Franz Alexander, Behringer Michael, Nosaka Kazunori, Buhren Bettina Alexandra, Schrumpf Holger, Mayer Constantin, Zilkens Christoph, Schumann Moritz
Institute of Anatomy I, Heinrich Heine University Medical School Duesseldorf, Germany.
Institute of Training Science and Sports Informatics, German Sport University Cologne, Germany.
Med Hypotheses. 2017 Jan;98:21-27. doi: 10.1016/j.mehy.2016.11.008. Epub 2016 Nov 23.
Eccentric exercise training is effective for increasing muscle mass and strength, and improving insulin sensitivity and blood lipid profiles. However, potential muscle damage symptoms such as prolonged loss of muscle function and delayed onset of muscle soreness may restrict the use of eccentric exercise, especially in clinical populations. Therefore, strategies to reduce eccentric exercise-induced muscle damage (EIMD) are necessary, and an extensive number of scientific studies have tried to identify potential intervention modalities to perform eccentric exercises without adverse effects. The present paper is based on a narrative review of current literature, and provides a novel hypothesis by which an ischemic preconditioning (IPC) of the extremities may reduce EIMD. IPC consists of an intermittent application of short-time non-lethal ischemia to an extremity (e.g. using a tourniquet) followed by reperfusion and was discovered in clinical settings in an attempt to minimize inflammatory responses induced by ischemia and ischemia-reperfusion-injury (I/R-Injury) during surgery. The present hypothesis is based on morphological and biochemical similarities in the pathophysiology of skeletal muscle damage during clinical surgery and EIMD. Even though the primary origin of stress differs between I/R-Injury and EIMD, subsequent cellular alterations characterized by an intracellular accumulation of Ca, an increased production of reactive oxygen species or increased apoptotic signaling are essential elements for both. Moreover, the incipient immune response appears to be similar in I/R-Injury and EIMD, which is indicated by an infiltration of leukocytes into the damaged soft-tissue. Thus far, IPC is considered as a potential intervention strategy in the area of cardiovascular or orthopedic surgery and provides significant impact on soft-tissue protection and downregulation of undesired excessive inflammation induced by I/R-Injury. Based on the known major impact of IPC on skeletal muscle physiology and immunology, the present paper aims to illustrate the potential protective effects of IPC on EIMD by discussing possible underlying mechanisms.
离心运动训练对于增加肌肉质量和力量、改善胰岛素敏感性及血脂状况有效。然而，诸如肌肉功能长期丧失和延迟性肌肉酸痛等潜在的肌肉损伤症状可能会限制离心运动的应用，尤其是在临床人群中。因此，减少离心运动诱导的肌肉损伤（EIMD）的策略是必要的，并且大量科学研究试图确定能够进行无不良影响的离心运动的潜在干预方式。本文基于对当前文献的叙述性综述，提出了一个新的假说，即肢体缺血预处理（IPC）可能减少EIMD。IPC包括对肢体间歇性施加短时间非致死性缺血（例如使用止血带），随后进行再灌注，它是在临床环境中被发现的，旨在尽量减少手术期间缺血和缺血再灌注损伤（I/R损伤）诱导的炎症反应。本假说基于临床手术期间骨骼肌损伤与EIMD病理生理学中的形态学和生物化学相似性。尽管I/R损伤和EIMD之间应激的主要来源不同，但随后以细胞内钙积累、活性氧产生增加或凋亡信号增加为特征的细胞改变是两者的基本要素。此外，I/R损伤和EIMD中初始免疫反应似乎相似，这表现为白细胞浸润到受损软组织中。迄今为止，IPC被认为是心血管或骨科手术领域的一种潜在干预策略，对软组织保护以及下调I/R损伤诱导的不良过度炎症具有显著影响。基于IPC对骨骼肌生理学和免疫学的已知主要影响，本文旨在通过讨论可能的潜在机制来说明IPC对EIMD的潜在保护作用。
