Strength Training and Arthritis Trial

力量训练和关节炎试验

基本信息

批准号：
8724168
负责人：
Stephen P Messier
金额：
$ 77.07万
依托单位：
WAKE FOREST UNIVERSITY
依托单位国家：
美国
项目类别：
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/8724168
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

项目摘要

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.

描述（由申请人提供）：肌肉损失和脂肪增加有助于与膝盖骨关节炎（OA）相关的残疾，疼痛和发病率，而大腿肌肉无力是其独立且可修改的风险因素。已发表的治疗指南建议加强肌肉来对抗肌肉减少症并改善膝关节OA患者的肌肉质量；但是，以前的力量训练研究要么使用强度低于建议水平，要么通常短（6至24周）。因此，它们具有低到最低的效应大小，无法检测到疾病进展的变化，无法解决OA机制，并且几乎没有持久的临床益处。高强度强度训练在改善症状，放缓进展和影响基本机制方面的功效尚未受到检查，这是由于未经证实的信念可能会加剧症状。我们的初步数据表明，具有高强度强度训练的耐受性以及膝盖OA老年人的疼痛和功能的减轻。在健康的老年人中，类似的研究发现大腿肌肉质量有所改善，大腿脂肪质量减少，经过16-18周的训练，体重的最小改变。我们建议对患有膝盖OA的老年人进行18个月的高强度强度训练干预措施，重点是改善大腿组成。我们假设，除了短期临床益处外，将更大的持续时间与高强度结合起来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，较低的疼痛水平和缓慢的进展。参与者（E 55岁； BMI E 25 kg/m2和D 40 kg/m2）将被随机分为3组之一：高强度强度训练（75-90％1RM）；低强度强度训练（30-40％1RM）；或注意力控制。研究样本将由372名卧床，社区居住人员组成：（1）轻度至中度的胫骨内侧OA（KL = 2-3）；（2）膝关节变形障碍（脱角度E 2度和D 10度）；（3）在过去6个月内，每周没有参加超过30分钟的正式实力训练计划。主要的临床目的是比较干预措施对膝盖疼痛的影响，主要的机理目的是比较它们对步行过程中膝关节压缩力的影响，这是一种影响OA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措施的影响；疾病进展，通过MRI测量；大腿肌肉和脂肪体积，通过CT测量；大腿肌肉功能的组成部分，包括髋关节绑架力强度和股四头肌的强度，力量和本体感受；膝关节负荷的其他措施；以及炎症和OA生物标志物。这项研究以三种方式具有创新性。首先，它测试了适用于膝盖OA老年人群的高强度强度训练方案的功效。其次，它考虑了临床和机械结果。第三，它结合了运动强度和持续时间，以确定能够改善临床症状并减缓疾病进展的非药物治疗，从而减少了不良反应。