Strength Training and Arthritis Trial

力量训练和关节炎试验

• 批准号: 8108330
• 负责人: Stephen P Messier
• 金额: $ 61.9万
• 依托单位: WAKE FOREST UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-01 至 2016-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8108330
• 关键词: Address; Adverse effects; Affect; Age; Arthritis; Attention; Belief; Biological Markers; Body Weight; Bone Marrow; Boston; Cartilage; Clinical; Communities; Control Groups; Cyclophosphamide; Data; Degenerative polyarthritis; Disease Pathway; Disease Progression; Educational Intervention; Elderly; Exercise; Fatty acid glycerol esters; Femur; Guidelines; Health Occupations; Hip region structure; Inflammation; Inflammatory; Interleukin-6; Intervention; Knee; Knee Osteoarthritis; Knee joint; Leptin; Lesion; Long-Term Effects; Magnetic Resonance Imaging; Measures; Medial; Morbidity - disease rate; Morphology; Muscle; Muscle Weakness; Muscle function; Older Population; Outcome; Pain; Participant; Patients; Persons; Prevalence; Prevention; Proprioception; Protocols documentation; Publishing; Randomized; Relative (related person); Risk Factors; Sampling Studies; Serum; Severity of illness; Symptoms; TNF gene; Thick; Thigh structure; Training; Training Programs; Walking; articular cartilage; combat; disability; efficacy testing; follow-up; improved; improved functioning; improved mobility; inflammatory marker; innovation; intervention effect; joint loading; knee pain; modifiable risk; muscle form; muscle strength; quadriceps muscle; sarcopenia; strength training; urinary

DESCRIPTION (provided by applicant): Muscle loss and fat gain contribute to the disability, pain, and morbidity associated with knee osteoarthritis (OA), and thigh muscle weakness is an independent and modifiable risk factor for it. Published treatment guidelines recommend muscle strengthening to combat sarcopenia and improve muscle quality in knee OA patients; however, previous strength-training studies either used intensities below recommended levels or were generally short (6 to 24 weeks). Consequently, they had low-to-modest effect sizes, could not detect changes in disease progression, did not address underlying OA mechanisms, and provided little lasting clinical benefit. The efficacy of high intensity strength training in improving symptoms, slowing progression, and affecting the underlying mechanisms has not been examined due to the unsubstantiated belief that it might exacerbate symptoms. Our preliminary data show excellent tolerance for high-intensity strength training as well as reduced pain and increased function among older adults with knee OA. Similar studies in healthy older adults found improvements in thigh muscle mass and decreases in thigh fat mass with minimal alteration in total body weight after 16-18 weeks of training. We propose an 18-month, high-intensity strength-training intervention for older adults with knee OA, focused on improving thigh composition. We hypothesize that in addition to short- term clinical benefits, combining greater duration with high intensity will alter thigh composition sufficiently to attain long-term changes in knee-joint forces, decrease inflammation, lower pain levels, and slow progression. Participants (age e 55 yrs; BMI e 25 kg/m2 and d 40 kg/m2) will be randomized to one of 3 groups: high- intensity strength training (75-90% 1RM); low-intensity strength training (30-40%1RM); or attention control. The study sample will consist of 372 ambulatory, community-dwelling persons with: (1) mild-to-moderate medial tibiofemoral OA (KL = 2-3); (2) knee varus malalignment (varus angle e 2 degrees and d 10 degrees); and (3) no participation in a formal strength-training program for more than 30 minutes per week within the past 6 months. The primary clinical aim is to compare the interventions' effects on knee pain, and the primary mechanistic aim is to compare their effects on knee-joint compressive forces during walking, a mechanism that affects the OA disease pathway. Secondary aims will compare intervention effects on additional clinical measures of disease severity; disease progression, measured by MRI; thigh muscle and fat volume, measured by CT; components of thigh muscle function, including hip abductor strength and quadriceps strength, power, and proprioception; additional measures of knee-joint loading; and inflammatory and OA biomarkers. This study is innovative in three ways. First, it tests the efficacy of a high-intensity strength training protocol suitable for an older population with knee OA. Second, it considers both clinical and mechanistic outcomes. Third, it combines exercise intensity and duration to identify a nonpharmacologic therapy capable of improving clinical symptoms and slowing disease progression with minimal adverse effects. PUBLIC HEALTH RELEVANCE: Given the prevalence and impact of OA and the widespread availability of this intervention, assessing its efficacy has immediate and vital clinical impact. Results of this trial will provide critically needed guidance for clinicians in a variety of health professions who prescribe and oversee treatment and prevention of OA-related complications.

描述（由申请人提供）：肌肉减少和脂肪增加导致膝关节骨关节炎（OA）相关的残疾、疼痛和发病率，大腿肌肉无力是其独立且可改变的风险因素。已发表的治疗指南建议加强肌肉以对抗膝关节OA患者的肌肉减少症并改善肌肉质量;然而，以前的力量训练研究要么使用低于推荐水平的强度，要么通常很短（6到24周）。因此，它们具有低至中等的效应量，不能检测疾病进展的变化，不能解决潜在的OA机制，并且几乎没有提供持久的临床益处。高强度力量训练在改善症状、减缓进展和影响潜在机制方面的疗效尚未得到检验，因为未经证实的信念认为它可能会加剧症状。我们的初步数据显示，高强度力量训练的耐受性良好，疼痛减轻，膝关节OA老年人的功能增强。在健康老年人中进行的类似研究发现，在16-18周的训练后，大腿肌肉质量得到改善，大腿脂肪质量减少，总体重变化极小。我们建议对患有膝关节OA的老年人进行为期18个月的高强度力量训练干预，重点是改善大腿组成。我们假设，除了短期临床获益外，将更长的持续时间与高强度相结合将充分改变大腿组成，以实现膝关节力的长期变化，减少炎症，降低疼痛水平并减缓进展。参与者（年龄55岁; BMI 25 kg/m2和40 kg/m2）将被随机分配到3组中的一组：高强度力量训练（75- 90%1RM）;低强度力量训练（30-40%1RM）;或注意力控制。研究样本将包括372名非卧床社区居民，他们患有：（1）轻度至中度内侧胫股OA（KL = 2-3）;（2）膝关节内翻对线不良（内翻角e 2度和d 10度）;（3）在过去6个月内每周未参加超过30分钟的正式力量训练计划。主要临床目的是比较干预措施对膝关节疼痛的影响，主要机制目的是比较它们对行走过程中膝关节压缩力的影响，这是一种影响OA疾病途径的机制。次要目的将比较干预对疾病严重程度的其他临床指标的影响;通过MRI测量的疾病进展;通过CT测量的大腿肌肉和脂肪体积;大腿肌肉功能的组成部分，包括髋外展肌力量和四头肌力量，力量和本体感觉;膝关节负荷的其他指标;以及炎症和OA生物标志物。本研究在三个方面具有创新性。首先，它测试了适用于膝关节OA老年人群的高强度力量训练方案的有效性。其次，它考虑了临床和机械结果。第三，它结合运动强度和持续时间，以确定能够改善临床症状和减缓疾病进展的非药物治疗，副作用最小。 公共卫生相关性：鉴于OA的患病率和影响以及这种干预措施的广泛可用性，评估其疗效具有直接和重要的临床影响。这项试验的结果将为各种卫生专业的临床医生提供急需的指导，这些医生处方和监督OA相关并发症的治疗和预防。