• Br J Anaesth · Oct 2019

    Randomized Controlled Trial

    Modulatory effects of different exercise modalities on the functional connectivity of the periaqueductal grey and ventral tegmental area in patients with knee osteoarthritis: a randomised multimodal magnetic resonance imaging study.

    • Jiao Liu, Lidian Chen, Xiangli Chen, Kun Hu, Youxue Tu, Meiqin Lin, Jia Huang, Weilin Liu, Jinsong Wu, Zhijie Qiu, Jingfang Zhu, Ming Li, Joel Park, Georgia Wilson, Courtney Lang, Guanli Xie, Jing Tao, and Jian Kong.
    • National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China; Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA.
    • Br J Anaesth. 2019 Oct 1; 123 (4): 506-518.

    BackgroundKnee osteoarthritis is a prevalent disorder with unsatisfactory treatment options. Both physical and mindful exercises may be able to relieve its pain symptoms. We compared the modulatory effects of different exercise modalities on the periaqueductal grey (PAG) and ventral tegmental area (VTA), which play important roles in descending opioidergic pathways and reward/motivation systems in patients with knee osteoarthritis.MethodsWe recruited and randomised 140 patients into Tai Chi, Baduanjin, stationary cycling, and health education control groups for 12 weeks. Knee injury and Osteoarthritis Outcome Score (KOOS), functional and structural MRI, and blood biomarkers were measured at the beginning and end of the experiment. We used the PAG and VTA as seeds in resting-state functional connectivity (rsFC) analysis.ResultsCompared with the control group: (i) all exercises significantly increased KOOS pain sub-scores (pain reduction) and serum programmed death 1 (PD-1) concentrations; (ii) all exercises decreased right PAG rsFC with the medial orbital prefrontal cortex, and the decreased rsFC was associated with improvements in knee pain; and (iii) grey matter volume in the medial orbital prefrontal cortex was significantly increased in all exercise groups. There was also significantly decreased rsFC between the left VTA and the medial orbital prefrontal cortex in the Tai Chi and Baduanjin groups.ConclusionsExercise can simultaneously modulate the rsFC of the descending opioidergic pathway and reward/motivation system and blood inflammation markers. Elucidating the shared and unique mechanisms of different exercise modalities may facilitate the development of exercise-based interventions for chronic pain.Clinical Trial RegistrationChiCTR-IOR-16009308.Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.

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