Fenton Jordan M, King James A, Hoekstra Sven P, Valentino Sydney E, Phillips Stuart M, Goosey-Tolfrey Victoria L
National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
Peter Harrison Centre for Disability Sport, Loughborough University, Loughborough, UK.
Disabil Rehabil. 2023 May;45(9):1433-1443. doi: 10.1080/09638288.2022.2063420. Epub 2022 Apr 24.
The purpose of this review was to compare all intervention modalities aimed at increasing skeletal muscle mass (SMM) in the paralysed limbs of persons with chronic (>1-year post-injury), motor complete spinal cord injury (SCI).
A systematic review of EMBASE, MEDLINE, Scopus, and SPORTDiscus databases was conducted from inception until December 2021. Published intervention studies aimed to increase SMM (measured by magnetic resonance imaging, computed tomography, ultrasound, muscle biopsy, or lean soft tissue mass by dual X-ray absorptiometry) in the paralysed limbs of adults (>18 years) with SCI were included.
Fifty articles were included that, overall, demonstrated a high risk of bias. Studies were categorised into six groups: neuromuscular electrical stimulation (NMES) with and without external resistance, functional electrical stimulation cycling, walking- and standing-based interventions, pharmacological treatments, and studies that compared or combined intervention modalities. Resistance training (RT) using NMES on the quadriceps produced the largest and most consistent increases in SMM of all intervention modalities.
Current evidence suggests that clinical practise aiming to increase SMM in the paralysed limbs of persons with motor complete SCI should perform NMES-RT. However, more high-quality randomised control trials are needed to determine how training variables, such as exercise volume and intensity, can be optimised for increasing SMM. Implications for rehabilitationPersons with spinal cord injury (SCI) experience severe reductions in skeletal muscle mass (SMM) post-injury, which may exacerbate their risk of obesity and metabolic disease.Out of all exercise and non-exercise-based interventions, this systematic review shows that neuromuscular electrical stimulation-based resistance training demonstrates the most robust and consistent evidence for increasing skeletal muscle mass in the paralysed limbs of adults with motor complete spinal cord injury.The findings from this review can be used to inform evidence-based practise for exercise practitioners, as well as direct future research focused on increasing muscle mass in this population.
本综述旨在比较所有旨在增加慢性（受伤后>1年）、运动完全性脊髓损伤（SCI）患者瘫痪肢体骨骼肌质量（SMM）的干预方式。
对EMBASE、MEDLINE、Scopus和SPORTDiscus数据库进行了从建库至2021年12月的系统综述。纳入了旨在增加成年（>18岁）SCI患者瘫痪肢体SMM（通过磁共振成像、计算机断层扫描、超声、肌肉活检或双能X线吸收法测量的瘦软组织质量）的已发表干预研究。
共纳入50篇文章，总体显示出较高的偏倚风险。研究分为六组：有和无外部阻力的神经肌肉电刺激（NMES）、功能性电刺激循环、基于步行和站立的干预、药物治疗以及比较或联合干预方式的研究。在所有干预方式中，对股四头肌使用NMES进行阻力训练（RT）使SMM增加幅度最大且最为一致。
目前的证据表明，旨在增加运动完全性SCI患者瘫痪肢体SMM的临床实践应采用NMES-RT。然而，需要更多高质量的随机对照试验来确定如何优化训练变量，如运动量和强度，以增加SMM。康复启示脊髓损伤（SCI）患者在受伤后骨骼肌质量（SMM）会严重下降，这可能会增加他们患肥胖症和代谢疾病的风险。在所有基于运动和非运动的干预措施中，本系统综述表明，基于神经肌肉电刺激的阻力训练在增加成年运动完全性脊髓损伤患者瘫痪肢体骨骼肌质量方面显示出最有力和一致的证据。本综述的结果可用于为运动从业者提供循证实践信息，并指导未来针对该人群增加肌肉质量的研究。
