Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland; Baltimore Veterans Administration Medical Center, Geriatrics Research, Education and Clinical Center (GRECC) and Maryland Exercise and Robotics Center of Excellence (MERCE), Baltimore, Maryland.
Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland; Baltimore Veterans Administration Medical Center, Geriatrics Research, Education and Clinical Center (GRECC) and Maryland Exercise and Robotics Center of Excellence (MERCE), Baltimore, Maryland.
J Stroke Cerebrovasc Dis. 2014 Feb;23(2):225-9. doi: 10.1016/j.jstrokecerebrovasdis.2012.12.014. Epub 2013 Jan 22.
Insulin resistance is highly prevalent after stroke, contributing to comorbid cardiovascular conditions that are the leading cause of death in the stroke population. This study determined the effects of unilateral resistive training (RT) of both the paretic and nonparetic legs on insulin sensitivity in stroke survivors.
We studied 10 participants (mean age 65 ± 2 years; mean body mass index 27 ± 4 kg/m2) with hemiparetic gait after remote (>6 months) ischemic stroke. All subjects underwent 1-repetition maximum (1-RM) strength testing, 9 had an oral glucose tolerance test (OGTT), and 7 completed a 2-hour hyperglycemic clamp (with glucose elevation targeted at 98 mg/dL above baseline fasting level) before and after 12 weeks (3×/week) of progressive, high repetition, high-intensity RT. Body composition was assessed by dual-energy x-ray absorbtiometry in all participants.
Leg press and leg extension 1-RM increased in the paretic leg by 22% (P < .05) and 45% (P < .01), respectively. Fasting insulin decreased 23% (P < .05), with no change in fasting glucose. The 16% reduction in OGTT insulin area under the curve (AUC) across training was not statistically significant (P = .18). There was also no change in glucose AUC. First-phase insulin response during the hyperglycemic clamp (0-10 minutes) decreased 24% (P < .05), and second-phase insulin response (10-120 minutes) decreased 26% (P < .01). Insulin sensitivity increased by 31% after RT according to clamp calculations (P < .05).
These findings provide the first preliminary evidence that RT may reduce hyperinsulinemia and improve insulin sensitivity after disabling stroke.
中风后胰岛素抵抗非常普遍，导致合并心血管疾病，这是中风患者死亡的主要原因。本研究旨在确定对患侧和非患侧肢体进行单侧抗阻训练（RT）对中风幸存者胰岛素敏感性的影响。
我们研究了 10 名（平均年龄 65 ± 2 岁；平均体重指数 27 ± 4 kg/m2）偏瘫步态的远程（>6 个月）缺血性中风后幸存者。所有受试者均进行了 1 次重复最大（1-RM）力量测试，9 名受试者进行了口服葡萄糖耐量试验（OGTT），7 名受试者在 12 周（每周 3 次）的渐进式、高重复、高强度 RT 前后完成了 2 小时高血糖钳夹（目标为空腹水平以上 98mg/dL 升高血糖）。所有参与者均通过双能 X 线吸收法评估身体成分。
患侧腿的腿压和腿伸 1-RM 分别增加了 22%（P <.05）和 45%（P <.01）。空腹胰岛素降低了 23%（P <.05），空腹血糖没有变化。训练过程中 OGTT 胰岛素曲线下面积（AUC）减少 16%，但无统计学意义（P =.18）。血糖 AUC 也没有变化。高血糖钳夹期间（0-10 分钟）第一时相胰岛素反应降低 24%（P <.05），第二时相胰岛素反应（10-120 分钟）降低 26%（P <.01）。根据钳夹计算，RT 后胰岛素敏感性增加了 31%（P <.05）。
这些发现首次提供了初步证据，表明 RT 可能减少致残性中风后高胰岛素血症并提高胰岛素敏感性。
