Ischemic Preconditioning to Augment muscle Function in Individuals with Spinal Cord Injuries

缺血预处理可增强脊髓损伤患者的肌肉功能

• 批准号: 10426263
• 负责人: Lisa Lombardo
• 金额: --
• 依托单位: LOUIS STOKES CLEVELAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10426263
• 关键词: Activities of Daily Living; Acute; Aerobic; Anaerobic Bacteria; Autonomic Dysreflexia; Blood; Blood Circulation; Blood Vessels; Blood flow; Bone Density; Cardiovascular Diseases; Cardiovascular Physiology; Cardiovascular system; Chronic; Clinic; Clinical; Communities; Complication; Custom; Effectiveness; Elasticity; Electric Stimulation; Environment; Exercise; Exercise Tolerance; Fatigue; Follow-Up Studies; Future; General Population; Health; Health Care Costs; Home; Impairment; Individual; Injury; Intervention; Investigation; Ischemia; Ischemic Preconditioning; Isotonic Exercise; Knee; Knowledge; Lead; Lower Extremity; Maintenance; Mental Depression; Metabolic; Muscle; Muscle Contraction; Muscle Fatigue; Muscle function; Muscular Atrophy; Obesity; Outcome; Output; Oxygen Consumption; Paralysed; Paraplegia; Performance; Perfusion; Peripheral; Physical activity; Physiological; Physiological Adaptation; Pilot Projects; Production; Protocols documentation; Quality of life; Recovery; Rehabilitation therapy; Reperfusion Therapy; Resistance; Safety; Skeletal Muscle; Spinal cord injury; Symptoms; Testing; Time; Tissues; Training; United States; Veterans; Veterans Health Administration; Volition; Weight Gain; Work; bone loss; cardiovascular disorder risk; clinical practice; comorbidity; deconditioning; exercise capacity; exercise intensity; exercise intervention; exercise training; experience; improved; intervention cost; medical specialties; muscle form; muscle strength; programs; recruit; rehabilitation paradigm; rehabilitation strategy; response; safety and feasibility; sedentary lifestyle; tissue oxygenation; trispecific killer engager

Spinal cord injury (SCI) often results in a sedentary lifestyle and profound deconditioning due to limited options for exercise. This decreased physical activity often leads to weight gain, bone loss, muscle atrophy, poor circulation, impaired cardiovascular function along with depression and decreased self-confidence. Options to exercise the muscles below the level of injury are restricted to electrical stimulation driven exercise that is constrained to reduced muscular force and work output. This ultimately results in reduced cardiorespiratory, metabolic and muscular adaptations compared to volitional exercise interventions in able bodied individuals. For this reason, an intervention that can increase the muscular force and work performed during electrical stimulation (ES) exercise is of utmost importance for individuals with SCI as it can lead to improved maintenance of lower limb muscle mass, better physiological adaptations and improved quality of life. Ischemic preconditioning (IPC) consists of brief periods of ischemia followed by reperfusion performed prior to exercise. In the general population, IPC has shown positive muscular benefits such as increased aerobic and anaerobic exercise performance, prolonging the time to skeletal muscle fatigue and improved recovery from maximal effort. However, this promising intervention has yet to be tested with ES exercise in those with SCI. Thus, the purpose of this SPiRE proposal is to determine if IPC prior to exercise with ES is safe and can improve skeletal muscle function and endurance in Veteran’s with complete SCI. 20 subjects will be recruited for a study consisting of 5 sessions that will involve performing IPC or a sham prior to ES isolated muscle contractions or ES lower body exercise. Specific Aim 1 will determine the safety of performing an acute bout of IPC prior to performing knee extension and if maximal muscle strength and fatigue resistance (Biodex isokinetic dynamometer) improves after IPC. In addition, tissue oxygenation, femoral blood flow and blood lactate will be assessed to identify potential impact of IPC on tissue perfusion and vascular function. Specific Aim 2 will determine whether performing an acute bout of IPC prior to ES cycling exercise (cycling on a recumbent tricycle) will improve performance including power output and time/distance cycled. Tissue oxygenation, femoral blood flow and blood lactate will also be collected during these sessions. Ultimately, if an acute bout of IPC is safe and augments muscle performance during ES exercise, further studies to determine long-term physiological benefits of chronic ES exercise in combination with IPC would be warranted. IPC has the potential to enhance the current rehabilitation standards for Veterans with SCI. In addition the ability to increase exercise intensity and cycling performance has potential to provide Veterans with SCI the additional muscle strength required to cycle overground and in the community on modified trikes with ES.

脊髓损伤 (SCI) 通常会导致久坐的生活方式和严重的功能失调。 运动选择的减少往往会导致体重增加， 骨质流失、肌肉萎缩、血液循环不良、心血管功能受损 抑郁和自信心下降的选择来锻炼水平以下的肌肉。 的伤害仅限于电刺激驱动的运动，该运动仅限于减少 这最终会导致心肺功能和代谢功能下降。 与身体健全者的意志运动干预相比，肌肉的适应性 因此，可以增加肌肉力量和工作量的干预措施。 在电刺激 (ES) 锻炼期间进行的锻炼对于个人来说至关重要 SCI 可以改善下肢肌肉质量的维持，更好 生理适应和生活质量的改善包括缺血预处理（IPC）。 一般情况下，运动前会进行短暂的缺血再灌注。 IPC 已显示出积极的肌肉益处，例如增加有氧运动和 无氧运动表现，延长骨骼肌疲劳时间并改善 然而，这种有希望的干预措施尚未经过测试。 因此，该 SPiRE 提案的目的是确定 IPC 是否有效。 运动前使用 ES 是安全的，并且可以改善骨骼肌功能和耐力 将招募 20 名具有完整 SCI 的退伍军人参加由 5 个课程组成的研究。 这将涉及在 ES 孤立肌肉收缩或 ES 降低之前进行 IPC 或假手术 具体目标 1 将确定进行急性 IPC 的安全性。 在进行膝关节伸展之前，以及最大肌肉力量和抗疲劳能力 （Biodex 等速测力计） IPC 后组织氧合、股骨也得到改善。 将评估血流量和血乳酸，以确定 IPC 对组织的潜在影响 灌注和血管功能将决定是否进行急性治疗。 在 ES 自行车运动（骑卧式三轮车）之前进行一次 IPC 将会有所改善 性能，包括功率输出和循环时间/距离、股骨。 如果是急性的，最终也会在这些过程中收集血流和血乳酸。 一次 IPC 是安全的，并且可以增强 ES 锻炼期间的肌肉表现，进一步研究 确定长期 ES 运动与 IPC 相结合的长期生理益处 IPC 有潜力提高当前的康复标准。 患有 SCI 的退伍军人还可以增加运动强度和骑自行车。 表现有潜力为患有 SCI 的退伍军人提供额外的肌肉力量 需要使用 ES 改装的三轮车在地面和社区内骑行。