Effect of Intense Multi-Modal Training on Bone Mineral Density, Bone Biomarkers,

描述（由申请人提供）：项目总结每年发生约11，000例脊髓损伤（SCI），其中80%的损伤发生在男性中。SCI的发作通常会减少身体活动的参与，改变内分泌功能，身体成分和活力，导致健康状况下降。SCI的另一个严重并发症是骨质疏松症。骨丢失在受伤后的最初六个月内是迅速的，并且在通常接受骨骼负荷的胫骨和股骨等部位最大。这种脱矿作用增加了日常活动中骨折的发生，几乎没有创伤。由于骨丢失和随后的骨折会导致严重的临床、心理和经济并发症，因此对SCI患者进行早期干预以减缓骨丢失速度至关重要。为了减缓这一人群骨质疏松症的进展，已经使用了各种康复方式，尽管它们在这一人群中维持甚至增加骨的能力是不确定的。一项研究报告说，单模式运动本身无法减缓SCI患者的骨丢失。 到目前为止，没有研究已经审查了康复的影响，包括多种运动方式提供下肢的骨骼健康和身体组成的人群。此外，没有研究测量骨状态的变化，使用骨生物标志物，对长期运动训练的反应。因此，本研究的主要目的是检查骨矿物质密度（BMD），骨健康，身体成分和生活质量的变化，以应对以骨负荷为特征的严格的多模式训练计划。总的来说，骨丢失是SCI的一个重要并发症，给临床医生带来了巨大的挑战。必须确定切实有效的方法来管理和减轻骨质流失，并改善这一人群的整体健康状况。 我们提议对大约24名SCI男性和女性进行一项为期六个月的新型训练研究。他们将完成每周6 - 9小时的密集多模式康复，重点是下肢负荷。他们的反应将与五名没有完成这种锻炼模式的SCI成年人进行比较。骨矿物质密度（BMD）是骨强度和骨折风险的临床有效指标，将在基线和项目3个月和6个月时在4个部位（脊柱、全身、髋关节和膝关节）进行评估。将评估由脂肪和无脂肪质量组成的身体组成。将以相似的时间间隔采集血样，以评估训练期间骨生长和骨吸收的变化。生活质量将被评估，以检查健康结果的变化，以应对培训。 公共卫生相关性：该项目将研究为期六个月的新型多模式训练方案对脊髓损伤患者骨骼健康，身体成分和生活质量的影响。目前，运动训练对骨状态的影响尚不明确，尽管似乎需要密集的康复来减缓骨丢失。该项目的数据可用于修改目前用于脊髓损伤患者的治疗方案，以改善生活质量并减少与骨丢失相关的并发症。

DESCRIPTION (provided by applicant): PROJECT SUMMARY Approximately 11,000 spinal cord injuries (SCI) occur annually, with 80 % of injuries occurring in men. Onset of SCI typically reduces participation in physical activity and alters endocrine function, body composition, and vitality, leading to reduced health status. Another serious complication of SCI is osteoporosis. Bone loss is rapid in the initial six months post-injury and is greatest in sites such as the tibia and femur that typically receive skeletal loading. This demineralization enhances occurrence of fracture in everyday activities involving little to no trauma. Because bone loss and subsequent fractures lead to severe clinical, psychological, and financial complications, early intervention to slow rate of bone loss in persons with SCI is essential. To slow progression of osteoporosis in this population, various rehabilitation modalities have been used, although their ability to maintain or even increase bone in this population is equivocal. One study reported that single mode exercise by itself is unable to slow bone loss in individuals with SCI. To date, no study has examined the effects of rehabilitation consisting of multiple exercise modalities providing loading of the lower extremities on bone health and body composition in this population. Moreover, no study has measured alterations in bone status, using bone biomarkers, in response to long-term exercise training. Consequently, the primary aim of this study is to examine changes in bone mineral density (BMD), bone health, body composition, and quality of life in response to a rigorous, multi-modal training program characterized by bone loading. Overall, bone loss is a significant complication of SCI presenting tremendous challenges to the clinician. Practical and effective methods must be identified to manage and mitigate bone loss, and improve overall health status, in this population. We propose a novel six-month training study in approximately 24 men and women with SCI. They will complete 6 - 9 hours per week of intense multi-modal rehabilitation focusing on lower extremity loading. Their responses will be compared to five adults with SCI who do not complete this mode of exercise. Bone mineral density (BMD), a clinically valid index of bone strength and fracture risk, will be assessed at four sites (spine, total body, hip, and knee) at baseline and at three and six months of the program. Body composition consisting of fat and fat-free mass will be assessed. Blood samples will be obtained at similar intervals to assess alterations in bone growth and resorption during training. Quality of life will be assessed to examine alterations in health outcomes in response to training. PUBLIC HEALTH RELEVANCE: This project will examine the effect of six months of a novel, multi-modal training regimen on bone health, body composition, and quality of life in individuals with spinal cord injury. Currently, changes in bone status in response to exercise training are equivocal, although it appears that intense rehabilitation is required to slow bone loss. Data from this project may be used to modify treatment options currently employed in persons with spinal cord injury to improve quality of life and reduce complications associated with bone loss.