Ischemic Preconditioning to Augment muscle Function in Individuals with Spinal Cord Injuries

缺血预处理可增强脊髓损伤患者的肌肉功能

• 批准号: 10775688
• 负责人: Lisa Lombardo
• 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: 2021-07-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10775688
• 关键词: Activities of Daily Living; Acute; Aerobic; Autonomic Dysreflexia; Blood; Blood Vessels; Blood flow; Bone Density; Cardiovascular Diseases; Cardiovascular Physiology; Cardiovascular system; Chronic; Circulation; Clinic; Clinical; Communities; Complication; Effectiveness; Elasticity; Electric Stimulation; Environment; Exercise; Exercise Tolerance; Fatigue; Femur; Follow-Up Studies; Future; General Population; Health; Health Care Costs; Home; Impairment; Individual; Injury; Intervention; Investigation; Ischemia; Ischemic Preconditioning; Isotonic Exercise; Knee; Knowledge; Learning; Lower Extremity; Maintenance; Mental Depression; Metabolic; Muscle; Muscle Contraction; Muscle Fatigue; Muscle function; Muscular Atrophy; Obesity; Outcome; Output; Oxygen Consumption; Paralysed; Paraplegia; Performance; Perfusion; Peripheral; Physical activity; Physiological; Physiological Adaptation; Pilot Projects; Production; Protocols documentation; Quality of life; Recovery; Rehabilitation therapy; Reperfusion Therapy; Resistance; Risk Reduction; Safety; Skeletal Muscle; Spinal cord injury; Symptoms; Testing; Time; Tissues; Training; United States; Veterans; Veterans Health Administration; Weight Gain; Work; bone loss; cardiovascular disorder risk; clinical practice; comorbidity; conditioning; deconditioning; exercise capacity; exercise intensity; exercise intervention; exercise training; experience; functional electrical stimulation; improved; intervention cost; medical specialties; muscle form; muscle strength; programs; recruit; rehabilitation paradigm; rehabilitation strategy; response; safety and feasibility; sedentary lifestyle; tissue oxygenation; trispecific killer engager

Spinal cord injury (SCI) often results in a sedentary lifestyle and profound deconditioning due to limited options for exercise. This decreased physical activity often leads to weight gain, bone loss, muscle atrophy, poor circulation, impaired cardiovascular function along with depression and decreased self-confidence. Options to exercise the muscles below the level of injury are restricted to electrical stimulation driven exercise that is constrained to reduced muscular force and work output. This ultimately results in reduced cardiorespiratory, metabolic and muscular adaptations compared to volitional exercise interventions in able bodied individuals. For this reason, an intervention that can increase the muscular force and work performed during electrical stimulation (ES) exercise is of utmost importance for individuals with SCI as it can lead to improved maintenance of lower limb muscle mass, better physiological adaptations and improved quality of life. Ischemic preconditioning (IPC) consists of brief periods of ischemia followed by reperfusion performed prior to exercise. In the general population, IPC has shown positive muscular benefits such as increased aerobic and anaerobic exercise performance, prolonging the time to skeletal muscle fatigue and improved recovery from maximal effort. However, this promising intervention has yet to be tested with ES exercise in those with SCI. Thus, the purpose of this SPiRE proposal is to determine if IPC prior to exercise with ES is safe and can improve skeletal muscle function and endurance in Veteran’s with complete SCI. 20 subjects will be recruited for a study consisting of 5 sessions that will involve performing IPC or a sham prior to ES isolated muscle contractions or ES lower body exercise. Specific Aim 1 will determine the safety of performing an acute bout of IPC prior to performing knee extension and if maximal muscle strength and fatigue resistance (Biodex isokinetic dynamometer) improves after IPC. In addition, tissue oxygenation, femoral blood flow and blood lactate will be assessed to identify potential impact of IPC on tissue perfusion and vascular function. Specific Aim 2 will determine whether performing an acute bout of IPC prior to ES cycling exercise (cycling on a recumbent tricycle) will improve performance including power output and time/distance cycled. Tissue oxygenation, femoral blood flow and blood lactate will also be collected during these sessions. Ultimately, if an acute bout of IPC is safe and augments muscle performance during ES exercise, further studies to determine long-term physiological benefits of chronic ES exercise in combination with IPC would be warranted. IPC has the potential to enhance the current rehabilitation standards for Veterans with SCI. In addition the ability to increase exercise intensity and cycling performance has potential to provide Veterans with SCI the additional muscle strength required to cycle overground and in the community on modified trikes with ES.

脊髓损伤（SCI）通常会导致久坐不动的生活方式和严重的失调， 有限的锻炼选择。这种体力活动的减少往往会导致体重增加， 骨质流失、肌肉萎缩、循环不良、心血管功能受损，沿着 抑郁和自信心下降。选项锻炼肌肉低于水平 的损伤仅限于电刺激驱动的运动， 肌肉力量和工作输出。这最终会导致心肺功能、代谢功能 与意志锻炼干预相比， 个体出于这个原因，可以增加肌肉力量和工作的干预措施 在电刺激（ES）运动期间进行的运动对于个人来说是至关重要的 与脊髓损伤，因为它可以导致改善维持下肢肌肉质量，更好地 生理适应和改善生活质量。缺血预处理（IPC）包括 短暂的缺血，然后在运动前进行再灌注。一般 IPC显示出积极的肌肉益处，如增加有氧运动和 无氧运动表现，延长骨骼肌疲劳时间，改善 从最大努力中恢复。然而，这一有希望的干预措施还有待检验， 在SCI患者中进行ES锻炼。因此，本SPiRE提案的目的是确定IPC是否 运动前使用ES是安全的，可以改善骨骼肌功能和耐力， 他是一个完全脊髓损伤的老兵。将招募20名受试者进行研究，包括5个阶段 这将涉及在ES隔离肌肉收缩或ES降低之前进行IPC或假手术 身体锻炼。具体目标1将确定进行急性IPC的安全性 在进行膝关节伸展之前，如果最大肌肉力量和抗疲劳性 （Biodex等速测力计）在IPC后改善。此外，股动脉组织氧合 将评估血流量和血乳酸，以确定IPC对组织的潜在影响 灌注和血管功能。具体目标2将决定是否进行急性 在ES自行车运动（在横卧三轮车上骑自行车）之前进行一次IPC将改善 性能包括功率输出和时间/距离循环。组织氧合，股动脉 在这些阶段期间还将收集血流量和血乳酸。最终，如果急性 一轮IPC是安全的，并增强肌肉性能在ES运动，进一步的研究， 确定长期ES运动结合IPC的长期生理益处 都是正当的IPC有可能提高目前的康复标准， 退伍军人SCI此外，增加运动强度和骑自行车的能力 性能有可能为SCI退伍军人提供额外的肌肉力量 需要骑自行车在地上和社区的修改三轮车与ES。