Aerobic Training to Improve Energy Utilization and Antioxidant Capacity in Stroke

有氧训练可提高中风患者的能量利用和抗氧化能力

• 批准号: 9566849
• 负责人: Monica C Serra
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-04-01 至 2019-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9566849
• 关键词: Accelerometer; Address; Aerobic; Aerobic Exercise; Affect; Aging; Antioxidants; Basal metabolic rate; Biopsy; Blood; Body Composition; Calories; Cardiovascular system; Caring; Cell Respiration; Chronic; Clinical; Dependence; Development; Diet; Diet Modification; Diet Records; Dietary intake; Disabled Persons; Elderly; Energy Metabolism; Ensure; Exercise; Expenditure; Failure; Fasting; Fatigue; Fatty acid glycerol esters; Fiber; Functional disorder; Gait; Guidelines; Health; Health Care Costs; Heart; Home environment; Impairment; Indirect Calorimetry; Individual; Injury; Intake; Intervention; Lead; Lipids; Macronutrients Nutrition; Measures; Mentors; Metabolic; Metabolism; Methods; Modification; Muscle; Muscular Atrophy; Neurologic Deficit; Nitrates; Nitrites; Nutritional; Oxidative Stress; Paresis; Pharmacologic Substance; Physical Function; Plasma; Population; Postmenopause; Production; Proteins; Randomized; Recurrence; Rehabilitation therapy; Research; Research Personnel; Risk Factors; Role; Skeletal Muscle; Sodium; Stretching; Stroke; Superoxide Dismutase; Testing; Thinness; Thiobarbituric Acid Reactive Substances; Tissues; Training; Veterans; Woman; adult obesity; antioxidant enzyme; cardiovascular disorder risk; cardiovascular fitness; cardiovascular health; catalase; chronic stroke; control trial; cost; disability; energy balance; enzyme activity; exercise intervention; exercise rehabilitation; exercise training; glutathione peroxidase; good diet; hemiparesis; impaired capacity; improved; men; metabolic profile; motor deficit; muscle form; muscle metabolism; novel; nutrition; oxidation; oxidative damage; physical inactivity; post stroke; prevent; protein intake; public health relevance; recruit; respiratory; saturated fat; sedentary; sedentary lifestyle; stroke survivor; stroke treatment; thiobarbituric acid; total energy expenditure; treadmill; treadmill training; vastus lateralis

DESCRIPTION Fifteen to 30% of stroke survivors are permanently disabled, which usually leads to a sedentary lifestyle and functional dependence following stroke. While it is known that hemiparetic gait elevates the energy cost of ambulatory activity by 1.5- 2 fold, how chronic stroke affects total daily energy expenditure (TDEE) and dietary intake is currently unknown. Altered energy balance (expenditure ` intake) may result in impaired substrate oxidation and skeletal muscle oxidative stress. Elevated oxidative stress in skeletal muscle is associated with fatigue and decreased cardiovascular and muscular endurance. Treadmill exercise training in older, non-stroke populations improves home ambulatory activity, physical function, and metabolic profiles and has antioxidant effects in skeletal muscle. Additionally, ensuring that energy and macronutrient intake meets an individual's energy and fuel needs may result in decreases in oxidative damage. This randomized control study tests the hypothesis that treadmill rehabilitation plus nutritional modification ("heart healthy" diet plus adequate protein) (TM+N) versus stretching plus nutritional modification (ST+N) (nutrition control) will 1) improve energy balance and substrate oxidation, 2) reduce systemic and tissue level oxidative stress, and 3) that the respective comparison of these interventions (TM+N and ST+N) to treadmill (TM) and stretching (ST) controls from her mentor's current R01 will support the rehabilitative role of nutritional modification in stroke. We propose the following aims: Aim 1: To assess the effects of six months of TM+N versus ST+N on TDEE and substrate oxidation in chronic stroke survivors. Aim 2: To examine the effects of six months of TM+N versus ST+N on systemic and tissue oxidative stress and antioxidant capacity in chronic stroke survivors. Aim 3: To compare the effects of TM+N and ST+N versus TM and ST alone, respectively, on energy balance and systemic and tissue oxidative stress, in chronic stroke survivors. Older (55-75 years), men and postmenopausal women (n=50) with chronic stroke (at least 6 months post stroke) with stable neurological deficits will be recruited. Subjects will be randomized to participate in six months o dietary modification (<30% of calories as fat, <10% as saturated fat, <2,400 mg sodium, 25 g/d of fiber, and 1.0-1.2 g/kg/d of lean protein) plus aerobic exercise training or dietary modificatio plus whole body stretching. Seven-day accelerometry and dietary records will be used to determine energy balance. Indirect calorimetry will be used to determine substrate oxidation during fasting and a peak and submaximal exercise bout. Blood draws and paretic and non-paretic vastus lateralis skeletal muscle biopsies will be performed to determine changes in systemic and tissue level oxidative stress content (nitrate/nitrite and thiobarbituric acid reactiv substances) and antioxidant capacity (superoxide dismutase, glutathione peroxidase, and catalase) following exercise rehabilitation or stretching with and without nutritional modification in chronic stroke survivors. The mentoring and training described in this CDA-2 application will greatly enhance the nominee's development into an independent investigator, while simultaneously identifying mechanisms by which aerobic exercise rehabilitation with nutritional modification can improve TDEE and reduce oxidative stress. We postulate that this study will provide evidence to improve stroke treatment, substrate utilization, and the antioxidant capacity of blood and skeletal muscle and reduce physical inactivity in Veteran stroke survivors, potentially leading to a reduction in clinical costs related to the care of Veterans with disabilit from chronic stroke.

描述 15％至30％的中风幸存者是永久性残疾的，这通常会导致久坐的生活方式和中风后的功能依赖性。尽管众所周知，偏瘫步态将门诊活动的能源成本提高了1.5-2倍，但慢性中风如何影响每日总能量消耗（TDEE）和饮食摄入量目前尚不清楚。能量平衡改变（消耗`摄入）可能导致底物氧化和骨骼肌氧化应激受损。骨骼肌中氧化应激的升高与疲劳和肌肉耐力降低有关。跑步机的跑步运动训练在较老的非中风人群中改善了家庭门诊活动，身体机能和代谢谱，并在骨骼肌中具有抗氧化作用。此外，确保能量和大量营养素摄入满足个人的能量和燃料需求可能会导致氧化损伤的减少。这项随机对照研究检验了以下假说：跑步机康复加营养修饰（“心脏健康”饮食加上足够的蛋白质）（TM+N）（TM+N）与拉伸以及营养修饰（ST+N）（营养控制）（营养控制）将1）提高能量和底层氧化，2）降低了系统和组织水平的氧化+3）。 ST+N）到跑步机（TM）和伸展（ST）控制者的当前R01控制将支持营养修饰在中风中的康复作用。我们提出以下目的：目标1：评估六个月的TM+N与ST+N对慢性中风幸存者中TDEE和底物氧化的影响。 目的2：检查六个月的TM+N与ST+N对慢性中风幸存者中系统性和组织氧化应激和抗氧化能力的影响。 目标3：在慢性中风幸存者中，分别比较TM+N和ST+N与TM和ST的影响分别对能量平衡以及全身性和组织氧化应激的影响。 年龄较大（55-75岁），男性和绝经后妇女（n = 50），患有慢性中风（至少在中风后至少6个月），将招募稳定的神经系统缺陷。受试者将被随机分配在六个月内o饮食改性（含量为脂肪的卡路里<30％，<10％的饱和脂肪，<2,400 mg钠，25 g/d的纤维和1.0-1.2 g/kg/kg/kg/kg/kg/kg/kg/kg/kg/d的瘦蛋白质）加上有氧运动训练或饮食训练或饮食训练或饮食修饰，再加上整个身体。七天的加速度计和饮食记录将用于确定能量平衡。间接量热法将用于确定禁食期间的底物氧化以及峰值和次最大的运动回合。将进行血液吸收，偏to和非预性股外侧骨骼肌活检，以确定全身和组织水平氧化应激含量的变化（硝酸盐/硝酸盐和硫代核酸反应性物质）和抗氧化能力（抗氧化剂，粘液酶歧义酶，粘液症和猫咪的cotivitiation cortiation and cout cortiation cortivition cortiation cortiants and cortoxidase and corcotition corsivation cortiviative coptives and cotivians and cortoxidase cortivation cortivians） 在慢性中风幸存者中。 在本CDA-2应用中描述的指导和培训将大大提高被提名人的发展成独立研究者，同时识别有氧运动进行营养修饰可以改善TDEE并减少氧化应激的机制。我们假设这项研究将提供证据，以改善中风治疗，底物利用以及血液和骨骼肌的抗氧化能力，并减少在退伍军人中风幸存者中的身体不活跃，这可能导致降低与长期持续性中风的退伍军人相关的临床成本。