Physical therapy for ischemic cerebrovascular disease-remote ischemic adaptation training

Professor Ji Xunming of Xuanwu Hospital and his team's project "Creation and Promotion of New Technology System for Hypoxia and Ischemia Adaptation to Prevent and Treat Ischemic Stroke" won the second prize of the 2020 National Science and Technology Progress Award.

This project is based on the human body's instinctive adaptation to ischemia and hypoxia, exploring how to improve the tolerance of brain tissue to ischemia and has achieved a series of innovative results: First, it proposed the "hypoxic tissue adaptation" theory for the first time, discovered and confirmed the brain protective effect of hypoxic adaptation, and clarified its mechanism of resisting ischemic and hypoxic damage; second, it pioneered a new method of "remote limb ischemia adaptation", confirmed its role in preventing and treating ischemic stroke, and revealed the "intervention in the periphery, protection of the central nervous system" mechanism; third, it developed special equipment for remote ischemia adaptation of both upper limbs, obtained a medical device registration certificate and a production license, and realized clinical transformation; fourth, it established a new strategy for the clinical application of remote ischemia adaptation of both upper limbs to prevent and treat ischemic stroke, formulated the international guidelines for "Remote Ischemia Adaptation for the Prevention and Treatment of Cerebrovascular Disease", and promoted remote ischemia adaptation technology globally.

1. What is remote ischemic adaptation?

Remote ischemic adaptation is to stimulate the body's endogenous resistance to ischemic damage by repeatedly and briefly ischemic stimulation of a certain organ or tissue, so that other organs or tissues outside the organ or tissue adapt to ischemia, thereby improving their tolerance to ischemic damage and reducing the damage caused by ischemia to related organs or tissues. This method has the advantages of being convenient and non-invasive, economical and practical, with few adverse reactions and easy to popularize.

For example, repeated, short-term ischemic stimulation of the arms can induce the heart, brain, kidneys and other important tissues or organs to resist ischemic damage. When cerebral and cardiac blood vessels are narrowed or even blocked, causing corresponding cerebral infarction and myocardial infarction, ischemic adaptation training enhances the tolerance of brain and cardiac tissues to ischemia and reduces the damage caused by ischemia. It is a clinically feasible method that is easy to implement and promote.

2. Where does the development of remote ischemic adaptation come from?

In 1986, American scholars Murry and others found that in a myocardial infarction model experiment on dogs, before ligating the anterior descending branch of the coronary artery, they were first trained to block and restore blood flow four times (each lasting 5 minutes), and then the anterior descending branch was continuously ligated for 40 minutes. It was found that the final myocardial infarction area was reduced by more than 75%. This phenomenon is called "ischemic preconditioning."

American scholars Przyklenk and others found through animal experiments that before ligating the anterior descending branch of the canine coronary artery, the area of ​​myocardial infarction could still be reduced by 70% by performing four blood flow blocking and blood flow restoration trainings (each lasting 5 minutes) on the other artery. In 1993, Przyklenk and others proposed "remote ischemia adaptation". The method used in this study is the prototype of remote ischemia adaptation training.

In 2006, domestic scholars Li et al. conducted experiments on rabbits and reported that repeated blood flow interruption and restoration to the limbs can also play a myocardial protective role and reduce myocardial damage.

In the following years, the Xuanwu Hospital team developed a method for implementing remote ischemia adaptation training that can be used in clinical practice. The "limb remote ischemia adaptation training" came into being and was applied in clinical practice around 2010.

After nearly 30 years of development, remote ischemic adaptation training has been accepted by experts and scholars at home and abroad. Remote ischemic adaptation training has been reported to be applied to a variety of organs or tissues, but the most convenient way to popularize and apply it clinically is to induce ischemic adaptation by ischemic stimulation of unilateral or bilateral limbs.

3. Why not perform ischemic training on the brain tissue directly in the neck?

Some people have raised the question of whether ischemia adaptation training can be performed on the neck. Wouldn’t it be more effective if the training site is close to the brain tissue? The brain is the organ with the most active metabolism in the body and is extremely sensitive to ischemia and hypoxia. When the brain tissue is completely ischemic or hypoxic for a few minutes, it can lead to the irreversible death of certain specific neurons. Therefore, ischemia adaptation training is prohibited on the neck.

The upper limbs are far less sensitive to ischemia and hypoxia than the brain. Repeated short-term blood flow blockage and recovery will not cause any harm, but can induce ischemic adaptation.

4. Can remote ischemic adaptation training be performed in the legs?

It is theoretically possible to do remote ischemia adaptation training in the legs, but it is worth noting that some people suffer from lower extremity venous thrombosis without knowing it. When doing training in the legs, there is a risk of emboli falling off and causing pulmonary embolism, which can be life-threatening in severe cases. Therefore, it is not recommended to do remote ischemia adaptation training in the lower extremities.

The upper limbs are often in an active state, and the possibility of thrombosis is much smaller than that of the lower limbs, so it is safe to do remote ischemia adaptation training on the upper limbs. When there is edema, inflammation, fractures, etc. in the upper limbs, the risk of thrombosis will increase, and remote ischemia adaptation training should not be done on the arms at this time.

5. Who is suitable for this training?

Remote ischemia adaptation therapy has been widely used in many fields such as cerebral stroke, cerebral hemorrhage, heart disease, and intraoperative protection.

1. Patients with high risk factors for cardiovascular and cerebrovascular diseases who are prone to stroke;

2. Patients who have had a stroke, including but not limited to the following symptoms;

3. Patients with insufficient cerebral blood supply due to stenosis of one or more head and neck blood vessels;

4. Patients with insufficient cerebral blood supply due to occlusion of one or more head and neck blood vessels;

5. Patients who need to use this training in the diagnosis and treatment plan formulated by doctors based on their condition.

6. How to conduct remote ischemia adaptation training?

Ordinary sphygmomanometer is a simple remote ischemic preconditioning training instrument.

The training method of ordinary blood pressure monitor: tie the blood pressure monitor cuff at a position slightly higher than the normal blood pressure measurement; pressurize the mercury column to about 200 mmHg, stay for 5 minutes, you will feel the arm sore and numb, then deflate. Do this 5 times, it can better prevent stroke.

You can also choose the patented remote ischemia training device - Xuanyitong

7. What are the precautions for remote ischemia adaptation training?

1. This training is more effective if you develop healthy living habits, persist in exercising, and control the risk factors of cardiovascular and cerebrovascular diseases.

2. This training cannot replace drug treatment: such as antiplatelet aggregation drugs aspirin, clopidogrel, and lipid-lowering drugs still need to be taken as usual; hypertensive patients should adjust the use of antihypertensive drugs according to blood pressure conditions; diabetic patients should adjust the use of hypoglycemic drugs according to blood sugar conditions, etc.

3. This training requires long-term persistence and gradual progress. It is recommended to start with Plan 1, adjust the plan every 7-14 days, and finally use Plan 4 for a long time, or use a specific plan as prescribed by a doctor.