Logo for the Journal of Rehab R&D
Volume 45 Number 2, 2008
Pages 261 — 272

Abstract - Skeletal muscle changes after hemiparetic stroke and potential beneficial effects of exercise intervention strategies

Charlene E. Hafer-Macko, MD;1-4* Alice S. Ryan, PhD;1 Frederick M. Ivey, PhD;1 Richard F. Macko, MD1-4

1Division of Gerontology, University of Maryland School of Medicine, Baltimore, MD; 2Baltimore Geriatric Research, Education, and Clinical Center and 3Department of Neurology, Department of Veterans Affairs (VA) Maryland Health Care System, Baltimore VA Medical Center, Baltimore, MD; 4Department of Neurology, University of Maryland School of Medicine, Baltimore, MD

Abstract — Stroke is the leading cause of disability in the United States. New evidence reveals significant structural and metabolic changes in skeletal muscle after stroke. Muscle alterations include gross atrophy and shift to fast myosin heavy chain in the hemiparetic (contralateral) leg muscle; both are related to gait deficit severity. The underlying molecular mechanisms of this atrophy and muscle phenotype shift are not known. Inflammatory markers are also present in contralateral leg muscle after stroke. Individuals with stroke have a high prevalence of insulin resistance and diabetes. Skeletal muscle is a major site for insulin-glucose metabolism. Increasing evidence suggests that inflammatory pathway activation and oxidative injury could lead to wasting, altered function, and impaired insulin action in skeletal muscle. The health benefits of exercise in disabled populations have now been recognized. Aerobic exercise improves fitness, strength, and ambulatory performance in subjects with chronic stroke. Therapeutic exercise may modify or reverse skeletal muscle abnormalities.

Key words: body composition, exercise, inflammation, insulin-glucose metabolism, myosin heavy chain isoforms, rehabilitation, sarcopenia, skeletal muscle, stroke, walking.

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