Muscle Atrophy, Physical Performance and Glucose Tolerance Post-Stroke

中风后的肌肉萎缩、身体机能和葡萄糖耐量

• 批准号: 8261042
• 负责人: ALICE S. RYAN
• 金额: --
• 依托单位: BALTIMORE VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-05-01 至 2013-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8261042
• 关键词: 1 year old; Acute; Adult; Aerobic Exercise; Age; Area; Atrophic; Attenuated; Balance training; Biological; Biopsy; Body Composition; Cardiac rehabilitation; Cardiovascular Diseases; Cardiovascular system; Caring; Chronic Phase; Data; Development; Diabetes Mellitus; Disabled Persons; Dual-Energy X-Ray Absorptiometry; Early identification; Elderly; Equilibrium; Exercise; Fatty acid glycerol esters; Fiber; Functional disorder; Gait; Glucose; Guidelines; Health; Health Benefit; Healthcare; Heart Diseases; High Prevalence; Histology; Hyperinsulinism; Individual; Insulin; Insulin Resistance; Intramuscular; Ischemic Stroke; Knowledge; Leg; Limb structure; Measurement; Medical; Metabolic; Muscle; Muscle Fibers; Muscular Atrophy; Myosin Heavy Chains; Natural History; Nature; Needles; Non-Insulin-Dependent Diabetes Mellitus; OGTT; Outcome; Oxygen Consumption; Patients; Performance; Persons; Phase; Pilot Projects; Population; Public Health; Recovery; Recurrence; Regimen; Rehabilitation therapy; Reporting; Residual state; Resources; Risk; Severities; Side; Skeletal Muscle; Stroke; Survivors; Testing; Time; Training Programs; United States; Veterans; Walking; acute stroke; aged; chronic stroke; diabetes risk; disability; fitness; frailty; glucose metabolism; glucose tolerance; hemiparesis; hemiparetic stroke; high risk; impaired glucose tolerance; improved; muscle form; non-diabetic; post stroke; prevent; programs; rehabilitation strategy; sarcopenia; stroke recovery

DESCRIPTION (provided by applicant): Stroke, a leading cause of disability, can promote metabolic dysfunction that increases the risk for diabetes, subsequent stroke recurrence, and cardiovascular disease complications. We have shown a marked loss of muscle mass in the paretic leg and a fiber type shift in stroke survivors with a stroke latency of approximately 3 years. These skeletal muscle changes in chronic stroke are associated with gait deficit severity. The fundamental hypothesis of this study is that skeletal muscle atrophy and fiber type shift occurs rapidly after a stroke and these changes are accompanied by a decline in physical performance and a worsening of glucose tolerance in hemiparetic stroke survivors. The aims of this 2-year pilot study are the following: 1) To determine immediate, 2, 4, and 6 month changes in paretic and nonparetic skeletal muscle composition (mass, volume, intramuscular fat by DXA and CT) and skeletal muscle histology (fiber type proportions) during sub-acute stroke recovery in veteran stroke survivors; 2) To assess functional deficit (short physical performance battery or SPPB, six minute walk, gait and balance, strength), and glucose tolerance (glucose and insulin concentrations by OGTT) during sub-acute stroke recovery and determine whether changes in skeletal muscle are associated with functional performance and glucose tolerance. To accomplish these aims, 30 hemiparetic ischemic stroke subjects aged 45- 75 years, BMI 20-40 kg/m2 will undergo body composition tests, fine-needle muscle biopsies, function deficit tests, and measurement of glucose tolerance ~2 weeks post stroke, and at 2, 4, and 6 months in the sub-acute stroke period. This proposal would be the first to investigate the trajectory of the skeletal muscle atrophy and abnormal glucose metabolism that occurs in stroke survivors. Knowledge of the skeletal muscle changes that occur in the early phases after stroke is essential to create new guidelines which incorporate exercise rehabilitation, much like cardiac rehabilitation, in order to facilitate and improve the health care of veteran stroke survivors. Results of this current pilot study will allow the development of a larger project that evaluates either an aerobic exercise (treadmill), strength (resistive), or gait and balance training program or a combination of these during the stroke recovery period. The results could effectively change the current guidelines for the care of stroke survivors during the acute recovery period and have a significant impact on the health of veterans.

描述（由申请人提供）： 中风是导致残疾的主要原因，它会促进代谢功能障碍，从而增加患糖尿病、随后中风复发和心血管疾病并发症的风险。我们发现中风幸存者的瘫痪腿部肌肉质量明显下降，纤维类型发生转变，中风潜伏期约为 3 年。慢性中风中的这些骨骼肌变化与步态缺陷的严重程度相关。这项研究的基本假设是，中风后骨骼肌萎缩和纤维类型转变迅速发生，这些变化伴随着偏瘫中风幸存者的身体机能下降和糖耐量恶化。这项为期 2 年的试点研究的目标如下： 1) 确定瘫痪和非瘫痪骨骼肌成分（通过 DXA 和 CT 测量的质量、体积、肌内脂肪）和骨骼肌组织学的即时、2、4 和 6 个月变化（纤维类型比例）老中风幸存者亚急性中风恢复期间； 2) 评估亚急性中风恢复期间的功能缺陷（短身体表现电池或 SPPB、六分钟步行、步态和平衡、力量）和葡萄糖耐量（OGTT 测定的葡萄糖和胰岛素浓度），并确定骨骼肌的变化是否与功能表现和葡萄糖耐量相关。为了实现这些目标，30 名年龄 45-75 岁、BMI 20-40 kg/m2 的偏瘫缺血性中风受试者将在中风后约 2 周接受身体成分测试、细针肌肉活检、功能缺陷测试和葡萄糖耐量测量，以及亚急性中风期的第 2、4 和 6 个月。 该提案将是第一个研究中风幸存者中骨骼肌萎缩和葡萄糖代谢异常的轨迹的提案。了解中风后早期发生的骨骼肌变化对于制定新的指南至关重要，其中包括运动康复（就像心脏康复一样），以促进和改善中风幸存者的医疗保健。当前试点研究的结果将允许开发一个更大的项目，评估中风恢复期间的有氧运动（跑步机）、力量（阻力）或步态和平衡训练计划或这些计划的组合。研究结果可能有效改变当前中风幸存者急性恢复期护理指南，并对退伍军人的健康产生重大影响。