101
|
Holmlund T, Ekblom-Bak E, Franzén E, Hultling C, Wahman K. Intensity of physical activity as a percentage of peak oxygen uptake, heart rate and Borg RPE in motor-complete para- and tetraplegia. PLoS One 2019; 14:e0222542. [PMID: 31794548 PMCID: PMC6890239 DOI: 10.1371/journal.pone.0222542] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 09/01/2019] [Indexed: 12/21/2022] Open
Abstract
Objective The aims were to describe VO2peak, explore the potential influence of anthropometrics, demographics and level of physical activity within each cohort; b) to define common, standardized activities as percentages of VO2peak and categorize these as light, moderate and vigorous intensity levels according to present classification systems, and c) to explore how clinically accessible methods such as heart-rate monitoring and Borg rating of perceived exertion (RPE) correlate or can describe light, moderate and vigorous intensity levels. Design Cross sectional. Setting Rehabilitation facility and laboratory environment. Subjects Sixty-three individuals, thirty-seven (10 women) with motor-complete paraplegia (MCP), T7-T12, and twenty-six (7 women) with motor-complete tetraplegia (MCT), C5-C8. Interventions VO2peak was obtained during a graded peak test until exhaustion, and oxygen uptake during eleven different activities was assessed and categorized using indirect calorimetry. Main outcome measures VO2peak, Absolute and relative oxygen consumption, Borg RPE. Results Absolute VO2peak was significantly higher in men than in women for both groups, with fairly small differences in relative VO2peak. For MCP sex, weight and time spent in vigorous-intensity activity explained 63% of VO2peak variance. For MCT sex and time in vigorous-intensity activity explained 55% of the variance. Moderate intensity corresponds to 61–72% HRpeak and RPE 10–13 for MCP vs. 71–79% HRpeak, RPE 13–14 for MCT. Conclusion Using current classification systems, eleven commonly performed activities were categorized in relative intensity terms, (light, moderate and vigorous) based on percent of VO2peak, HRpeak and Borg RPE. This categorization enables clinicians to better guide persons with SCI to meet required physical activity levels.
Collapse
Affiliation(s)
- Tobias Holmlund
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden
- Rehab Station Stockholm/Spinalis R&D Unit, Solna, Sweden
- * E-mail: ,
| | - Elin Ekblom-Bak
- Åstrand Laboratory of Work Physiology, The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Erika Franzén
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
- Allied Health Professionals Function, Function Area Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Claes Hultling
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden
- Spinals Foundation–R&D Unit, Stockholm, Sweden
| | - Kerstin Wahman
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden
- Rehab Station Stockholm/Spinalis R&D Unit, Solna, Sweden
| |
Collapse
|
102
|
Repecki C, Sliwinski M, Harding L. Supporting the need for community exercise programs: a case study. Spinal Cord Ser Cases 2019; 5:95. [PMID: 31798970 PMCID: PMC6877531 DOI: 10.1038/s41394-019-0236-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 09/03/2019] [Accepted: 10/11/2019] [Indexed: 11/08/2022] Open
Abstract
Introduction Participation in exercise activities post spinal cord injury (SCI) can positively impact physical functioning and quality of life. Physically active individuals have improved functional performance compared with sedentary individuals with SCI. Consistent exercise interventions following SCI not only prompt neural recovery and offer myriad health benefits but they may also have persisting effects on functional abilities. Case presentation A 29-year-old male subject had a 15-year history of a C5-C6 AIS B SCI. The subject demonstrated improvements in the outcome measures and he reported enhanced ability to cough and to clear secretions, as well as an enhanced overall quality of life, after undergoing a 14-week course of Spinal Mobility training in combination with inspiratory muscle training (IMT). In addition to the Spinal Mobility training and IMT, he continued to partake in his normal exercise routine, which consisted of aerobic and strength training 3 days per week. Discussion This case reaffirms the benefits of consistent exercise training, in combination with IMT, for individuals with SCI. Community programs specifically targeted to individuals with SCI are needed. The subject's functional improvements demonstrate that incorporating Spinal Mobility training into a regular exercise routine may assist with functional gains in the chronic stage of SCI.
Collapse
Affiliation(s)
- Christopher Repecki
- Columbia University Medical Center, Program in Physical Therapy, New York, NY USA
| | - Martha Sliwinski
- Columbia University Medical Center, Program in Physical Therapy, New York, NY USA
| | | |
Collapse
|
103
|
Vivodtzev I, Picard G, Cepeda FX, Taylor JA. Acute Ventilatory Support During Whole-Body Hybrid Rowing in Patients With High-Level Spinal Cord Injury: A Randomized Controlled Crossover Trial. Chest 2019; 157:1230-1240. [PMID: 31738927 DOI: 10.1016/j.chest.2019.10.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 09/27/2019] [Accepted: 10/25/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND High-level spinal cord injury (SCI) results in profound spinal and supraspinal deficits, leading to substantial ventilatory limitations during whole-body hybrid functional electrical stimulation (FES)-rowing, a form of exercise that markedly increases the active muscle mass via electrically induced leg contractions. This study tested the effect of noninvasive ventilation (NIV) on ventilatory and aerobic capacities in SCI. METHODS This blinded, randomized crossover study enrolled 19 patients with SCI (level of injury ranging from C4 to T8). All patients were familiar with FES-rowing and had plateaued in their training-related increases in aerobic capacity. Patients performed two FES-rowing peak exercise tests with NIV or without NIV (sham). RESULTS NIV increased exercise tidal volume (peak, 1.50 ± 0.31 L vs 1.36 ± 0.34 L; P < .05) and reduced breathing frequency (peak, 35 ± 7 beats/min vs 38 ± 6 beats/min; P < .05) compared with the sham test, leading to no change in alveolar ventilation but a trend toward increased oxygen uptake efficiency (P = .06). In those who reached peak oxygen consumption (Vo2peak) criteria (n = 13), NIV failed to significantly increase Vo2peak (1.73 ± 0.66 L/min vs 1.78 ± 0.59 L/min); however, the range of responses revealed a correlation between changes in peak alveolar ventilation and Vo2peak (r = 0.89; P < .05). Furthermore, those with higher level injuries and shorter time since injury exhibited the greatest increases in Vo2peak. CONCLUSIONS Acute NIV can successfully improve ventilatory efficiency during FES exercise in SCI but may not improve Vo2peak in all patients. Those who benefit most seem to be patients with cervical SCI within a shorter time since injury. TRIAL REGISTRY ClinicalTrials.gov; Nos.: NCT02865343 and NCT03267212; URL: www.clinicaltrials.gov.
Collapse
Affiliation(s)
- Isabelle Vivodtzev
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston MA; Cardiovascular Research Laboratory, Spaulding Rehabilitation Hospital, Cambridge, MA.
| | - Glen Picard
- Cardiovascular Research Laboratory, Spaulding Rehabilitation Hospital, Cambridge, MA
| | | | - J Andrew Taylor
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston MA; Cardiovascular Research Laboratory, Spaulding Rehabilitation Hospital, Cambridge, MA
| |
Collapse
|
104
|
Hutchinson MJ, Kilgallon JW, Leicht CA, Goosey-Tolfrey VL. Perceived exertion responses to wheelchair propulsion differ between novice able-bodied and trained wheelchair sportspeople. J Sci Med Sport 2019; 23:403-407. [PMID: 31706827 DOI: 10.1016/j.jsams.2019.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 09/17/2019] [Accepted: 10/15/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To investigate peripheral (RPEP) and central (RPEC) Ratings of Perceived Exertion during wheelchair propulsion in untrained able-bodied (AB) participants, and trained wheelchair rugby athletes with and without cervical spinal cord injury (CSCI). DESIGN Cross-sectional study. METHODS 38 participants (AB: n=20; wheelchair rugby athletes with CSCI: n=9; without CSCI: n=9) completed an incremental wheelchair propulsion test to exhaustion on a motorised treadmill. Gas exchange measures and heart rate (HR) were collected throughout. RPEP and RPEC on the Category Ratio-10 were verbally recorded each minute. Blood lactate concentration ([BLa]) was determined post-test. RESULTS Between 50-100% peak oxygen uptake (V̇O2peak), RPEP was greater than RPEC in AB (p<0.05), but not in athletes with (p=0.07) or without (p=0.16) CSCI. RPEP was greater in AB compared to players with CSCI (Effect sizes: 1.24-1.62), as were respiratory exchange ratio (1.02±0.10 vs 0.82±0.11, p<0.05) and [BLa]peak (7.98±2.53 vs 4.66±1.57mmol·L-1). RPEC was greater in athletes without CSCI compared to those with CSCI (Effect sizes: 0.70-1.38), as were HR (166±20 vs 104±15 beats·min-1, p<0.05) and ventilation (59.2±28.8 vs 35.1±16.6L·min-1, p=0.01). CONCLUSIONS RPEP was dominant over RPEC during wheelchair propulsion for untrained AB participants. For athletes with CSCI, lower RPEP and RPEC were reported at the same %V̇O2peak compared to those without CSCI. The mechanism for this remains to be fully elucidated.
Collapse
Affiliation(s)
- Michael J Hutchinson
- The Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences Loughborough University, United Kingdom
| | - Jonathan W Kilgallon
- The Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences Loughborough University, United Kingdom
| | - Christof A Leicht
- The Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences Loughborough University, United Kingdom
| | - Victoria L Goosey-Tolfrey
- The Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences Loughborough University, United Kingdom.
| |
Collapse
|
105
|
Popp WL, Schneider S, Bär J, Bösch P, Spengler CM, Gassert R, Curt A. Wearable Sensors in Ambulatory Individuals With a Spinal Cord Injury: From Energy Expenditure Estimation to Activity Recommendations. Front Neurol 2019; 10:1092. [PMID: 31736845 PMCID: PMC6838774 DOI: 10.3389/fneur.2019.01092] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 09/30/2019] [Indexed: 12/13/2022] Open
Abstract
Inappropriate physical inactivity is a global health problem increasing the risk of cardiometabolic diseases. Wearable sensors show great potential to promote physical activity and thus a healthier lifestyle. While commercial activity trackers are available to estimate energy expenditure (EE) in non-disabled individuals, they are not designed for reliable assessments in individuals with an incomplete spinal cord injury (iSCI). Furthermore, activity recommendations for this population are currently rather vague and not tailored to their individual needs, and activity guidelines provided for the non-disabled population may not be easily translated for this population. However, especially in iSCI individuals with impaired abilities to stand and walk, the assessment of physical activities and appropriate recommendations for a healthy lifestyle are challenging. Therefore, the study aimed at developing an EE estimation model for iSCI individuals able to walk based on wearable sensor data. Additionally, the data collected within this study was used to translate common activity recommendations for the non-disabled population to easily understandable activity goals for ambulatory individuals with an iSCI. In total, 30 ambulatory individuals with an iSCI were equipped with wearable sensors while performing 12 different physical activities. EE was measured continuously and demographic and anthropometric variables, clinical assessment scores as well as wearable-sensor-derived features were used to develop different EE estimation models. The best EE estimation model comprised the estimation of resting EE using the updated Harris-Benedict equation, classifying activities using a k-nearest neighbor algorithm, and applying a multiple linear regression-based EE estimation model for each activity class. The mean absolute estimation error of this model was 15.2 ± 6.3% and the corresponding mean signed error was −3.4 ± 8.9%. Translating activity recommendations of global health institutions, we suggest a minimum of 2,000–3,000 steps per day for ambulatory individuals with an iSCI. If ambulatory individuals with an iSCI targeted the popular 10,000 steps a day recommendation for the non-disabled population, their equivalent would be around 8,000 steps a day. The combination of the presented dedicated EE estimation model for ambulatory individuals with an iSCI and the translated activity recommendations is an important step toward promoting an active lifestyle in this population.
Collapse
Affiliation(s)
- Werner L Popp
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland.,Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, Eidgenössische Technische Hochschule (ETH) Zürich, Zurich, Switzerland
| | - Sophie Schneider
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Jessica Bär
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Philipp Bösch
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland.,Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, Eidgenössische Technische Hochschule (ETH) Zürich, Zurich, Switzerland
| | - Christina M Spengler
- Exercise Physiology Lab, Department of Health Sciences and Technology, Eidgenössische Technische Hochschule (ETH) Zürich, Zurich, Switzerland
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, Eidgenössische Technische Hochschule (ETH) Zürich, Zurich, Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| |
Collapse
|
106
|
Sarafis ZK, Monga AK, Phillips AA, Krassioukov AV. Is Technology for Orthostatic Hypotension Ready for Primetime? PM R 2019; 10:S249-S263. [PMID: 30269810 DOI: 10.1016/j.pmrj.2018.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 04/04/2018] [Accepted: 04/12/2018] [Indexed: 01/29/2023]
Abstract
Spinal cord injury (SCI) often results in the devastating loss of motor, sensory, and autonomic function. After SCI, the interruption of descending sympathoexcitatory pathways disrupts supraspinal control of blood pressure (BP). A common clinical consequence of cardiovascular dysfunction after SCI is orthostatic hypotension (OH), a debilitating condition characterized by rapid profound decreases in BP when assuming an upright posture. OH can result in a diverse array of insidious and pernicious health consequences. Acute effects of OH include decreased cardiac filling, cerebral hypoperfusion, and associated presyncopal symptoms such as lightheadedness and dizziness. Over the long term, repetitive exposure to OH is associated with a drastically increased prevalence of heart attack and stroke, which are leading causes of death in those with SCI. Current recommendations for managing BP after SCI primarily include pharmacologic interventions with prolonged time to effect. Because most episodes of OH occur in less than 3 minutes, this delay in action often renders most pharmacologic interventions ineffective. New innovative technologies such as epidural and transcutaneous spinal cord stimulation are being explored to solve this problem. It might be possible to electrically stimulate sympathetic circuitry caudal to the injury and elicit rapid modulation of BP to manage OH. This review describes autonomic control of the cardiovascular system before injury, resulting cardiovascular consequences after SCI such as OH, and the clinical assessment tools for evaluating autonomic dysfunction after SCI. In addition, current approaches for clinically managing OH are outlined, and new promising interventions are described for managing this condition.
Collapse
Affiliation(s)
- Zoe K Sarafis
- ICORD-BSCC, University of British Columbia, Vancouver, BC, Canada(∗)
| | - Aaron K Monga
- ICORD-BSCC, University of British Columbia, Vancouver, BC, Canada(†)
| | - Aaron A Phillips
- Departments of Physiology and Pharmacology, Clinical Neurosciences, Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada(‡)
| | - Andrei V Krassioukov
- ICORD-BSCC; Experimental Medicine Program; Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia; GF Strong Rehabilitation Center, Vancouver Coastal Health; 818 West 10th Avenue, Vancouver, BC, Canada, V5Z1M9(§).
| |
Collapse
|
107
|
Wiest MJ, West C, Ditor D, Furlan JC, Miyatani M, Farahani F, Alavinia SM, Oh PI, Bayley MT, Craven BC. Development of Cardiometabolic Health indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project. J Spinal Cord Med 2019; 42:166-175. [PMID: 31573456 PMCID: PMC6781462 DOI: 10.1080/10790268.2019.1613322] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Context: Spinal cord injury or disease (SCI/D) leads to unchanged low-density lipoprotein and cholesterol, very low high-density lipoprotein a form of dyslipidemia and physical inactivity which combine to increase risk of morbidity and mortality from cardiometabolic disease. Herein, we describe the selection of structure, process and outcome indicators for adults in the first 18 months post-SCI/D rehabilitation admission. Methods: A Pan-Canadian Cardiometabolic Health Working Group was formed to develop a construct definition. Cardiometabolic risk factors were summarized in a Driver diagram. Release of the Paralyzed Veterans of America "Identification and Management of Cardiometabolic Risk after Spinal Cord Injury" and the International Scientific Exercise Guidelines: "Evidence-based scientific exercise guidelines for adults with spinal cord injury", informed the group's focus on prevention strategies to advance this Domain of rehabilitation admission. Results: The structure indicator identifies during rehabilitation the presence of appropriate time and resources for physical exercise prescription. Process indicators are lipid profile assessment at rehabilitation admission and documented exercise prescriptions prior to discharge. The outcome indicators track patient's knowledge retention regarding exercise prescription at discharge, current exercise adherence and lipid status 18 months after rehabilitation discharge. Conclusion: Routine national implementation of these indicators at the specified time points will enhance efforts to detect dyslipidemia and assure routine participation in endurance exercise. These indicators align with international initiatives to improve cardiometabolic health through interventions targeting modifiable risk factors specifically endurance exercising and optimal lipid profiles, crucial to augmenting cardiometabolic health after SCI/D.
Collapse
Affiliation(s)
- Matheus J. Wiest
- KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada
| | - Christopher West
- Cell & Physiological Sciences, Southern Medical Program, University of British Columbia, Kelowna, British Columbia, Canada,ICORD, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Ditor
- Faculty of Applied Health Science, Brock University, St. Catharines, Ontario, Canada
| | - Julio C. Furlan
- KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada,Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada,Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - Masae Miyatani
- KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada
| | - Farnoosh Farahani
- KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada
| | - S. Mohammad Alavinia
- KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada,Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Paul I. Oh
- Cardiac Prevention and Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - Mark T. Bayley
- KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada,Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada,Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - B. Catharine Craven
- KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada,Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada,Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada,Correspondence to: B. Catharine Craven, Neural Engineering & Therapeutic Team, KITE Toronto Rehabilitation Institute, University Health Network 520 Sutherland Drive, Toronto, ON M4G 3V9, Canada; Ph: (416) 597-3422 (ext: 6122).
| |
Collapse
|
108
|
Hutchinson MJ, Valentino SE, Totosy de Zepetnek J, MacDonald MJ, Goosey-Tolfrey VL. Perceptually regulated training does not influence the differentiated RPE response following 16-weeks of aerobic exercise in adults with spinal cord injury. Appl Physiol Nutr Metab 2019; 45:129-134. [PMID: 31251892 DOI: 10.1139/apnm-2019-0062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study investigated the effect of prolonged familiarisation with ratings of perceived exertion (RPE) on the peripheral (RPEP) and central (RPEC) RPE responses to moderate-vigorous exercise in adults with spinal cord injury (SCI). RPEP and RPEC characterise the exertion of the working musculature and cardiorespiratory systems, respectively. Nineteen participants (age, 41.4 ± 11.4 years; peak oxygen uptake, 19.2 ± 7.2 mL·kg-1·min-1) with chronic SCI were randomly assigned to RPE-guided (n = 11; EXP) or active control (n = 8; CON) groups. EXP performed 16-weeks of RPE-guided, supervised aerobic training for 20 min, twice weekly, at RPE 3-6 (Category-Ratio 10 scale). CON had access to the same exercise equipment but received no specific advice on their exercise-training regime. Participants completed a graded exercise test, using an arm crank ergometer at pre- and post-training to determine peak oxygen uptake, with RPEP and RPEC recorded every minute throughout tests. Sixteen weeks training did not improve peak oxygen uptake. RPE decreased post-training at 50% (p = 0.02) and 70% peak oxygen uptake (p = 0.03), though there was no effect of group at either intensity (p = 0.54, 0.42, respectively). At 70% peak oxygen uptake, RPEP was greater than RPEC (4.2 ± 1.7 vs 3.4 ± 1.8, p < 0.005). Training with RPE-guidance for 16 weeks had no additional effect on the differentiated RPE responses to moderate-vigorous exercise in adults with SCI. Novelty In adults with SCI, differentiated RPE responses were not different between those who did, and did not, perform 16 weeks of RPE-guided training. This challenges whether familiarisation with RPE is necessary to be an effective regulator of exercise intensity in this population.
Collapse
Affiliation(s)
- Michael John Hutchinson
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
| | - Sydney Ella Valentino
- Exercise Metabolism Research Group, Department of Kinesiology, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Julia Totosy de Zepetnek
- Exercise Metabolism Research Group, Department of Kinesiology, McMaster University, Hamilton, ON L8S 4L8, Canada.,Faculty of Kinesiology and Health Studies, University of Regina, Regina, SK S4S 0A2, Canada
| | - Maureen Jane MacDonald
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK.,Exercise Metabolism Research Group, Department of Kinesiology, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Victoria Louise Goosey-Tolfrey
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
| |
Collapse
|
109
|
Holmlund T, Ekblom-Bak E, Franzén E, Hultling C, Wahman K. Defining accelerometer cut-points for different intensity levels in motor-complete spinal cord injury. Spinal Cord 2019; 58:116-124. [PMID: 31243318 DOI: 10.1038/s41393-019-0308-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 11/10/2022]
Abstract
STUDY DESIGN Descriptive. OBJECTIVE The present aim was to define accelerometer cut-point values for wrist-worn accelerometers to identify absolute- and relative-intensity physical activity (PA) levels in people with motor-complete paraplegics (PP) and tetraplegics (TP). SETTINGS Rehabilitation facility in Sweden. METHODS The participants were 26 (19 men, 7 women) with C5-C8, AIS A and B (TP) and 37 (27 men, 10 women) with T7-T12 (PP), AIS A and B. Wrist-worn accelerometer recordings (Actigraph GT3X+) were taken during seven standardized activities. Oxygen consumption was measured, as well as at-rest and peak effort, with indirect calorimetry. Accelerometer cut-points for absolute and relative intensities were defined using ROC-curve analyses. RESULTS The ROC-curve analyses for accelerometer cut-points revealed good-to-excellent accuracy (AUC >0.8), defining cut-points for absolute intensity (2, 3, 4, 5, 6, 7 METs for PP and 2 to 6 METs for TP) and relative intensity (30, 40, 50, 60, 70, and 80% for PP and 40-80% for TP). The cut-points for moderate-to-vigorous physical activity was defined as ≥9515 vector magnitude counts per minute (VMC) for PP and ≥4887 VMC/min for TP. CONCLUSION This study presents cut-points for wrist-worn accelerometers in both PP and TP, which could be used in clinical practice to describe physical activity patterns and time spent at different intensity levels.
Collapse
Affiliation(s)
- Tobias Holmlund
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, 171 77, Stockholm, Sweden. .,Rehab Station Stockholm/Spinalis R&D Unit, Frösundaviks allé 4 169 89, Solna, Sweden.
| | - Elin Ekblom-Bak
- Åstrand Laboratory of Work Physiology, The Swedish School of Sport and Health Sciences, Box 5626, 114 86, Stockholm, Sweden
| | - Erika Franzén
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, 141 83, Stockholm, Sweden.,Allied Health Professionals Function, Function Area Occupational Therapy & Physiotherapy, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Claes Hultling
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Kerstin Wahman
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, 171 77, Stockholm, Sweden.,Rehab Station Stockholm/Spinalis R&D Unit, Frösundaviks allé 4 169 89, Solna, Sweden
| |
Collapse
|
110
|
Pinto AP, Guimarães CL, Souza GADS, Leonardo PS, Neves MFD, Lima FPS, Lima MO, Lopes-Martins RAB. Sensory-motor and cardiorespiratory sensory rehabilitation associated with transcranial photobiomodulation in patients with central nervous system injury: Trial protocol for a single-center, randomized, double-blind, and controlled clinical trial. Medicine (Baltimore) 2019; 98:e15851. [PMID: 31232920 PMCID: PMC6636949 DOI: 10.1097/md.0000000000015851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Central nervous system diseases such as stroke, spinal cord injury, traumatic brain injury, and multiple sclerosis can be fatal or cause sequelae, affecting sensorimotor and cardiorespiratory systems and quality of life. These subjects present a low response to aerobic and resistance exercise, due to decreased recruitment of muscle fibers and reduction of metabolic capacity. Aerobic exercises bring benefits in terms of fatigue retardation, gait improvement, regulation of the autonomic nervous system, neuroprotection of the brain, stimulation of the production of endogenous neutrotransmitters related to general well-being, and a favoring of neuroplasticity. Photobiomodulation (PBM Therapy) (previously known as low-level laser therapy), and especially transcranial PBM Therapy, has shown benefits in animals and humans such as cognitive improvement, memory, and behavioral improvement, including attenuation of depression and anxiety, and increased cortical oxygenation. The aims of this trial will be to evaluate the parameters related to the function of the musculoskeletal and cardiorespiratory system and the impact of PBM therapy on these parameters, as part of a rehabilitation and training program for people with reduced mobility. METHODS This is a randomized, double-blind, placebo-controlled trial with 3 groups: Control, only cardiorespiratory rehabilitation (CCR), CCR with PBM Therapy (CR-PBM), CCR and placebo PBM Therapy (CR-PlaceboPBM). n = 90, 30 per group. PBM Therapy parameters: 810 nm laser, 0.028 cm, 100 mW, 3.5 W/cm, 30 seconds per point, 3 J per point, 107.1 J /cm to 3 electroencephalogram points F7 and F8 and AFz. The trial will be conducted at the University Clinics and the sessions will be 1 hour twice a week for 9 weeks. Baseline, intermediate (4th week), final (9th week), and 2-month follow-up will be performed. Muscular activation, heart rate variability, lung volumes and capacities, fatigability, exercise tolerance, cognition, and quality of life at baseline will be evaluated. Subsequent to baseline evaluations, the PBM Therapy groups will be offered laser therapy (active or inactive); all groups will then receive CCR. TRIAL REGISTRATION NUMBER ClinicalTrials.gov ID - NCT03751306 (approval date: November 22, 2018).
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Rodrigo Alvaro Brandão Lopes-Martins
- Laboratório de Engenharia de Reabilitação Sensório Motora
- Laboratório de Biofotônica e Terapêutica Experimental, Instituto de Pesquisa e Desenvolvimento, Universidade do Vale do Paraíba, São José dos Campos, São Paulo, Brazil
| |
Collapse
|
111
|
Prevalence of Depression and Pain Among Patients with Spinal Cord Injury in Iran: A Systematic Review and Meta-Analysis. Trauma Mon 2019. [DOI: 10.5812/traumamon.87503] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
|
112
|
Physical Activity and Spinal Cord Injury: Lessons Learned at the Lowest End of the Physical Activity Spectrum. ACTA ACUST UNITED AC 2019. [DOI: 10.1123/kr.2018-0062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
113
|
Jörgensen S, Hill M, Lexell J. Cardiovascular Risk Factors Among Older Adults With Long-Term Spinal Cord Injury. PM R 2019; 11:8-16. [PMID: 29964213 DOI: 10.1016/j.pmrj.2018.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 06/15/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Individuals with spinal cord injury (SCI) now live longer, which increases the risk of cardiovascular disease. Knowledge of cardiovascular risk factors amenable to intervention are therefore needed to support their healthy aging. OBJECTIVE To describe the occurrence of cardiovascular risk factors among older adults with long-term SCI and investigate the association with sociodemographics and injury characteristics. DESIGN Cross-sectional descriptive cohort study. SETTING Home settings. PARTICIPANTS In total, 123 individuals (71% men, injury levels C1-L5, American Spinal Injury Association Impairment Scale A-D), mean age 63 years, mean time since injury 24 years. METHODS Data from the Swedish Aging with Spinal Cord Injury Study (SASCIS), collected through interviews and assessments during home visits and from medical records. MAIN OUTCOME MEASURES Anthropometric measurements, blood pressure, fasting plasma glucose and blood lipids, and data on cardiovascular comorbidity and tobacco use. RESULTS One third had a previous diagnosis of hypertension, and 55% presented with a blood pressure ≥ 140/90 mm Hg at the time of assessment. Sixteen percent had a history of diabetes and in 15% fasting glucose levels were ≥ 7 mmol/L. Dyslipidemia was present in 76%, whereas 16% had prediagnosed dyslipidemia. Mean body mass index (BMI) was 27 kg/m2 and mean waist circumference was 101 cm. When SCI-adjusted BMI cut-off values were used, 93% were considered overweight (BMI ≥22 kg/m2 ), and 60% had a waist circumference associated with cardiometabolic risk. A total of 16% smoked regularly. The median number of cardiovascular risk factors was 3. No significant associations were found between the total number of risk factors and sociodemographics and injury characteristics. CONCLUSIONS The high occurrence of cardiovascular risk factors among older adults with long-term SCI can pose additional consequences to their health. Regular assessments and interventions targeting cardiovascular risk in this population are therefore warranted. Further research is needed to identify modifiable factors associated with their risk profile. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Sophie Jörgensen
- Department of Health Sciences, Rehabilitation Medicine Research Group, Lund University, Lund; and Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
| | - Mattias Hill
- Department of Health Sciences, Rehabilitation Medicine Research Group, Lund University, Lund; and Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
| | - Jan Lexell
- Department of Health Sciences, Rehabilitation Medicine Research Group, Lund University, Lund; and Department of Neuroscience, Rehabilitation Medicine,, Uppsala University, Uppsala, Sweden
| |
Collapse
|
114
|
Jörgensen S, Svedevall S, Magnusson L, Martin Ginis KA, Lexell J. Associations between leisure time physical activity and cardiovascular risk factors among older adults with long-term spinal cord injury. Spinal Cord 2019; 57:427-433. [PMID: 30622291 DOI: 10.1038/s41393-018-0233-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 11/28/2018] [Accepted: 12/03/2018] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN This is a cross-sectional study. OBJECTIVES To describe the association between cardiovascular risk factors (body mass index (BMI), waist circumference (WC), blood pressure, blood glucose and lipids) and leisure time physical activity (LTPA) in older adults with long-term spinal cord injury (SCI). SETTING Community settings, southern Sweden. METHODS Data from the baseline data collection of the Swedish Aging with Spinal Cord Injury Study (SASCIS) (n = 123, 71% men, injury levels C1-L5, American Spinal Injury Association Impairment Scale A-D, mean age 63 years, mean time since injury 24 years). Data were collected through home interviews, assessments and blood samples. The Physical Activity Recall Assessment for People with SCI was used to assess LTPA. Associations were investigated using multivariable linear regression analyses adjusted for age, gender, level and severity of injury, cause of injury, time since injury and tobacco use. RESULTS More minutes per day of moderate-to-heavy LTPA were significantly associated with a lower BMI (Beta = -0.31; p = 0.001) and a lower WC (Beta = -0.24; p = 0.009). More minutes per day of total LTPA (mild intensity or greater) were associated with a higher systolic blood pressure (Beta = 0.27; p = 0.041) among participants with tetraplegia. No other significant associations between the cardiovascular risk factors and total LTPA were found. CONCLUSION Participation in daily LTPA is associated with better cardiovascular health with regard to BMI and WC in older adults with long-term SCI. Further studies are needed to establish the specific amount of activity needed to obtain positive health effects in this group and the directional causality of the associations. SPONSORSHIP Not applicable.
Collapse
Affiliation(s)
- Sophie Jörgensen
- Department of Health Sciences, Lund University, Lund, Sweden. .,Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden.
| | - Stina Svedevall
- Department of Health Sciences, Lund University, Lund, Sweden
| | | | - Kathleen A Martin Ginis
- School of Health and Exercise Sciences, University of British Columbia, Okanagan Campus, Kelowna, BC, Canada
| | - Jan Lexell
- Department of Health Sciences, Lund University, Lund, Sweden.,Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden.,Department of Neuroscience, Rehabilitation Medicine, Uppsala University, Uppsala, Sweden
| |
Collapse
|
115
|
Yu P, Zhang W, Liu Y, Sheng C, So KF, Zhou L, Zhu H. The effects and potential mechanisms of locomotor training on improvements of functional recovery after spinal cord injury. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2019; 147:199-217. [DOI: 10.1016/bs.irn.2019.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
116
|
Sliwinski MM, Akselrad G, Alla V, Buan V, Kaemmerlen E. Community exercise programing and its potential influence on quality of life and functional reach for individuals with spinal cord injury. J Spinal Cord Med 2018; 43:358-363. [PMID: 30475164 PMCID: PMC7241565 DOI: 10.1080/10790268.2018.1543104] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Context/Objective: After an individual with a Spinal Cord Injury (SCI) participates in the initial rehabilitation process, they often experience limited access to physical therapy services and other fitness activities. The purpose of this study was to examine previously collected data for changes in quality of life (QoL) and functional reach in individuals with SCI following an 8-week community exercise program.Design: Secondary analysis of previously collected data.Setting: Community-based exercise program.Participants: Twenty-two participants with an average of 9 years post-SCI, both complete and incomplete injuries, and injury levels ranging from C2 to L5.Interventions: Participants completed an 8-week program, once per week for 4 hours that included a four-station circuit of resistance training, aerobic exercise, trunk stability, and education.Outcome Measures: Physical function was measured using the modified Functional Reach Test (mFRT). QoL was measured with the Life Satisfaction Questionnaire-9 (LiSAT-9).Results: The mFRT improved by 2 inches (±7.04) P < 0.001 and QoL improved as well, P < 0.001.Conclusion: The findings of this study are consistent with the hypothesis that a supervised post-rehabilitation community exercise program, like Spinal Mobility, may positively impact the QoL and functional reach in individuals with SCI.
Collapse
Affiliation(s)
- Martha M. Sliwinski
- Program in Physical Therapy, Columbia University Medical Center, New York, New York, USA,Correspondence to: Martha M. Sliwinski, Program in Physical Therapy, Department of Rehabilitation and Regenerative Medicine at Vagelos College of Physicians & Surgeons, Columbia University, 617 West 168th Street, 3rd Floor Room 309, New York, NY 10032, USA.
| | - Gila Akselrad
- Physical Therapy Department, NewYork-Presbyterian, New York, New York, USA
| | - Victoria Alla
- Physical Therapy Department, ProActive Physical Therapy Specialists, Oregon City, Oregon, USA
| | - Valerie Buan
- Physical Therapy Department, California Rehabilitation Institute, Los Angeles, California, USA
| | - Emily Kaemmerlen
- Physical Therapy Department, Life’s Work Physical Therapy, Portland, Oregon, USA
| |
Collapse
|
117
|
Nash MS, Bilzon JLJ. Guideline Approaches for Cardioendocrine Disease Surveillance and Treatment Following Spinal Cord Injury. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2018; 6:264-276. [PMID: 30546969 PMCID: PMC6267529 DOI: 10.1007/s40141-018-0203-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW Persons with spinal cord injuries (SCI) commonly experience individual risks and coalesced health hazards of the cardiometabolic syndrome (CMS). This review will examinethe role of exercise and nutritional intervention as countermeasures to these disease risks. RECENT FINDINGS The CMS hazards of overweight/obesity, insulin resistance, hypertension, and dyslipidemia are strongly associated with physical deconditioning and are common after SCI. Both the CMS diagnosis and physical deconditioning worsen the prognosis for all-cause cardiovascular disease occurring early after SCI. Evidence supports a therapeutic role for physical activity after SCI as an effective countermeasure to these risks and often represents the first-line approach to CMS abatement. This evidence is supported by authoritative systematic reviews and associated guidelines that recommend specific activities, frequencies, and activities of work. In many cases, the most effective exercise programming uses more intense periods of work with limited rest. As SCI is also associated with poor dietary habits, including excessive energy intake and saturated fat consumption, more comprehensive lifestyle management incorporating both exercise and nutrition represents a preferred approach for overall health management. SUMMARY Irrespective of the interventional strategy, improved surveillance of the population for CMS risks and encouraged incorporation of exercise and nutritional management according to recent population-specific guidelines will most likely play an important role in the preservation of activity, optimal health, and independence throughout the lifespan.
Collapse
Affiliation(s)
- Mark S. Nash
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL USA
- Departments of Neurological Surgery and Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine, Miami, FL USA
| | - James L. J. Bilzon
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL USA
- Department for Health, University of Bath, Bath, Somerset UK
| |
Collapse
|
118
|
Rodríguez-Gómez I, Martín-Manjarrés S, Martín-García M, Vila-Maldonado S, Gil-Agudo Á, M. Alegre L, Ara I. Cardiorespiratory fitness and arm bone mineral health in young males with spinal cord injury: the mediator role of lean mass. J Sports Sci 2018; 37:717-725. [DOI: 10.1080/02640414.2018.1522948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Irene Rodríguez-Gómez
- GENUD Toledo Research Group, Universidad de Castilla-La Mancha, Toledo, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
| | - Soraya Martín-Manjarrés
- Department of Physical Medicine and Rehabilitation, National Hospital for Paraplegics. SESCAM, Toledo, Spain
| | - María Martín-García
- GENUD Toledo Research Group, Universidad de Castilla-La Mancha, Toledo, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
| | - Sara Vila-Maldonado
- GENUD Toledo Research Group, Universidad de Castilla-La Mancha, Toledo, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
| | - Ángel Gil-Agudo
- Biomechanics and Technical Aids Unit, Department of Physical Medicine and Rehabilitation, National Hospital for Spinal Cord Injury. SESCAM, Toledo, Spain
| | - Luis M. Alegre
- GENUD Toledo Research Group, Universidad de Castilla-La Mancha, Toledo, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
| | - Ignacio Ara
- GENUD Toledo Research Group, Universidad de Castilla-La Mancha, Toledo, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
| |
Collapse
|
119
|
Au JS, Sithamparapillai A, Currie KD, Krassioukov AV, MacDonald MJ, Hicks AL. Assessing Ventilatory Threshold in Individuals With Motor-Complete Spinal Cord Injury. Arch Phys Med Rehabil 2018; 99:1991-1997. [DOI: 10.1016/j.apmr.2018.05.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/16/2018] [Accepted: 05/12/2018] [Indexed: 11/28/2022]
|
120
|
Ma JK, McCracken LA, Voss C, Chan FHN, West CR, Martin Ginis KA. Physical activity measurement in people with spinal cord injury: comparison of accelerometry and self-report (the Physical Activity Recall Assessment for People with Spinal Cord Injury). Disabil Rehabil 2018; 42:240-246. [DOI: 10.1080/09638288.2018.1494213] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Jasmin K. Ma
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
- International Collaboration on Repair Discoveries (ICORD) Blusson Spinal Cord Centre (BSCC) University of British Columbia, Vancouver, BC, Canada
| | - Laura A. McCracken
- International Collaboration on Repair Discoveries (ICORD) Blusson Spinal Cord Centre (BSCC) University of British Columbia, Vancouver, BC, Canada
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Christine Voss
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Franco H. N. Chan
- International Collaboration on Repair Discoveries (ICORD) Blusson Spinal Cord Centre (BSCC) University of British Columbia, Vancouver, BC, Canada
| | - Christopher R. West
- International Collaboration on Repair Discoveries (ICORD) Blusson Spinal Cord Centre (BSCC) University of British Columbia, Vancouver, BC, Canada
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Kathleen A. Martin Ginis
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
- International Collaboration on Repair Discoveries (ICORD) Blusson Spinal Cord Centre (BSCC) University of British Columbia, Vancouver, BC, Canada
- Southern Medical Program, Faculty of Medicine, University of British Columbia, Kelowna, BC, Canada
| |
Collapse
|
121
|
Shea JR, Shay BL, Leiter J, Cowley KC. Energy Expenditure as a Function of Activity Level After Spinal Cord Injury: The Need for Tetraplegia-Specific Energy Balance Guidelines. Front Physiol 2018; 9:1286. [PMID: 30283348 PMCID: PMC6156377 DOI: 10.3389/fphys.2018.01286] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 08/27/2018] [Indexed: 01/08/2023] Open
Abstract
The World Health Organization recognizes obesity as a global and increasing problem for the general population. Because of their reduced physical functioning, people with spinal cord injury (SCI) face additional challenges for maintaining an appropriate whole body energy balance, and the majority with SCI are overweight or obese. SCI also reduces exercise capacity, particularly in those with higher-level injury (tetraplegia). Tetraplegia-specific caloric energy expenditure (EE) data is scarce. Therefore, we measured resting and exercise-based energy expenditure in participants with tetraplegia and explored the accuracy of general population-based energy use predictors. Body composition and resting energy expenditure (REE) were measured in 25 adults with tetraplegia (C4/5 to C8) and in a sex-age-height matched group. Oxygen uptake, carbon dioxide production, heart rate, perceived exertion, and exercise intensity were also measured in 125 steady state exercise trials. Those with motor-complete tetraplegia, but not controls, had measured REE lower than predicted (mean = 22% less, p < 0.0001). REE was also lower than controls when expressed per kilogram of lean mass. Nine had REE below 1200 kcal/day. We developed a graphic compendium of steady state EE during arm ergometry, wheeling, and hand-cycling. This compendium is in a format that can be used by persons with tetraplegia for exercise prescription (calories, at known absolute intensities). EE was low (55–450 kcal/h) at the intensities participants with tetraplegia were capable of maintaining. If people with tetraplegia followed SCI-specific activity guidelines (220 min/week) at the median intensities we measured, they would expend 563–1031 kcal/week. Participants with tetraplegia would therefore require significant time (4 to over 20 h) to meet a weekly 2000 kcal exercise target. We estimated total daily EE for a range of activity levels in tetraplegia and compared them to predicted values for the general population. Our analysis indicated that the EE values for sedentary through moderate levels of activity in tetraplegia fall well below predicted sedentary levels of activity for the general population. These findings help explain sub-optimal responses to exercise interventions after tetraplegia, and support the need to develop tetraplegia-specific energy-balance guidelines that reflects their unique EE situation.
Collapse
Affiliation(s)
- Jessie R Shea
- Department of Physiology and Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Barbara L Shay
- Department of Physical Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Jeff Leiter
- Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Pan Am Clinic Foundation, Winnipeg, MB, Canada
| | - Kristine C Cowley
- Department of Physiology and Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| |
Collapse
|
122
|
Seated pressures in daily wheelchair and sports equipment: investigating the protective effects of cushioned shorts. Spinal Cord Ser Cases 2018; 4:47. [PMID: 29900009 DOI: 10.1038/s41394-018-0084-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/08/2018] [Accepted: 02/17/2018] [Indexed: 11/08/2022] Open
Abstract
Study design The primary study design was a pretest and posttest study performed in a single session with subjects as their own control. We summarize three integrated and sequential studies. Objective The objective of this study was to investigate whether commercially available cushioned shorts would add skin protection when used in adaptive sports equipment (AE). Setting Community in Tacoma Washington, USA. Methods TekScan Pressure Mapping System for recording average (AP) and peak (PP) seating pressures.Part 1. Pretest/posttest design, subjects as own control. Eight adults with SCI (C5-T6) mapped in daily wheelchair and AE with and without bicycle shorts.Part 2. Sixteen able-bodied subjects were mapped with and without an impact short and full-coverage short in a hand-cycle.Part 3. One individual with T5 SCI was mapped with and without a full-coverage short in personal basketball chair and mountain hand-cycle. Results Part 1. Significant differences between the daily wheelchair and AE in the static condition for AP and PP and AP in the dynamic condition. Bicycle shorts showed no significance.Part 2. Impact shorts increased static PP and AP. The full-coverage short decreased static AP.Part 3. The full-coverage short increased AP and PP in the basketball chair. In the mountain hand-cycle, AP decreased but PP increased. Conclusion Athletes who are static in their AE may be at greater risk of tissue breakdown than those actively playing. Cushioned shorts had highly variable effects on seated pressure in adaptive equipment. Pressure mapping is recommended prior to using any cushioning in AE by the SCI population.
Collapse
|
123
|
Development of an International Canine Spinal Cord Injury observational registry: a collaborative data-sharing network to optimize translational studies of SCI. Spinal Cord 2018; 56:656-665. [PMID: 29795173 PMCID: PMC6035082 DOI: 10.1038/s41393-018-0145-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/23/2018] [Accepted: 04/09/2018] [Indexed: 11/21/2022]
Abstract
Study Design Prospective cross sectional cohort study Objectives The canine spontaneous model of spinal cord injury (SCI) is as an important pre-clinical platform as it recapitulates key facets of human injury in a naturally occurring context. The establishment of an observational canine SCI registry constitutes a key step in performing epidemiologic studies and assessing the impact of therapeutic strategies to enhance translational research. Further, accumulating information on dogs with SCI may contribute to current “big data” approaches to enhance understanding of the disease using heterogeneous multi-institutional, multi-species data sets from both pre-clinical and human studies. Setting Multiple veterinary academic institutions across the United States and Europe. Methods Common data elements recommended for experimental and human SCI studies were reviewed and adapted for use in a web-based registry, to which all dogs presenting to member veterinary tertiary care facilities were prospectively entered over approximately one year. Results Analysis of data accumulated during the first year of the registry suggests that 16% of dogs with SCI present with severe, sensorimotor complete, injury and that 15% of cases are seen by a tertiary care facility within 8 hours of injury. Similar to the human SCI population, 34% were either overweight or obese. Conclusions Severity of injury and timing of presentation suggests that neuroprotective studies using the canine clinical model could be conducted efficiently using a multi-institutional approach. Additionally, pet dogs with SCI experience similar comorbidities to people with SCI, in particular obesity, and could serve as an important model to evaluate the effects of this condition.
Collapse
|
124
|
Goosey-Tolfrey VL, van der Scheer JW, Lexell J, Clements K, Martin Ginis KA. Development of scientific exercise guidelines for adults with spinal cord injury. Br J Sports Med 2018; 52:1166-1167. [DOI: 10.1136/bjsports-2018-099202] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2018] [Indexed: 11/04/2022]
|
125
|
Morgan JW, Ferrazzani E, Taylor JA, Vivodtzev I. Augmenting exercise capacity with noninvasive ventilation in high-level spinal cord injury. J Appl Physiol (1985) 2018; 124:1294-1296. [PMID: 29494290 DOI: 10.1152/japplphysiol.01028.2017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
High-level spinal cord injury (SCI) results in a very limited innervated skeletal muscle mass that strongly reduces exercise capacity. Our recent work showed that when adding functional electrical stimulation (FES) of the paralyzed legs (hybrid FES-exercise) to produce higher exercise capacity, peak ventilation became a limiting factor to training-induced improvement in aerobic capacity. Our assumption was that the systemic adaptations to exercise training are delimited by the maximal ventilation that can be achieved. However, herein, we present a case showing an acute increase in aerobic capacity when using noninvasive ventilatory support (NIV) during FES-rowing test in an individual who had previously experimented a plateau in his aerobic capacity for 18 mo. An 18-yr-old man with C5 SCI trained with arms-only rowing for 6 mo and subsequently trained with hybrid FES-rowing for 18 mo. Peak minute ventilation (V̇epeak) and peak oxygen consumption (V̇o2peak) were increased after arms-only training and increased further with 6 mo of hybrid FES-row training. Despite continued intense and frequent, hybrid FES-row training, neither V̇epeak nor V̇o2peak increased further over the next year (1.94 and 66.0 l/min). However, when this individual performed a FES-rowing V̇o2peak test with the addition of NIV, V̇epeak increased by 5 l/min, resulting in an improved V̇o2peak (2.23 l/min, +12%). This case demonstrates that noninvasive ventilation can overcome limitations to ventilation in high-level SCI and improve aerobic capacity during hybrid FES-exercise to a level not otherwise achievable. In addition, it broadly illustrates the intimate role of pulmonary function in determining the capacity to perform exercise.
Collapse
Affiliation(s)
- James W Morgan
- Cardiovascular Research Laboratory, Spaulding Rehabilitation Hospital , Cambridge, Massachusetts.,Department of Physical Medicine and Rehabilitation, Harvard Medical School , Boston, Massachusetts
| | - Eric Ferrazzani
- Exercise for Persons with Disabilities Program, Spaulding Hospital Cambridge, Cambridge, Massachusetts
| | - J Andrew Taylor
- Cardiovascular Research Laboratory, Spaulding Rehabilitation Hospital , Cambridge, Massachusetts.,Department of Physical Medicine and Rehabilitation, Harvard Medical School , Boston, Massachusetts
| | - Isabelle Vivodtzev
- Cardiovascular Research Laboratory, Spaulding Rehabilitation Hospital , Cambridge, Massachusetts.,Department of Physical Medicine and Rehabilitation, Harvard Medical School , Boston, Massachusetts
| |
Collapse
|
126
|
Martin Ginis KA, van der Scheer JW, Latimer-Cheung AE, Barrow A, Bourne C, Carruthers P, Bernardi M, Ditor DS, Gaudet S, de Groot S, Hayes KC, Hicks AL, Leicht CA, Lexell J, Macaluso S, Manns PJ, McBride CB, Noonan V, Pomerleau P, Rimmer JH, Shaw RB, Smith B, Smith KM, Steeves J, Tussler D, West CR, Wolfe DL, Goosey-Tolfrey VL. Response to correspondence from the ESSA Statement authors. Spinal Cord 2018; 56:409-411. [PMID: 29348688 DOI: 10.1038/s41393-017-0051-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 12/10/2017] [Accepted: 12/13/2017] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | - Andy Barrow
- Paralympian and Inspirational Speaker, London, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Pierre Pomerleau
- Institut de Réadaptation en Déficience Physique de Québec, Ville de Québec, Canada
| | | | - Robert B Shaw
- University of British Columbia, British Columbia, Canada
| | | | | | - John Steeves
- ICORD University of British Columbia, Vancouver, Canada
| | - Dot Tussler
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK
| | | | - Dalton L Wolfe
- Parkwood Institute, Lawson Health Research Institute, Ontario, Canada
| | | |
Collapse
|
127
|
Correspondence re "Evidence-based scientific exercise guidelines for adults with spinal cord injury: an update and new guideline". Spinal Cord 2018; 56:406-408. [PMID: 29348691 DOI: 10.1038/s41393-017-0052-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 11/27/2017] [Indexed: 11/09/2022]
|
128
|
Li C, DiPiro ND, Krause JS. A latent structural analysis of health behaviors among people living with spinal cord injury. Spinal Cord 2017; 56:265-273. [DOI: 10.1038/s41393-017-0027-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 09/21/2017] [Accepted: 10/01/2017] [Indexed: 02/06/2023]
|
129
|
Martin Ginis KA, van der Scheer JW, Latimer-Cheung AE, Barrow A, Bourne C, Carruthers P, Bernardi M, Ditor DS, Gaudet S, de Groot S, Hayes KC, Hicks AL, Leicht CA, Lexell J, Macaluso S, Manns PJ, McBride CB, Noonan VK, Pomerleau P, Rimmer JH, Shaw RB, Smith B, Smith KM, Steeves JD, Tussler D, West CR, Wolfe DL, Goosey-Tolfrey VL. Evidence-based scientific exercise guidelines for adults with spinal cord injury: an update and a new guideline. Spinal Cord 2017; 56:308-321. [PMID: 29070812 DOI: 10.1038/s41393-017-0017-3] [Citation(s) in RCA: 231] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 09/14/2017] [Accepted: 09/20/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To describe the process and outcomes of using a new evidence base to develop scientific guidelines that specify the type and minimum dose of exercise necessary to improve fitness and cardiometabolic health in adults with spinal cord injury (SCI). SETTING International. METHODS Using Appraisal of Guidelines, Research and Evaluation (AGREE) II reporting criteria, steps included (a) determining the guidelines' scope; (b) conducting a systematic review of relevant literature; (c) holding three consensus panel meetings (European, Canadian and International) to formulate the guidelines; (d) obtaining stakeholder feedback; and (e) process evaluation by an AGREE II consultant. Stakeholders were actively involved in steps (c) and (d). RESULTS For cardiorespiratory fitness and muscle strength benefits, adults with a SCI should engage in at least 20 min of moderate to vigorous intensity aerobic exercise 2 times per week AND 3 sets of strength exercises for each major functioning muscle group, at a moderate to vigorous intensity, 2 times per week (strong recommendation). For cardiometabolic health benefits, adults with a SCI are suggested to engage in at least 30 min of moderate to vigorous intensity aerobic exercise 3 times per week (conditional recommendation). CONCLUSIONS Through a systematic, rigorous, and participatory process involving international scientists and stakeholders, a new exercise guideline was formulated for cardiometabolic health benefits. A previously published SCI guideline was endorsed for achieving fitness benefits. These guidelines represent an important step toward international harmonization of exercise guidelines for adults with SCI, and a foundation for developing exercise policies and programs for people with SCI around the world.
Collapse
Affiliation(s)
| | | | | | - Andy Barrow
- Paralympian and Inspirational Speaker, London, UK
| | | | | | | | | | - Sonja Gaudet
- Spinal Cord Injury British Columbia, Vancouver, Canada
| | | | | | | | | | | | | | | | | | | | - Pierre Pomerleau
- Institut de Réadaptation en Déficience Physique de Québec, Ville de Québec, Canada
| | | | | | | | | | | | - Dot Tussler
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK
| | | | - Dalton L Wolfe
- Parkwood Institute, Lawson Health Research Institute, London, Canada
| | | |
Collapse
|