Lemmey Andrew B, Marcora Samuele M, Chester Kathryn, Wilson Sally, Casanova Francesco, Maddison Peter J
Bangor University, Bangor, UK.
Arthritis Rheum. 2009 Dec 15;61(12):1726-34. doi: 10.1002/art.24891.
To confirm, in a randomized controlled trial (RCT), the efficacy of high-intensity progressive resistance training (PRT) in restoring muscle mass and function in patients with rheumatoid arthritis (RA). Additionally, to investigate the role of the insulin-like growth factor (IGF) system in exercise-induced muscle hypertrophy in the context of RA.
Twenty-eight patients with established, controlled RA were randomized to either 24 weeks of twice-weekly PRT (n = 13) or a range of movement home exercise control group (n = 15). Dual x-ray absorptiometry-assessed body composition (including lean body mass [LBM], appendicular lean mass [ALM], and fat mass); objective physical function; disease activity; and muscle IGFs were assessed at weeks 0 and 24.
Analyses of variance revealed that PRT increased LBM and ALM (P < 0.01); reduced trunk fat mass by 2.5 kg (not significant); and improved training-specific strength by 119%, chair stands by 30%, knee extensor strength by 25%, arm curls by 23%, and walk time by 17% (for objective function tests, P values ranged from 0.027 to 0.001 versus controls). In contrast, body composition and physical function remained unchanged in control patients. Changes in LBM and regional lean mass were associated with changes in objective function (P values ranged from 0.126 to <0.0001). Coinciding with muscle hypertrophy, previously diminished muscle levels of IGF-1 and IGF binding protein 3 both increased following PRT (P < 0.05).
In an RCT, 24 weeks of PRT proved safe and effective in restoring lean mass and function in patients with RA. Muscle hypertrophy coincided with significant elevations of attenuated muscle IGF levels, revealing a possible contributory mechanism for rheumatoid cachexia. PRT should feature in disease management.
在一项随机对照试验（RCT）中，证实高强度渐进性抗阻训练（PRT）对恢复类风湿关节炎（RA）患者肌肉量和功能的疗效。此外，研究胰岛素样生长因子（IGF）系统在RA背景下运动诱导的肌肉肥大中的作用。
28例病情已得到控制的RA患者被随机分为两组，一组接受为期24周、每周两次的PRT（n = 13），另一组接受一系列居家运动的对照组（n = 15）。在第0周和第24周时，采用双能X线吸收法评估身体成分（包括瘦体重[LBM]、四肢瘦体重[ALM]和脂肪量）；客观身体功能；疾病活动度；以及肌肉IGF水平。
方差分析显示，PRT增加了LBM和ALM（P < 0.01）；躯干脂肪量减少了2.5 kg（无统计学意义）；训练特异性力量提高了119%，从椅子上站起能力提高了30%，膝关节伸肌力量提高了25%，弯臂能力提高了23%，步行时间提高了17%（对于客观功能测试，与对照组相比，P值范围为0.027至0.001）。相比之下，对照组患者的身体成分和身体功能保持不变。LBM和局部瘦体重的变化与客观功能的变化相关（P值范围为0.126至<0.0001）。与肌肉肥大同时发生的是，PRT后先前降低的肌肉IGF-1和IGF结合蛋白3水平均升高（P < 0.05）。
在一项RCT中，24周的PRT被证明对恢复RA患者的瘦体重和功能是安全有效的。肌肉肥大与衰减的肌肉IGF水平显著升高同时出现，揭示了类风湿性恶病质可能的促成机制。PRT应纳入疾病管理。
