Exercise stress and tissue remodeling: advances in exosome-mediated RNA-RBP networks in musculoskeletal injury repair and functional recovery.

Exercise is a double-edged sword. It can either cause adaptive remodeling of musculoskeletal tissues or lead to acute or chronic injury. Exosomes that are boosted with circular RNAs (circRNAs), long non-coding RNAs (lncRNAs), and RNA-binding proteins (RBPs) have been a focus in recent years as important contributors to the process of repair after exposure to stress during exercise. This narrative review is a summarization of the impacts of different types and intensities of exercise modalities on musculoskeletal patterns of RNA expression and exosome secretion. It also describes the role of exosomes that initiate RNA-RBP networks that coordinate regenerative and inflammatory reactions in recipient cells. The article notes the promise of these networks as diagnostic biomarkers and therapeutic targets and also suggests new clinical uses, such as engineered exosome-based interventions. This review will build a holistic but theoretically sound framework to inform future direct-to-patient research in exercise medicine by taking into account multi-omics data and its functional validation. The purpose of this article is to present better diagnostic and rehabilitative approaches to musculoskeletal injuries, leading to suitable functional recovery outcomes.