Blood flow restriction exercise to improve skeletal muscle and peripheral vascular function in person with spinal cord injuries

血流限制运动可改善脊髓损伤患者的骨骼肌和周围血管功能

• 批准号: 10187096
• 负责人: John McDaniel
• 金额: --
• 依托单位: LOUIS STOKES CLEVELAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-01 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10187096
• 关键词: Activities of Daily Living; Area; Benefits and Risks; Blood; Blood Circulation; Blood Platelets; Blood Vessels; Blood flow; C-reactive protein; Cardiovascular Diseases; Cardiovascular Physiology; Caring; Chronic; Clinical; Development; Educational Intervention; Endothelium; Exercise; Exercise Tolerance; Fatigue; Financial Hardship; Future; General Population; Goals; Health; Healthcare Systems; Immunologic Markers; Impairment; Incidence; Individual; Inflammatory; Injury; Interferons; Interleukin-1 beta; Interleukin-6; Intervention; Investigation; Isotonic Exercise; Knee; Lead; Lesion; Limb structure; Measurement; Mediating; Mental Depression; Metabolic Diseases; Muscle; Muscle function; Muscular Atrophy; Nitric Oxide; Obesity; Peripheral; Persons; Physical activity; Physiologic pulse; Population; Prevalence; Protocols documentation; Publications; Quality of life; Rehabilitation therapy; Research; Resistance; Risk; Safety; Series; Skeletal Muscle; Spinal cord injury; Testing; Thrombosis; Training; United States; Vascular Diseases; Veterans; Walking; Weight Gain; arterial stiffness; bone loss; cytokine; exercise capacity; exercise intensity; exercise intolerance; exercise prescription; exercise program; exercise rehabilitation; exercise training; experience; functional electrical stimulation; hypoxia inducible factor 1; immune activation; improved; light intensity; long-term rehabilitation; mode of exercise; motor impairment; muscle form; muscle strength; nerve supply; neutrophil; novel; programs; reactive hyperemia; recruit; resistance exercise; scaffold; strength training

Spinal cord injuries (SCI) are among the most debilitating conditions an individual can sustain with the estimates of SCI incidence in the United States at 12,000 new cases per year. The loss of innervation to the tissues muscle below the level of the lesion results in reduced physical activity which leads to an array of secondary complications including muscle atrophy, cardiovascular and metabolic disease, obesity and vascular dysfunction. This further leads to exercise intolerance, reduced quality of life and depression. Although current rehabilitative programs focus on improving muscle strength in this population, the efficacy of these programs is challenged by the injury related motor impairment, which limits the exercise intensity and subsequent positive muscular adaptations. Therefore, development of an exercise program that promotes maximal muscular adaptations to light intensity exercise could greatly improve the efficacy of rehabilitation in the SCI population and help restore functional capacity and quality of life for these individuals. Blood flow restriction (BFR) exercise has shown tremendous promise for improving muscle size and strength in a variety of healthy and clinical populations, however the benefits of BFR exercise for those with SCI has not been established. Thus, the purpose of this Merit proposal is to conduct a comprehensive study that explores the benefits and risks of BFR exercise in the incomplete SCI population. In general individuals with chronic incomplete SCI will be recruited to partake in two 8-week training periods (20 sessions) that involve traditional knee extension/flexion exercise or knee extension/flexion exercise with blood flow restriction. There will be a series of measurements before and after the 8-week intervention to look at changes in muscle and vascular function. Specific Aim 1 will determine how the 8-weeks of BFR exercise influenced muscle strength (Biodex isokinetic dynamometer), muscle cross sectional area and volume (CTscan) and fatigue resistance. Specific Aim 2 will determine how this novel 8-week training intervention impacts peripheral vascular function. Specifically, changes in nitric oxide mediated endothelial function will be determined through tests of flow mediated dilation, changes in endothelial function of the microvascular network will be determined through assessments of reactive hyperemia and changes in arterial stiffness will be determined through measurements of pulse wave velocity. Specific Aim 3 will focus on the safety of BFR exercise for the SCI population. Those with SCI are at greater risk for thrombosis and DVT compared to able bodied individuals. Although unlikely, the introduction of temporary blood stasis during BFR exercise might augment this risk. Thus, the third aim of this study will be to determine changes in innate immune activation and thrombosis risk. Specifically, blood will be collected at multiple timepoints throughout the training intervention and analyzed for hypoxia-inducible factor 1-alpha, neutrophil extra cellular traps (which act as prothrombotic scaffolds), neutrophil-platelet aggregates and inflammatory cytokines. Ultimately, if the improvements in muscle and vascular function following BFR resistance exercise is greater than the traditional resistance exercise often performed in rehabilitation settings, without increasing risk for DVT, it should be incorporated into the long-term rehabilitation programs for veterans with SCI.

脊髓损伤（SCI）是一个人可以承受的最衰弱的条件之一， 美国SCI发病率估计为每年12，000例新病例。神经支配的丧失 低于病变水平的组织肌肉导致身体活动减少，这导致一系列的 继发性并发症包括肌肉萎缩、心血管和代谢疾病、肥胖和 血管功能障碍这进一步导致运动不耐受，生活质量下降和抑郁症。 虽然目前的康复计划侧重于改善这一人群的肌肉力量， 这些计划的挑战是与伤害有关的运动障碍，这限制了运动强度 以及随后的积极的肌肉适应。因此，开发一个锻炼计划， 促进肌肉对低强度运动的最大适应，可以大大提高 康复的SCI人群，并帮助恢复功能能力和生活质量，为这些人。 血流限制（BFR）运动已显示出巨大的承诺，改善肌肉的大小和力量 然而，在各种健康和临床人群中，BFR运动对SCI患者的益处 尚未建立。因此，本Merit提案的目的是进行一项全面研究， 探讨BFR运动在不完全SCI人群中的益处和风险。一般来说， 将招募一名慢性不完全性脊髓损伤患者参加两个为期8周的培训期（20节）， 传统的膝关节伸展/屈曲运动或具有血流限制的膝关节伸展/屈曲运动。 在为期8周的干预前后将进行一系列测量，以观察肌肉的变化 和血管功能。具体目标1将确定8周的BFR运动如何影响肌肉 力量（Biodex等速测力计）、肌肉横截面积和体积（CT扫描）和疲劳 阻力具体目标2将确定这种新的8周训练干预如何影响外周 血管功能具体来说，将确定一氧化氮介导的内皮功能的变化 通过血流介导的扩张试验，微血管网内皮功能的变化将被 将通过评估反应性充血和动脉硬度变化来确定 通过测量脉搏波速度。具体目标3将侧重于BFR运动的安全性， SCI人口。与健全人相比，SCI患者发生血栓形成和DVT的风险更大。 个体虽然不太可能，但在BFR运动期间引入暂时性血瘀可能会增加 这个风险。因此，本研究的第三个目的是确定先天免疫激活的变化， 血栓形成风险。具体而言，将在整个培训干预期间的多个时间点采集血液 并分析缺氧诱导因子1-α、中性粒细胞胞外陷阱（其作为促血栓形成因子）、 支架）、嗜血小板聚集体和炎性细胞因子。最后，如果改善 BFR抗阻训练后的肌肉和血管功能优于传统抗阻训练 经常在康复环境中进行的运动，而不会增加DVT的风险， 为脊髓损伤的退伍军人提供长期康复计划。