Comparative Resistance Exercise Effects on Knee Osteoarthritis Pain, Functional I

描述(申请人提供)：骨性关节炎(OA)与肌肉力量下降、软骨破坏和疼痛相关的残疾有关。仅膝骨性关节炎的治疗，每个患者每年的自付费用估计为2600美元，每年的总费用估计为5700美元。这项拟议的研究将首次严格评估两种抗阻运动(RX)模式对膝骨性关节炎疼痛和功能障碍的影响。使用RX可能有助于缓解OA症状，降低医疗管理成本，并推迟或避免昂贵的膝关节置换手术。目前尚不清楚两种阻力运动模式对膝关节疼痛、软骨转换和身体功能是否有不同的疗效：偏心集中运动(ERX)和传统的向心集中运动(CRX)。使用创新的原型阻力运动设备，我们将进行一项为期四个月的随机单盲对照研究，比较eRx和CRX与非运动对照(CON)条件对患有膝骨性关节炎(60-85岁)的老年人膝关节疼痛、身体功能和软骨转换的相对疗效。这项研究的主要目的是确定eRx是否将比CRX或CON更好地减少老年人的膝关节疼痛(使用西安大略省和麦克马斯特大学的骨关节炎指数(WOMAC评分)。第二个目标1将在第四个月确定eRx是否比CRx和Con更能改善身体功能和习惯性体力活动(通过功能测试电池进行评估)。二级目标2将在第四个月测试ERX是否会比CRX或CON(使用II型前胶原C-前肽[CTX-II]、II型胶原C-端肽[CPII])引起更大的软骨生物标记物更替变化。这项拟议的研究是一项前瞻性、随机、对照研究(RCT)，将确定两种阻力运动方案中的一种是否可以改善患有膝骨性关节炎的老年人的疼痛、身体功能和软骨代谢。这是一个重复措施，三组设计。参与者(n=90)将被随机分配到三个研究组中的一个(每组n=30)。这三个组将包括非运动对照组(CON)、集中耐力训练组(CRX；一套/练习，每周两次)和偏心集中抵抗力训练组(ERX；一套/锻炼，每周两次)。研究措施将在基线和第四个月收集。患有骨性关节炎相关膝部疼痛的男性和女性将有资格参加这项研究。人口统计学、身体成分、骨性关节炎病史和严重程度将被收集为描述性变量。活动能力和身体功能测试(6分钟步行测试、7天计步器测试、椅子起立时间和爬楼梯时间)、膝关节疼痛(WOMAC评分)和软骨转换生物标记物(CTX-II、CPII)将在基线和4个月的抗阻运动或控制期后进行。这项拟议的研究的独特性存在于两个方面：将确定两种肌肉收缩类型对老年人膝关节骨性关节炎症状和功能的比较效果，并将评估两种形式的抗阻运动对软骨更新生物标志物水平的影响。这位候选人是佛罗里达大学骨科和康复学系的助理教授。他拥有佛罗里达大学的运动生理学博士学位，并拥有物理医学和康复方面的董事会认证。这位候选人也是克劳德·D·佩珀老年美国人独立中心(OAIC)的初级学者。他的研究重点是检查阻力运动对临床人群，特别是老年人的身体机能和生理适应的影响。为了实现成为一名独立的临床科学家的目标，候选人为这个奖项确立了以下目标：1)提高他的临床研究技能；2)增进他目前关于骨关节炎发病机制和病理生理学的知识，主要集中在膝关节和关节软骨的生化和生物力学变化；3)获得与膝关节骨关节炎发展相关的背景知识和技术技能，包括生物力学和生化分析；4)提高赠款的撰写熟练程度。这位候选人已经建立了一支由经验丰富的资深教师组成的指导和协作团队。主要导师是老年病和老年病学部的克里斯蒂安·勒文伯格博士。共同导师是斯科特·班克斯博士和史蒂文·格维扎尼。文森特博士的导师在骨关节炎研究和指导初级教员方面拥有丰富的经验。在他们的帮助下，设计了一项为期三年的职业发展计划，以利用选定的教学课程、指导实验室经验、出席会议/讲习班、有组织的会议和定期安排的研讨会。文森特博士还将得到约翰·舒斯特博士和北卡罗来纳大学乔安妮·乔丹博士的指导，以帮助他发展统计分析技能，乔丹博士将帮助临床与OA和研究设计相关。除了一支杰出和经验丰富的指导团队外，文森特博士还将完全可以使用必要的设施和支持办公室来进行拟议的研究。这项拟议研究的数据收集的主要地点将是佛罗里达大学(UF)整形外科和运动医学研究所内的人类动力学实验室。这项研究还将利用UF老龄研究所内OAIC的研究核心(招聘、临床研究、生物统计和数据管理、基因组学和生物标记物)以及临床和转化科学研究所的资源。

DESCRIPTION (provided by applicant): Osteoarthritis (OA) is associated with muscle strength decline, cartilage breakdown and pain-related disability. The annual estimated out-of-pocket cost per patient for the management of knee OA alone is estimated to be $2600 with total annual expenses estimated to be $5700. The proposed investigation will be the first to rigorously evaluate the influence of two modes of resistance exercise (RX) on knee OA pain and functional impairment. Use of RX may help with resolution of OA symptoms, decrease medical management costs and delay or avoid costly knee replacements. It is unknown whether there is differential efficacy of two modes of resistance exercise on knee pain, cartilage turnover and physical function: eccentrically-focused exercise (ERX) and traditional concentrically-focused exercise (CRX). Using innovative prototype resistance exercise equipment, we will conduct a four-month, randomized, single-blind controlled study of the relative efficacy of ERX and CRX compared to a non-exercise control (CON) condition on knee pain, physical function and cartilage turnover in older adults with knee OA (aged 60-85). Primary Aim of this study is to determine if ERX will reduce knee pain in older adults (using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC Score) more than CRX or CON. Secondary Aim 1 will be to determine if ERX improves physical function and habitual physical activity more than CRX and CON by month four (assessed by a functional test battery). Secondary Aim 2 will test whether ERX will induce greater changes in cartilage biomarker turnover than CRX or CON by month four (using C-propeptide of type II procollagen [CTX-II], Collagen Type II C- telopeptide [CPII]). This proposed study is a prospective, randomized, controlled study (RCT) that will determine whether one of two resistance exercise protocols improves pain, physical function, and cartilage metabolism in older persons with knee OA. This is a repeated-measures, three group design. Participants (n=90) will be randomly assigned to one of three study groups (n=30 per group). The three groups will include a non-exercise control (CON) group, a concentrically focused resistance training group (CRX; one set/ exercise, two sessions/ week) and an eccentrically focused resistance training group (ERX; one set/ exercise, two sessions/ week). Study measures will be collected at baseline and at month four. Men and women with OA related knee pain will be eligible for this study. Demographics, body composition, OA history and severity will be collected as descriptive variables. Mobility and physical function tests (Six minute walk test, 7-day pedometer test, chair rise time and stair climb time), knee pain (WOMAC Score), and biomarkers of cartilage turnover (CTX-II, CPII) will be performed at baseline and after four months of resistance exercise or control period. The uniqueness of the proposed study exists on two fronts: the comparative efficacy of two muscle contraction types on knee OA symptoms and function in older adults will be determined, and the effects of two forms of resistance exercise on the levels of biomarkers of cartilage turnover will be assessed. The candidate is an Assistant Professor in the Department of Orthopaedics and Rehabilitation at the University of Florida. He has a PhD in Exercise Physiology from the University of Florida and is board certified in Physical Medicine and Rehabilitation. The candidate is also a Junior Scholar in the Claude D. Pepper Older Americans Independence Center (OAIC). His research focus is to examine the influence of resistance exercise on physical function and physiological adaptations in clinical populations, particularly older adults. To achieve the goal of becoming an independent clinician scientist, the candidate has established the following objectives for this award: 1) Enhance his clinical research skills; 2) Advance his current knowledge of the pathogenesis and pathophysiology of osteoarthritis with a primary focus on the biochemical and biomechanical changes in the knee joint and articular cartilage ; 3) Acquire background knowledge and technical skills relevant to the development of knee OA including both biomechanical and biochemical analysis; 4)Improve grant writing proficiency. The candidate has developed a mentoring and collaborative team composed of accomplished senior faculty. The primary mentor is Dr. Christiaan Leeuwenburgh, from the Department of Aging and Geriatrics. The Co-mentors are Drs. Scott banks and Steven Ghvizzani. Dr. Vincent's mentors have extensive experience with osteoarthritis research and mentoring junior faculty. With their assistance a three-year career development plan has been designed to take advantage of select didactic courses, mentored laboratory experiences, conference/workshop attendance, structured meetings and regularly scheduled seminars. Dr. Vincent will also have guidance from Dr. John Shuster to assist with his statistical analysis skill development and from Dr. Joanne Jordan from the University of North Carolina who will help with clinical correlation to OA and research design. In addition to a distinguished and experienced mentoring team, Dr. Vincent will have full access to the necessary facilities and support offices to conduct the proposed study. The primary location for data collection for the proposed study will be the Human Dynamics Laboratory within the Orthopaedics and Sports Medicine Institute at The University of Florida (UF). This study will also utilize the research cores (Recruitment, Clinical Research, Biostatistic and Data Management, and Genomics and Biomarkers) of the OAIC within the UF Institute on Aging, and the resources of the Clinical and translational Science Institute.