Strength Training for Skeletal Muscle Adaptation After Stroke
研究概览
详细说明
This study investigates the hypothesis that a novel, high intensity, high repetition ST program will improve abnormalities in paretic and non-paretic leg muscle volume and composition compared to an attention-matched control regimen of supervised stretching over a 3-month intervention period in those disabled by stroke. The investigators further hypothesize that ST-induced skeletal muscle adaptation will translate into improved insulin sensitivity, strength, and function in this population. The specific objectives are to: 1) Determine the effects ST compared to a control intervention on paretic and non-paretic abnormalities in skeletal muscle volume, intramuscular fat, muscle fiber distribution, muscle capillary density, and muscle inflammation in chronically disabled stroke survivors. 2) Determine the effects ST compared to a control intervention on insulin sensitivity in stroke survivors, and whether structural and cellular skeletal muscle mechanisms contribute to improvements in insulin sensitivity after ST. 3) Determine the effects ST compared to a control intervention on physical function (strength, walking speed and balance) in stroke survivors, and whether structural skeletal muscle mechanisms predict ST-induced functional improvement.
The project design consists of 4 phases over 5 months for stroke participants enrolled in either of the two intervention arms (ST vs. CONTROL). During phase 1 the investigators will screen and consent chronic stroke patients with residual gait deficits. Phase 2 (3 weeks) will consist of baseline testing that includes dual energy X-ray absorptiometry (DEXA) scanning, bilateral CT scanning of the legs, bilateral vastus lateralis muscle biopsies, strength testing, timed walks, balance measurements, oral glucose tolerance testing, and hyperglycemic clamp testing. Following completion of baseline testing, volunteers are to be randomized to ST or the CONTROL group. Phase 3 (Intervention Phase, 3 months) will begin with 2 sessions of acclimatization for those assigned to the ST group. ST will then be progressed to 2 sets of 20 repetitions on each leg on each machine (Keiser Leg Press, Leg Extension, Leg Curl) with gradual increases in resistance over 3 months. Those in the CONTROL group will receive equal exposure to health care personnel in the Baltimore VA Exercise facility, performing a full battery of upper and lower body passive and active stretching exercises at each intervention session. In Phase 4 all baseline testing and laboratory analyses will be repeated.
Developing evidence-based therapies to combat skeletal muscle deterioration is highly relevant for chronically disabled stoke survivors. There is mounting evidence that current models of post-stroke rehabilitation are not optimal for maximizing recovery of muscle mass, strength, and metabolic health. The proposed research will develop new insight into the utility of progressive ST for reversing detrimental changes to gross muscle composition, muscle molecular phenotype, muscle inflammation, and muscle capillarization. Changes to any or all of these muscle parameters should have measurable impact on both whole body insulin sensitivity and function. Collectively, the results from this trial may change the current standard of care for stroke survivors by providing evidenced reasons for augmenting physical therapists' treatments, allowing more intense and diverse therapy sessions for maintenance of skeletal muscle.
研究类型
注册 (实际的)
阶段
- 不适用
联系人和位置
学习地点
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Maryland
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Baltimore、Maryland、美国、21201
- Baltimore VA Medical Center VA Maryland Health Care System, Baltimore, MD
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参与标准
资格标准
适合学习的年龄
接受健康志愿者
有资格学习的性别
描述
Inclusion Criteria:
- Stroke greater than 6 months prior with residual hemiparetic gait in women or men aged 40-85 years
- Completion of all regular post-stroke physical therapy
- Adequate language and neurocognitive function to participate in testing and training and to give adequate informed consent
Exclusion Criteria:
- Alcohol consumption greater than 3 oz. liquor, or 3 x 4 oz glasses of wine, or 3 x 12 oz. beers per day, by self-report
clinical history of:
- unstable angina
- recent (less than 3 months) myocardial infarction or congestive heart failure (NYHA category II)
- hemodynamically significant valvular dysfunction
- peripheral arterial occlusive disease (PAOD) with claudication
- major orthopedic, chronic pain, or non-stroke neuromuscular disorders restricting exercise
- pulmonary or renal failure
- poorly controlled hypertension (greater than 190/110)
- recent hospitalization for severe disease or surgery
- severe or global receptive aphasia which confounds reliable testing and training
- Allergy to lidocaine
- Known muscle disorder
- Taking Coumadin or Lovenox (contraindication for muscle biopsies)
- Dementia
- Untreated major depression
学习计划
研究是如何设计的?
设计细节
- 主要用途:治疗
- 分配:随机化
- 介入模型:并行分配
- 屏蔽:无(打开标签)
武器和干预
参与者组/臂 |
干预/治疗 |
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实验性的:Arm 1
Participants in this group undergo lower-extremity strength training on three pneumatic resistance machines (Keiser Leg Press, Keiser Leg Extension, and Keiser Leg Curl).
Training sessions happen 3 times per week (M,W,F) and last approximately 45 minutes to 1 hour.
Participants in this group exercise each limb individually to account for the large discrepancies in strength between legs in stroke survivors.
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3x per week lower-extremity ST lasting approximately 45 minutes to 1 hour.
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有源比较器:Arm 2
Participants in this group receive equal exposure to study staff compared with the experimental ST group (approximately 45 minutes to 1 hour 3 times per week).
Exercise sessions for this group involve a full battery of active and passive...upper and lower body...stretching and range of motion exercises performed on raised padded tables.
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3x per week upper and lower body stretching mixed with active and passive range of motion exercises
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研究衡量的是什么?
主要结果指标
结果测量 |
措施说明 |
大体时间 |
---|---|---|
Change in 1-repetition Maximum (RM) Muscle Strength (Leg Press, Paretic Side)
大体时间:Baseline, 3 months
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Baseline, 3 months
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Change in 1-RM Muscle Strength (Leg Press, Non-Paretic Side)
大体时间:Baseline, 3 months
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Baseline, 3 months
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Change in 1-RM Muscle Strength (Leg Extension, Paretic Side)
大体时间:Baseline, 3 Months
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Baseline, 3 Months
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Change in 1-RM Muscle Strength (Leg Extension, Non-Paretic Side)
大体时间:Baseline, 3 Months
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Baseline, 3 Months
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Change in Leg Muscle Endurance (Paretic Side)
大体时间:Baseline, 3 Months
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Tests how training impacts the total number of submaximal repetitions a participant can perform according to standardized cadence (at the same absolute level of resistance, pre and post).
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Baseline, 3 Months
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Change in Leg Muscle Endurance (Non-Paretic Side)
大体时间:Baseline, 3 months
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Tests how training impacts the total number of submaximal repetitions a participant can perform according to standardized cadence (at the same absolute level of resistance, pre and post).
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Baseline, 3 months
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Change in 6-minute Walk Distance
大体时间:Baseline, 3 Months
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Baseline, 3 Months
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Change in 10 Meter Walking Speed (Self-Selected)
大体时间:Baseline, 3 months
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Baseline, 3 months
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Change in 10 Meter Walking Speed (Fastest)
大体时间:Baseline, 3 Months
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Baseline, 3 Months
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Change in Peak Aerobic Capacity (VO2 Peak)
大体时间:Baseline, 3 Months
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Baseline, 3 Months
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Change in Berg Balance Scale
大体时间:Baseline, 3 months
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This measure is a 14 item scale, with each item scored (0-4) and summed for a maximum score of 56 points.
Range is 0-56 and higher values represent a better outcome.
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Baseline, 3 months
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Change in Paretic Limb Step Time (Self-Selected)
大体时间:Baseline, 3 months
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This and other measures come from Instrumented Walkway (Gait Rite)
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Baseline, 3 months
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Change in Paretic Limb Step Time (Fastest)
大体时间:Baseline, 3 Months
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This and other measures come from Instrumented Walkway (Gait Rite)
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Baseline, 3 Months
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Change in Non-Paretic Limb Step Time (Self-Selected)
大体时间:Baseline, 3 months
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This and other measures come from Instrumented Walkway (Gait Rite)
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Baseline, 3 months
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Change in Non-Paretic Limb Step Time (Fastest)
大体时间:Baseline, 3 Months
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This and other measures come from Instrumented Walkway (Gait Rite)
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Baseline, 3 Months
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Change in Paretic Limb Step Length (Self-Selected)
大体时间:Baseline, 3 Months
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This and other measures come from Instrumented Walkway (Gait Rite)
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Baseline, 3 Months
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Change in Paretic Limb Step Length (Fastest)
大体时间:Baseline, 3 months
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This and other measures come from Instrumented Walkway (Gait Rite)
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Baseline, 3 months
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Change in Non-Paretic Limb Step Length (Self-Selected)
大体时间:Baseline, 3 Months
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This and other measures come from Instrumented Walkway (Gait Rite)
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Baseline, 3 Months
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Change in Non-Paretic Limb Step Length (Fastest)
大体时间:Baseline, 3 Months
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This and other measures come from Instrumented Walkway (Gait Rite)
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Baseline, 3 Months
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合作者和调查者
出版物和有用的链接
一般刊物
- Ivey FM, Prior SJ, Hafer-Macko CE, Katzel LI, Macko RF, Ryan AS. Strength Training for Skeletal Muscle Endurance after Stroke. J Stroke Cerebrovasc Dis. 2017 Apr;26(4):787-794. doi: 10.1016/j.jstrokecerebrovasdis.2016.10.018. Epub 2016 Nov 16.
- Ivey FM, Ryan AS. Resistive training improves insulin sensitivity after stroke. J Stroke Cerebrovasc Dis. 2014 Feb;23(2):225-9. doi: 10.1016/j.jstrokecerebrovasdis.2012.12.014. Epub 2013 Jan 22.
研究记录日期
研究主要日期
学习开始 (实际的)
初级完成 (实际的)
研究完成 (实际的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (估计)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
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