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Inflammatory Abnormalities in Muscle After Stroke: Effects of Exercise

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
Department of Veterans Affairs
ClinicalTrials.gov Identifier:
NCT00387712
First received: October 12, 2006
Last updated: October 20, 2014
Last verified: October 2014

October 12, 2006
October 20, 2014
October 2006
August 2012   (final data collection date for primary outcome measure)
Cardiovascular fitness (VO2 peak) [ Time Frame: 6 month ] [ Designated as safety issue: No ]
Modification of Skeletal muscle contractile protein expression.
Complete list of historical versions of study NCT00387712 on ClinicalTrials.gov Archive Site
  • Muscle strength [ Time Frame: 6 month ] [ Designated as safety issue: No ]
  • Walking (step activity monitor, 10 meter walking speed, 6 minute walking distance [ Time Frame: 6 month ] [ Designated as safety issue: No ]
  • Bilateral thigh muscle protein and inflammation [ Time Frame: 6 month ] [ Designated as safety issue: No ]
Reduction of inflammatory injury pathway markers in skeltal muscles
Not Provided
Not Provided
 
Inflammatory Abnormalities in Muscle After Stroke: Effects of Exercise
Inflammatory Abnormalities in Muscle After Stroke: Effects of Exercise

The purpose of this study is to first define whether abnormalities of skeletal muscle are related to the presence of inflammation and to poor motor performance and whether this can be modified by exercise interventions.

Background: Stroke is the leading cause of disability in the United States. Biological changes in hemiparetic skeletal muscle may further propagate the disability. The investigators report gross muscular atrophy and major shift to fast myosin heavy chain (MHC) isoform distribution in hemiparetic thigh that are related to reduced fitness and slow walking speed. The investigators also find elevated inflammatory mediators, TNFa and NFkB in the paretic thigh muscle. No prior studies have systematically examined the profile of hemiparetic muscle contractile proteins and their relationship to function and fitness after stroke. Furthermore, the molecular mechanisms underlying hemiparetic skeletal muscle atrophy and contractile protein abnormalities are unknown.

The investigators have investigated treadmill aerobic exercise (T-AEX), as a task-oriented training model. This exercise model can reverse the alterations in MHC profile in hemiparetic leg muscles after stroke. This T-AEX program also improves fitness levels, leg strength, and ambulatory performance in chronic stroke. Moreover, post hoc analyses our randomized treadmill exercise program show that specific features of the exercise prescription likely influence the nature of exercise-mediated adaptations. Specifically, The investigators find that the degree of training velocity progression predicts gains in VO2 peak, but not walking function. In contrast, increasing training duration is associated with improved 6-minute walking function, but not fitness gains. These findings provide initial evidence that cardiovascular metabolic adaptations are contingent upon advancing the training velocity, rather than training duration. These exercise-mediated changes in MHC profiles and inflammation might be extremely important in the context of muscle structure and function, ambulation and overall fitness.

Hypothesis: The investigators propose a randomized clinical study to investigate the hypothesis that in chronic stroke patients a 6 month velocity-based progressive T-AEX program is superior to duration-based progressive T-AEX for improving HP leg skeletal muscle contractile protein expression and reducing inflammatory markers to improve muscle function, fitness, and ambulation.

Specific Aims: 1) Determine whether skeletal muscle MHC isoform expression is altered and inflammatory mediators, TNF and markers of NFkB activation, present in the hemiparetic vastus lateralis muscle, compared the non-paretic leg and matched non-stroke control leg muscles, and related to muscle function, fitness, and gait performance. 2) Determine whether 6 months progressive T-AEX programs can attenuate this abnormal MHC profile and inflammatory mediators to improve muscle structure and function.

Methods: At baseline, bilateral VL biopsies are obtained from chronically disabled, stroke participants with hemiparetic gait to examine the HP and non-P thigh skeletal muscles for alterations in MHC isoforms, key muscle contractile protein, and evidence for inflammation (TNFa) and NFkB activation. Participants are randomized to 6 months of progressive velocity-based or duration-based T-AEX training. Repeat VL muscle biopsies are obtained in the HP limb only after exercise interventions to assess whether 6-month exercise rehabilitation can restore MHC profile and attenuate activation of inflammatory pathways. Expression of the specific MHC isoforms, TNF, and NFKB marker expression (mRNA and protein) are investigated in these muscle tissues by real-time RT-PCR, Western Blot analysis, and immunohistochemistry. The investigators will explore relationships between T-AEX mediated changes in MHC expression and inflammatory activation in skeletal muscle after stroke to improve muscle strength, muscle performance, fitness and activity levels, ADL performance, and gait deficit severity.

Anticipated Results and Relevance: The cross-sectional baseline data will provide the first systematic study of a substantial cohort of stroke patients to define the relationship between altered structural and contractile protein expression to both muscle physiology and clinical measures of muscle performance, metabolic fitness, and rehabilitation mobility outcomes. HP VL muscle will be directly compared to the non-P limb muscle within -subjects and to non-stroke reference controls, in order to better understand the scope of skeletal muscle inflammatory and metabolic abnormalities in the stroke population. The intervention results will allow us to determine the specific requirements of treadmill training that are optimal and crucial to produce the exercise-mediated adaptations in hemiparetic skeletal muscle that lead to improved rehabilitation outcomes to reduce the disability of chronic stroke.

Interventional
Phase 1
Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
  • Stroke
  • Inflammation
Other: Chronic stroke treadmill exercise to improve function
6 month of treadmill exercise with a safety harness to prevent falls. Exercise is gradually progressed in walking speed and time on treadmill based on individual participant's tolerance, abilities and safety. Stroke participants are randomized to a) walking longer duration or b) walking at faster speeds on a treadmill for 6 months.
  • Experimental: Arm 1
    Chronic hemiparetice stroke survivors randomized to velocity based treadmill training
    Intervention: Other: Chronic stroke treadmill exercise to improve function
  • Experimental: Arm 2
    Chronic hemiparetice stroke survivors randomized to duration based treadmill training
    Intervention: Other: Chronic stroke treadmill exercise to improve function

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Completed
120
August 2014
August 2012   (final data collection date for primary outcome measure)

Inclusion Criteria:

  • Chronic stroke (>6 months after initial stroke)
  • Age 40-80
  • Stable neurologic deficits
  • Able to walk with an assistive device
  • Language skills to understand the training program safely

Exclusion Criteria:

  • No anticoagulation or medical conditions that preclude exercise.
  • No dementias or depression
Both
40 Years to 80 Years
No
Contact information is only displayed when the study is recruiting subjects
United States
 
NCT00387712
B3834-R
Yes
Department of Veterans Affairs
Department of Veterans Affairs
Not Provided
Principal Investigator: Charlene Hafer-Macko, MD VA Maryland Health Care System, Baltimore
Department of Veterans Affairs
October 2014

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP