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

项目概述：每年约有11,000例脊髓损伤(SCI)发生，其中80%的损伤发生在男性。脊髓损伤的发病通常会减少对体力活动的参与，改变内分泌功能、身体成分和活力，导致健康状况下降。脊髓损伤的另一个严重并发症是骨质疏松症。在受伤后的最初六个月内，骨丢失迅速，在通常接受骨骼负荷的胫骨和股骨等部位，骨丢失最严重。这种脱矿作用增加了日常活动中骨折的发生，这些活动几乎没有创伤。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，因此早期干预以减缓脊髓损伤患者的骨丢失速度是必不可少的。为了减缓骨质疏松症在这一人群中的进展，已经使用了各种康复方法，尽管它们在这一人群中保持甚至增加骨骼的能力是模棱两可的。一项研究报告称，单一模式的运动本身无法减缓脊髓损伤患者的骨丢失。到目前为止，还没有研究检查包括多种运动方式的康复对这一人群的骨健康和身体成分的影响。此外，还没有研究使用骨骼生物标记物来衡量长期运动训练后骨骼状态的变化。因此，这项研究的主要目的是检查骨密度(BMD)、骨健康、身体成分和生活质量在以骨负荷为特征的严格、多模式训练计划的响应下的变化。总体而言，骨丢失是脊髓损伤的重要并发症，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丢失，并改善这一人群的整体健康状况。我们建议对大约24名患有脊髓损伤的男性和女性进行为期六个月的新的培训研究。他们将完成每周6-9个小时的密集多模式康复，重点是腿部负荷。他们的反应将与没有完成这种锻炼模式的五名患有脊髓损伤的成年人进行比较。骨矿密度(BMD)是骨强度和骨折风险的临床有效指标，将在基线以及计划实施3个月和6个月时在四个部位(脊柱、全身、髋部和膝盖)进行评估。将评估由脂肪和脱脂质量组成的身体成分。将在类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。将评估生活质量，以检查培训后健康结果的变化。

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.