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: 8382766
• 负责人: Kevin Robert Vincent
• 金额: $ 12.55万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-01 至 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8382766
• 关键词: Aging; American; Arthralgia; Award; Biochemical; Biological Markers; Biomechanics; Biometry; Body Composition; C-telopeptide; Cartilage; Clinical; Clinical Research; Clinical Sciences; Collagen Type II; Control Groups; Controlled Study; Cyclophosphamide; Data; Data Collection; Degenerative polyarthritis; Dependency; Development; Development Plans; Diagnosis; Disease; Doctor of Philosophy; Economic Burden; Educational Intervention; Educational workshop; Elderly; Equipment; Exercise; Exercise Physiology; Faculty; Florida; Functional disorder; Future; Genomics; Geriatrics; Goals; Grant; Healthcare Systems; Human; Impairment; Institutes; Intervention; Investigation; Jordan; Knee; Knee Osteoarthritis; Knee joint; Knowledge; Laboratories; Laboratory Research; Literature; Location; Measures; Medical; Mentors; Methods; Movement; Muscle; Muscle Contraction; North Carolina; Ontario; Orthopedics; Outcome; Pain; Participant; Pathogenesis; Patients; Persons; Physical Function; Physical Medicine; Physical activity; Physiological Adaptation; Population; Procedures; Process; Protocols documentation; Publishing; Randomized; Randomized Controlled Trials; Recording of previous events; Regimen; Rehabilitation therapy; Relative (related person); Research; Research Design; Resistance; Resolution; Resources; Schedule; Scientist; Severities; Sports Medicine; Stimulus; Structure; Symptoms; Testing; Time; Training; Translational Research; Type II Procollagen; Universities; Walking; Woman; Writing; aged; articular cartilage; base; blind; career development; cartilage metabolism; combat; comparative; comparative efficacy; cost; data management; demographics; design; disability; experience; functional disability; improved; indexing; innovation; knee pain; knee replacement arthroplasty; meetings; men; muscle strength; novel; prevent; primary outcome; professor; programs; prospective; prototype; quadriceps muscle; response; skills; standard care; strength training; symposium

DESCRIPTION (provided by applicant): Osteoarthritis (OA) is associated with muscle strength decline, cartilage breakdown and pain-related disability. The annual estimated out-of-pocket cost per patient for the management of knee OA alone is estimated to be $2600 with total annual expenses estimated to be $5700. The proposed investigation will be the first to rigorously evaluate the influence of two modes of resistance exercise (RX) on knee OA pain and functional impairment. Use of RX may help with resolution of OA symptoms, decrease medical management costs and delay or avoid costly knee replacements. It is unknown whether there is differential efficacy of two modes of resistance exercise on knee pain, cartilage turnover and physical function: eccentrically-focused exercise (ERX) and traditional concentrically-focused exercise (CRX). Using innovative prototype resistance exercise equipment, we will conduct a four-month, randomized, single-blind controlled study of the relative efficacy of ERX and CRX compared to a non-exercise control (CON) condition on knee pain, physical function and cartilage turnover in older adults with knee OA (aged 60-85). Primary Aim of this study is to determine if ERX will reduce knee pain in older adults (using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC Score) more than CRX or CON. Secondary Aim 1 will be to determine if ERX improves physical function and habitual physical activity more than CRX and CON by month four (assessed by a functional test battery). Secondary Aim 2 will test whether ERX will induce greater changes in cartilage biomarker turnover than CRX or CON by month four (using C-propeptide of type II procollagen [CTX-II], Collagen Type II C- telopeptide [CPII]). This proposed study is a prospective, randomized, controlled study (RCT) that will determine whether one of two resistance exercise protocols improves pain, physical function, and cartilage metabolism in older persons with knee OA. This is a repeated-measures, three group design. Participants (n=90) will be randomly assigned to one of three study groups (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. Men and women with OA related knee pain will be eligible for this study. Demographics, body composition, OA history and severity will be collected as descriptive variables. Mobility and physical function tests (Six minute walk test, 7-day pedometer test, chair rise time and stair climb time), knee pain (WOMAC Score), and biomarkers of cartilage turnover (CTX-II, CPII) will be performed at baseline and after four months of resistance exercise or control period. The uniqueness of the proposed study exists on two fronts: the comparative efficacy of two muscle contraction types on knee OA symptoms and function in older adults will be determined, and the effects of two forms of resistance exercise on the levels of biomarkers of cartilage turnover will be assessed. The candidate is an Assistant Professor in the Department of Orthopaedics and Rehabilitation at the University of Florida. He has a PhD in Exercise Physiology from the University of Florida and is board certified in Physical Medicine and Rehabilitation. The candidate is also a Junior Scholar in the Claude D. Pepper Older Americans Independence Center (OAIC). His research focus is to examine the influence of resistance exercise on physical function and physiological adaptations in clinical populations, particularly older adults. To achieve the goal of becoming an independent clinician scientist, the candidate has established the following objectives for this award: 1) Enhance his clinical research skills; 2) Advance his current knowledge of the pathogenesis and pathophysiology of osteoarthritis with a primary focus on the biochemical and biomechanical changes in the knee joint and articular cartilage ; 3) Acquire background knowledge and technical skills relevant to the development of knee OA including both biomechanical and biochemical analysis; 4)Improve grant writing proficiency. The candidate has developed a mentoring and collaborative team composed of accomplished senior faculty. The primary mentor is Dr. Christiaan Leeuwenburgh, from the Department of Aging and Geriatrics. The Co-mentors are Drs. Scott banks and Steven Ghvizzani. Dr. Vincent's mentors have extensive experience with osteoarthritis research and mentoring junior faculty. With their assistance a three-year career development plan has been designed to take advantage of select didactic courses, mentored laboratory experiences, conference/workshop attendance, structured meetings and regularly scheduled seminars. Dr. Vincent will also have guidance from Dr. John Shuster to assist with his statistical analysis skill development and from Dr. Joanne Jordan from the University of North Carolina who will help with clinical correlation to OA and research design. In addition to a distinguished and experienced mentoring team, Dr. Vincent will have full access to the necessary facilities and support offices to conduct the proposed study. The primary location for data collection for the proposed study will be the Human Dynamics Laboratory within the Orthopaedics and Sports Medicine Institute at The University of Florida (UF). This study will also utilize the research cores (Recruitment, Clinical Research, Biostatistic and Data Management, and Genomics and Biomarkers) of the OAIC within the UF Institute on Aging, and the resources of the Clinical and translational Science Institute. PUBLIC HEALTH RELEVANCE: Osteoarthritis elicits quadriceps 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）与肌肉力量下降、软骨破裂和疼痛相关的残疾有关。单是膝关节OA治疗，每位患者每年的自付费用估计为2600美元，每年的总费用估计为5700美元。这项拟议的研究将首次严格评估两种模式的阻力运动（RX）对膝关节OA疼痛和功能损害的影响。使用RX可能有助于缓解OA症状，降低医疗管理费用，延迟或避免昂贵的膝关节置换术。偏心聚焦运动（ERX）和传统的集中聚焦运动（CRX）两种阻力运动模式对膝关节疼痛、软骨周转和身体功能的疗效是否存在差异尚不清楚。使用创新的原型阻力运动设备，我们将进行一项为期四个月的随机单盲对照研究，比较ERX和CRX与非运动控制（CON）条件对老年膝关节OA（60-85岁）患者膝关节疼痛、身体功能和软骨转换的相对疗效。本研究的主要目的是确定ERX是否能减轻老年人的膝关节疼痛（使用西安大略省和麦克马斯特大学骨关节炎指数（WOMAC评分）），而不是CRX或CON。次要目的1是确定ERX在第四个月是否比CRX和CON更能改善身体功能和习惯性身体活动（通过功能测试电池评估）。Secondary Aim 2将测试ERX在第四个月时是否会比CRX或CON诱导更大的软骨生物标志物转换变化（使用II型前胶原C-前肽[CTX-II]， II型胶原C-末端肽[CPII]）。本研究是一项前瞻性、随机对照研究（RCT），旨在确定两种阻力运动方案中的一种是否能改善老年膝关节OA患者的疼痛、身体功能和软骨代谢。这是一个重复测量的三组设计。参与者（n=90）将被随机分配到三个研究组（每组n=30）中的一个。这三组将包括一个非运动控制组（CON），一个集中的阻力训练组（CRX；一组/运动，两次/周）和一个离心集中的阻力训练组（ERX；一组/运动，两次/周）。将在基线和第四个月收集研究测量数据。患有OA相关膝关节疼痛的男性和女性将符合本研究的条件。人口统计、身体组成、OA病史和严重程度将作为描述变量收集。活动能力和身体功能测试（6分钟步行测试、7天计步器测试、椅子起身时间和爬楼梯时间）、膝关节疼痛（WOMAC评分）和软骨转换生物标志物（CTX-II、CPII）将在基线和四个月阻力运动或控制期后进行。该研究的独特性存在于两个方面：两种肌肉收缩类型对老年人膝关节OA症状和功能的比较功效将被确定，两种形式的阻力运动对软骨转换生物标志物水平的影响将被评估。候选人是佛罗里达大学骨科和康复系的助理教授。他拥有佛罗里达大学运动生理学博士学位，并获得物理医学和康复委员会认证。该候选人也是Claude D. Pepper老年美国人独立中心（OAIC）的初级学者。他的研究重点是研究抗阻运动对临床人群（特别是老年人）身体功能和生理适应的影响。为了实现成为独立临床科学家的目标，候选人为本奖项确立了以下目标：1)提高他的临床研究技能；2)在骨性关节炎的发病机制和病理生理方面，主要关注膝关节和关节软骨的生化和生物力学变化；3)掌握与膝关节OA发展相关的背景知识和技术技能，包括生物力学和生化分析；4)提高基金写作水平。候选人已经建立了一个由有成就的资深教师组成的指导和协作团队。主要导师是来自老年病学部门的克里斯蒂安·李文伯格博士。共同导师是博士。斯科特·班克斯和史蒂文·格维扎尼。文森特博士的导师在骨关节炎研究和指导初级教师方面有着丰富的经验。在他们的帮助下，设计了一个三年职业发展计划，利用精选的教学课程、指导的实验室经验、会议/讲习班出席情况、有组织的会议和定期安排的研讨会。Vincent博士还将接受John Shuster博士和北卡罗来纳大学Joanne Jordan博士的指导，John Shuster博士将帮助他发展统计分析技能，Joanne Jordan博士将帮助他进行OA的临床相关性和研究设计。除了一个杰出且经验丰富的指导团队外，文森特博士还将完全有权使用必要的设施和支持办公室来进行拟议的研究。拟议研究数据收集的主要地点将是佛罗里达大学（UF）骨科和运动医学研究所的人体动力学实验室。本研究还将利用UF衰老研究所OAIC的研究核心（招聘、临床研究、生物统计和数据管理、基因组学和生物标志物），以及临床和转化科学研究所的资源。