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性延续。我们之前的研究表明，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也可以增加完全SCI后葡萄糖耐受性患者的胰岛素作用。本提案的总体目标是扩展我们的研究，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治疗是否能有效“治疗”完全性脊髓损伤患者的IGT或DIA；2)在snmes诱导的运动疗法后，哪些生理适应（增加肌肉量，减少脂肪量，增加肌肉耐力）是改善胰岛素作用的原因？100名受试者（84名开始项目，78名预计结束项目）患有完全SCI（截瘫或四肢瘫痪），他们要么是IGT，要么是DIA，年龄在18至55岁之间，将在未来5年内进行研究。阻力训练将包括膝关节伸展和脚踝重量，每周40次举重两次，持续3个月。使用的重量将根据需要增加。耐力运动疗法将使用抽搐刺激，每周三次，每次30分钟。另设对照组（无运动）进行比较。以下技术将用于评估治疗的疗效；胰岛素作用的口服葡萄糖耐量试验，肌肉大小和脂质沉积的磁共振成像，以及疲劳试验的SNMES。拒绝零假设将表明，完全性脊髓损伤患者可以使用基于住院、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，最能预测胰岛素作用变化的生理适应也将被确定。将采用分块设计分别评估IGT和DIA。本研究将探讨如何预防糖尿病，这是一个重要的健康问题。这项研究还将使用实际的自我管理运动方案，并将测试胰岛素作用与可改变的生理功能之间的联系。因此，这项研究有可能显著造福脊髓损伤患者。

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.