Comparative Resistance Exercise Effects on Knee Osteoarthritis Pain, Functional I

比较阻力运动对膝骨关节炎疼痛（功能性 I）的影响

• 批准号: 8109398
• 负责人: Kevin Robert Vincent
• 金额: $ 7.03万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-09 至 2013-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8109398
• 关键词: Age-Years; American; Arthralgia; Arthritis; Biological Markers; C-telopeptide; Cardiovascular system; Cartilage; Chronic; Collagen Type II; Control Groups; Controlled Study; Cyclophosphamide; Data; Degenerative polyarthritis; Dependency; Diagnosis; Disease; Economic Burden; Educational Intervention; Elderly; Equipment; Ergometry; Exercise; Future; Healthcare Systems; Impairment; Intervention; Isotonic Exercise; Joints; Knee; Knee Osteoarthritis; Laboratories; Laboratory Research; Leg; Literature; Measures; Metabolic; Methods; Modality; Modeling; Movement; Muscle; Muscle Contraction; Ontario; Outcome; Pain; Participant; Patients; Persons; Physical Function; Physical activity; Population; Procedures; Process; Protocols documentation; Publishing; Randomized; Recruitment Activity; Regimen; Relative (related person); Resistance; Stimulus; Symptoms; Testing; Time; Training; Type II Procollagen; Universities; Walking; articular cartilage; base; blind; combat; comparative; cost; design; disability; experience; functional disability; improved; indexing; innovation; knee pain; muscle form; muscle strength; novel; prevent; primary outcome; programs; prototype; public health relevance; quadriceps muscle; response; standard care; strength training

DESCRIPTION (provided by applicant): Osteoarthritis (OA) is present in 40 million Americans and up to 30% of these people experience significant pain and disability. Quadricep muscle strength decline and cartilage breakdown are associated with OA related-functional impairment. Interventions that can both improve muscle strength and minimize cartilage loss would be important for preventing onset of costly, painful chronic disability. Resistance exercise has been shown to improve physical abilities and lower knee pain in patients with symptomatic knee OA; however, earlier evidence is fraught with major methodological limitations. Recent, compelling evidence suggests that eccentrically focused resistance exercise (ERX) may induce superior increases in muscle mass and leg function at a lower cardiovascular and metabolic cost compared to concentrically focused resistance exercise (CRX). Currently, there are no published studies comparing pure ERX and CRX on OA pain, cartilage turnover and physical function. Using an innovative prototype of resistance exercise equipment, our laboratory will rigorously compare two modes of resistance exercise on these variables in older adults with symptomatic knee OA. This proposed study is a randomized, single-blind controlled study of the relative efficacy of two resistance exercise protocols on knee pain, physical function and cartilage turnover in older adults with knee OA. The Primary Aim of this study is to determine if four months of ERX will reduce OA-related knee pain in older adults more than CRX or standard care (non-exercise control; CON). The primary outcome will be the change in knee pain subscale of the well-established, reliable and validated Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC Score) from baseline to month four. The Secondary Aim 1 will be to determine if ERX improves physical function and habitual physical activity more than CRX and CON by month four. Function and habitual physical activity will be assessed by a battery of tests (graded maximal walk test, six-minute walk test, stair climbing, 7-day pedometer test). Secondary Aim 2 will be to determine whether ERX will induce greater changes in cartilage biomarker turnover than CRX or CON by month four. Cartilage turnover will be assessed using a ratio of cartilage formation (C-propeptide of type II procollagen, [CPII]) to cartilage breakdown (Collagen Type II C- telopeptide [CTX-II]). Older adults (N=90; >60 years of age) with tibiofemoral knee OA will be recruited for this study. Participants will be randomly assigned to one of three study groups in equal distributions (n=30 per group). The three groups will include a non-exercise control (CON) group, a concentrically focused resistance training group (CRX; one set/ exercise, two sessions/ week) and an eccentrically focused resistance training group (ERX; one set/ exercise, two sessions/ week). Study measures will be collected at baseline and at month four. Mixed model analyses of covariance will be applied to the outcome variables of the Primary Aim and Secondary Aim 1. Analysis of covariance will be applied to the change in cartilage turnover ratios; Pearson correlations adjusted with Bonferroni correction, will be performed to find associations between training induced changes in pain, physical function and cartilage turnover. The findings from this novel study will be used to further develop optimal strengthening prescriptions to treat knee OA and prevent continued cartilage breakdown. PUBLIC HEALTH RELEVANCE: Osteoarthritis elicits quadricep muscle deficits and cartilage breakdown, both of which contribute to pain and functional impairment in the older adult. A possible method to combat these disease processes is resistance exercise training. This project will examine whether there are differential improvements in osteoarthritis symptoms, impairment and cartilage turnover using a novel eccentric resistance exercise program compared with concentric focused resistance exercise in older persons.

描述（由申请人提供）： 骨关节炎（OA）存在于4000万美国人中，其中高达30%的人经历显著的疼痛和残疾。股四头肌肌力下降和软骨破坏与OA相关的功能障碍有关。既能提高肌肉力量又能最大限度地减少软骨损失的干预措施对于预防昂贵、痛苦的慢性残疾的发生至关重要。抗阻运动已被证明可以改善症状性膝关节OA患者的体能和下膝疼痛;然而，早期的证据充满了主要的方法学局限性。最近，令人信服的证据表明，偏心集中阻力运动（ERX）可能会导致上级增加肌肉质量和腿部功能，在较低的心血管和代谢成本相比，同心集中阻力运动（CRX）。目前，还没有发表的研究比较纯ERX和CRX对OA疼痛，软骨转换和身体功能的影响。我们的实验室将使用创新的抗阻运动设备原型，严格比较两种抗阻运动模式对有症状的膝关节OA老年人的这些变量。这项拟议的研究是一项随机、单盲对照研究，旨在评价两种抗阻运动方案对膝关节OA老年人膝关节疼痛、身体功能和软骨更新的相对疗效。本研究的主要目的是确定四个月的ERX是否比CRX或标准护理（非运动对照; CON）更能减少老年人OA相关的膝关节疼痛。主要结局将是从基线到第4个月，已确立、可靠和有效的西安大略和麦克马斯特大学骨关节炎指数（WOMAC评分）的膝关节疼痛子量表的变化。次要目标1是确定ERX在第4个月时是否比CRX和CON更能改善身体功能和习惯性体力活动。将通过一系列试验（分级最大步行试验、6分钟步行试验、爬楼梯、7天计步器试验）评估功能和习惯性体力活动。次要目的2将是确定ERX是否会在第4个月时比CRX或CON诱导软骨生物标志物转换的更大变化。将使用软骨形成（II型前胶原的C-前肽，[CPII]）与软骨分解（II型胶原C-端肽[CTX-II]）的比率评估软骨更新。本研究将招募患有胫股膝关节OA的老年人（N = 90;> 60岁）。受试者将被随机分配到三个研究组之一，平均分布（每组n = 30）。这三组将包括非运动对照组（CON）、集中阻力训练组（CRX;一组/运动，两次/周）和偏心集中阻力训练组（ERX;一组/运动，两次/周）。将在基线和第4个月收集研究指标。协方差的混合模型分析将应用于主要目的和次要目的1的结局变量。协方差分析将应用于软骨转换率的变化;将进行经Bonferroni校正的Pearson相关性，以发现训练诱导的疼痛、身体功能和软骨转换变化之间的相关性。这项新研究的结果将用于进一步开发最佳的强化处方，以治疗膝关节OA并防止持续的软骨破坏。 公共卫生相关性：骨关节炎会导致股四头肌肌肉缺陷和软骨破坏，这两者都会导致老年人的疼痛和功能障碍。对抗这些疾病过程的一种可能方法是阻力运动训练。本项目将研究是否有差异的改善骨关节炎的症状，损伤和软骨周转使用一种新的离心阻力运动计划相比，同心集中阻力运动在老年人。