of Sports Medicine, vol. 57, no. 2, pp. 109-116, 2023, doi: 10.1136/bjsports-2021-104936.
H. Tim, E. Julian, S. André, et al., “Return to sport following low-risk and high-risk bone stress injuries: a systematic review and meta-analysis,” British Journal of Sports Medicine, vol. 57, no. 7, 2023, doi: 10.1136/bjsports-2022-106328.
M. B. Doyle, M. R. Pasculli, F. N. Elkabbani, et al., “Simultaneous tibial and fibular sesamoid bone stress injuries in a collegiate volleyball player: the role of shockwave therapy in recovery and return to sport,” PM & R: The Journal of Injury, Function, and Rehabilitation, 2026, doi: 10.1002/pmrj.70093.
B. Susanne, G. Linnéa, E. S. Hamrin, et al., “Young athletes who return to sport before 9 months after anterior cruciate ligament reconstruction have a rate of new injury 7 times that of those who delay return,” The Journal of Orthopaedic and Sports Physical Therapy, vol. 50, no. 2, pp. 83-90, 2020, doi: 10.2519/jospt.2020.9071.
R. Turk, S. Shah, M. Chilton, T. L. Thomas, C. Anene, A. Mousad, S. Le Breton, L. Li, R. Pettit, K. Ives, and A. Ramappa, “Return to sport after anterior cruciate ligament reconstruction requires evaluation of >2 functional tests, psychological readiness, quadriceps/hamstring strength, and time after surgery of 8 months,” Arthroscopy, vol. 39, no. 3, pp. 790– 801.e6, 2023, doi: 10.1016/j.arthro.2022.08.038.
W. Kristen, B. Matthew, C. Ariana, et al., “Anterior cruciate ligament rehabilitation and return to sport: how fast is too fast? Arthroscopy, Sports Medicine, and Rehabilitation,” 2022; 4(1): e175-e179, doi: 10.1016/j.asmr.2021.10.027.
W. A. Beynnon, B. S. Defrate, H. Airelle, et al., “ACL reconstruction rehabilitation: clinical data, biologic healing, and criterion-based milestones to inform a return-to-sport guideline,” Sports Health, vol. 14, no. 5, Art. no. 19417381211056873, 2021, doi: 10.1177/19417381211056873.
S. Filbay, “Appraisal of clinical practice guideline: Aspetar clinical practice guideline on rehabilitation after anterior cruciate ligament reconstruction,” Journal of Physiotherapy, vol. 71, no. 2, pp. 137, 2025, doi: 10.1016/j.jphys.2025.02.006.
X. Michelle, N. V. Maike, N. N. Tran, et al., “Patients who return to sport after primary anterior cruciate ligament reconstruction have significantly higher psychological readiness: a systematic review and meta-analysis of 3744 patients,” The American Journal of Sports Medicine, vol. 51, no. 10, pp. 2774-2783, 2023, doi: 10.1177/03635465221102420.
M. A. Wackerle, A. Sprague, R. Joreitz, et al., “Freddie Fu Panther Symposium Expert Group 2024: rehabilitation and return to sport after anterior cruciate ligament reconstruction part 1: early and intermediate phases of rehabilitation,” Knee Surgery, Sports Traumatology, Arthroscopy, vol. 34, no. 2, pp. 520-530, 2025, doi: 10.1002/ksa.70115.
M. Yukiko and E, “DC, Sofia PH, et al,” Unique considerations for the pediatric athlete during rehabilitation and return to sport after anterior cruciate ligament reconstruction. Arthroscopy, Sports Medicine, and Rehabilitation, vol. 4, no. 1, Art. no. e221-e230, 2022, doi: 10.1016/j.asmr.2021.09.037.
X. Jin, Y. Dong, W. Huang, and et al.Exposure-Response Relationship Between Prolonged Static Load and Low Back Musculoskeletal Disorders in College Students[C]//Congress of the International Ergonomics Association, “Springer, Singapore, 2025,”, doi: 10.1007/978-981-96-8908-8_44.
S. J. Langgård, K. Signe, M. B. Bagger, et al., “Effects of blood-flow restricted exercise versus conventional resistance training in musculoskeletal disorders - a systematic review and meta-analysis,” BMC Sports Science, Medicine & Rehabilitation, vol. 15, no. 1, pp. 141, 2023, doi: 10.1186/s13102-023-00750-z.
S. Öberg, V. L. Schewelov, and E. Tengman, “The impact of blood flow restriction training on tendon adaptation and tendon rehabilitation - a scoping review,” BMC Musculoskeletal Disorders, vol. 26, no. 1, pp. 503, 2025, doi: 10.1186/s12891-025-08734-5.
P. Stefano, V. Filippo, V. Marco, et al., “Managing lower limb muscle reinjuries in athletes: from risk factors to return-to-play strategies,” Journal of Functional Morphology and Kinesiology, vol. 8, no. 4, pp. 155, 2023, doi: 10.3390/jfmk8040155.
K. Mishti, R. N. J, C. Tom, et al., “The effects of collagen peptide supplementation on body composition, collagen synthesis, and recovery from joint injury and exercise: a systematic review,” Amino Acids, vol. 53, no. 10, pp. 1493-1506, 2021, doi: 10.1007/s00726-021-03072-x.
A. H. M and J. L. L. V. C, “The impact of collagen protein ingestion on musculoskeletal connective tissue remodeling: a narrative review,” Nutrition Reviews, vol. 80, no. 6, 2021, doi: 10.1093/nutrit/nuab083.
J. Simon, C. Christoph, L. Benedikt, et al., “Effects of specific collagen peptide supplementation combined with resistance training on Achilles tendon properties,” Scandinavian Journal of Medicine & Science in Sports, vol. 32, no. 7, pp. 1131-1141, 2022, doi: 10.1111/sms.14164.
W. Jianhui, R. Bowen, W. Daochao, et al., “Regulatory T cells in skeletal muscle repair and regeneration: recent insights,” Cell Death & Disease, vol. 13, no. 8, pp. 680, 2022, doi: 10.1038/s41419-022-05142-8.
B. Clara, Z. Aliki, P. Quentin, et al., “Role of macrophages during skeletal muscle regeneration and hypertrophy - implications for immunomodulatory strategies,” Physiological Reports, vol. 10, no. 19, Art. no. e15480, 2022, doi: 10.14814/phy2.15480.
W. Welling, “Return to sports after an ACL reconstruction in 2024 - a glass half full? A narrative review,” Physical Therapy in Sport: Official Journal of the Association of Chartered Physiotherapists in Sports Medicine, vol. 67, pp. 141-148, 2024, doi: 10.1016/j.ptsp.2024.05.001.
P. Pablo, J. M. Luis, L. F. Miguel, et al., “Epidemiology of sports-related injuries and associated risk factors in adolescent athletes: an injury surveillance,” International Journal of Environmental Research and Public Health, vol. 18, no. 9, pp. 4857, 2021, doi: 10.3390/ijerph18094857.
C. Eser, T. Bıyıklı, J. P. Byrne, et al., “The impact of the FIFA 11+ neuromuscular training programme on ankle injury reduction in football players: a systematic review and meta-analysis,” Muscles, vol. 4, no. 3, pp. 30, 2025, doi: 10.3390/muscles4030030.
B. Marco, M. Sergio, NAT, et al., “Implementing strength training strategies for injury prevention in soccer: scientific rationale and methodological recommendations,” International Journal of Sports Physiology and Performance, vol. 16, no. 3, pp. 1-6, 2021, doi: 10.1123/ijspp.2020-0862.