Effects of Protein Supplementation on Rehabilitation Outcomes in Individuals with Chronic Stroke

[[abstract]]背景與目的：腦中風是造成慢性失能(chronicdisability) 並影響日常生活功能的主要原因之一。讓慢性中風患者得到最佳的復健治療，提高中風患者身體健康狀態與更有效地利用健康照護資源，為物理治療領域持續努力的議題。目前，運動後補充醣類合併蛋白質或胺基酸補充品用以提高肌肉量與肌力的概念已在體育界廣泛應用；然而，國內外尚無研究探討蛋白質補充對慢性中風者運動治療效果的影響。本研究目的為探討為期8 週的物理治療運動介入合併豆漿增補對慢性中風病人復健成效之影響。方法：本研究共招募20 位慢性中風受試者，並依體脂率與中風年數將受試者分為豆漿增補組(soy milk 組，SMS組，N = 10) 及安慰劑對照組(placebo，PLA 組，N = 10)。所有受試者在介入前後接受患側下肢肌肉力量與體能表現的評估。結果：本研究發現SMS 組8 英呎行走測試的進步量顯著高於PLA組(SMS: +39.9% vs. PLA: +19.6%, p ＜ 0.05)；在15 英呎行走測試中，SMS 組的進步量同樣較PLA 組多(SMS: +48.0% vs. PLA: +39.6%, p ＜0.05)；而6 分鐘行走測試的行走距離改變量同樣是SMS組顯著高於PLA 組(SMS: +40.0% vs.PLA: +19%, p ＜ 0.05)。蛋白質增補對受試者身體組成、平衡能力、坐到站速度與患側下肢肌力並無顯著影響。結論：本研究證實大豆蛋白質增補增加物理治療運動介入對慢性中風病人行走速度的正向影響能力部分的治療效果有顯著效益。臨床意義：蛋白質增補有助運動治療對慢性中風病人行走能力的療效，可能對於其日常生活功能有所幫助，將可做為臨床人員將營養介入融入中風物理治療計畫之科學依據

[[alternative]]Effects of protein supplementation on rehabilitation treatment outcomes in individuals with chronic stroke.

[[abstract]]腦中風是造成慢性失能 (chronic disability) 並影響日常生活功能的主要原因之一。然而，如何讓慢性中風病人得到最佳的復健治療，對提高中風患者身體健康狀態與更有效地利用健康照護資源，在物理治療領域仍有極大的努力空間。目前，運動後補充醣類合併蛋白質或胺基酸補充品用以提高肌肉量與肌力的概念已被運動員廣泛應用；然而，國內外尚無研究針對慢性中風者運動治療與蛋白質補充關係進行探討。本研究目的探討為期 8 週的中風物理治療運動訓練合併豆漿增補對慢性中風病人復健成效 (患側下肢肌肉力量、體能表現) 之影響。本研究共招募 20 位慢性中風受試者，並依體脂率與中風年份將受試者分為豆漿增補組 (soy milk 組，SMS 組，N=10) 及安慰劑對照組 (placebo，PLA 組，N=10)。本研究結果顯示 SMS 組在 8 英呎行走測試中，後測之行走速度改變量顯著高於 PLA 組 (SMS: +39.9% V.S PLA:+19.6%, p<0.05)；在 15 英呎行走測試中，SMS 組同樣顯示了較 PLA 組顯著的行走速度改變量 (SMS: +48.0% V.S PLA:+39.6%, p<0.05)；而 6MWT 的行走距離改變量同樣是 SMS 組顯著高於 PLA 組 (SMS: +40.0% V.S PLA:+19%, p<0.05)。然而，本研究中蛋白質增補對受試者身體組成、平衡能力、坐到站速度、患側下肢肌力各方面並無差異。本研究證實大豆蛋白質增補合併物理治療運動治療對慢性中風病人在行走能力部分的治療效果有顯著效益，可能對於其日常生活功能有幫助，這些發現將可做為臨床人員將營養介入融入中風物理治療計畫之科學依據。[[abstract]]Stroke is one of the primary causes resulting in chronic disability that impairs activity of daily living (ADL) and life quality.Recently, provision of carbohydrate plus protein after exercise training has been wildly accepted by athletes to improve their muscle mass and strength. However, there are still very few studies focusing the effects of nutritional supplementation on promoting therapeutic exercise training effects in chronic stroke survivors. Therefore, the purpose of this proposal is to investigate whether a 8-week stroke therapeutic exercise training combined with soy milk supplementation on rehabilitation outcomes (i.e. muscle strength of affected lower extremity, physical performance) in individuals with chronic stroke. In this proposed proposal, we recruited 20 subjects with chronic stroke, and they were assigned to either soy milk group (SMS group, N=10) or placebo control group (PLA group, N=10) by their body fat percentage and years after stroke. Results of this study indicate that the Δ% of 8-feet walking speed of the SMS group was significantly higher than that of the PLA group. In the 15-foot walking test, the SMS group also showed a significant improvement in walking speed compared to the PLA group. In the 6MWT, the SMS group also showed a significant improvement % of 6WMT distance compared to the PLA group. In the present study, protein supplementation had no significant effects on body composition, balance, sit-to-stand speed, and muscle strength of affected lower limb. Results of this study provide preliminary evidence that protein supplementation combined with therapeutic exercise therapy is useful in walking ability in patients with chronic stroke

慢性中風病人的運動復健與營養增補策略：可能生理機制與實務應用初探 The rehabilitation exercise and nutrition/supplement strategy in chronic stroke survivor: Possible physiological mechanisms and practical applications

[[abstract]]腦中風（cerebral vascular accident, CVA）是慢性失能及影響日常生活功能的主因之一，因此以提昇患者身體功能的積極復健運動訓練日趨重要。研究證實，營養增補策略有助於提高運動訓練適應效果與運動表現。慢性中風患者（中風發生大於6個月）在積極進行復健運動訓練的同時，也有特殊營養需求，但目前探討的研究仍然不多。因此，本文將以運動訓練促進肌力與提高肌肉蛋白質合成為主軸，透過整合現有科學證據，逐節探討慢性中風患者在復健運動介入及營養補充的特殊需求。同時，進一步評析營養介入促進訓練適應之生理機制，並進行多種營養增補策略對中風復健運動訓練效果的初探。文獻回顧指出，阻力運動或耐力運動後，立即補充蛋白質營養（如：乳清蛋白或大豆蛋白），可使運動促進肌肉蛋白質合成效率產生加成效益，進而提高肌肉組織質量。最近的動物研究結果顯示，益生菌可預防神經功能退化的危險因子與促進運動訓練效益，同時天然多酚類化合物（如：兒茶素或白藜蘆醇）或維生素也可以降低動物中風後引起的氧化壓力傷害、促進神經組織增生。鑒於相關營養增補對促進神經修復與保護作用之議題仍以動物研究成果居多，因此確實效益仍有待後續人體研究進行證實。本文建議未來研究方向可朝向天然抗氧化物增補、益生菌、複合營養補充劑配方增補、及整合性人體臨床研究等方向進行後續探討。 ＂Cerebral vascular accident (CVA)＂ is one of the primary causes of functional disability and substantially affecting activities of daily living (ADL), thus constructive rehabilitation exercise training program is essential to improve physical performance and motor functionality recovery in the chronic stroke patients. Accumulative evidence has revealed that appropriate nutritional supplementation strategies, including the proper types and timing of nutrient provision, can additionally help to improve exercise training adaptations and physical performance. Chronic stroke patients (6-12 months after onset) have specific nutritional demands when they perform rehabilitation exercise resulting from their neurological impairments, whereas there are still few studies focusing on the potential enhancing effects of applying nutritional supplementation during stroke rehabilitation in this populations. Therefore, through integrating currently existing scientific evidence, this review here focus on the special demands of rehabilitation exercise training and nutritional supplementation in chronic stroke patients, and the underlying physiological mechanisms for the benefits of rehabilitation exercise training and potential nutritional interventions on promoting exercise training adaptations are explored and discussed as well. Recent literature suggests that ingestion of protein-based supplementation (e.g. whey protein or soy protein) immediately after resistance or endurance exercise can further elicit muscle protein accretion by increasing the efficiency of protein synthesis. Furthermore, recent animal studies have shown that probiotics can prevent aging-caused neurological degeneration and promote exercise training adaptations, and natural-sourced polyphenolic compounds (e.g., catechins, or resveratrol) and vitamins are also reported to reduce oxidative stress and to promote neurogenesis in the stroke animal models. However, it has to be noted that the potential neuroprotective and exercise performance-enhancing benefits of these novel nutraceutical supplements on these physical and neurological promoting effects are still mostly based on the findings obtained from animal research results. Therefore, the effectiveness, efficacy, and safety are still needed to be carefully investigated and verified through subsequent systemic human clinical trial studies. Taken together, the future research directions can focus on the potential benefits of natural antioxidants, probiotics, and formula of varied nutritional supplements, and more human clinical trial research are warranted to confirm the effectiveness of these nutritional interventions in the chronic stroke rehabilitation program