National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, China; College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, China; Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA.
College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, China.
Brain Behav Immun. 2019 Nov;82:253-263. doi: 10.1016/j.bbi.2019.08.193. Epub 2019 Aug 28.
Knee osteoarthritis (KOA) is a common degenerative joint disease with no satisfactory intervention. Recently, both physical and mindfulness exercises have received considerable attention for their implications in KOA pain management, and the dorsolateral prefrontal cortex (DLPFC) has displayed a critical role in pain modulation. This study aimed to comparatively investigate the modulation effects of different exercises using multidisciplinary measurements.
140 KOA patients were randomized into Tai Chi, Baduanjin, stationary cycling, or health education control groups for 12 weeks. Knee Injury and Osteoarthritis Outcome Score (KOOS), resting state functional magnetic resonance imaging (fMRI), structural MRI, and serum biomarkers were measured at baseline and at the end of the study.
We found: 1) increased KOOS pain subscores (pain reduction) and serum programmed cell death protein 1 (PD-1) levels in the three exercise groups compared to the control group; 2) decreased resting state functional connectivity (rsFC) of the DLPFC-supplementary motor area (SMA) and increased rsFC between the DLPFC and anterior cingulate cortex in all exercise groups compared to the control group; 3) significant associations between DLPFC-SMA rsFC with KOOS pain subscores and serum PD-1 levels at baseline; 4) significantly increased grey matter volume in the SMA in the Tai Chi and stationary cycling groups, and a trend toward significant increase in the Baduanjin group compared to the control group; 5) significant DLPFC rsFC differences among different exercise groups; and 6) that baseline DLPFC-SMA rsFC can predict the effect of mind-body exercise on pain improvement in KOA.
Our results suggest that different exercises can modulate both common and unique DLPFC (cognitive control) pathways, and altered DLPFC-SMA rsFC is associated with serum biomarker levels. Our findings also highlight the potentials of neuroimaging biomarkers in predicting the therapeutic effect of mind-body exercises on KOA pain.
膝骨关节炎（KOA）是一种常见的退行性关节疾病，目前尚无满意的干预措施。最近，身体和正念练习都因其在 KOA 疼痛管理中的作用而受到广泛关注，而背外侧前额叶皮层（DLPFC）在疼痛调节中发挥着关键作用。本研究旨在通过多学科测量比较不同运动的调节作用。
140 例 KOA 患者随机分为太极拳、八段锦、固定自行车或健康教育对照组，进行 12 周治疗。在基线和研究结束时测量膝关节损伤和骨关节炎结果评分（KOOS）、静息态功能磁共振成像（fMRI）、结构磁共振成像和血清生物标志物。
我们发现：1）与对照组相比，三组运动组的 KOOS 疼痛亚量表（疼痛减轻）和血清程序性死亡蛋白 1（PD-1）水平均升高；2）与对照组相比，所有运动组的 DLPFC-辅助运动区（SMA）静息态功能连接（rsFC）降低，DLPFC 与前扣带回之间的 rsFC 增加；3）基线时 DLPFC-SMA rsFC 与 KOOS 疼痛亚量表和血清 PD-1 水平之间存在显著相关性；4）与对照组相比，太极拳和固定自行车组 SMA 的灰质体积显著增加，八段锦组有增加的趋势；5）不同运动组之间 DLPFC rsFC 存在显著差异；6）基线 DLPFC-SMA rsFC 可预测身心锻炼对 KOA 疼痛改善的效果。
我们的研究结果表明，不同的运动可以调节共同和独特的 DLPFC（认知控制）途径，并且改变的 DLPFC-SMA rsFC 与血清生物标志物水平相关。我们的研究结果还强调了神经影像学生物标志物在预测身心锻炼对 KOA 疼痛治疗效果的潜力。
