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% 的中风幸存者会永久残疾，这通常会导致中风后久坐的生活方式和功能依赖。虽然众所周知，偏瘫步态会使行走活动的能量消耗增加 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。能量平衡的改变（消耗`摄入）可能导致底物氧化受损和骨骼肌氧化应激。骨骼肌氧化应激升高与疲劳以及心血管和肌肉耐力下降有关。对老年人、非中风人群进行跑步机运动训练可以改善家庭行走活动、身体机能和代谢特征，并对骨骼肌具有抗氧化作用。此外，确保能量和大量营养素的摄入满足个人的能量和燃料需求可能会减少氧化损伤。这项随机对照研究测试了以下假设：跑步机康复加营养调整（“心脏健康”饮食加足够的蛋白质）(TM+N) 与拉伸加营养调整 (ST+N)（营养控制）将 1) 改善能量平衡和基质氧化，2) 减少全身和组织水平的氧化应激，3) 这些干预措施（TM+N 和 ST+N）与她导师当前 R01 中的跑步机 (TM) 和拉伸 (ST) 对照的分别比较将支持营养调整对中风的康复作用。我们提出以下目标： 目标 1：评估六个月的 TM+N 与 ST+N 对慢性中风幸存者的 TDEE 和底物氧化的影响。 目标 2：比较六个月的 TM+N 与 ST+N 对慢性中风幸存者全身和组织氧化应激和抗氧化能力的影响。 目标 3：比较 TM+N 和 ST+N 分别与单独 TM 和 ST 对慢性中风幸存者能量平衡以及全身和组织氧化应激的影响。 将招募患有慢性中风（中风后至少 6 个月）且具有稳定神经功能缺损的老年（55-75 岁）男性和绝经后女性（n=50）。受试者将随机参加六个月的饮食调整（<30% 的卡路里为脂肪，<10% 的饱和脂肪，<2,400 毫克钠，25 克/天的纤维，以及 1.0-1.2 克/公斤/天的膳食纤维）瘦蛋白）加上有氧运动训练或饮食调整加上全身伸展运动。七天的加速度测量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以及峰值和次最大运动期间的底物氧化。将进行抽血以及瘫痪和非瘫痪股外侧骨骼肌活检，以确定全身和组织水平氧化应激含量（硝酸盐/亚硝酸盐和硫代巴比妥酸反应物质）和抗氧化能力（超氧化物歧化酶、谷胱甘肽过氧化物酶和过氧化氢酶）的变化运动康复或拉伸后（有或没有营养调整） 慢性中风幸存者。 CDA-2 申请中描述的指导和培训将极大地促进被提名者发展成为一名独立研究者，同时确定有氧运动康复和营养调整可以改善 TDEE 并减少氧化应激的机制。我们假设这项研究将为改善中风治疗、基质利用率以及血液和骨骼肌的抗氧化能力提供证据，并减少退伍军人中风幸存者的身体活动不足，从而可能减少与残疾退伍军人护理相关的临床成本来自慢性中风。