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

胡家約(Chia-Yueh Hu) ； 蔡秀純(Shiow-Chwen Tsai) ； 陳喬男(Chiao-Nan (Joyce) Chen) ； 王斐蒂(Fei-Ti Wang) ； 廖翊宏(Yi-Hung Liao)

《體育學報》 53卷1期 (2020/03) Pp. 1-20

https://doi.org/10.6222/pej.202003_53(1).0001

摘要

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。

關鍵字

復健運動 ； 蛋白質補充 ； 營養補充時機 ； 氧化壓力 ； 抗氧化劑 ； 益生菌

並列摘要

＂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.

並列關鍵字

rehabilitation exercise ； protein supplementation ； nutrition timing ； oxidative stress ； antioxidants ； probiotics

參考文獻

何建德、劉斐文、廖翊宏 (2013)。運動訓練與營養補充對失用性肌萎縮預防與治療效益之探討。中華體育季刊，27(3)，195-202。doi: 10.6223/qcpe.2702.201309.1003 [Ho C. T., Liu F. W., & Liao Y. H. (2013). The current understanding for the potential preventive and therapeutic effects of exercise training and nutritional supplementation on disuse muscle atrophy. Quarterly of Chinese Physical Education, 27(3), 195-202.]

邱志暉、巫錦霖 (2010)。補充支鏈胺基酸對於運動表現及運動後恢復期的影響。中華體育季刊，24(3)，93-101。doi: 10.6223/qcpe.2403.201009.2010 [Chiu C. H., & Wu C. L. (2010). Effects of branched-chain amino acids supplementation on exercise performance and post-exercise recovery. Quarterly of Chinese Physical Education, 24(3), 93-101.]

廖建彰、李采娟、林瑞雄、宋鴻樟 (2006)。2000年臺灣腦中風發生率與盛行率的城鄉差異。臺灣公共衛生雜誌，25(3)，223-230。doi: 10.6288/TJPH2006-25-03-06 [Liao C. C., Li T. C., Lin R. S., & Sung F. C. (2006). Urban and rural difference in prevalence and incidence of stroke in 2000 in Taiwan. Taiwan Journal of Public Health, 25(3), 223-230.]

Drummond, M. J., Marcus, R. L., & Lastayo, P. C. (2012). Targeting anabolic impairment in response to resistance exercise in older adults with mobility impairments: Potential mechanisms and rehabilitation approaches. Journal of Aging Research, 2012, 1-8. doi: 10.1155/2012/486930

Abdulla, H., Smith, K., Atherton, P. J., & Idris, I. (2016). Role of insulin in the regulation of human skeletal muscle protein synthesis and breakdown: A systematic review and meta-analysis. Diabetologia, 59(1), 44-55. doi: 10.1007/s00125-015-3751-0