REVISTA
BRASILEIRA
DE
REUMATOLOGIA
ww w . r e u m a t o l o g i a . c o m . b r
Original
article
Evaluation
of
grip
strength
in
normal
and
obese
Wistar
rats
submitted
to
swimming
with
overload
after
median
nerve
compression
夽
Josinéia
Gresele
Coradini
a,
Camila
Mayumi
Martin
Kakihata
a,
Regina
Inês
Kunz
a,
Tatiane
Kamada
Errero
a,
Maria
Lúcia
Bonfleur
a,b,
Gladson
Ricardo
Flor
Bertolini
a,c,∗ aUniversidadeEstadualdoOestedoParaná,Cascavel,PR,BrazilbUniversidadeEstadualdeCampinas,Campinas,SP,Brazil
cHealthSciencesAppliedtotheLocomotorApparatus,FaculdadedeMedicinadeRibeirãoPreto,UniversidadedeSãoPaulo,Ribeirão
Preto,SP,Brazil
a
r
t
i
c
l
e
i
n
f
o
Articlehistory:
Received16September2013 Accepted26August2014
Availableonline26November2014
Keywords:
Musclestrength Nervecompression Obesity
Swimming
a
b
s
t
r
a
c
t
Objective:Toverifythefunctionalitythroughmusclegripstrengthinanimalswithobesity inducedbymonosodiumglutamate(MSG)andincontrolanimals,whichsuffered compres-sionoftherightmediannerve,andtreatedwithswimmingwithoverload.
Methods:Duringthefirstfivedaysoflife,neonatalWistarratsreceivedsubcutaneous injec-tionsofMSG.Thecontrolgroupreceivedahypertonicsalinesolution.Forty-eightratswere dividedintosixgroups:G1(control);G2(control+injury);G3(control+injury+swimming); G4(obese);G5(obese+injury);andG6(obese+injury+swimming).Theanimalsingroups G2, G3,G5andG6weresubmittedtocompressionofthemediannerveandG3andG6 groupsweretreated,afterinjury,withswimmingexercisewithloadforthreeweeks.The swimmingexercisehadaprogressiveduration,accordingtotheweek,of20,30and40min. Musclestrengthwasassessedusingagripstrengthmeterpreoperativelyandonthe3rd,7th, 14thand21stdaysaftersurgery.Theresultswereexpressedandanalyzedusingdescriptive andinferentialstatistics.
Results:Whenthegripstrengthwascomparedamongassessmentsregardlessofgroup,in thesecondassessmenttheanimalsexhibitedlowergripstrength.G1andG4groupshad greatergripstrength,comparedtoG2,G3,G4andG6.
Conclusion: The swimming exercisewith overload has not been effectivein promoting improvementinmusclegripstrengthaftercompressioninjuryoftherightmediannervein controlandinobese-MSGrats.
©2014ElsevierEditoraLtda.Allrightsreserved.
夽
LaboratoryofEndocrinePhysiologyandMetabolism;LaboratoryfortheStudyofInjuriesandPhysicalTherapyResources,Universidade EstadualdoOestedoParaná.
∗ Correspondingauthor.
E-mail:gladsonricardo@yahoo.com.br(G.R.F.Bertolini).
http://dx.doi.org/10.1016/j.rbre.2014.08.002
Avaliac¸ão
da
forc¸a
de
preensão
em
ratos
Wistar,
normais
e
obesos,
submetidos
à
natac¸ão
com
sobrecarga
após
compressão
do
nervo
mediano
Palavras-chave:
Forc¸amuscular Compressãonervosa Obesidade
Natac¸ão
r
e
s
u
m
o
Objetivo:Verificarafuncionalidadepormeiodaforc¸amusculardepreensãoemanimaiscom obesidadeinduzidaporglutamatomonossódico(MSG)eanimaiscontrole,quesofreram compressãodonervomedianodireito,tendocomotratamentoanatac¸ãocomcarga.
Métodos:RatosWistarneonatosduranteosprimeiroscincodiasdevidareceberaminjec¸ões subcutâneasdeMSG.Ogrupocontrolerecebeusoluc¸ãosalinahiperosmótica.Quarentae oitoratosforamdivididosemseisgrupos:G1(controle);G2(controlecomlesão);G3(controle comlesão+natac¸ão);G4(obesos);G5(obesoscomlesão);G6(obesoscomlesão+natac¸ão). OsanimaisdosgruposG2,G3,G5eG6foramsubmetidosàcompressãodonervomediano eosdosgruposG3eG6foramtratados,apósalesão,comexercíciodenatac¸ãocomcarga durantetrêssemanas.Anatac¸ãotevedurac¸ãoprogressivaconformeassemanas,de20,30 e40minutos.Aforc¸amuscularfoiavaliadapormeiodeummedidordeforc¸adepreensão nopré-operatório,noterceiro,sétimo,14◦e21◦diapós-operatório.Osresultadosforam
expressoseanalisadosporestatísticadescritivaeinferencial.
Resultados: Quandocomparadaaforc¸adepreensãoentreasavaliac¸ões,indiferentemente degrupos,nasegundaavaliac¸ãoosanimaisapresentarammenorforc¸adepreensão.Os gruposG1eG4apresentaramforc¸adepreensãomaior,emcomparac¸ãocomosgruposG2, G3,G4eG6.
Conclusão: Oexercíciodenatac¸ãocomsobrecarganãofoieficazempromovermelhoriana forc¸amusculardepreensãoapóslesãodecompressãodonervomedianodireitoemratos controleeobesos-MSG.
©2014ElsevierEditoraLtda.Todososdireitosreservados.
Introduction
Peripheral nerve lesions are commonly encountered in the clinical practice ofphysiotherapy, especially traumatic injuriessuchascrushing,compressionorstretching, result-inginfunctionalimpairment,causedbytheinterruptionin thepropertransmissionofnerveimpulse.1,2Theinterruption
ofthenervesupplyleadstoadecreasedmuscleactivity, caus-ingmuscularatrophy,andthemaineffectofthisatrophyisthe reductionoftheareaanddiameterofthemusclefiberand con-sequentreductioninitsstrength.1Axonsofinjuredperipheral
nerveshavethecapacitytoregenerate;however,thisprocess isslowandthefunctionalrecoveryisusuallynotcomplete.3
Studiesinvolvingdisordersinperipheralnervesandobesity canbefound inthe literature;4,5 however, the approachof
conservativetreatmentforperipheralnerveinjuryinobese subjectsisstillscarce.
Physical therapy seeks to repair the consequences of peripheralnerveinjury,restoringfunctionalitytothe individ-ual.Thetreatmentcanbeperformedbyvarioustherapeutic approaches,suchaspassiveandactivecinesiotherapy, elec-trotherapy,functionalskills training,specificproprioceptive neuromuscularfacilitationtechniquesandtherapeutic exer-cise.
Animal studies demonstrate the efficacy of exercise on peripheral nerve regeneration.6,7 The exercise practice
promotes recovery of contractile and metabolic properties of muscle after denervation,8 helps removing degenerated
myelinandsubsequentsynthesis,9 aidsinaxonaldiameter
recovery10and axonalsprouting,favorstheregenerationof
injurednervesandfunctionalrecovery11 andalsoincreases
theexpressionofnervegrowthfactorssuchasBDNFandNGF, stimulatingthegrowthanddevelopmentofnewcells.12The
physiologicaleffectsofexerciseintheaquaticenvironment providebenefitstothecardiovascular,skeletal,muscularand nervoussystems,increasingthetissuerepairprocess.13
How-ever, Oliveira et al.,10 despite observing improvements in
axonaldiameter,reportthattheswimmingpracticedidnot affect the maturation of regenerated nerve fibers or their functionality, and when associatedwithelectrical stimula-tion,delayedfunctionalrecovery.Thesefindingsdisagreewith whatwasobservedbyTeodorietal.,7whoobserveda
signif-icanteffectofswimmingexercise,withaccelerationofnerve regenerationinpost-axonotmesisofsciaticnervesofrats.
One wayto evaluatethe functionalityofthe individual is bythe measurementof muscle strength,which enables a functionaldiagnosis byanevaluationofimprovementor worseningduringtreatment,andasapredictiveorprognostic measure.14Inthiscontext,theaimofthisstudywastoassess
themusclegripstrengthinMSG-obeseandincontrolanimals, whichsuffered compressionofthe rightmediannerveand underwentswimmingwithload.
Materials
and
methods
Characterizationofthestudyandsample
Classes–CEEAAP,UniversidadeEstadualdoOestedoParaná, underprotocolnumber01712.
Neonatal Wistar rats during the first five days of age receivedsubcutaneousinjectionsofmonosodiumglutamate (MSG)inaconcentrationof4g/kgbodyweight/day,forming the obese group. The control group received a hyperos-motic saline solution at a concentration of 1.25g/kg body weight/day.15Theanimalswerekeptinalight/dark
photope-riodof12handatatemperatureof23±2◦C,withfoodand
wateradlibitum.
At 68 days of life, 48 rats were divided into six experimental groups: G1 (control); G2 (control+injury); G3 (control+injury+swimming);G4(MSG);G5(MSG+injury);and G6(MSG+injury+swimming).At73±4daysoflife,the ani-mals in groups G2, G3, G5 and G6 underwent surgery for mediannervecompression.
Nervecompression
Thecompressionoftherightmediannervewasbasedonthe modelpresentedbyChenetal.,16withnervetie-downusing
4.0chromiccatgutin4points,withanapproximatedistanceof 1mminthemediannerve,proximaltotheelbow.Toperform thesurgicalprocedureforcompressionofthemediannerve, theanimalswereanesthetizedwithketaminehydrochloride solution(50mg/kg)andxylazine(10mg/kg).
Swimming
Fivedayspriortothesurgery,theanimalswereadaptedand trainedinagradualmannertoswim,whereininthefirstthree daystheratsswamfor15minwithanoverloadof5%ofbody weight;inthefollowingtwodays,theyswam20minwithan overloadof10%ofbodyweight.Theswimmingexercisewas heldin anoval tankmadeof strongplastic material(200l capacity,60cmdeep)andcontainingwatermaintainedata controlledtemperatureof32±1◦C.Thetreatmentbeganon
thethirddaypostoperatively;theexerciseswereperformed onceaday,fivetimesaweek,totaling15daysofswimming. Theanimalswereweighedeverydayforweightcontroland adjustmentoftheirloadsfortheswimmingexercise.Inthe firstweek,G3andG6groupsstartedwith20minofexercise; duringthesecondweek,30min;andinthethirdweek,40min. Inallpractices,theanimalssupportedaloadof10%ofbody weight.Theothergroupsofanimalswereplacedinwaterfor 1min.
Musclestrength
For muscle strength assessment, one grip strength meter describedbyBertelliandMira17wasused.Thisassessment
isausefultoolforanalyzing therecoveryofmediannerve lesions,throughthefunctionoftheflexordigitorummuscle. Toperformtheevaluation,theanimalwaspulledbythetail withincreasingforce.Theratcouldseizeagridattachedto aforcetransducer, tilltheanimallost itsgrip.Theanterior left limb was temporarily immobilized by wrapping with tape.Five days priortosurgery, the animals were adapted andtrainedontheequipment.Thefirstevaluation(AV1)was performedbeforethe compressionofthemediannerve, to
obtainbaselinevalues,i.e.,preoperatively,followedbya sec-ondassessmentonthe3rdpostoperativeday(AV2).Theother assessmentswerecarriedoutattheendofeachweekof treat-ment,i.e.,the7th(AV3),14th(AV4)and21st(AV5)day,with theaimtoobservetheevolutionofthelesionandthetype oftreatmentused.Ineachevaluationthetestwasrepeated threetimes,andthemeanvalueofrepetitionswasused.
Statisticalanalysis
Theresultswere expressedand analyzedusing descriptive andinferentialstatistics.Tocomparegroupsandtimes, one-wayANOVAwithTukeypost-testwasused,withasignificance levelof5%.
Results
Both G1 and G4 showed no intragroup variations(P>0.05), whichwasexpected,sinceinthesegroupsinjurieswerenot inflicted.Fortheothergroups,thevaluesofAV1weresuperior totheotherassessments(P<0.05),whereasG2andG6showed significantincreasesinAV4,whencomparedtoAV2(P<0.05); thesamewasobservedforG2,G3andG6,whencomparing AV5versusAV2(P<0.05)(Table1).
Asforthecomparisonamonggroups,inAV1(thepre-injury time)therewerenosignificantdifferences(P>0.05).However, from AV2toAV5,differencesbetweenG1versusG2,G3,G5 and G6(P<0.05)groupswere observed,occurringthesame withrespecttoG4 (Table 1), i.e.,the valuesfoundrevealed that thelesionreduced thegrip strength,whencomparing controlgroups(G1andG4)withthosewhichonlyunderwent injury(G2andG5),orthosewhichunderwentinjuryassociated withswimming(G3andG6).Nosignificantdifferenceswere notedamonggroupsofobeseanimalscomparedtoeutrophic animals.
Discussion
Peripheral nerve injuries are responsible for high morbid-ityandfunctionalloss,requiringtherapeuticinterventions18
toassist inthe morphologicaland functionaltissue repair, hence the importance of controlled experiments to evalu-atetheeffectivenessoftherapies.Mostoftheexperimental studies in rats are carried out on models of sciatic nerve injury/compression.However,themostcommon injuriesin humansoccurintheupperlimbs.19Thus,inthepresentstudy,
wesoughttofindamodelthatcouldproduceacompressive lesion inthe mediannerve. Thenervecompression model used was presentedby Bennettand Xie20 forcompressing
thesciaticnerve;subsequently,theprocedurewasmodified forthemediannervebyChenetal.,16whichcauses,besides
Table1–ValuesfoundforhandgripofWistarrats(meanandstandarddeviation),ingrams,fordifferenttimepoints (AV1–AV5)inthedifferentgroups(G1–G6).
AV1 AV2 AV3 AV4 AV5
G1 265.8±106.3 330.9±87.6 327.8±99.6 303.7±124.3 332.1±121.3
G2 284.6±60.2 32.1±19.6a,b,c 83.1±48.2a,b,c 95.4±26.7a,b,c,d 103.5±21.1a,b,c,d
G3 329.8±113.9 39.5±26.1a,b,c 79.6±31.3a,b,c 93.3±25.5a,b,c 124.0±46.9a,b,c,d G4 212.9±55.3 270.5±54.7 277.8±79.6 268.3±88.8 294.3±127.6 G5 247.5±72.9 34.0±27.8a,b,c 62.0±49.3a,b,c 74.5±18.9a,b,c 83.7±33.5a,b,c G6 226.6±49.2 42.7±35.3a,b,c 81.1±26.1a,b,c 109.4±42.4a,b,c,d 107.3±57.5a,b,c,d
a SignificantdifferencewhencomparingwithG1. b SignificantdifferencewhencomparingwithG4.
c SignificantdifferencewhencomparingwithAV1,withinthesamegroup. dSignificantdifferencewhencomparingwithAV2,withinthesamegroup.
proteindegradation21andbyfunctioningasapossible
anal-gesiamediatedbyendogenousopioids,22whichcouldreduce
theimmobilityofthelimbduetopain.
When aperipheral nervesuffers compression (inducing localischemia),someelectrophysiologicalnerveconduction changeoccurs,23leadingtomuscleweakness.24,25Theresults
showthat,atthefirstassessment(whenthenerve compres-sion had not yet been performed), the animals showed a significantlyhigherstrengthcomparedwiththeotherresults –whichisconsistentwithnormalstandards.Areductionin musclestrengthmayberelatedtothehypernociception gen-eratedbynervecompression,producingmuscleinhibition.26
Silvaetal.27warnedthat, afterthesurgicalcompressionof
themediannerve,apainfulconditionsettlesdown,lasting atleastuntilthe8thpostoperativeday,notdecreasinginits intensity.
Theresultsalso revealed that therewas no increase in grip strength in injured/swimming-treated animals versus injured/sedentary animals, suggesting that the swimming exercisewasnotefficienttoproduceanincreaseinmuscle strength,aftertheinjurybycompressionofthemediannerve. InastudybyPossamai,SiepkoandAndrew,2840Wistarrats
were functional and histologicallyevaluated, being divided into fourgroupsaccording tothedaythe treatmentwould beginafteranaxonotmesis-typesciaticnerveinjury.The ani-malswere submittedtofreestyleswimmingfor30min/day. Theresultsshowthattherewasnointerferenceofphysical exerciseonperipheralnerve regeneration.Additionally,the treatedgroupsshowednohistologicalchangescomparedto sedentaryrats.Accordingly,Oliveiraetal.10notedthatdaily
swimmingexercisefor30min,5timesaweekfor22days,was ineffectivewithrespecttonerverecoveryinratssubjectedto axonotmesis;whenthiswascombinedwithelectrical stim-ulation, thefunctional recovery wasdelayed. Onthe other hand,Teodorietal.,7evaluatingfunctionaland
morpholog-icalcharacteristics ofrats with sciatic axonotmesis, found that30min/dayofswimmingfortwoweeksacceleratednerve regeneration.Thus,adisagreementregardingtheeffectsof exerciseonaquaticrecoveryfromnerveinjurybecomes evi-dent.
This divergence is also found in the case of exercise outside theaquaticenvironment. Sobral etal.29 performed
histomorphometricand functionalanalysestoevaluatethe influence of exercise on a treadmill, applied in early and late stages of sciatic nerve regeneration in rats following
axonotmesis.Theauthorsconcludedthatthetreadmill exer-ciseprotocolappliedtotheimmediateandlatephasesdid notinfluenceaxonalsprouting,degreeofmaturation ofthe regeneratedfibers,northefunctionalityofthereinnervated muscles. Conversely, Seo et al.11 reported that 30min of
walking onatreadmillbetweenthe3rdand14thday post-injury and witha speed of18m/min, playedanimportant role inaxonalregeneration. Ilhaet al.6 reported that,after
two weeksofcompression ofthe sciatic nerveinrats, the animalsperformedexercisesduringfiveweeks,namely: pro-gressivetreadmillexercises(about9m/min)inthefirstweek and,intheremainingfourweeks,60min/day.Theseauthors noted improvement in nerve regeneration. However, ani-malsthatperformedclimbing-stairexercises(trainingagainst resistance) withbodyoverload,withorwithout swimming, exhibitedadelayedfunctionalrecovery.
The obesitymodel usedin this study wasthe neonatal administration ofMSG.Animals exposed tothis substance undergo a neural reorganization that is reflected in a new metabolic structure, which predisposes to obesity in adulthood,30andthatalsocauseschangesintheanimalby
applicationofMSG,suchasareductioninleanbodymass.31
These animals havelower levels ofgrowth hormone (GH), hencelowerbodyweightandlength,butwithincreasedfat deposition.15In theresultsfoundattheendofthe
experi-ment,despitetheMSGanimalshavepresentedlowermeans forgripstrength,therewerenosignificantdifferencesin con-trol and obese-MSG animals (independent of having been injured/treated,ornot)withswimming–afactthatmaybe relatedtothenociceptionduetoinjury.
Becauseofthediscrepancyintheliteratureregardingthe optimal exercise time and about what is the better stage tostartthepractice,itisbelievedthatswimminghasbeen ineffectivewithrespecttoincreasinggripstrengthasaresult ofsomeoftheseparameters,consideringthattheexercises were implemented in the immediate phase after injury, withprogressivedurationalongtheweeks.Additionally,an excessive load mayhave beengeneratedinanimals which swam,byvirtueoftheloadof10%oftheirbodyweightduring thetreatment–afactoridentifiedasanimportantcauseof delay innerve regeneration.32 Wewishto emphasize,asa
ofphysicalexercise, withdifferent protocols (i.e., withthe additionofdifferentoverloads).
Conclusion
Theswimming exercise withoverload hasnot been effec-tiveinpromotingimprovementinmusclegripstrengthafter compressioninjuryoftherightmediannerveincontroland obese-MSGrats.
Conflicts
of
interest
Theauthorsdeclarenoconflictsofinterest.
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