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: 8532821
• 负责人: Kevin Robert Vincent
• 金额: $ 12.59万
• 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/8532821
• 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.

描述（由申请人提供）：骨关节炎（OA）与肌肉力量下降、软骨破坏和疼痛相关的残疾有关。每例患者仅用于膝关节OA管理的年度自付费用估计为2600美元，年度总费用估计为5700美元。这项研究将首次严格评估两种抗阻运动（RX）模式对膝关节OA疼痛和功能障碍的影响。使用RX可能有助于缓解OA症状，降低医疗管理成本，延迟或避免昂贵的膝关节置换术。目前尚不清楚两种抗阻运动模式对膝关节疼痛、软骨周转和身体功能是否有不同的疗效：偏心集中运动（ERX）和传统的同心集中运动（CRX）。使用创新的原型阻力运动设备，我们将进行一项为期4个月的随机单盲对照研究，比较ERX和CRX与非运动对照（CON）条件对膝关节OA老年人（60 - 85岁）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是否能比CRX或CON更好地减轻老年人的膝关节疼痛（使用西安大略和麦克马斯特大学骨关节炎指数（WOMAC评分））。次要目的1是确定ERX在第4个月时是否能比CRX和CON更好地改善身体功能和习惯性体力活动（通过功能测试组合进行评估）。次要目标2将测试ERX是否会在第4个月时诱导软骨生物标志物转换的变化大于CRX或CON（使用II型前胶原的C-前肽[CTX-II]、II型胶原C-端肽[CPII]）。这项拟议的研究是一项前瞻性、随机、对照研究（RCT），将确定两种抗阻运动方案之一是否能改善膝关节OA老年人的疼痛、身体功能和软骨代谢。这是一个重复测量，三组设计。参与者（n = 90）将被随机分配到三个研究组之一（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。患有OA相关膝关节疼痛的男性和女性将有资格参加本研究。将收集人口统计学、身体组成、OA病史和严重程度作为描述性变量。将在基线和4个月抗阻运动或对照期后进行活动性和身体功能测试（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）和软骨更新生物标志物（CTX-II、CPII）。这项研究的独特性存在于两个方面：将确定两种肌肉收缩类型对老年人膝关节OA症状和功能的比较疗效，并评估两种形式的阻力运动对软骨周转生物标志物水平的影响。 候选人是佛罗里达大学矫形外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。候选人也是克劳德D的初级学者。Pepper Older Americans Independence Center（OAIC）他的研究重点是研究抗阻运动对临床人群，特别是老年人的身体功能和生理适应的影响。为了实现成为一名独立的临床科学家的目标，候选人为该奖项设立了以下目标：1）提高他的临床研究技能; 2）推进他目前对骨关节炎发病机制和病理生理学的认识，主要关注膝关节和关节软骨的生化和生物力学变化; 3）获得与膝关节OA发展相关的背景知识和技术技能，包括生物力学和生物化学分析; 4）提高基金撰写能力。候选人已经建立了一个由有成就的高级教师组成的指导和协作团队。主要导师是来自老龄和老年医学系的Christiaan Leeuwenburgh博士。共同导师是斯科特·班克斯博士和史蒂文·格维扎尼。Vincent博士的导师在骨关节炎研究和指导初级教师方面拥有丰富的经验。在他们的协助下，设计了一个为期三年的职业发展计划，以利用选定的教学课程、指导的实验室经验、出席会议/讲习班、有组织的会议和定期安排的研讨会。Vincent博士还将得到John Shuster博士的指导，以帮助他发展统计分析技能，并得到来自北卡罗来纳州大学的Joanne Jordan博士的指导，他将帮助OA的临床相关性和研究设计。除了杰出且经验丰富的指导团队外，Vincent博士还可以充分利用必要的设施和支持办公室来开展拟议的研究。拟定研究的主要数据收集地点为佛罗里达大学（UF）骨科和运动医学研究所的人体动力学实验室。这项研究还将利用研究核心（招聘，临床研究，生物统计学和数据管理，基因组学和生物标志物）的OAIC在UF研究所老化，以及临床和转化科学研究所的资源。