偏心测力计训练促进严重慢性阻塞性肺病患者的运动肌肉力量而非线粒体适应

Eccentric ergometer training promotes locomotor muscle strength but not mitochondrial

adaptation in patients with severe chronic obstructive pulmonary disease.

Keywords：COPD, Cross sectional area, Endurance exercise training, Hypertrophy, Mitochondrial biogenesis, Muscle dysfunction, Rehabilitation, Respiration

关键词：COPD、横截面积、耐力运动训练、肥大、线粒体生物发生、肌肉功能障碍、康复、呼吸

哺乳动物：人

组织：骨骼肌
作者：MacMillan Norah J、Kapchinsky Sophia、Konokhova Yana、Gouspillou Gilles、de Sousa Sena Riany、Jagoe R Thomas、Baril Jacinthe、Carver Tamara E、Andersen Ross E、Richard Ruddy、Perrault Helene、Bourbeau Jean、 Hepple Russell T、Taivassalo Tanja
出版期刊：《Front Physiol》（2017）

Abstract：

Eccentric ergometer training (EET) is increasingly being proposed as a therapeutic strategy to improve skeletal muscle strength in various cardiorespiratory diseases, due to the principle that lengthening muscle actions lead to high force-generating capacity at low cardiopulmonary load. One clinical population that may particularly benefit from this strategy is chronic obstructive pulmonary disease (COPD), as ventilatory constraints and locomotor muscle dysfunction often limit efficacy of conventional exercise rehabilitation in patients with severe disease. While the feasibility of EET for COPD has been established, the nature and extent of adaptation within COPD muscle is unknown. The aim of this study was therefore to characterize the locomotor muscle adaptations to EET in patients with severe COPD, and compare them with adaptations gained through conventional concentric ergometer training (CET). Male patients were randomized to either EET (n = 8) or CET (n = 7) for 10 weeks and matched for heart rate intensity. EET patients trained on average at a workload that was three times that of CET, at a lower perception of leg fatigue and dyspnea. EET led to increases in isometric peak strength and relative thigh mass (p < 0.01) whereas CET had no such effect. However, EET did not result in fiber hypertrophy, as morphometric analysis of muscle biopsies showed no increase in mean fiber cross-sectional area (p = 0.82), with variability in the direction and magnitude of fiber-type responses (20% increase in Type 1, p = 0.18; 4% decrease in Type 2a, p = 0.37) compared to CET (26% increase in Type 1, p = 0.04; 15% increase in Type 2a, p = 0.09). EET had no impact on mitochondrial adaptation, as revealed by lack of change in markers of mitochondrial biogenesis, content and respiration, which contrasted to improvements (p < 0.05) within CET muscle. While future study is needed to more definitively determine the effects of EET on fiber hypertrophy and associated underlying molecular signaling pathways in COPD locomotor muscle, our findings promote the implementation of this strategy to improve muscle strength. Furthermore, contrasting mitochondrial adaptations suggest evaluation of a sequential paradigm of eccentric followed by concentric cycling as a means of augmenting the training response and attenuating skeletal muscle dysfunction in patients with advanced COPD.

文章摘要：

偏心测力计训练 (EET) 越来越多地被提议作为一种治疗策略，以改善各种心肺疾病的骨骼肌力量，因为延长肌肉动作会导致在低心肺负荷下产生高力量产生能力的原理。可能特别受益于这一策略的一个临床人群是慢性阻塞性肺病 (COPD)，因为通气受限和运动肌肉功能障碍通常会限制传统运动康复对重症患者的疗效。虽然已经确定了 EET 治疗 COPD 的可行性，但 COPD 肌肉内适应的性质和程度尚不清楚。因此，本研究的目的是描述重度 COPD 患者的运动肌肉对 EET 的适应性，并将其与通过常规同心测力计训练 (CET) 获得的适应性进行比较。男性患者被随机分配到 EET (n = 8) 或 CET (n = 7) 10 周，并匹配心率强度。 EET 患者的平均训练量是 CET 的三倍，对腿部疲劳和呼吸困难的感知较低。 EET 导致等长峰值强度和相对大腿质量的增加（p < 0.01），而 CET 没有这种影响。然而，EET 并未导致纤维肥大，因为肌肉活检的形态测量分析显示平均纤维横截面积没有增加（p = 0.82），纤维类型反应的方向和幅度存在差异（类型增加 20% 1，p = 0.18；与 CET 相比，2a 型降低 4%，p = 0.37）（1 型增加 26%，p = 0.04；2a 型增加 15%，p = 0.09）。 EET 对线粒体适应没有影响，正如线粒体生物发生、含量和呼吸的标志物缺乏变化所揭示的那样，这与 CET 肌肉内的改善 (p < 0.05) 形成鲜明对比。虽然未来的研究需要更明确地确定 EET 对 COPD 运动肌肉中纤维肥大和相关潜在分子信号通路的影响，但我们的研究结果促进了该策略的实施，以提高肌肉力量。此外，对比线粒体适应表明评估偏心的顺序范式，然后是向心循环作为增强训练反应和减轻晚期 COPD 患者骨骼肌功能障碍的手段。

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