Novel Exercise Interventions to Improve Trunk Muscle Function: A Pilot Study

改善躯干肌肉功能的新型运动干预措施：一项试点研究

• 批准号: 8885652
• 负责人: Brian C Clark
• 金额: $ 19.6万
• 依托单位: OHIO UNIVERSITY ATHENS
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2017-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8885652
• 关键词: Acute; Address; Area; Arthritis; Atrophic; Back Pain; Blood coagulation; Blood flow; Chest; Chronic; Clinical Research; Clinical Trials; Control Groups; Data; Dose; Elbow; Endocrine; Exercise; Exhibits; Foundations; Future; Growth Factor; Health; Individual; Inflammation; Injury; Intervention; Leg; Low Back Pain; Magnetic Resonance Imaging; Mechanics; Medical; Modality; Morphology; Muscle; Muscle function; Musculoskeletal; Neural Conduction; Outcome; Patients; Pilot Projects; Prevention; Protocols documentation; Randomized; Recruitment Activity; Recurrence; Recurrent Low Back Pain; Rehabilitation therapy; Research; Resistance; Safety; Skin; Societies; Spinal; Stimulus; Testing; Therapeutic; Training; Vertebral column; Work; arterial stiffness; base; cost effective; design; disability; improved; indexing; innovation; morphometry; muscle strength; novel; pressure; programs; rehabilitation strategy; response; strength training

DESCRIPTION (provided by applicant): Low back pain (LBP) has a staggeringly negative impact on society in terms of medical expenses and disability. Acute occurrence of LBP results in rapid onset of atrophy of the multifidus muscle, and recurrent LBP is associated with even greater maladaptive changes in trunk extensor muscle morphology and function (i.e., decreased size, strength, and endurance). Rehabilitation strategies for LBP often include resistance training to address these changes in the trunk extensor muscles; however, these exercise protocols are only modestly effective in promoting trunk extensor muscle adaptation as they are generally performed at low-loads (e.g., 25% max strength) that are well below those recommended for muscle adaption (>70% max strength). The use of higher-load trunk exercise is commonly contraindicated because of concern that high spinal compressive loads can cause further injury to the spine. Thus, it is critical to develop therapeutic approaches utilizing low mechanical loads that can still deliver sufficient stimuli to the trunk extensor muscles and reverse the changes in trunk extensor muscle function commonly observed in patients with LBP. Low-load resistance exercise with blood flow restriction (BFR) is an innovative approach for exactly this purpose. This paradigm involves performing exercise with low loads while blood flow to the working muscles is partially occluded by a pressure cuff. We have previously shown that a single bout of BFR exercise increases circulating endocrine growth factors, and we recently completed preliminary studies on chronic BFR exercise training and observed that this modality enhances muscle function without negatively impacting indices of arterial stiffness, nerve conduction, inflammation, and blood coagulation. While this exercise modality cannot be applied directly to the trunk (unfeasible to restrict thorax blood flow), our pilot data indicate a unique cross-transfer effect to the erector spinae muscles when low-load trunk extensor exercise is performed after BFR exercise with the appendicular muscles. Thus performing exercise with the appendicular muscles under BFR prior to low-load exercise with the trunk muscles could enhance muscle size and function without high spinal compressive loads. In this application we propose to conduct an exploratory trial as it relates to determining the effects BFR exercise on erector spinae muscle morphometry and function in patients with recurrent LBP. Our central hypothesis is that BFR exercise with the appendicular muscles performed prior to low-load trunk extensor exercise will produce systemic effects that enhance increases in trunk extensor size, strength, and endurance beyond those seen with only low-load trunk extensor exercise. The potential impact of this work is clear: If effective, this novel exercise modality will provide the foundation for a cost-effective and easy-to-implement rehabilitation strategy that is superior to existing paradigms in its capacity to induce muscle adaptation in the absence of high mechanical and compressive loading on the spine.

描述（由申请人提供）： 腰痛 (LBP) 在医疗费用和残疾方面对社会产生惊人的负面影响。腰痛的急性发生导致多裂肌迅速萎缩，复发性腰痛与躯干伸肌形态和功能的更大适应不良变化相关（即尺寸、力量和耐力下降）。腰痛的康复策略通常包括阻力训练，以应对躯干伸肌的这些变化；然而，这些锻炼方案在促进躯干伸肌适应方面效果有限，因为它们通常在低负荷（例如 25% 最大强度）下进行，远低于推荐的肌肉适应负荷（>70% 最大强度）。由于担心高脊柱压缩负荷会导致脊柱进一步受伤，因此通常禁止使用较高负荷的躯干锻炼。因此，开发利用低机械负荷的治疗方法至关重要，这些方法仍然可以向躯干伸肌提供足够的刺激，并逆转 LBP 患者中常见的躯干伸肌功能的变化。限制血流 (BFR) 的低负荷阻力运动正是用于此目的的创新方法。这种范例涉及以低负荷进行锻炼，同时流向工作肌肉的血液被压力袖带部分阻塞。我们之前已经表明，单次 BFR 运动会增加循环内分泌生长因子，并且我们最近完成了对慢性 BFR 运动训练的初步研究，并观察到这种方式增强了肌肉功能，而不会对动脉僵硬度、神经传导、炎症和炎症等指标产生负面影响。血液凝固。虽然这种锻炼方式不能直接应用于躯干（无法限制胸部血流），但我们的试验数据表明，在用四肢进行 BFR 锻炼后进行低负荷躯干伸肌锻炼时，对竖脊肌有独特的交叉转移效应肌肉。因此，在对躯干肌肉进行低负荷锻炼之前，在 BFR 下进行四肢肌肉锻炼可以增强肌肉的大小和功能，而无需高脊柱压缩负荷。在本申请中，我们建议进行一项探索性试验，因为它涉及确定 BFR 运动对复发性 LBP 患者的竖脊肌形态和功能的影响。我们的中心假设是，在低负荷躯干伸肌运动之前进行四肢肌肉 BFR 运动将产生全身效应，增强躯干伸肌尺寸、力量和耐力的增加，超过仅低负荷躯干伸肌运动所见的效果。这项工作的潜在影响是显而易见的：如果有效，这种新颖的锻炼方式将提供 为具有成本效益且易于实施的康复策略奠定了基础，该策略在脊柱上没有高机械和压缩负载的情况下诱导肌肉适应的能力优于现有范例。

项目成果

Development of a trunk motor paradigm for use in neuroimaging.

• DOI: 10.1515/tnsci-2020-0116
• 发表时间: 2020
• 期刊: Translational neuroscience
• 影响因子: 2.1
• 作者: Saunders E;Clark BC;Clark LA;Grooms DR
• 通讯作者: Grooms DR