Exercise-Facilitated NeuroRehabilitation in Diabetic Neuropathy

糖尿病神经病变的运动促进神经康复

基本信息

批准号：
8839269
负责人：
Morris Fisher
金额：
--
依托单位：
EDWARD HINES JR VA HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-07-01 至 2013-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8839269
关键词：
Accounting Acetylcarnitine Address Adult Advanced Glycosylation End Products Aerobic Aerobic Exercise Affect Age Aging Aldehyde Reductase American Animals Blinded Blindness Blood flow Body mass index Caring Chronic Clinical Clinical Research Clinical Trials Complications of Diabetes Mellitus Conduct Clinical Trials Data Deterioration Development Diabetes Mellitus Diabetic Angiopathies Diabetic Neuropathies Disease Distal Effectiveness Epidemic Esthesia Exercise Fiber Functional disorder Glucose Goals Health Health Promotion Health Surveys Healthcare Hexosamines Homeostasis Hospitals Human Hyperglycemia Individual Institution Insulin-Dependent Diabetes Mellitus Intervention Isotonic Exercise Kidney Diseases Kidney Failure Leg Length Life Style Limb structure Maintenance Measurable Measures Medical Medical center Metabolic Metabolism Microvascular Dysfunction Morbidity - disease rate Motor Muscle National Institute of Diabetes and Digestive and Kidney Diseases Nerve Nerve Fibers Nerve Growth Factors Neural Conduction Neuraxis Neurologic Examination Neurological outcome Neuropathy Neurorehabilitation Non-Insulin-Dependent Diabetes Mellitus Obesity Outcome Outcome Measure Oxidation-Reduction Oxygen Pain Pain management Patient Care Patients Perception Peripheral Nerves Peripheral Nervous System Diseases Peripheral Vascular Diseases Physical Examination Physical activity Physical therapy exercises Polyneuropathy Population Prevalence Prophylactic treatment Proteins Protocols documentation Public Health Publishing Quality of life Randomized Recording of previous events Recovery Recruitment Activity Rehabilitation therapy Reporting Research Methodology Resources Retinal Diseases Risk Savings Secondary to Sensory Services Signal Transduction Pathway Site Staging Symptoms System Testing Therapeutic Therapeutic Intervention Tissues Torque Training Training Programs Treadmill Tests Triad Acrylic Resin United States Veterans Visit Visual Analogue Pain Scale Walking Western World Work aged atherogenesis autonomic nerve cost density design diabetes management diabetes prevention program diabetes risk diabetic diabetic patient diet and exercise experience follow-up glycation glycemic control group intervention improved infrared spectroscopy inhibitor/antagonist innovation limb amputation mortality muscle strength nerve injury neuromechanism novel therapeutics nutrition oxidation painful neuropathy palliative patient population polyol primary outcome programs prophylactic prospective quadriceps muscle relating to nervous system response secondary outcome strength training sural tibialis anterior muscle tissue oxygenation treadmill training treatment strategy uptake

项目摘要

ABSTRACT Purpose: A single-site, randomized, blinded, prospective clinical trial is proposed to determine the significance of a combined isokinetic strength and aerobic exercise training program on the rehabilitation of peripheral nerve function in type 2 diabetic veterans with neuropathy. Background and Significance: Obesity is a major factor in the increasing rates of diabetes and its related complications. Diabetes affects greater than 7% of the population. Veterans are at even greater risk, with approximately 16% currently receiving treatment at Department of Veterans Affairs Medical Centers for diabetes. More than half of affected veterans experience debilitating complications of diabetes, including peripheral neuropathy (PN). Exercise training, in combination with pharmacologic intervention, is now recognized as a cornerstone of management for diabetes. Therapeutic interventions currently available for the treatment of PN in diabetic patients are limited, however, to pain management and stringent glycemic control. Exercise is reported to significantly decrease peripheral nerve microvascular complications common among chronic diabetics. Our preliminary findings demonstrate that exercise intervention improves peripheral nerve function in the diabetic veteran with PN. Intervention strategies, such as proposed in this application, offer a unique and novel therapeutic option for the rehabilitation of the neuro-compromised diabetic veteran. Methods & Research Plan: One-hundred subjects will be recruited for this 24-week study. Subjects each will be randomly assigned to aerobic, isokinetic strength training, combined aerobic and strength training, or non-exercise (control) intervention groups. Isokinetic strength training (Biodex System 3), aerobic exercise training (treadmill), or the combination of strength and aerobic training will be administered 3x per week for the initial 12 weeks. Control subjects will receive 12 clinical visits over the course of the initial 12 weeks. The effects of exercise training type, compared with control subjects, on recovery of peripheral nerve function will be rigorously determined from baseline, 12- and 24-week testing using electrodiagnostic primary outcome measures, Quantitative Sensory Testing, and a battery of validated qualitative and quantitative secondary outcome measures that include an incremental symptom-limited treadmill test, peak torque, Total Neuropathy Score, visual analogue pain scale, and quality of life SF-36V Health Survey. Sustainability of effect will be determined at 24-weeks.The individual effects of exercise training type, compared with control subjects, on tissue oxygenation will be determined from baseline, 12- and 24-week testing by non-invasive quantitated infrared spectroscopy using an InSpectraTM Tissue Spectrometer. Expected Outcomes: This study will objectively and critically determine the type and combination of exercise needed to rehabilitate the neuro-compromised diabetic Veteran. Guided exercise protocols may prove to be practical therapeutic options for the prophylactic management of diabetic subjects with neuropathy.

抽象的目的：提出了一个单位，随机，盲目的前瞻性临床试验来确定重要性关于外围康复的同动力和有氧运动训练计划的组合有神经病的2型糖尿病退伍军人的神经功能。背景和意义：肥胖是主要的糖尿病及其相关并发症发生率的增加。糖尿病会影响超过7％的糖尿病人口。退伍军人面临更大的风险，目前约有16％在退伍军人事务部医疗中心糖尿病。超过一半的受影响的退伍军人经验糖尿病的并发症，包括周围神经病（PN）。锻炼训练，结合通过药理学干预，现在被认为是糖尿病管理的基石。治疗性但是，目前可用于治疗糖尿病患者PN的干预措施受到限制管理和严格的血糖控制。据报道运动可显着降低周围神经慢性糖尿病患者常见的微血管并发症。我们的初步发现表明运动干预可改善PN糖尿病退伍军人的外围神经功能。干涉策略，例如本应用程序中提出的策略，为该策略提供了一种独特而新颖的治疗选择神经受损的糖尿病老兵的康复。方法与研究计划：一百个学科这项为期24周的研究将被招募。每个受试者将被随机分配给有氧，同动强度训练，有氧和力量训练或非运动（对照）干预组。等速学力量训练（Biodex System 3），有氧运动训练（跑步机）或力量和强度和有氧训练将在最初的12周内每周进行3倍。控制对象将收到12 最初12周的临床访问。与运动训练类型的影响相比控制受试者，在基线12和12和使用电诊断的主要结果指标，定量感觉测试和A的24周测试一系列经过验证的定性和定量次要结果指标，包括增量症状受限的跑步机测试，峰值扭矩，总神经病评分，视觉模拟疼痛量表和质量 Life SF-36V健康调查。效果的可持续性将在24周确定。与对照组相比，运动训练类型，在组织中的氧合作用将根据基线确定使用Inspectratm组织通过非侵入性定量红外光谱进行了12周和24周的测试光谱仪。预期结果：这项研究将客观和批判性地确定类型和恢复神经支持的糖尿病老兵所需的运动结合。指导运动方案可能被证明是对糖尿病患者进行预防治疗的实际治疗选择有神经病。