Muscle Plasticity, Fitness, and Health after Spinal Cord Injury

描述(由申请人提供)：这项拟议的研究是对先前奖项的修订竞争延续。我们先前的研究表明，表面神经肌肉电刺激(SNMES)可以显著增加完全性脊髓损伤(SCI)患者的肌肉质量。我们发现试点数据表明，SNMES还可以增加糖耐量正常的完全性脊髓损伤后的胰岛素作用。这项建议的总体目的是扩展我们的研究，以测试运动疗法是否可以改善患有糖尿病(DIA)或糖耐量受损(IGT)的完全性脊髓损伤患者的胰岛素作用。具体目标是：1)3个月的阻力或耐力运动疗法能否有效地“治疗”完全性脊髓损伤患者的IGT或DIA；以及2)在SNMES诱导的运动疗法之后，哪些生理适应(增加的肌肉质量、减少的脂肪质量、增加的肌肉耐力)导致胰岛素作用的改善。100名患有完全性脊髓损伤(截瘫或四肢瘫痪)的18至55岁的IGT或DIA受试者(84人开始计划，78人预计完成)将在接下来的5年内进行研究。阻力训练将包括膝关节伸展和脚踝举重，每周两次，每次40次，为期3个月。所使用的重量将根据需要增加。耐力运动疗法将使用抽动刺激，每周三次，每次30分钟。另设对照组(不做运动)作为对照。以下技术将被用来评估治疗的有效性：胰岛素作用的口服葡萄糖耐量测试，肌肉大小和脂肪沉积的磁共振成像，以及疲劳测试的SNMES。否定零假设将表明，那些完全脊髓损伤的人可以使用基于居住地的、自我给药的抵抗或耐力运动疗法来治疗IGT/DIA，并降低心血管疾病的风险。此外，还将确定最能预测胰岛素作用变化的生理适应。分组设计将用于分别评估IGT和DIA。这项研究将解决预防糖尿病的方法，糖尿病是脊髓损伤中的一个重要健康问题。这项研究还将使用实用的自我管理运动方案，并将测试胰岛素作用和可改变的生理功能之间的联系。因此，这项研究有可能极大地造福于脊髓损伤患者。

DESCRIPTION (provided by applicant): This proposed research is a revised competing continuation of a previous award. Our previous research showed that surface neuromuscular electrical stimulation (SNMES) can markedly increase muscle mass in individuals with complete spinal cord injury (SCI). We found pilot data that suggested that SNMES can also increase insulin action after complete SCI who are glucose tolerant. The general aim of this proposal is to extend our research to test whether exercise therapy can improve insulin action in complete SCI individuals who are either diabetic (DIA) or have impaired glucose tolerance (IGT). The specific aims are: 1) Can 3 months of resistance or endurance exercise therapy be affective at "treating" IGT or DIA in complete, SCI individuals; and 2) What are the physiological adaptations (increased muscle mass, decreased fat mass, increased muscle endurance) are responsible for the improved insulin action following SNMES-induced exercise therapy. 100 subjects (84 to start the program, 78 expected to finish) with complete SCI (either paraplegic or quadriplegic) who are either IGT or DIA, 18 to 55 yrs of age, will be studied over the next 5 yrs. The resistance training will consist of knee extensions with ankle weights, two sessions of 40 lifts per week for 3 months. The weight used will be increased as needed. Endurance exercise therapy will use twitch stimulations for 30 minutes three times per week. A control group (no exercise) will be used for comparison. The following techniques will be used to assess the efficacy of the therapies; an oral glucose tolerance test for insulin action, magnetic resonance imaging for muscle size and lipid deposits, and SNMES for the fatigue tests. Rejection of the null hypothesis will show that those with a complete SCI can use either residence-based, self-administered resistance or endurance exercise therapy to treat IGT/DIA and reduce the risk of cardiovascular disease. In addition, physiological adaptations that best predict changes in insulin action will be determined. A blocked design will be used to separately evaluate IGT and DIA. This research will address methods to prevent diabetes which is an important health problem in SCI. This study will also use practical self-administered exercise protocols, and will test links between insulin action and modifiable physiological functions. Thus, this research has the potential to significantly benefit people with spinal cord injuries.