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Nightingale TE, Walhin JP, Turner JE, Thompson D, Bilzon JLJ. The influence of a home-based exercise intervention on human health indices in individuals with chronic spinal cord injury (HOMEX-SCI): study protocol for a randomised controlled trial. Trials 2016; 17:284. [PMID: 27278276 PMCID: PMC4898470 DOI: 10.1186/s13063-016-1396-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 05/11/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Spinal cord injury (SCI) creates a complex pathology that can lead to an increase in sedentary behaviours and deleterious changes in body composition. Consequently, individuals with SCI are at increased risk of developing cardiovascular disease and type-2 diabetes mellitus. While the role of physical activity on the reduction of chronic disease risk is well documented in non-disabled individuals the evidence is less conclusive for persons with SCI. The aim of this methodological paper is to outline the design of a study that will assess the role of a home-based exercise intervention on biomarkers of metabolic and cardiovascular health in persons with SCI: the HOMEX-SCI study. METHODS/DESIGN Eligible participants will be inactive (physical activity level ≤1.60) individuals, with a chronic (more than 1 year) spinal cord lesion between the second thoracic and the fifth lumbar vertebrae, and aged between 18 and 65 years. Following baseline laboratory testing and lifestyle monitoring, participants will be randomly allocated to a control (CON) group or a 6-week home-based exercise intervention (INT) group. The INT consists of 45 minutes of moderate-intensity (60-65 % peak oxygen uptake) arm-crank exercise four times per week. Participants assigned to the CON group will be asked to maintain their normal lifestyle. The main outcomes of this study (biomarkers of metabolic and cardiovascular health) are obtained from venous blood samples, collected in the fasted and postprandial state. Eight other measurement categories will be assessed: (1) body composition, (2) physical activity, (3) energy intake, (4) measures of health and wellbeing, (5) resting metabolic rate, heart rate and blood pressure, (6) aerobic capacity, (7) immune function, and (8) adipose tissue gene expression. DISCUSSION This study will explore the feasibility of home-based moderate-intensity exercise and ascertain its impact on metabolic and cardiovascular health in comparison to a lifestyle maintenance CON group. Findings from this study may help to inform new evidence-based physical activity guidelines and also help to elucidate the physiological mechanisms whereby exercise might exert beneficial effects in persons with chronic SCI. The results will also act as a scientific platform for further intervention studies in other diverse and at-risk populations. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number: ISRCTN57096451 . Registered on 11 July 2014.
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Affiliation(s)
| | | | - James E Turner
- Department for Health, University of Bath, BA2 7AY, Bath, UK
| | - Dylan Thompson
- Department for Health, University of Bath, BA2 7AY, Bath, UK
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Wilroy J, Knowlden A. Systematic Review of Theory-Based Interventions Aimed at Increasing Physical Activity in Individuals With Spinal Cord Injury. AMERICAN JOURNAL OF HEALTH EDUCATION 2016. [DOI: 10.1080/19325037.2016.1158673] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Jereme Wilroy
- Department of Health Science, The University of Alabama
| | - Adam Knowlden
- Department of Health Science, The University of Alabama
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Popp WL, Brogioli M, Leuenberger K, Albisser U, Frotzler A, Curt A, Gassert R, Starkey ML. A novel algorithm for detecting active propulsion in wheelchair users following spinal cord injury. Med Eng Phys 2016; 38:267-74. [DOI: 10.1016/j.medengphy.2015.12.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 12/15/2015] [Accepted: 12/31/2015] [Indexed: 11/30/2022]
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The effect of FES-rowing training on cardiac structure and function: pilot studies in people with spinal cord injury. Spinal Cord 2016; 54:822-829. [PMID: 26754476 DOI: 10.1038/sc.2015.228] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 09/27/2015] [Accepted: 11/30/2015] [Indexed: 01/19/2023]
Abstract
STUDY DESIGN Two studies were conducted: Study-1 was cross-sectional; and Study-2 a longitudinal repeated measures design. OBJECTIVES To examine the influence of functional electrical stimulation (FES) rowing training on cardiac structure and function in people with spinal cord injury (SCI). SETTING A university sports science department and home-based FES-training. METHODS Fourteen participants with C4-T10 SCI (American Spinal Injury Association Impairment Scale A or B) were recruited for the studies. Cardiac structure and function, and peak: oxygen uptake ([Vdot ]O2peak), power output (POpeak) and heart rate (HRpeak), were compared between two FES-untrained groups (male n=3, female n=3) and an FES-trained group (male n=3) in Study-1 and longitudinally assessed in an FES-naive group (male n=1, female n=4) in Study-2. Main outcome measures left ventricular-dimensions, volumes, mass, diastolic and systolic function, and [Vdot ]O2peak, POpeak and HRpeak. In Study-2, in addition to peak values, the [Vdot ]O2 sustainable over 30 min and the related PO and HR were also assessed. RESULTS Sedentary participants with chronic SCI had cardiac structure and function at the lower limits of non-SCI normal ranges. Individuals with chronic SCI who habitually FES-row have cardiac structure and function that more closely resemble non-SCI populations. A programme of FES-rowing training improved cardiac structure and function in previously FES-naive people. CONCLUSION FES-rowing training appears to be an effective stimulus for positive cardiac remodelling in people with SCI. Further work, with greater participant numbers, should investigate the impact of FES-rowing training on cardiac health in SCI. SPONSORSHIP We thank the INSPIRE Foundation, UK, for funding these studies.
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Social Cognitive and Planned Behavior Variables Associated With Stages of Change for Physical Activity in Spinal Cord Injury: A Multivariate Analysis. REHABILITATION RESEARCH, POLICY, AND EDUCATION 2016. [DOI: 10.1891/2168-6653.30.1.89] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Purpose:To apply the constructs of social cognitive theory (SCT) and the theory of planned behavior (TPB) to understand the stages of change (SOC) for physical activities among individuals with a spinal cord injury (SCI).Method:Ex post facto design using multivariate analysis of variance (MANOVA). The participants were 144 individuals with SCI who completed an online SCT, TPB, and SOC for physical activities survey.Results:Participants in the preintender, intender, and actor groups differed significantly in functional disability, secondary health conditions, exercise self-efficacy, perceived benefits and barriers, intention, and physical health.Conclusion:Findings support the concept of stage-matching exercise and physical activity cognitive behavioral interventions for people with SCI.
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A behavioural intervention increases physical activity in people with subacute spinal cord injury: a randomised trial. J Physiother 2016; 62:35-41. [PMID: 26701155 DOI: 10.1016/j.jphys.2015.11.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 11/16/2015] [Accepted: 11/17/2015] [Indexed: 11/21/2022] Open
Abstract
QUESTIONS For people with subacute spinal cord injury, does rehabilitation that is reinforced with the addition of a behavioural intervention to promote physical activity lead to a more active lifestyle than rehabilitation alone? DESIGN Randomised, controlled trial with concealed allocation, intention-to-treat analysis, and blinded assessors. PARTICIPANTS Forty-five adults with subacute spinal cord injury who were undergoing inpatient rehabilitation and were dependent on a manual wheelchair. The spinal cord injuries were characterised as: tetraplegia 33%; motor complete 62%; mean time since injury 150 days (SD 74). INTERVENTION All participants received regular rehabilitation, including handcycle training. Only the experimental group received a behavioural intervention promoting an active lifestyle after discharge. This intervention involved 13 individual sessions delivered by a coach who was trained in motivational interviewing; it began 2 months before and ended 6 months after discharge from inpatient rehabilitation. OUTCOME MEASURES The primary outcome was physical activity, which was objectively measured with an accelerometer-based activity monitor 2 months before discharge, at discharge, and 6 and 12 months after discharge from inpatient rehabilitation. The accelerometry data were analysed as total wheeled physical activity, sedentary time and motility. Self-reported physical activity was a secondary outcome. RESULTS The behavioural intervention significantly increased wheeled physical activity (overall between-group difference from generalised estimating equation 21minutes per day, 95% CI 8 to 35). This difference was evident 6 months after discharge (28minutes per day, 95% CI 8 to 48) and maintained at 12 months after discharge (25minutes per day, 95% CI 1 to 50). No significant intervention effect was found for sedentary time or motility. Self-reported physical activity also significantly improved. CONCLUSION The behavioural intervention was effective in eliciting a behavioural change toward a more active lifestyle among people with subacute spinal cord injury. TRIAL REGISTRATION NTR2424.
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Roberton T, Bucks RS, Skinner TC, Allison GT, Dunlop SA. Barriers to Physical Activity in Individuals with Spinal Cord Injury: A Western Australian Study. AUSTRALIAN JOURNAL OF REHABILITATION COUNSELLING 2015. [DOI: 10.1375/jrc.17.2.74] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThis study examined barriers to physical activity reported individuals with spinal cord injury (SCI) and the degree to which these barriers differed across varying degrees of independence. Participants were 65 individuals recruited from the Western Australian Spinal Cord Injury database. Data on physical activity participation and perceived barriers to physical activity participation were collected using a cross-sectional survey and analysed using independent samples t-tests. We found that, regardless of level of ambulation or ability to transfer, few participants reported being physically active. While there were no significant differences in the amount of barriers reported by individuals with different levels of independence, the type of barriers reported varied across groups.
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Huang ZH, Wang ZG, Lu XY, Li WY, Zhou YX, Shen XY, Zhao XT. The Principle of the Micro-Electronic Neural Bridge and a Prototype System Design. IEEE Trans Neural Syst Rehabil Eng 2015; 24:180-91. [PMID: 26276996 DOI: 10.1109/tnsre.2015.2466659] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The micro-electronic neural bridge (MENB) aims to rebuild lost motor function of paralyzed humans by routing movement-related signals from the brain, around the damage part in the spinal cord, to the external effectors. This study focused on the prototype system design of the MENB, including the principle of the MENB, the neural signal detecting circuit and the functional electrical stimulation (FES) circuit design, and the spike detecting and sorting algorithm. In this study, we developed a novel improved amplitude threshold spike detecting method based on variable forward difference threshold for both training and bridging phase. The discrete wavelet transform (DWT), a new level feature coefficient selection method based on Lilliefors test, and the k-means clustering method based on Mahalanobis distance were used for spike sorting. A real-time online spike detecting and sorting algorithm based on DWT and Euclidean distance was also implemented for the bridging phase. Tested by the data sets available at Caltech, in the training phase, the average sensitivity, specificity, and clustering accuracies are 99.43%, 97.83%, and 95.45%, respectively. Validated by the three-fold cross-validation method, the average sensitivity, specificity, and classification accuracy are 99.43%, 97.70%, and 96.46%, respectively.
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Ellenbroek D, Kressler J, Cowan RE, Burns PA, Mendez AJ, Nash MS. Effects of prandial challenge on triglyceridemia, glycemia, and pro-inflammatory activity in persons with chronic paraplegia. J Spinal Cord Med 2015; 38:468-75. [PMID: 24617559 PMCID: PMC4612202 DOI: 10.1179/2045772314y.0000000199] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
CONTEXT/OBJECTIVE Exaggerated postprandial lipemia has been reported after spinal cord injury (SCI). We examined metabolite and accompanying pro-inflammatory biomarker responses to repeat feeding of typical high-fat meals in individuals with chronic paraplegia. DESIGN Descriptive trial. METHODS Metabolites (triglycerides, glucose, and insulin) and inflammatory biomarkers (interleukin-6 and high-sensitivity C-reactive protein (hsCRP)) were measured under fasting conditions in 11 recreationally active individuals with chronic (>1 year) paraplegia. Subjects received high-fat meals at time point 0 and again at minute 240. Antecubital venous blood was obtained at time points -30 (fasting), 0 (first meal), 30, 60, 90, 120, 240 (second meal), 360, and 480 minutes. Correlations were examined among the study variables. Exploratory subgroup analysis was performed for subjects with levels of postprandial glucose greater than >200 mg/dl. RESULTS Triglycerides showed a significant rise 4 hours after eating. Basal inflammatory markers were elevated, and did not undergo additional change during the testing. Additionally, subjects with excessive postprandial glucose responses showed higher hsCRP levels than those having typical glucose responses both for fasting (11.8 ± 6.5 vs. 2.9 ± 2.7 mg/l, P = 0.064) and postprandial (11.1 ± 4.9 vs. 3.7 ± 3.8 mg/l, P = 0.018) values. CONCLUSIONS Despite elevations in metabolic response markers, inflammatory markers did not change significantly after consumption of population-representative (i.e. hypercaloric) mixed-nutrient meals. Levels of fasting CRP in the high-risk range are consistent with other reports in persons with SCI and continue to pose concern for their cardiovascular disease risk. The possible association between postprandial metabolic responses and inflammatory states warrants further investigation to identify individual component risks for this secondary health hazard.
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Affiliation(s)
- Dennis Ellenbroek
- Department of Physiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Jochen Kressler
- The Miami Project to Cure Paralysis, University of Miami, Miami, FL, USA,Correspondence to: Jochen Kressler, The Miami Project to Cure Paralysis, University of Miami, 1095 NW 14th Ter, Miami, FL 33136, USA.
| | | | - Patricia A. Burns
- The Miami Project to Cure Paralysis, University of Miami, Miami, FL, USA
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Astorino TA, Harness ET, White AC. Efficacy of Acute Intermittent Hypoxia on Physical Function and Health Status in Humans with Spinal Cord Injury: A Brief Review. Neural Plast 2015; 2015:409625. [PMID: 26167303 PMCID: PMC4475712 DOI: 10.1155/2015/409625] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 05/25/2015] [Accepted: 05/27/2015] [Indexed: 12/27/2022] Open
Abstract
Spinal cord injury (SCI) results in a loss of motor and sensory function and is consequent with reductions in locomotion, leading to a relatively sedentary lifestyle which predisposes individuals to premature morbidity and mortality. Many exercise modalities have been employed to improve physical function and health status in SCI, yet they are typically expensive, require many trained clinicians to implement, and are thus relegated to specialized rehabilitation centers. These characteristics of traditional exercise-based rehabilitation in SCI make their application relatively impractical considering the time-intensive nature of these regimens and patients' poor access to exercise. A promising approach to improve physical function in persons with SCI is exposure to acute intermittent hypoxia (IH) in the form of a small amount of sessions of brief, repeated exposures to low oxygen gas mixtures interspersed with normoxic breathing. This review summarizes the clinical application of IH in humans with SCI, describes recommended dosing and potential side effects of IH, and reviews existing data concerning the efficacy of relatively brief exposures of IH to modify health and physical function. Potential mechanisms explaining the effects of IH are also discussed. Collectively, IH appears to be a safe, time-efficient, and robust approach to enhance physical function in chronic, incomplete SCI.
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Affiliation(s)
- Todd A. Astorino
- Department of Kinesiology, CSU San Marcos, San Marcos, CA 92096-0001, USA
| | | | - Ailish C. White
- Department of Kinesiology, CSU San Marcos, San Marcos, CA 92096-0001, USA
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Evans N, Hartigan C, Kandilakis C, Pharo E, Clesson I. Acute Cardiorespiratory and Metabolic Responses During Exoskeleton-Assisted Walking Overground Among Persons with Chronic Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2015; 21:122-32. [PMID: 26364281 DOI: 10.1310/sci2102-122] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Lower extremity robotic exoskeleton technology is being developed with the promise of affording people with spinal cord injury (SCI) the opportunity to stand and walk. The mobility benefits of exoskeleton-assisted walking can be realized immediately, however the cardiorespiratory and metabolic benefits of this technology have not been thoroughly investigated. OBJECTIVE The purpose of this pilot study was to evaluate the acute cardiorespiratory and metabolic responses associated with exoskeleton-assisted walking overground and to determine the degree to which these responses change at differing walking speeds. METHODS Five subjects (4 male, 1 female) with chronic SCI (AIS A) volunteered for the study. Expired gases were collected during maximal graded exercise testing and two, 6-minute bouts of exoskeleton-assisted walking overground. Outcome measures included peak oxygen consumption (V̇O2peak), average oxygen consumption (V̇O2avg), peak heart rate (HRpeak), walking economy, metabolic equivalent of tasks for SCI (METssci), walk speed, and walk distance. RESULTS Significant differences were observed between walk-1 and walk-2 for walk speed, total walk distance, V̇O2avg, and METssci. Exoskeleton-assisted walking resulted in %V̇O2peak range of 51.5% to 63.2%. The metabolic cost of exoskeleton-assisted walking ranged from 3.5 to 4.3 METssci. CONCLUSIONS Persons with motor-complete SCI may be limited in their capacity to perform physical exercise to the extent needed to improve health and fitness. Based on preliminary data, cardiorespiratory and metabolic demands of exoskeleton-assisted walking are consistent with activities performed at a moderate intensity.
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Affiliation(s)
- Nicholas Evans
- Beyond Therapy, Shepherd Center, Atlanta, Georgia.,Hulse Spinal Cord Injury Laboratory, Shepherd Center, Atlanta, Georgia
| | - Clare Hartigan
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, Georgia
| | - Casey Kandilakis
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, Georgia
| | | | - Ismari Clesson
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, Georgia
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Bakkum AJT, de Groot S, Stolwijk-Swüste JM, van Kuppevelt DJ, van der Woude LHV, Janssen TWJ. Effects of hybrid cycling versus handcycling on wheelchair-specific fitness and physical activity in people with long-term spinal cord injury: a 16-week randomized controlled trial. Spinal Cord 2015; 53:395-401. [DOI: 10.1038/sc.2014.237] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 11/25/2014] [Accepted: 11/25/2014] [Indexed: 11/09/2022]
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Warms CA, Backus D, Rajan S, Bombardier CH, Schomer KG, Burns SP. Adverse events in cardiovascular-related training programs in people with spinal cord injury: a systematic review. J Spinal Cord Med 2014; 37:672-92. [PMID: 24090603 PMCID: PMC4231956 DOI: 10.1179/2045772313y.0000000115] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
CONTEXT There are anecdotal reports of adverse events (AEs) associated with exercise in people with spinal cord injury (SCI) and consequent concern by people with SCI and their providers about potential risks of exercise. Enumeration of specific events has never been performed and the extent of risk of exercise to people with SCI is not understood. OBJECTIVE To systematically review published evidence to identify and enumerate reports of adverse events or AEs associated with training in persons with SCI. METHODS Review was limited to peer-reviewed studies published in English from 1970 to 2011: (1) in adults with SCI, (2) evaluating training protocols consisting of repeated sessions over at least 4 weeks to maintain or improve cardiovascular health, (3) including volitional exercise modalities and functional electrical stimulation (FES)-enhanced exercise modalities, and (4) including a specific statement about AEs. Trained reviewers initially identified a total of 145 studies. After further screening, 38 studies were included in the review. Quality of evidence was evaluated using established procedures. RESULTS There were no serious AEs reported. There were no common AEs reported across most types of interventions, except for musculoskeletal AEs related to FES walking. There were few AEs in volitional exercise studies. CONCLUSION There is no evidence to suggest that cardiovascular exercise done according to guidelines and established safety precautions is harmful. To improve the strength of these conclusions, future publications should include definition of AEs, information about pre-intervention screening, and statements of the nature and extent of AEs.
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Affiliation(s)
- Catherine A. Warms
- University of Washington Medical Center and School of Nursing, University of Washington, Seattle, Washington, USA,Correspondence to: Catherine Warms, University of Washington Medical Center and School of Nursing, University of Washington, Seattle, Washington, USA.
| | | | - Suparna Rajan
- VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Charles H. Bombardier
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Katherine G. Schomer
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
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FES-rowing in tetraplegia: a preliminary report. Spinal Cord 2014; 52:880-6. [PMID: 25266698 DOI: 10.1038/sc.2014.159] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 08/01/2014] [Accepted: 08/12/2014] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN A training intervention study using functional electrical stimulation-rowing (FES-R) in a group of eight individuals with tetraplegia. OBJECTIVES To assess the feasibility of a structured progressive FES-R training programme in people with tetraplegia, and to explore the number and type of FES-training sessions required to enable continuous FES-R for 30 min. SETTING A fully integrated sports centre, elite rowing training centre and university sport science department. METHODS Eight participants with chronic complete and incomplete tetraplegia (C4 to C7, American Spinal Injury Association Impairment Scale A, B and C) who had not previously used any form of FES-assisted exercise, participated in the study. Participants completed a progressive FES-assisted training programme building to three continuous 30-min FES-R sessions per week at 60-80% of their predetermined peak power output. Thereafter, rowing performance was monitored for 12 months. MAIN OUTCOME MEASURES number and type of FES-training sessions required before achieving 30-min continuous FES-R, and FES-R average power output (POav) pre and post 12 months training. Participant feedback of perceived benefits was also documented. RESULTS All participants were able to continuously FES-row for 30 min after completing 13±7 FES-R training sessions. Each individual POav during 30 min FES-R increased over 12 months FES-training. FES-R was found safe and well tolerated in this group of individuals with tetraplegia. CONCLUSION Individuals with tetraplegia are able to engage in a progressive programme of FES-R training. Future research examining FES-R training as an adjunctive therapy in people with tetraplegia is warranted.
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Sisto SA, Evans N. Activity and Fitness in Spinal Cord Injury: Review and Update. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2014. [DOI: 10.1007/s40141-014-0057-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Hasnan N, Ektas N, Tanhoffer AIP, Tanhoffer R, Fornusek C, Middleton JW, Husain R, Davis GM. Exercise responses during functional electrical stimulation cycling in individuals with spinal cord injury. Med Sci Sports Exerc 2014; 45:1131-8. [PMID: 23685444 DOI: 10.1249/mss.0b013e3182805d5a] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study compared acute exercise responses during arm cranking, functional electrical stimulation (FES)-assisted leg cycling, and combined arm and leg ("hybrid") cycling in individuals with spinal cord injury during maximal and submaximal exercise. METHODS Nine male subjects with long-standing neurological lesions from C7 to T12 were recruited. All subjects performed arm crank ergometry (ACE), FES leg cycle exercise (FES-LCE), combined ACE + FES-LCE, and cycling on a hybrid FES tricycle (HYBRID). They were assessed for their peak exercise responses in all four modalities. Subsequently, their submaximal heart rates (HR), cardiac outputs (Q), stroke volumes (SV), and arteriovenous oxygen extractions (Ca-Cv)O2 were measured at 40%, 60%, and 80% of mode-specific V˙O2peak. RESULTS Arm exercise alone and arm + leg exercise resulted in significantly higher V˙O2peak and HRpeak compared with FES-LCE (P < 0.05). Submaximal V˙O2 during FES-LCE was significantly lower than all other modalities across the range of exercise intensities (P < 0.05). ACE elicited 70%-94% higher steady-state V˙O2, and HYBRID evoked 99%-148% higher V˙O2 compared with FES-LCE. Steady-state FES-LCE also produced significantly lower Q, HR, and (Ca-Cv)O2. ACE evoked 31%-36% higher Q and 19%-47% greater HR than did FES-LCE. HYBRID elicited 31%-49% greater Q and 23%-56% higher HR than FES-LCE. CONCLUSIONS Combined arm and leg exercise can develop a higher oxygen uptake and greater cardiovascular demand compared with ACE or FES-LCE alone. These findings suggested that combined arm + leg FES training at submaximal exercise intensities may lead to greater gains of aerobic fitness than would arm exercise alone. These data also proffered that FES leg cycling exercise by itself may be insufficient to promote aerobic fitness in the spinal cord injury population.
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Affiliation(s)
- Nazirah Hasnan
- Clinical Exercise and Rehabilitation Unit, Faculty of Health Sciences, University of Sydney, Sydney, Australia.
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Home-based circuit resistance training to overcome barriers to exercise for people with spinal cord injury: a case study. J Neurol Phys Ther 2014; 37:65-71. [PMID: 23703369 DOI: 10.1097/npt.0b013e31829247a9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE People with spinal cord injury (SCI) have limited options for aerobic exercise. Existing options are often difficult to access, or they result in muscle imbalances that can eventually contribute to joint dysfunction. These difficulties can cause individuals to live a more sedentary lifestyle, putting them at greater risk for developing obesity and other cardiovascular disease risk factors. Therefore, a mode of exercise that allows people with SCI an affordable, accessible, and effective way to engage in cardiovascular exercise is needed. CASE DESCRIPTION The participant was a 44-year-old man with chronic, complete T12 SCI resulting from a motor vehicle accident 28 years ago. He participated in a case study evaluating the effectiveness of a home-based aerobic and strengthening exercise program. INTERVENTION Outcome measures were assessed before and after completing a 12-week home-based circuit resistance training (CRT) program. The intervention was a modified version of a previously studied CRT program performed in a traditional gym that was designed to improve strength and aerobic fitness and to elicit healthy cholesterol levels in people with paraplegia. OUTCOMES After performing the CRT program, the participant demonstrated improvements in cardiovascular fitness and upper extremity strength. Cholesterol levels were unchanged. He also lost weight and his shoulder pain improved. DISCUSSION The findings demonstrate the potential for some individuals with SCI to safely and effectively engage in aerobic and strengthening exercise in their home to improve or prevent cardiovascular-related risk factors.Video Abstract available (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A44) for more insights from the authors.
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Rosety-Rodriguez M, Camacho A, Rosety I, Fornieles G, Rosety MA, Diaz AJ, Bernardi M, Rosety M, Ordonez FJ. Low-grade systemic inflammation and leptin levels were improved by arm cranking exercise in adults with chronic spinal cord injury. Arch Phys Med Rehabil 2013; 95:297-302. [PMID: 24060491 DOI: 10.1016/j.apmr.2013.08.246] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 08/23/2013] [Accepted: 08/27/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To ascertain the effect of arm cranking exercise on improving plasma levels of inflammatory cytokines and adipokines in untrained adults with chronic spinal cord injury (SCI). DESIGN Longitudinal study. SETTING Community-based supervised intervention. PARTICIPANTS Men (N=17) with complete SCI at or below T5 volunteered for this study. Participants were randomly allocated to the intervention (n=9) or control group (n=8) using a concealed method. INTERVENTION A 12-week arm cranking exercise program of 3 sessions per week consisted of warm-up (10-15min), arm crank (20-30min; increasing 2min and 30s every 3wk) at a moderate work intensity of 50% to 65% of heart rate reserve (starting at 50% and increasing 5% every 3wk), and cool-down (5-10min). MAIN OUTCOME MEASURES Plasma levels of leptin, adiponectin, plasminogen activator inhibitor-1, tumor necrosis factor-alpha, and interleukin-6 were determined. Furthermore, physical fitness (maximum oxygen consumption [V˙O2max]) and body composition (anthropometric index, waist circumference, and body mass index) were also assessed. RESULTS Plasma levels of leptin, tumor necrosis factor-alpha, and interleukin-6 were significantly decreased after the completion of the training program. Similarly, the anthropometric index and waist circumference were diminished too. A moderate correlation was found between leptin and the anthropometric index. Finally, V˙O2max was significantly increased, suggesting an improvement of physical fitness in the intervention group. No changes were found in the control group. CONCLUSIONS Arm cranking exercise improved low-grade systemic inflammation by decreasing plasma levels of inflammatory cytokines. Furthermore, it also reduced plasma leptin levels. Long-term, well-conducted studies are still required to determine whether these changes may improve clinical outcomes of adults with chronic SCI.
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Affiliation(s)
| | - Alejandra Camacho
- Division of Internal Medicine, Juan Ramon Jimenez Hospital, Huelva, Spain
| | - Ignacio Rosety
- Human Anatomy Department, School of Medicine, University of Cadiz, Cadiz, Spain
| | - Gabriel Fornieles
- Medicine Department, School of Medicine, University of Cadiz, Cadiz, Spain
| | - Miguel A Rosety
- School of Sports Medicine, University of Cadiz, Cadiz, Spain
| | - Antonio J Diaz
- Medicine Department, School of Medicine, University of Cadiz, Cadiz, Spain
| | - Marco Bernardi
- School of Speciality in Sports Medicine, Department of Physiology and Pharmacology, "V. Erspamer," "Sapienza," University of Rome, Rome, Italy
| | - Manuel Rosety
- School of Sports Medicine, University of Cadiz, Cadiz, Spain
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Weaver LC, Fleming JC, Mathias CJ, Krassioukov AV. Disordered cardiovascular control after spinal cord injury. HANDBOOK OF CLINICAL NEUROLOGY 2013; 109:213-33. [PMID: 23098715 DOI: 10.1016/b978-0-444-52137-8.00013-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Damage to the spinal cord disrupts autonomic pathways, perturbing cardiovascular homeostasis. Cardiovascular dysfunction increases with higher levels of injury and greater severity. Disordered blood pressure control after spinal cord injury (SCI) has significant ramifications as cord-injured people have an increased risk of developing heart disease and stroke; cardiovascular dysfunction is currently a leading cause of death among those with SCI. Despite the clinical significance of abnormal cardiovascular control following SCI, this problem has been generally neglected by both the clinical and research community. Both autonomic dysreflexia and orthostatic hypotension are known to prevent and delay rehabilitation, and significantly impair the overall quality of life after SCI. Starting with neurogenic shock immediately after a higher SCI, ensuing cardiovascular dysfunctions include orthostatic hypotension, autonomic dysreflexia and cardiac arrhythmias. Disordered temperature regulation accompanies these autonomic dysfunctions. This chapter reviews the human and animal studies that have furthered our understanding of the pathophysiology and mechanisms of orthostatic hypotension, autonomic dysreflexia and cardiac arrhythmias. The cardiovascular dysfunction that occurs during sexual function and exercise is elaborated. New awareness of cardiovascular dysfunction after SCI has led to progress toward inclusion of this important autonomic problem in the overall assessment of the neurological condition of cord-injured people.
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70
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Machida M, Irwin B, Feltz D. Resilience in competitive athletes with spinal cord injury: the role of sport participation. QUALITATIVE HEALTH RESEARCH 2013; 23:1054-1065. [PMID: 23771633 DOI: 10.1177/1049732313493673] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Individuals who experience loss of their physical abilities often face the challenges of adapting to a new way of life. Past research has shown that sport participation can assist the physical and psychological adaptation to acquired physical disabilities. The purposes of our study were to examine the following: (a) the resilience process of sport participants with acquired spinal cord injury, and (b) the role of sport participation in the resilience process. We conducted semistructured phenomenological interviews with 12 male quadriplegic wheelchair rugby players. Results show that the development of resilience is a multifactorial process involving pre-existing factors and pre-adversity experiences, disturbance/disturbing emotions, various types and sources of social support, special opportunities and experiences, various behavioral and cognitive coping strategies, motivation to adapt to changes, and learned attributes or gains from the resilience process. We discuss implications for future research and practice.
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Affiliation(s)
- Moe Machida
- Juntendo University, School of Health and Sports Science, Inzai, Chiba, Japan.
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71
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Burns P, Kressler J, Nash MS. Physiological responses to exergaming after spinal cord injury. Top Spinal Cord Inj Rehabil 2013; 18:331-9. [PMID: 23459619 DOI: 10.1310/sci1804-331] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To investigate whether exergaming satisfies guideline-based intensity standards for exercise conditioning (40%/50% oxygen uptake reserve [VO2R] or heart rate reserve (HRR), or 64%/70% of peak heart rate [HRpeak]) in persons with paraplegia. METHODS Nine men and women (18-65 years old) with chronic paraplegia (T1-L1, AIS A-C) underwent intensity-graded arm cycle exercise (AE) to evaluate VO2peak and HRpeak. On 2 randomized nonconsecutive days, participants underwent graded exercise using a custom arm cycle ergometer that controls the video display of a Nintendo Gamecube (GameCycle; Three Rivers Holdings LLC, Mesa, AZ) or 15 minutes of incrementally wrist-weighted tennis gameplay against a televised opponent (XaviX Tennis System; SSD Co Ltd, Kusatsu, Japan). RESULTS GameCycle exergaming (GCE) resistance settings ≥0.88 Nm evoked on average ≥50% VO2R. During XaviX Tennis System exergaming (XTSE) with wrist weights ≥2 lbs, average VO2 reached a plateau of ~40% VO2R. Measurements of HR were highly variable and reached average values ≥50% HRR during GCE at resistance settings ≥0.88 Nm. During XTSE, average HR did not reach threshold levels based on HRR for any wrist weight (20%-35% HRR). CONCLUSIONS On average, intensity responses to GCE at resistance setting ≥0.88 Nm were sufficient to elicit exercise intensities needed to promote cardiorespiratory fitness in individuals with SCI. The ability of XTSE to elicit cardiorespiratory fitness benefits is most likely limited to individuals with very low fitness levels and may become subminimal with time if used as a conditioning stimulus.
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Affiliation(s)
- Patricia Burns
- Department of Neurological Surgery, The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami , Miami, Florida
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Lam T, Chen Z, Sayed-Ahmed MM, Krassioukov A, Al-Yahya AA. Potential role of oxidative stress on the prescription of rehabilitation interventions in spinal cord injury. Spinal Cord 2013; 51:656-62. [PMID: 23857328 DOI: 10.1038/sc.2013.71] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 05/28/2013] [Accepted: 06/05/2013] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Review article. OBJECTIVES To provide an overview of free radical biology, particularly with respect to muscle physiology, as well as the potential effects of muscle morphological changes, physical capacity and nutritional status on oxidative stress in people with chronic spinal cord injury (SCI). The potential implications of these factors for determining the optimal dosage of rehabilitation training interventions in people with chronic SCI will also be presented. SETTING Vancouver, BC, Canada. METHODS Literature review. RESULTS Not applicable. CONCLUSION There has been a great deal of focus on rehabilitation exercise interventions providing intensive practice of movements to enhance functional recovery and physical capacity following SCI. However, there is still much to be understood about the appropriate dosage of training parameters (e.g. frequency, duration). It has been known for several decades that exercise increases free radical production, leading to oxidative stress. To date, there has been little consideration of the potential interaction of oxidative stress with training parameters on functional outcomes in chronic SCI. Furthermore, individuals with chronic SCI face many secondary consequences of their injury, such as muscle atrophy, change in muscle fiber type, general deconditioning and nutritional status, that are known to influence free radical production and antioxidant capacity. Better understanding of the potential confounding effects of oxidative stress associated with exercise will improve our ability to determine the optimal 'dose' of rehabilitation training to maximize functional recovery following SCI.
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Affiliation(s)
- T Lam
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada.
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73
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Martin Ginis KA, Jörgensen S, Stapleton J. Exercise and sport for persons with spinal cord injury. PM R 2013; 4:894-900. [PMID: 23174556 DOI: 10.1016/j.pmrj.2012.08.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 08/07/2012] [Indexed: 12/14/2022]
Abstract
This review article provides an overview of the evidence that links exercise and sports participation to physical and psychological well-being among people with spinal cord injury. Two aspects of physical well-being are examined, including the prevention of chronic disease and the promotion of physical fitness. Multiple aspects of psychosocial well-being are discussed, including mental health, social participation, and life satisfaction. The review concludes with future research recommendations and a discussion of challenges and opportunities for using exercise and sports to promote health and well-being among people living with spinal cord injury.
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Abstract
Individuals with spinal cord injury (SCI) tend to report poorer quality of life (QOL) than people without a physical disability. Leisure-time physical activity (LTPA) has been shown to improve the QOL of people with and without disabilities and chronic conditions. The purpose of this systematic review was to examine the LTPA-QOL relationship among people with SCI by focusing on both objective and subjective QOL for both global QOL and domain-specifc (physical, psychological, social) QOL. Results suggest that LTPA is significantly associated with increases in both objective and subjective QOL in global QOL and all three QOL domains, with relatively few studies demonstrating a negative or nonsignificant relationship. Recommendations for future QOL research and interventions are discussed.
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75
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Rauch A, Fekete C, Cieza A, Geyh S, Meyer T. Participation in physical activity in persons with spinal cord injury: a comprehensive perspective and insights into gender differences. Disabil Health J 2013; 6:165-76. [PMID: 23769475 DOI: 10.1016/j.dhjo.2013.01.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 01/07/2013] [Accepted: 01/10/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND To prevent secondary conditions and to improve and maintain health, regular physical activity is recommended as an important component of a health-promoting lifestyle for persons with spinal cord injury (SCI). However, participation in physical activity is low in persons with SCI, especially in women. OBJECTIVE The objective of this study is to identify (1) categories of functioning, the environment and personal factors that influence participation in physical activity in persons with SCI and (2) gender differences within identified factors. METHODS An explorative qualitative study design using both focus groups and individual interviews based on a semi-structured interview guide was used. Statements were linked to categories or chapters of the four components of functioning (body structures, body functions, activities and participation) and of the environment included in the International Classification of Functioning, Disability and Health (ICF) and a recently developed list of personal factors. An in-depth analysis of the statements was performed to identify relevant associations and gender differences. RESULTS Twenty-six persons (13 female, 13 male) participated in the study. Sixty-seven categories and four chapters from all components of functioning and environmental factors included in the ICF and 33 subdivisions of personal factors were found to be associated with physical activity in persons with SCI. Gender differences could be assigned to areas of gender roles, social support, athletic identity, interests, and general behavioral patterns. CONCLUSION This study contributes to a comprehensive understanding of participation in physical activity in persons with SCI and presents a first step toward the identification of gender differences. The results should be validated by further quantitative research.
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Affiliation(s)
- Alexandra Rauch
- Swiss Paraplegic Research (SPF), Guido A Zäch Strasse 4, Nottwil, Switzerland.
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76
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Fekete C, Rauch A. Correlates and determinants of physical activity in persons with spinal cord injury: A review using the International Classification of Functioning, Disability and Health as reference framework. Disabil Health J 2012; 5:140-50. [PMID: 22726854 DOI: 10.1016/j.dhjo.2012.04.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 12/07/2011] [Accepted: 04/11/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Participation in physical activity (PA) decreases after the onset of a spinal cord injury (SCI) and is generally low in persons with SCI. OBJECTIVE To provide an overview of findings on correlates/determinants of PA in persons with SCI applying the International Classification of Functioning, Disability and Health (ICF) to analyze and report results. METHODS A systematic literature review using the databases MEDLINE, PsycINFO, SSCI, and CINHAL was conducted. Independent variables were extracted and linked to ICF codes. Quality of evidence was rated using internationally accepted standards. RESULTS Overall, evidence quality of the 25 included studies is low. Environmental Factors were consistently found as correlates of PA, whereas Personal Factors (socio-demographics and psychological constructs) were weakly associated with PA in the SCI population. Associations with Body Functions, Body Structures, Activities and Participation and Health Conditions were less frequently studied. CONCLUSION Although quality of evidence of reviewed literature is low, results indicate that rather environmental barriers than the 'classical' socio-demographic factors known from social epidemiology correlate with PA in persons with SCI. There is insufficient evidence to draw conclusions concerning the association of Body Functions and Structures and Activity and Participation with PA. Future research is encouraged to better understand the interplay between functioning, contextual factors, health conditions and PA in SCI to establish a sound basis for intervention planning in this special needs population. In addition, our experience showed that linking study results to the ICF facilitates data analysis and reporting.
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Affiliation(s)
- Christine Fekete
- Swiss Paraplegic Research, Guido A. Zäch Institute, 6207 Nottwil, Switzerland.
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van der Woude LHV, de Groot S, Postema K, Bussmann JBJ, Janssen TWJ, Post MWM. Active LifestyLe Rehabilitation interventions in aging spinal cord injury (ALLRISC): a multicentre research program. Disabil Rehabil 2012; 35:1097-103. [PMID: 23030594 DOI: 10.3109/09638288.2012.718407] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND With today's specialized medical care, life expectancy of persons with a spinal cord injury (SCI) has considerably improved. With increasing age and time since injury, many individuals with SCI, however, show a serious inactive lifestyle, associated with deconditioning and secondary health conditions (SHCs) (e.g. pressure sores, urinary and respiratory tract infections, osteoporosis, upper-extremity pain, obesity, diabetes, cardiovascular disease) and resulting in reduced participation and quality of life (QoL). Avoiding this downward spiral, is crucial. OBJECTIVES To understand possible deconditioning and SHCs in persons aging with a SCI in the context of active lifestyle, fitness, participation and QoL and to examine interventions that enhance active lifestyle, fitness, participation and QoL and help prevent some of the SHCs. METHODS A multicentre multidisciplinary research program (Active LifestyLe Rehabilitation Interventions in aging Spinal Cord injury, ALLRISC) in the setting of the long-standing Dutch SCI-rehabilitation clinical research network. RESULTS ALLRISC is a four-study research program addressing inactive lifestyle, deconditioning, and SHCs and their associations in people aging with SCI. The program consists of a cross-sectional study (n = 300) and three randomized clinical trials. All studies share a focus on fitness, active lifestyle, SHCs and deconditioning and outcome measures on these and other (participation, QoL) domains. It is hypothesized that a self-management program, low-intensity wheelchair exercise and hybrid functional electrical stimulation-supported leg and handcycling are effective interventions to enhance active life style and fitness, help to prevent some of the important SHCs in chronic SCI and improve participation and QoL. CONCLUSION ALLRISC aims to provide evidence-based preventive components of a rehabilitation aftercare system that preserves functioning in aging persons with SCI.
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Affiliation(s)
- L H V van der Woude
- Centre for Human Movement Sciences, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
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Nash MS, Cowan RE, Kressler J. Evidence-based and heuristic approaches for customization of care in cardiometabolic syndrome after spinal cord injury. J Spinal Cord Med 2012; 35:278-92. [PMID: 23031165 PMCID: PMC3459557 DOI: 10.1179/2045772312y.0000000034] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Component and coalesced health risks of the cardiometabolic syndrome (CMS) are commonly reported in persons with spinal cord injuries (SCIs). These CMS hazards are also co-morbid with physical deconditioning and elevated pro-atherogenic inflammatory cytokines, both of which are common after SCI and worsen the prognosis for all-cause cardiovascular disease. This article describes a systematic procedure for individualized CMS risk assessment after SCI, and emphasizes evidence-based and intuition-centered countermeasures to disease. A unified approach will propose therapeutic lifestyle intervention as a routine plan for aggressive primary prevention in this risk-susceptible population. Customization of dietary and exercise plans then follow, identifying shortfalls in diet and activity patterns, and ways in which these healthy lifestyles can be more substantially embraced by both stakeholders with SCI and their health care providers. In cases where lifestyle intervention utilizing diet and exercise is unsuccessful in countering risks, available pharmacotherapies and a preferred therapeutic agent are proposed according to authoritative standards. The over-arching purpose of the monograph is to create an operational framework in which existing evidence-based approaches or heuristic modeling becomes best practice. In this way persons with SCI can lead more active and healthy lives.
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Affiliation(s)
- Mark S. Nash
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA; The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL, USA; and Department of Rehabilitation Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA,Correspondence to: Mark S. Nash, Miller School of Medicine, University of Miami, 1095 NW 14th Terrace, R-48, Miami, FL 33136, USA.
| | - Rachel E. Cowan
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA; and The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Jochen Kressler
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA; and The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL, USA
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79
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Cragg JJ, Stone JA, Krassioukov AV. Management of Cardiovascular Disease Risk Factors in Individuals with Chronic Spinal Cord Injury: An Evidence-Based Review. J Neurotrauma 2012; 29:1999-2012. [DOI: 10.1089/neu.2012.2313] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jacquelyn J. Cragg
- International Collaboration on Repair Discoveries (ICORD), Division of Physical Medicine and Rehabilitation University of British Columbia, Vancouver, British Columbia, Canada
- School of Population and Public Health, Division of Physical Medicine and Rehabilitation University of British Columbia, Vancouver, British Columbia, Canada
| | - James A. Stone
- University of Calgary, the Libin Cardiovascular Institute, and the Cardiac Wellness Institute of Calgary, Calgary, Alberta, Canada
| | - Andrei V. Krassioukov
- International Collaboration on Repair Discoveries (ICORD), Division of Physical Medicine and Rehabilitation University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medicine, Division of Physical Medicine and Rehabilitation University of British Columbia, Vancouver, British Columbia, Canada
- G.F. Strong Rehabilitation Centre, Vancouver Health Authority, Vancouver, British Columbia, Canada
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A review of the potential for cardiometabolic dysfunction in youth with spina bifida and the role for physical activity and structured exercise. Int J Pediatr 2012; 2012:541363. [PMID: 22778758 PMCID: PMC3384902 DOI: 10.1155/2012/541363] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 04/05/2012] [Accepted: 04/20/2012] [Indexed: 11/28/2022] Open
Abstract
Children and adolescents who have decreased mobility due to spina bifida may be at increased risk for the components of metabolic syndrome, including abdominal obesity, insulin resistance, and dyslipidemia due to low physical activity. Like their nondisabled peers, adolescents with spina bifida that develop metabolic risk factors early in life have set the stage for adult disease. Exercise interventions can improve metabolic dysfunction in nondisabled youth, but the types of exercise programs that are most effective and the mechanisms involved are not known. This is especially true in adolescents with spina bifida, who have impaired mobility and physical function and with whom there have been few well-controlled studies. This paper highlights the current lack of knowledge about the role of physical activity and the need to develop exercise strategies targeting the reduction of cardiometabolic risk and improving quality of life in youth with spina bifida.
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81
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Systematic review of the methodological quality and outcome measures utilized in exercise interventions for adults with spinal cord injury. Spinal Cord 2012; 50:718-27. [DOI: 10.1038/sc.2012.78] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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82
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Kim IT, Mun JH, Jun PS, Kim GC, Sim YJ, Jeong HJ. Leisure time physical activity of people with spinal cord injury: mainly with clubs of spinal cord injury patients in busan-kyeongnam, Korea. Ann Rehabil Med 2011; 35:613-26. [PMID: 22506183 PMCID: PMC3309251 DOI: 10.5535/arm.2011.35.5.613] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Accepted: 07/16/2011] [Indexed: 11/06/2022] Open
Abstract
Objective To estimate hours of leisure time physical activity (LTPA) performed by people with chronic spinal cord injury (SCI) and to identify the demographic and injury-related characteristics associated with LTPA of people with chronic SCI. Method Seventy nine persons with SCI living in Busan and Gyongsangnam-do were recruited. They completed a self-administered questionnaire, which consisted of items about personal characteristics, type of LTPA, hours of LTPA, LTPA intensity, and LTPA satisfaction. Results Most participants (92.4%) did not work. The respondents reported a daily mean of 3.13 hours (±1.47) of LTPA; however, 3.8% reported no LTPA whatsoever. Years post-injury, income sources, and type of medical payment emerged as a predictors of LTPA. Years post-injury were positively correlated with amount of leisure activity. In the case of self income, LTPA was longer than for groups with different income sources (e.g.partner, parents). For patients receiving workers' compensation insurance, LTPA was longer than for patients receiving non-WC insurance. Most LTPA was done at a moderate intensity. The three most frequently reported types of LTPA were wheeling (26%), sports (19%), and stretching exercise (15%). There was overall dissatisfaction with LTPA. Conclusion Daily LTPA hours were longer than previously reported, but wheeling accounted for a large part of the activity. Intensity of activity was generally moderate. The employment rate was very low. Clearly, participating in regular LTPA for health purposes is very important to people with chronic SCI, but it is also important for them to have jobs.
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Affiliation(s)
- In Taek Kim
- Department of Physical Medicine and Rehabilitation, Dong Eui Hospital, Busan 614-710, Korea
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83
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Thomas K, Wise H, Nietert P, Brown D, Sword D, Diehl N. Interaction with a Health Care Professional Influences Change in Physical Activity Behaviors Among Individuals with a Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2011. [DOI: 10.1310/sci1701-94] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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84
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Lauer RT, Smith BT, Mulcahey MJ, Betz RR, Johnston TE. Effects of cycling and/or electrical stimulation on bone mineral density in children with spinal cord injury. Spinal Cord 2011; 49:917-23. [PMID: 21423253 DOI: 10.1038/sc.2011.19] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Randomized clinical trial. OBJECTIVES To determine the effect of cycling and/or electrical stimulation on hip and knee bone mineral density (BMD) in children with spinal cord injury (SCI). SETTING Children's hospital specializing in pediatric SCI. METHODS A total of 30 children, aged 5-13 years, with chronic SCI were randomized to one of three interventions: functional electrical stimulation cycling (FESC), passive cycling (PC), and non-cycling, electrically stimulated exercise (ES). Each group exercised for 1 h, three times per week for 6 months at home. The hip, distal femur and proximal tibia BMD were examined via dual-energy X-ray absorptiometry (DXA) pre- and post-intervention. RESULTS In all, 28 children completed data collection. The FESC group exhibited increases in hip, distal femur and proximal tibia BMD of 32.4, 6.62 and 10.3%, respectively. The PC group exhibited increases at the hip (29.2%), but no change at the distal femur (1.5%) or proximal tibia (-1.0%). The ES group had no change at the hip (-0.24%) and distal femur (3.3%), but a loss at the proximal tibia (-7.06%). There were no differences between groups or within groups over time. Significant negative correlations were found between baseline BMD and the amount of BMD change. CONCLUSION Although not achieving statistical significance, hip BMD changes observed were greater than the reported 0.9-10% gains after exercise for children with and without disability. Thus, cycling with and without electrical stimulation may be beneficial for skeletal health in pediatric SCI, but further research is needed with a larger sample size.
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Affiliation(s)
- R T Lauer
- Department of Physical Therapy, Temple University, Philadelphia, PA, USA
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Nash MS, Lewis JE, Dyson-Hudson TA, Szlachcic Y, Yee F, Mendez AJ, Spungen AM, Bauman WA. Safety, tolerance, and efficacy of extended-release niacin monotherapy for treating dyslipidemia risks in persons with chronic tetraplegia: a randomized multicenter controlled trial. Arch Phys Med Rehabil 2011; 92:399-410. [PMID: 21276961 DOI: 10.1016/j.apmr.2010.06.029] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Revised: 06/07/2010] [Accepted: 06/23/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To test the safety, tolerance, and efficacy of extended-release niacin monotherapy on dyslipidemia in persons with chronic tetraplegia. DESIGN Placebo-controlled, blinded, multicenter, randomized controlled trial. SETTING Three spinal cord injury research/rehabilitation centers. PARTICIPANTS Persons with chronic tetraplegia (N=54) and low plasma high-density lipoprotein cholesterol (HDL-C) levels. INTERVENTION Extended-release niacin monotherapy (48 weeks; n=31) on a dose-titration schedule versus matched placebo (n=23). MAIN OUTCOME MEASURES Safety was assessed by using percentages of treatment-emergent adverse events and increased levels of hepatic transaminases, uric acid, glycosylated hemoglobin, and fasting glucose. Tolerance was assessed by using participant reports for frequency and intensity of adverse effects of extended-release niacin. Primary effectiveness outcomes were fasting HDL-C level and plasma total cholesterol (TC)/HDL-C ratio. Secondary outcomes included plasma low-density lipoprotein cholesterol (LDL-C) and TC levels and LDL-C/HDL-C ratio. RESULTS Significant increases in fasting HDL-C levels (24.5%) were accompanied by decreases in TC/HDL-C and LDL-C/HDL-C ratios, LDL-C levels, and TC levels (all P<.05). No evidence of sustained hepatotoxicity or hyperglycemia was observed. Treatment-emergent withdrawals (12.9%) accompanied flushing (n=1), hypotension/presyncope (n=1), and diarrhea (n=2). One subject experienced transient hyperuricemia. Other drug-reported symptoms did not differ from those for placebo. CONCLUSIONS Extended-release niacin monotherapy is safe, tolerated, and effective for most persons with chronic tetraplegia. Special precautions for changes in bowel habits and postadministration hypotension should be observed.
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Affiliation(s)
- Mark S Nash
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, FL, USA.
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86
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Mutti LC, Salles BFD, Lemos A, Simão R. Os benefícios dos exercícios resistidos na melhoria da capacidade funcional e saúde dos paraplégicos. REV BRAS MED ESPORTE 2010. [DOI: 10.1590/s1517-86922010000600014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Os exercícios resistidos (ER) têm-se mostrado como um dos recursos efetivos para a promoção da saúde e melhoria da capacidade funcional de paraplégicos. Entretanto, o número limitado de estudos sobre a influência dos ER para tal população, acaba por limitar as possibilidades de utilização desta prática. O principal objetivo deste estudo foi realizar uma revisão sobre os benefícios dos ER na melhoria da capacidade funcional e saúde dos paraplégicos. Para tanto, foi realizada uma pesquisa na base de dados do Lilacs, Medline, SportDiscus, SciELO e Scholar Google com o intuito de selecionar as evidências científicas. Os estudos revisados demonstraram que programas de ER são capazes de promover benefícios psicológicos, sociais e físicos, dentre eles a melhoria da aderência ao exercício, melhoria dos níveis de força, resistência e potência, aumento do metabolismo e da melhoria do perfil lipídico aterogênico, e a redução de dores nos ombros em paraplégicos. Os ER são benéficos e até mesmo necessários para manter a capacidade funcional e saúde nesta população.
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87
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van der Woude LHV, de Groot S, Bijker KE, Dekker R, Th van Aanholt PC, Hoekstra F, Janssen TWJ, Hettinga FJ, Houdijk H. 4th International State-of-the-art-congress ‘Rehabilitation: Mobility, Exercise & Sports’. Disabil Rehabil 2010; 32:2149-54. [DOI: 10.3109/09638288.2010.525289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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88
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Leisure time physical activity in a population-based sample of people with spinal cord injury part II: activity types, intensities, and durations. Arch Phys Med Rehabil 2010; 91:729-33. [PMID: 20434610 DOI: 10.1016/j.apmr.2009.12.028] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Revised: 12/03/2009] [Accepted: 12/07/2009] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To describe the types, intensities, and average duration of leisure time physical activities (LTPAs) performed by people with chronic spinal cord injury (SCI). DESIGN Cross-sectional telephone survey. SETTING General community. PARTICIPANTS Men and women with SCI (N=347) who reported engaging in LTPA over the previous 3 days. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Mean minutes a day of LTPA performed at mild, moderate, and heavy intensities; proportion of respondents performing specific types of LTPA. RESULTS Participants reported a mean +/- SD of 55.15+/-59.05min/d of LTPA at a mild intensity or greater. Median LTPA was 33.33min/d. More activity was done at a moderate intensity (mean +/- SD, 25.49+/-42.11min/d) than mild (mean +/- SD, 19.14+/-37.77min/d) or heavy intensities (mean +/- SD, 10.52+/-22.17min/d). Most participants reported mild (54%) or moderate intensity LTPA (68%), while a minority reported heavy intensity LTPA (43%). The 3 most frequently reported types of LTPA were resistance training (33%), aerobic exercise (25%), and wheeling (24%). Craftsmanship (mean +/- SD, 83.79+/-96.00min/d) and sports activities (mean +/- SD, 60.86+/-59.76 min/d) were performed for the longest durations. CONCLUSIONS There is considerable variability in daily LTPA among active people with SCI and variability across different types of LTPA in terms of typical durations and intensities. This information can be used to help people with chronic SCI become more active by highlighting activities that meet individual abilities, needs, and desires.
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89
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Martin Ginis KA, Latimer AE, Arbour-Nicitopoulos KP, Buchholz AC, Bray SR, Craven BC, Hayes KC, Hicks AL, McColl MA, Potter PJ, Smith K, Wolfe DL. Leisure Time Physical Activity in a Population-Based Sample of People With Spinal Cord Injury Part I: Demographic and Injury-Related Correlates. Arch Phys Med Rehabil 2010; 91:722-8. [DOI: 10.1016/j.apmr.2009.12.027] [Citation(s) in RCA: 144] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Revised: 12/03/2009] [Accepted: 12/07/2009] [Indexed: 10/19/2022]
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90
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Hettinga F, Valent L, Groen W, van Drongelen S, de Groot S, van der Woude L. Hand-Cycling: An Active Form of Wheeled Mobility, Recreation, and Sports. Phys Med Rehabil Clin N Am 2010; 21:127-40. [DOI: 10.1016/j.pmr.2009.07.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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91
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Abstract
BACKGROUND In individuals with motor incomplete spinal cord injury (SCI), ambulatory function determined in the clinical setting is related to specific measures of body structure and function and activity limitations, although few studies have quantified the relationship of these variables with daily stepping (steps/day). OBJECTIVE The aim of this study was to quantify daily stepping in ambulatory individuals with SCI and its relationship with clinical walking performance measures and specific demographics, impairments, and activity limitations. DESIGN A cross-sectional study was performed to estimate relationships among clinical variables to daily stepping in self-identified community versus non-community (household) walkers. METHODS Average daily stepping was determined in 50 people with chronic, motor incomplete SCI. Data for clinical and self-report measures of walking performance also were collected, and their associations with daily stepping were analyzed using correlation and receiver operating characteristic (ROC) analyses. Relationships between daily stepping and the measures of demographics, impairments, and activity limitations were identified using correlation and regression analyses. RESULTS The ROC analyses revealed a significant discriminative ability between self-reported community and non-community walkers using clinical gait measures and daily stepping. Stepping activity generally was low throughout the sample tested, however, with an average of approximately 2,600 steps/day. Knee extension strength (force-generating capacity) and static balance were the primary variables related to daily stepping, with metabolic efficiency and capacity and balance confidence contributing to a lesser extent. LIMITATIONS The small sample size and use of specific impairment-related measures were potential limitations of the study. CONCLUSIONS Daily stepping is extremely limited in individuals with incomplete SCI, with a potentially substantial contribution of impairments in knee extension strength and balance.
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92
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Duffell LD, Donaldson NDN, Newham DJ. Power Output During Functional Electrically Stimulated Cycling in Trained Spinal Cord Injured People. Neuromodulation 2009; 13:50-7. [DOI: 10.1111/j.1525-1403.2009.00245.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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93
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van der Woude L, de Groot S, van Drongelen S, Janssen T, Haisma J, Valent L, Veeger D. Evaluation of Manual Wheelchair Performance in Everyday Life. Top Spinal Cord Inj Rehabil 2009. [DOI: 10.1310/sci1502-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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94
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Johnston TE, Smith BT, Mulcahey MJ, Betz RR, Lauer RT. A randomized controlled trial on the effects of cycling with and without electrical stimulation on cardiorespiratory and vascular health in children with spinal cord injury. Arch Phys Med Rehabil 2009; 90:1379-88. [PMID: 19651272 DOI: 10.1016/j.apmr.2009.02.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Revised: 02/18/2009] [Accepted: 02/24/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To examine the cardiorespiratory/vascular effects of cycling with and without functional electrical stimulation (FES) in children with spinal cord injury (SCI). DESIGN Randomized controlled trial. SETTING Pediatric referral hospital. PARTICIPANTS Children with SCI (N=30), ages 5 to 13 years, with injury levels from C4 to T11, and American Spinal Injury Association grades A, B, or C. INTERVENTIONS Children were randomly assigned to 1 of 3 groups: FES leg cycling exercise, passive leg cycling, or noncycling control group receiving electrical stimulation therapy. After receiving instruction on the use of the equipment, children exercised for 1 hour 3 times per week for 6 months at home with parental supervision. MAIN OUTCOME MEASURES Oxygen uptake (Vo(2)) during an incremental arm ergometry test, resting heart rate, forced vital capacity, and a fasting lipid profile. RESULTS There were no differences (P>.05) between groups after 6 months of exercise when comparing pre- and postvalues. However, there were differences between groups for some variables when examining percent change. The FES cycling group showed an improvement (P=.035) in Vo(2) (16.2%+/-25.0%) as compared with the passive cycling group (-28.7%+/-29.1%). For lipid levels, the electrical stimulation-only group showed declines (P=.032) in cholesterol levels (-17.1%+/-8.5%) as compared with the FES cycling group (4.4%+/-20.4%). CONCLUSIONS Cycling with FES led to gains in Vo(2), whereas electrical stimulation alone led to improvements in cholesterol.
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Affiliation(s)
- Therese E Johnston
- Department of Physical Therapy, University of the Sciences in Philadelphia, Philadelphia, PA 19104, USA.
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95
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Carlson KF, Wilt TJ, Taylor BC, Goldish GD, Niewoehner CB, Shamliyan TA, Kane RL. Effect of exercise on disorders of carbohydrate and lipid metabolism in adults with traumatic spinal cord injury: systematic review of the evidence. J Spinal Cord Med 2009; 32:361-78. [PMID: 19777857 PMCID: PMC2830675 DOI: 10.1080/10790268.2009.11754465] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND/OBJECTIVE Carbohydrate and lipid metabolism disorders may affect adults with spinal cord injuries (SCIs) differently than able-bodied individuals because of reduced physical activity in the SCI population. The objective of this study was to conduct a systematic review to determine the effectiveness of exercise to improve carbohydrate and lipid metabolism disorders in adults with chronic SCI. METHODS Studies were identified in MEDLINE (1996-2008), Cochrane Library, bibliographies of identified articles, and expert recommendations. English language articles were included if they evaluated adults with chronic SCI; evaluated exercise; and reported carbohydrate-, lipid-, and/or cardiovascular disease-related outcomes. RESULTS Twenty-two studies met inclusion criteria, including 15 intervention case-series and 7 cross-sectional surveys using self-reported physical activity measures. Intervention protocols involved active (n=7) or electrically stimulated (n=7) exercise or an educational program (n ) from 8 to 52 weeks in duration. Frequency of exercise was typically 2 to 3 sessions/week, lasting 30 to 60 minutes/session. Totals of 150 and 369 subjects participated in studies with carbohydrate (n=12) or lipid and cardiovascular (n=16) outcomes, respectively; 78% were men. Level of SCI ranged from C4 to L5 and included both incomplete and complete lesions. Outcomes measures included fasting and postload blood glucose and insulin concentrations and serum cholesterol levels. Small sample sizes and variations in study design, intervention, SCI characteristics, and reported outcomes precluded quantitative pooling of results or reliable assessment of metabolic efficacy. No intervention studies assessed cardiovascular outcomes. CONCLUSIONS Evidence is insufficient to determine whether exercise improves carbohydrate and lipid metabolism disorders among adults with SCI. Expert consensus, based on the preliminary evidence, is needed to inform future studies.
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Affiliation(s)
- Kathleen F Carlson
- Center for Chronic Disease Outcomes Research, VA Medical Center, Minneapolis, Minnesota 55417, USA.
| | - Timothy J Wilt
- Center for Chronic Disease Outcomes Research, VA Medical Center, Minneapolis, Minnesota
,Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Brent C Taylor
- Center for Chronic Disease Outcomes Research, VA Medical Center, Minneapolis, Minnesota
,Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Gary D Goldish
- Center for Chronic Disease Outcomes Research, VA Medical Center, Minneapolis, Minnesota
| | | | | | - Robert L Kane
- School of Public Health, University of Minnesota, Minneapolis, Minnesota
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96
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Stucki G, Reinhardt JD, Cieza A, Brach M, Celio M, Joggi D, Villiger B, Zäch GA, Krieg W. Developing swiss paraplegic research: Building a research institution from the comprehensive perspective. Disabil Rehabil 2009; 30:1063-78. [DOI: 10.1080/09638280701456369] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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97
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Nash M, Mendez A. Nonfasting Lipemia and Inflammation as Cardiovascular Disease Risks After SCI. Top Spinal Cord Inj Rehabil 2009. [DOI: 10.1310/sci1403-15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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98
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Cowan R, Malone L, Nash M. Exercise is Medicine™: Exercise Prescription After SCI to Manage Cardiovascular Disease Risk Factors. Top Spinal Cord Inj Rehabil 2009. [DOI: 10.1310/sci1403-69] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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99
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Margonato V. Effects of training on cardiorespiratory fitness and lipidic profile of paraplegics. SPORT SCIENCES FOR HEALTH 2008. [DOI: 10.1007/s11332-008-0055-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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100
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Martin Ginis KA, Hicks AL. Facteurs dont il faut tenir compte dans la création d’un guide d’activité physique pour les Canadiens qui ont un handicap physiqueCet article est tiré d’un supplément intitulé Advancing physical activity measurement and guidelines in Canada: a scientific review and evidence-based foundation for the future of Canadian physical activity guidelines (Favoriser les lignes directrices et la mesure de l’activité physique au Canada: examen scientifique et justification selon les données probantes pour l’avenir des lignes directrices de l’activité physique canadienne) publié par Physiologie appliquée, nutrition et métabolisme et la Revue canadienne de santé publique. On peut aussi mentionner Appl. Physiol. Nutr. Metab. 32 (Suppl. 2F) ou Can. J. Public Health 98 (Suppl. 2). Appl Physiol Nutr Metab 2007; 32 Suppl 2F:S150-64. [DOI: 10.1139/h07-162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This paper provides a brief overview of the epidemiological data regarding Canadians with physical disabilities, with a particular emphasis on health status. A literature review is then presented, focusing on activity levels and the physiological and health-related quality of life benefits of activity for people with four different physical disabilities (arthritis, fibromyalgia, spinal cord injury, and multiple sclerosis). The unique physical activity barriers faced by people with physical disabilities are discussed. The paper concludes with recommendations for the development of a physical activity guide for Canadians with physical disabilities.
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Affiliation(s)
| | - Audrey L. Hicks
- Département de kinésiologie, Université McMaster, Hamilton, ON L8S 4K1, Canada
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