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: 8088529
• 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/8088529
• 关键词: 1 year old; Acute; Adult; Aerobic Exercise; Age; Area; Atrophic; Attenuated; Balance training; Biological; Biopsy; Body Composition; Cardiac; 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. PUBLIC HEALTH RELEVANCE: Stroke, a leading cause of disability in the veteran population, increases the risk for diabetes, subsequent stroke recurrence, and cardiovascular disease complications. The downsizing of private and federal health care resources, along with the anticipated increase in stroke rates as our veteran population ages, mandate that alternative strategies be developed to reduce the public health burden of stroke. This pilot study may facilitate our knowledge of the timing of paretic leg muscle atrophy, fiber type shift, and the progression of worsening of glucose tolerance after stroke. Knowledge of the skeletal muscle changes occurring in the sub-acute stroke period is essential to create new guidelines incorporating exercise rehabilitation, much like cardiac rehabilitation, in order to facilitate and improve the health care of veteran stroke survivors.

描述（由申请人提供）： 中风是残疾的主要原因，可以促进代谢功能障碍，从而增加糖尿病的风险，随后的中风复发和心血管疾病并发症。我们已经显示出明显的肌腿肌肉肿块，并且中风潜伏期约为3年，中风幸存者的纤维类型转移。慢性中风中的这些骨骼肌肉变化与步态不足的严重程度有关。这项研究的基本假设是，骨骼肌萎缩和纤维类型转移发生后迅速发生，这些变化伴随着身体性能的下降以及半上陷入困境幸存者中葡萄糖耐受性的恶化。这项为期两年的试点研究的目的是：1）确定立即的2、4和6个月的变化，在亚急性Stroke Recessoke Recespeion ceptionan Stroke STROKE STROKE STROKE STROKE STROKE SERTIVERS中，在亚急性Stroke恢复期间，在亚急性stroke恢复期间，DXA和CT的肌肉内脂肪量（质量，体积，肌内脂肪）以及骨骼肌组织学（纤维类型比例）的变化； 2）在亚急性中风恢复过程中评估功能缺陷（短步行或SPPB，步行和平衡，六分钟步行，步态和平衡，强度）和葡萄糖耐受性（通过OGTT的葡萄糖和胰岛素浓度），并确定骨骼肌的变化是否与功能性能和耐糖剂耐受性相关。为了实现这些目标，30名年龄45-75岁的半毛缺血性中风受试者，BMI 20-40 kg/m2将接受身体成分测试，细针肌肉活检，功能不足测试，葡萄糖耐受性测量，葡萄糖耐受性〜2周后2周，以及在2、4和6个月中的STROKE sTEROKE。 该建议将是第一个研究中风幸存者中发生的骨骼肌萎缩和异常葡萄糖代谢的轨迹。在中风后早期阶段发生的骨骼肌肉变化的知识对于创建新的指南至关重要，以纳入运动康复，就像心脏康复一样，以促进和改善老兵中风幸存者的医疗保健。当前的试点研究的结果将允许开发一个更大的项目，该项目评估有氧运动（跑步机），力量（电阻）或步态和平衡训练计划或在中风恢复期间的组合。结果可以有效地改变急性恢复期间中风幸存者的当前指南，并对退伍军人的健康产生重大影响。 公共卫生相关性： 中风是退伍军人人口残疾的主要原因，增加了糖尿病的风险，随后的中风复发和心血管疾病并发症。随着我们的资深人口年龄，私人和联邦卫生保健资源的缩减，以及预期的中风率提高，要求制定替代策略来减轻中风的公共卫生负担。这项试点研究可能会促进我们对paretic腿肌肉萎缩，纤维类型转移的时机以及中风后葡萄糖耐受性恶化的进展。在亚急性中风期间发生的骨骼肌变化的知识对于创建纳入运动康复的新准则（例如心脏康复）至关重要，以促进和改善老兵中风幸存者的医疗保健。