The Promoted Effect And Mechanism Of Physiological Ischemic Training On Functional Recovery In Patients With Acute Cerebral Infarction

Objective To investigate the effect of physiological ischemic training(PIT) induced by isometric contraction on functional recovery of patients with acute cerebral infarction(ACI),and to explore the mechanism.Methods Twenty patients with ACI were devided into PIT group(n=10) and control group(n=10). All patients were received routine rehabilitation training, while patients in PIT group enrolled 4-week PIT. PIT was induced by isometric exercise(hangdgrip) with maximal voluntary contraction. Fugl-Meyer motor function score, modified Barthel Index(m BI), the MOS 36-item Short Form Health Survey(SF-36), the formation of collateral circulation(the ipsilateral / contralateral cerebral blood flow) in cerebral ischemic zone, plasma concentration of vascular endothelial growth factor(VEGF), numbers of endothelial progenitor cells(EPCs) in blood were measured at baseline and after training.Results â‘  Functional Index : Compared with the pre, the Fugl-Meyer motor function score, m BI and SF-36 of both groups were significantly increased(P<0.01),Fugl-Meyer motor function score and SF-36 in PIT group significantly higher than in control group(p<0.05),while m BI showed no difference between the two groups(p>0.05). â‘¡ Formation of collateral circulation in cerebral ischemia zone: Compared with the pre, the ipsilateral / contralateral CBF of both groups were significantly increased(P<0.01), and the ipsilateral / contralateral CBF in PIT group significantly higher than that in control group(p<0.05) â‘¢ Molecular biologyand cytology: Compared with the pre, both the VEGF and EPCs of PIT group increased significantly(p<0.01), while in control group, VEGF showed no significant changes(p>0.05) and the EPCs increased significantly(p<0.01).At the end point, both of the VEGF(p<0.01) and EPCs(p<0.05) in PIT group significantly higher than that in control group. â‘£Correlation analysis: The Fugl-Meyer motor function score and the ipsilateral / contralateral CBF(r=0.686,P<0.01), the ipsilateral / contralateral CBF and VEGF( r=0.591,P<0.01), the EPCs and VEGF( r=0.626,P<0.01)were all positively correlated.Conclusion: PIT can promote the recovery of function in patients with acute cerebral infarction, the possible mechanism is to promote the formation of collateral circulation in cerebral ischemia zone by increasing the revascularization via VEGF-mediated mobilization of EPCs.