Novel Exercise Interventions to Improve Trunk Muscle Function: A Pilot Study

改善躯干肌肉功能的新型运动干预措施：一项试点研究

• 批准号: 8625923
• 负责人: Brian C Clark
• 金额: $ 16.34万
• 依托单位: OHIO UNIVERSITY ATHENS
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2016-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8625923
• 关键词: Acute; Address; Area; Arthritis; Atrophic; Back Pain; Blood coagulation; Blood flow; Chest; Chronic; Clinical Research; Clinical Trials; Control Groups; Data; Dose; Elbow; Endocrine; Exercise; Exhibits; Foundations; Future; Growth Factor; Individual; Inflammation; Injury; Intervention; Leg; Low Back Pain; Magnetic Resonance Imaging; Mechanics; Medical; Modality; Morphology; Muscle; Muscle function; Musculoskeletal; Neural Conduction; Outcome; Patients; Pilot Projects; Prevention; Protocols documentation; Randomized; Recruitment Activity; Recurrence; Recurrent Low Back Pain; Rehabilitation therapy; Research; Resistance; Safety; Skin; Societies; Spinal; Stimulus; Testing; Therapeutic; Training; Vertebral column; Work; arterial stiffness; base; cost effective; design; disability; improved; indexing; innovation; morphometry; muscle strength; novel; pressure; programs; public health relevance; rehabilitation strategy; response; strength training

DESCRIPTION (provided by applicant): Low back pain (LBP) has a staggeringly negative impact on society in terms of medical expenses and disability. Acute occurrence of LBP results in rapid onset of atrophy of the multifidus muscle, and recurrent LBP is associated with even greater maladaptive changes in trunk extensor muscle morphology and function (i.e., decreased size, strength, and endurance). Rehabilitation strategies for LBP often include resistance training to address these changes in the trunk extensor muscles; however, these exercise protocols are only modestly effective in promoting trunk extensor muscle adaptation as they are generally performed at low-loads (e.g., 25% max strength) that are well below those recommended for muscle adaption (>70% max strength). The use of higher-load trunk exercise is commonly contraindicated because of concern that high spinal compressive loads can cause further injury to the spine. Thus, it is critical to develop therapeutic approaches utilizing low mechanical loads that can still deliver sufficient stimuli to the trunk extensor muscles and reverse the changes in trunk extensor muscle function commonly observed in patients with LBP. Low-load resistance exercise with blood flow restriction (BFR) is an innovative approach for exactly this purpose. This paradigm involves performing exercise with low loads while blood flow to the working muscles is partially occluded by a pressure cuff. We have previously shown that a single bout of BFR exercise increases circulating endocrine growth factors, and we recently completed preliminary studies on chronic BFR exercise training and observed that this modality enhances muscle function without negatively impacting indices of arterial stiffness, nerve conduction, inflammation, and blood coagulation. While this exercise modality cannot be applied directly to the trunk (unfeasible to restrict thorax blood flow), our pilot data indicate a unique cross-transfer effect to the erector spinae muscles when low-load trunk extensor exercise is performed after BFR exercise with the appendicular muscles. Thus performing exercise with the appendicular muscles under BFR prior to low-load exercise with the trunk muscles could enhance muscle size and function without high spinal compressive loads. In this application we propose to conduct an exploratory trial as it relates to determining the effects BFR exercise on erector spinae muscle morphometry and function in patients with recurrent LBP. Our central hypothesis is that BFR exercise with the appendicular muscles performed prior to low-load trunk extensor exercise will produce systemic effects that enhance increases in trunk extensor size, strength, and endurance beyond those seen with only low-load trunk extensor exercise. The potential impact of this work is clear: If effective, this novel exercise modality will provide the foundation for a cost-effective and easy-to-implement rehabilitation strategy that is superior to existing paradigms in its capacity to induce muscle adaptation in the absence of high mechanical and compressive loading on the spine.

描述（由申请人提供）：在医疗费用和残疾方面，腰痛（LBP）对社会产生了惊人的负面影响。 LBP的急性发生导致多肌肌肉萎缩快速发作，而复发性LBP与躯干伸肌肌肉形态和功能的适应不良变化更大有关（即尺寸，强度和耐力降低）。 LBP的康复策略通常包括抵抗训练，以解决躯干伸肌肌肉中的这些变化；但是，这些运动方案仅在促进躯干延伸肌肉适应性方面非常有效，因为它们通常以低负载（例如25％的最大强度）进行，远低于建议的肌肉适应性（最大强度> 70％）。由于担心高脊柱压缩载荷会导致脊柱进一步伤害，因此通常禁忌使用高负载的躯干运动。因此，使用低机械负荷的低机械载荷开发治疗方法至关重要，这仍然可以为躯干伸肌肌肉提供足够的刺激，并逆转LBP患者通常观察到的躯干伸肌功能的变化。血流限制（BFR）的低负载耐药性运动是为此目的的创新方法。该范式涉及以低负荷进行运动，而流向工作肌肉的血液则被压袖所部分遮住。我们先前已经表明，单次BFR运动会增加循环的内分泌生长因子，并且最近我们完成了有关慢性BFR运动训练的初步研究，并观察到这种形态可以增强肌肉功能，而不会对动脉僵硬，神经传导，炎症，炎症和血液凝结产生负面影响。虽然这种运动方式不能直接应用于躯干（不限制胸腔血流不可行），但我们的飞行员数据表明​​，当BFR运动后进行低负载的躯干伸肌运动时，对勃起的螺旋肌肉产生了独特的交叉转移效果，并进行了附上的肌肉。因此，在BFR下，在用躯干肌肉进行低负载运动之前，在BFR下使用阑尾肌肉进行运动可以增强肌肉的大小和功能，而无需高脊柱压缩载荷。在此应用中，我们建议进行探索性试验，因为它与确定勃起运动对勃起的肌肉肌肉形态计量学和功能的效果有关。我们的中心假设是，在低负载的躯干伸肌运动之前，BFR运动具有阑尾肌肉，将产生系统性效果，从而增强躯干伸肌的大小，强度和耐力的增加，而耐力仅超出了仅具有低负载的躯干Ensensor运动。这项工作的潜在影响很明显：如果有效，这种新颖的运动方式将为 基础是具有成本效益且易于实施的康复策略，其在没有高脊柱机械和压缩负荷的情况下诱导肌肉适应的能力优于现有范例。