1
|
Gorgey AS, Khalil RE, Carter W, Ballance B, Gill R, Khan R, Goetz L, Lavis T, Sima AP, Adler RA. Effects of two different paradigms of electrical stimulation exercise on cardio-metabolic risk factors after spinal cord injury. A randomized clinical trial. Front Neurol 2023; 14:1254760. [PMID: 37808500 PMCID: PMC10556465 DOI: 10.3389/fneur.2023.1254760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/30/2023] [Indexed: 10/10/2023] Open
Abstract
Objective To examine the combined effects of neuromuscular electrical stimulation-resistance training (NMES-RT) and functional electrical stimulation-lower extremity cycling (FES-LEC) compared to passive movement training (PMT) and FES-LEC in adults with SCI on (1) oxygen uptake (VO2), insulin sensitivity and glucose disposal in adults with SCI; (2) Metabolic and inflammatory biomarkers; (3) skeletal muscle, intramuscular fat (IMF) and visceral adipose tissue (VAT) cross-sectional areas (CSAs). Materials and methods Thirty-three participants with chronic SCI (AIS A-C) were randomized to 24 weeks of NMES-RT + FES or PMT + FES. The NMES-RT + FES group underwent 12 weeks of evoked surface NMES-RT using ankle weights followed by an additional 12 weeks of progressive FES-LEC. The control group, PMT + FES performed 12 weeks of passive leg extension movements followed by an additional 12 weeks of FES-LEC. Measurements were performed at baseline (BL; week 0), post-intervention 1 (P1; week 13) and post-intervention 2 (P2; week 25) and included FES-VO2 measurements, insulin sensitivity and glucose effectiveness using the intravenous glucose tolerance test; anthropometrics and whole and regional body composition assessment using dual energy x-ray absorptiometry (DXA) and magnetic resonance imaging to measure muscle, IMF and VAT CSAs. Results Twenty-seven participants completed both phases of the study. NMES-RT + FES group showed a trend of a greater VO2 peak in P1 [p = 0.08; but not in P2 (p = 0.25)] compared to PMT + FES. There was a time effect of both groups in leg VO2 peak. Neither intervention elicited significant changes in insulin, glucose, or inflammatory biomarkers. There were modest changes in leg lean mass following PMT + FES group. Robust hypertrophy of whole thigh muscle CSA, absolute thigh muscle CSA and knee extensor CSA were noted in the NMES-RT + FES group compared to PMT + FES at P1. PMT + FES resulted in muscle hypertrophy at P2. NMES-RT + FES resulted in a decrease in total VAT CSA at P1. Conclusion NMES-RT yielded a greater peak leg VO2 and decrease in total VAT compared to PMT. The addition of 12 weeks of FES-LEC in both groups modestly impacted leg VO2 peak. The addition of FES-LEC to NMES-RT did not yield additional increases in muscle CSA, suggesting a ceiling effect on signaling pathways following NMES-RT. Clinical trial registration identifier NCT02660073.
Collapse
Affiliation(s)
- Ashraf S. Gorgey
- Spinal Cord Injury and Disorders, Richmond VA Medical Center, Richmond, VA, United States
- Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University, Richmond, VA, United States
| | - Refka E. Khalil
- Spinal Cord Injury and Disorders, Richmond VA Medical Center, Richmond, VA, United States
| | - William Carter
- Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University, Richmond, VA, United States
| | - Boyd Ballance
- Spinal Cord Injury and Disorders, Richmond VA Medical Center, Richmond, VA, United States
| | - Ranjodh Gill
- Endocrinology Service, Richmond VA Medical Center, Richmond, VA, United States
- Endocrine Division, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Rehan Khan
- Radiology Service, Richmond VA Medical Center, Richmond, VA, United States
| | - Lance Goetz
- Spinal Cord Injury and Disorders, Richmond VA Medical Center, Richmond, VA, United States
- Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University, Richmond, VA, United States
| | - Timothy Lavis
- Spinal Cord Injury and Disorders, Richmond VA Medical Center, Richmond, VA, United States
- Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University, Richmond, VA, United States
| | - Adam P. Sima
- Department of Biostatistics, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Robert A. Adler
- Endocrinology Service, Richmond VA Medical Center, Richmond, VA, United States
- Endocrine Division, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| |
Collapse
|
2
|
Gorgey AS, Goldsmith JA, Khalil RE, Liu XH, Pan J, Cardozo C, Adler RA. Predictors of muscle hypertrophy responsiveness to electrically evoked resistance training after spinal cord injury. Eur J Appl Physiol 2023; 123:479-493. [PMID: 36305973 DOI: 10.1007/s00421-022-05069-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 10/08/2022] [Indexed: 11/03/2022]
Abstract
The purpose of the study was to identify potential predictors of muscle hypertrophy responsiveness following neuromuscular electrical stimulation resistance training (NMES-RT) in persons with chronic spinal cord injury (SCI). Data for twenty individuals with motor complete SCI who completed twice weekly NMES-RT lasting 12-16 weeks as part of their participation in one of two separate clinical trials were pooled and retrospectively analyzed. Magnetic resonance imaging (MRI) was used to measure muscle cross-sectional area (CSA) of the whole thigh and knee extensor muscle before and after NMES-RT. Muscle biopsies and fasting biomarkers were also measured. Following the completion of the respective NMES-RT trials, participants were classified into either high-responders (n = 8; muscle CSA > 20%) or low-responders (n = 12; muscle CSA < 20%) based on whole thigh muscle CSA hypertrophy. Whole thigh muscle and knee extensors CSAs were significantly greater (P < 0.0001) in high-responders (29 ± 7% and 47 ± 15%, respectively) compared to low-responders (12 ± 3% and 19 ± 6%, respectively). There were no differences in total caloric intake or macronutrient intake between groups. Extensor spasticity was lower in the high-responders compared to the low-responders as was the dosage of baclofen. Prior to the intervention, the high-responders had greater body mass compared to the low-responders with SCI (87.8 ± 13.7 vs. 70.4 ± 15.8 kg; P = 0.012), body mass index (BMI: 27.6 ± 2.7 vs. 22.9 ± 6.0 kg/m2; P = 0.04), as well as greater percentage in whole body and regional fat mass (P < 0.05). Furthermore, high-responders had a 69% greater increase (P = 0.086) in total Akt protein expression than low-responders. High-responders also exhibited reduced circulating IGF-1 with a concomitant increase in IGFBP-3. Exploratory analyses revealed upregulation of mRNAs for muscle hypertrophy markers [IRS-1, Akt, mTOR] and downregulation of protein degradation markers [myostatin, MurF-1, and PDK4] in the high-responders compared to low-responders. The findings indicate that body composition, spasticity, baclofen usage, and multiple signaling pathways (anabolic and catabolic) are involved in the differential muscle hypertrophy response to NMES-RT in persons with chronic SCI.
Collapse
Affiliation(s)
- Ashraf S Gorgey
- Spinal Cord Injury and Disorders Service, Central Virginia VA Health Care System, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA.
- Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA.
| | - Jacob A Goldsmith
- Spinal Cord Injury and Disorders Service, Central Virginia VA Health Care System, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - Refka E Khalil
- Spinal Cord Injury and Disorders Service, Central Virginia VA Health Care System, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - Xin-Hua Liu
- National Center for the Medical Consequences of Spinal Cord Injury and Medical and Surgical Service, James J Peters VA Medical Center, Bronx, NY, USA
- Department of Medicine, Icahn School of Medicine, New York, NY, USA
| | - Jiangping Pan
- National Center for the Medical Consequences of Spinal Cord Injury and Medical and Surgical Service, James J Peters VA Medical Center, Bronx, NY, USA
- Department of Medicine, Icahn School of Medicine, New York, NY, USA
| | - Christopher Cardozo
- National Center for the Medical Consequences of Spinal Cord Injury and Medical and Surgical Service, James J Peters VA Medical Center, Bronx, NY, USA
- Department of Medicine, Icahn School of Medicine, New York, NY, USA
| | - Robert A Adler
- Endocrinology Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
- Endocrine Division, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| |
Collapse
|
3
|
Gorgey AS, Graham ZA, Chen Q, Rivers J, Adler RA, Lesnefsky EJ, Cardozo CP. Sixteen weeks of testosterone with or without evoked resistance training on protein expression, fiber hypertrophy and mitochondrial health after spinal cord injury. J Appl Physiol (1985) 2020; 128:1487-1496. [PMID: 32352341 DOI: 10.1152/japplphysiol.00865.2019] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
We investigated the effects of testosterone replacement therapy (TRT) with and without evoked resistance training (RT) on protein expression of key metabolic and hypertrophy regulators, muscle fiber cross-sectional area (CSA), and markers of mitochondrial health after spinal cord injury (SCI). Twenty-two men with chronic motor complete SCI were randomly assigned to either TRT + RT (n = 11) or TRT (n = 11) for 16 wk. TRT + RT men underwent twice weekly progressive RT using electrical stimulation with ankle weights. TRT was administered via testosterone patches (2-6 mg/day). Muscle biopsies were obtained before and after 16 wk from the right vastus lateralis. Expression of proteins associated with oxidative muscles and mechanical loading (PGC-1α and FAK), muscle hypertrophy (total and phosphorylated Akt, total and phosphorylated mTOR), and cellular metabolism (total and phosphorylated AMPK and GLUT4) were evaluated. Immunohistochemistry analysis was performed to measure fiber CSA and succinate dehydrogenase (SDH) activity as well as mitochondrial citrate synthase (CS) activity and complex III (CIII) activities. TRT + RT demonstrated a robust 27.5% increase in average fiber CSA compared with a -9% decrease following TRT only (P = 0.01). GLUT4 protein expression was elevated in the TRT + RT group compared with TRT only (P = 0.005). Total Akt (P = 0.06) and phosphorylated Akt Ser389 (P = 0.049) were also elevated in the TRT + RT group. Mitochondrial activity of SDH (P = 0.03) and CS (P = 0.006) increased in the TRT + RT group, with no changes in the TRT-only group. Sixteen weeks of TRT with RT resulted in fiber hypertrophy and beneficial changes in markers of skeletal muscle health and function.NEW & NOTEWORTHY Fiber cross-sectional area (CSA), protein expression, mitochondrial citrate synthase (CS), and succinate dehydrogenase (SDH) were measured following 16 wk of low-dose testosterone replacement therapy (TRT) with and without electrically evoked resistance training (RT) in men with spinal cord injury (SCI). Fiber CSA and protein expression of total GLUT4, total Akt, and phosphorylated Akt increased following TRT + RT but not in the TRT-only group. Mitochondrial CS and SDH increased after TRT + RT but not in TRT-only group.
Collapse
Affiliation(s)
- Ashraf S Gorgey
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia.,Virginia Commonwealth University, Department of Physical Medicine and Rehabilitation, Richmond, Virginia
| | - Zachary A Graham
- Birmingham Veterans Affairs Medical Center, Birmingham, Alabama.,Department of Cell, Developmental, and Integrative Biology, University of Alabama-Birmingham, Birmingham, Alabama
| | - Qun Chen
- Medical Service, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia.,Division of Cardiology, Department of Internal Medicine, Pauley Heart Center Virginia Commonwealth University, Richmond, Virginia
| | - Jeannie Rivers
- Surgery Service, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia
| | - Robert A Adler
- Endocrinology Service, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia.,Endocrine Division, Virginia Commonwealth University School of Medicine¸ Richmond, Virginia
| | - Edward J Lesnefsky
- Medical Service, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia.,Division of Cardiology, Department of Internal Medicine, Pauley Heart Center Virginia Commonwealth University, Richmond, Virginia
| | - Christopher P Cardozo
- Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, New York.,Icahn School of Medicine at Mt. Sinai, New York, New York
| |
Collapse
|
4
|
Holman ME, Gorgey AS. Testosterone and Resistance Training Improve Muscle Quality in Spinal Cord Injury. Med Sci Sports Exerc 2020; 51:1591-1598. [PMID: 30845047 DOI: 10.1249/mss.0000000000001975] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Spinal cord injury (SCI) negatively impacts muscle quality and testosterone levels. Resistance training (RT) has been shown to increase muscle cross-sectional area (CSA) after SCI, whereas testosterone replacement therapy (TRT) has been shown to improve muscle quality in other populations. The purpose of this pilot study was to examine if the combined effects of these interventions, TRT + RT, may maximize the beneficial effects on muscle quality after SCI. METHODS Twenty-two SCI subjects randomized into either a TRT + RT (n = 11) or TRT (n = 11) intervention for 16 wk. Muscle quality measured by peak torque (PT) at speeds of 0°·s (PT-0°), 60°·s (PT-60°), 90°·s (PT-90°), and 180°·s (PT-180°), knee extensor CSA, specific tension, and contractile speed (rise time [RTi], and half-time to relaxation [½TiR]) was assessed for each limb at baseline and postintervention using 2 × 2 mixed models. RESULTS After 16 wk, subjects in the TRT + RT group increased PT-0° (48.4%, P = 0.017), knee extensor CSA (30.8%, P < 0.0001), and RTi (17.7%, P = 0.012); with no significant changes observed in the TRT group. Regardless of the intervention, changes to PT-60° (28.4%, P = 0.020), PT-90° (26.1%, P = 0.055), and PT-180° (20.6%, P = 0.09) for each group were similar. CONCLUSIONS The addition of mechanical stress via RT to TRT maximizes improvements to muscle quality after complete SCI when compared with TRT administered alone. Our evidence shows that this intervention increases muscle size and strength while also improving muscle contractile properties.
Collapse
Affiliation(s)
- Matthew E Holman
- Spinal Cord Injury and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, VA
| | | |
Collapse
|
5
|
Gorgey AS, Witt O, O’Brien L, Cardozo C, Chen Q, Lesnefsky EJ, Graham ZA. Mitochondrial health and muscle plasticity after spinal cord injury. Eur J Appl Physiol 2018; 119:315-331. [DOI: 10.1007/s00421-018-4039-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 11/22/2018] [Indexed: 01/15/2023]
|
6
|
Otzel DM, Lee J, Ye F, Borst SE, Yarrow JF. Activity-Based Physical Rehabilitation with Adjuvant Testosterone to Promote Neuromuscular Recovery after Spinal Cord Injury. Int J Mol Sci 2018; 19:ijms19061701. [PMID: 29880749 PMCID: PMC6032131 DOI: 10.3390/ijms19061701] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 05/31/2018] [Accepted: 06/01/2018] [Indexed: 12/22/2022] Open
Abstract
Neuromuscular impairment and reduced musculoskeletal integrity are hallmarks of spinal cord injury (SCI) that hinder locomotor recovery. These impairments are precipitated by the neurological insult and resulting disuse, which has stimulated interest in activity-based physical rehabilitation therapies (ABTs) that promote neuromuscular plasticity after SCI. However, ABT efficacy declines as SCI severity increases. Additionally, many men with SCI exhibit low testosterone, which may exacerbate neuromusculoskeletal impairment. Incorporating testosterone adjuvant to ABTs may improve musculoskeletal recovery and neuroplasticity because androgens attenuate muscle loss and the slow-to-fast muscle fiber-type transition after SCI, in a manner independent from mechanical strain, and promote motoneuron survival. These neuromusculoskeletal benefits are promising, although testosterone alone produces only limited functional improvement in rodent SCI models. In this review, we discuss the (1) molecular deficits underlying muscle loss after SCI; (2) independent influences of testosterone and locomotor training on neuromuscular function and musculoskeletal integrity post-SCI; (3) hormonal and molecular mechanisms underlying the therapeutic efficacy of these strategies; and (4) evidence supporting a multimodal strategy involving ABT with adjuvant testosterone, as a potential means to promote more comprehensive neuromusculoskeletal recovery than either strategy alone.
Collapse
Affiliation(s)
- Dana M Otzel
- Brain Rehabilitation Research Center, Malcom Randall Veterans Affairs Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL 32608, USA.
| | - Jimmy Lee
- Research Service, Malcom Randall Veterans Affairs Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL 32608, USA.
| | - Fan Ye
- Research Service, Malcom Randall Veterans Affairs Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL 32608, USA.
| | - Stephen E Borst
- Department of Applied Physiology, Kinesiology and University of Florida College of Health and Human Performance, Gainesville, FL 32603, USA.
| | - Joshua F Yarrow
- Research Service, Malcom Randall Veterans Affairs Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL 32608, USA.
- Division of Endocrinology, Diabetes and Metabolism, University of Florida College of Medicine, Gainesville, FL 32610, USA.
| |
Collapse
|
7
|
Yarar-Fisher C, Polston KFL, Eraslan M, Henley KY, Kinikli GI, Bickel CS, Windham ST, McLain AB, Oster RA, Bamman MM. Paralytic and nonparalytic muscle adaptations to exercise training versus high-protein diet in individuals with long-standing spinal cord injury. J Appl Physiol (1985) 2018; 125:64-72. [PMID: 29494292 DOI: 10.1152/japplphysiol.01029.2017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
This study compares the effects of an 8-wk isocaloric high-protein (HP) diet versus a combination exercise (Comb-Ex) regimen on paralytic vastus lateralis (VL) and nonparalytic deltoid muscle in individuals with long-standing spinal cord injury (SCI). Fiber-type distribution, cross-sectional area (CSA), levels of translation initiation signaling proteins (Erk-1/2, Akt, p70S6K1, 4EBP1, RPS6, and FAK), and lean thigh mass were analyzed at baseline and after the 8-wk interventions. A total of 11 participants (C5-T12 levels, 21.8 ± 6.3 yr postinjury; 6 Comb-Ex and 5 HP diet) completed the study. Comb-Ex training occurred 3 days/wk and consisted of upper body resistance training (RT) in addition to neuromuscular electrical stimulation (NMES)-induced-RT for paralytic VL muscle. Strength training was combined with high-intensity arm-cranking exercises (1-min intervals at 85-90%, V̇o2peak) for improving cardiovascular endurance. For the HP diet intervention, protein and fat each comprised 30%, and carbohydrate comprised 40% of total energy. Clinical tests and muscle biopsies were performed 24 h before and after the last exercise or diet session. The Comb-Ex intervention increased Type IIa myofiber distribution and CSA in VL muscle and Type I and IIa myofiber CSA in deltoid muscle. In addition, Comb-Ex increased lean thigh mass, V̇o2peak, and upper body strength ( P < 0.05). These results suggest that exercise training is required to promote favorable changes in paralytic and nonparalytic muscles in individuals with long-standing SCI, and adequate dietary protein consumption alone may not be sufficient to ameliorate debilitating effects of paralysis. NEW & NOTEWORTHY This study is the first to directly compare the effects of an isocaloric high-protein diet and combination exercise training on clinical and molecular changes in paralytic and nonparalytic muscles of individuals with long-standing spinal cord injury. Our results demonstrated that muscle growth and fiber-type alterations can best be achieved when the paralyzed muscle is sufficiently loaded via neuromuscular electrical stimulation-induced resistance training.
Collapse
Affiliation(s)
- Ceren Yarar-Fisher
- Physical Medicine and Rehabilitation, University of Alabama at Birmingham , Birmingham, Alabama.,University of Alabama at Birmingham Center for Exercise Medicine, University of Alabama at Birmingham , Birmingham, Alabama
| | - Keith F L Polston
- University of Tennessee Health Science Center College of Medicine , Memphis, Tennessee
| | - Mualla Eraslan
- Physical Medicine and Rehabilitation, University of Alabama at Birmingham , Birmingham, Alabama
| | - Kathryn Y Henley
- Physical Medicine and Rehabilitation, University of Alabama at Birmingham , Birmingham, Alabama
| | - Gizem I Kinikli
- Physical Therapy and Rehabilitation, Hacettepe University , Ankara , Turkey
| | - C Scott Bickel
- Physical Therapy and Rehabilitation, Samford University , Birmingham, Alabama
| | - Samuel T Windham
- Department of Surgery, University of Alabama at Birmingham , Birmingham, Alabama.,University of Alabama at Birmingham Center for Exercise Medicine, University of Alabama at Birmingham , Birmingham, Alabama
| | - Amie B McLain
- Physical Medicine and Rehabilitation, University of Alabama at Birmingham , Birmingham, Alabama.,University of Alabama at Birmingham Center for Exercise Medicine, University of Alabama at Birmingham , Birmingham, Alabama
| | - Robert A Oster
- Department of Medicine/Division of Preventive Medicine, University of Alabama at Birmingham , Birmingham, Alabama
| | - Marcas M Bamman
- Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham , Birmingham, Alabama.,University of Alabama at Birmingham Center for Exercise Medicine, University of Alabama at Birmingham , Birmingham, Alabama.,Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center , Birmingham, Alabama
| |
Collapse
|
8
|
Gorgey AS, Khalil RE, Lester RM, Dudley GA, Gater DR. Paradigms of Lower Extremity Electrical Stimulation Training After Spinal Cord Injury. J Vis Exp 2018:57000. [PMID: 29443103 PMCID: PMC5912427 DOI: 10.3791/57000] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Skeletal muscle atrophy, increased adiposity and reduced physical activity are key changes observed after spinal cord injury (SCI) and are associated with numerous cardiometabolic health consequences. These changes are likely to increase the risk of developing chronic secondary conditions and impact the quality of life in persons with SCI. Surface neuromuscular electrical stimulation evoked resistance training (NMES-RT) was developed as a strategy to attenuate the process of skeletal muscle atrophy, decrease ectopic adiposity, improve insulin sensitivity and enhance mitochondrial capacity. However, NMES-RT is limited to only a single muscle group. Involving multiple muscle groups of the lower extremities may maximize the health benefits of training. Functional electrical stimulation-lower extremity cycling (FES-LEC) allows for the activation of 6 muscle groups, which is likely to evoke greater metabolic and cardiovascular adaptation. Appropriate knowledge of the stimulation parameters is key to maximizing the outcomes of electrical stimulation training in persons with SCI. Adopting strategies for long-term use of NMES-RT and FES-LEC during rehabilitation may maintain the integrity of the musculoskeletal system, a pre-requisite for clinical trials aiming to restore walking after injury. The current manuscript presents a combined protocol using NMES-RT prior to FES-LEC. We hypothesize that muscles conditioned for 12 weeks prior to cycling will be capable of generating greater power, cycle against higher resistance and result in greater adaptation in persons with SCI.
Collapse
Affiliation(s)
- Ashraf S Gorgey
- Spinal Cord Injury and Disorders Service, Hunter Holmes McGuire VAMC; Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University;
| | - Refka E Khalil
- Spinal Cord Injury and Disorders Service, Hunter Holmes McGuire VAMC
| | - Robert M Lester
- Spinal Cord Injury and Disorders Service, Hunter Holmes McGuire VAMC
| | - Gary A Dudley
- Deceased, Department of Kinesiology, The University of Georgia
| | - David R Gater
- Department of Physical Medicine and Rehabilitation, Penn State Milton S. Hershey Medical Center
| |
Collapse
|
9
|
Milanese C, Cavedon V, Sandri M, Tam E, Piscitelli F, Boschi F, Zancanaro C. Metabolic effect of bodyweight whole-body vibration in a 20-min exercise session: A crossover study using verified vibration stimulus. PLoS One 2018; 13:e0192046. [PMID: 29385196 PMCID: PMC5792008 DOI: 10.1371/journal.pone.0192046] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 01/16/2018] [Indexed: 01/19/2023] Open
Abstract
The ability of whole body vibration (WBV) to increase energy expenditure (EE) has been investigated to some extent in the past using short-term single exercises or sets of single exercises. However, the current practice in WBV training for fitness is based on the execution of multiple exercises during a WBV training session for a period of at least 20 min; nevertheless, very limited and inconsistent data are available on EE during long term WBV training session. This crossover study was designed to demonstrate, in an adequately powered sample of participants, the ability of WBV to increase the metabolic cost of exercise vs. no vibration over the time span of a typical WBV session for fitness (20 min). Twenty-two physically active young males exercised on a vibration platform (three identical sets of six different exercises) using an accelerometer-verified vibration stimulus in both the WBV and no vibration condition. Oxygen consumption was measured with indirect calorimetry and expressed as area under the curve (O2(AUC)). Results showed that, in the overall 20-min training session, WBV increased both the O2(AUC) and the estimated EE vs. no vibration by about 22% and 20%, respectively (P<0.001 for both, partial eta squared [η2] ≥0.35) as well as the metabolic equivalent of task (+5.5%, P = 0.043; η2 = 0.02) and the rate of perceived exertion (+13%, P<0.001; ŋ2 = 0.16). Results demonstrated that vibration is able to significantly increase the metabolic cost of exercise in a 20-min WBV training session.
Collapse
Affiliation(s)
- Chiara Milanese
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- * E-mail:
| | - Valentina Cavedon
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Marco Sandri
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Enrico Tam
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesco Piscitelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Federico Boschi
- Department of Computer Science, University of Verona, Verona, Italy
| | - Carlo Zancanaro
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| |
Collapse
|
10
|
Gorgey AS, Graham ZA, Bauman WA, Cardozo C, Gater DR. Abundance in proteins expressed after functional electrical stimulation cycling or arm cycling ergometry training in persons with chronic spinal cord injury. J Spinal Cord Med 2017; 40:439-448. [PMID: 27735783 PMCID: PMC5537961 DOI: 10.1080/10790268.2016.1229397] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
STUDY DESIGN Longitudinal design. OBJECTIVES The study determined the effects of two forms of exercise training on the abundance of two proteins, (glucose transporter-4 [GLUT-4], adenosine monophosphate kinase [AMPK]) involved in glucose utilization and the transcriptional coactivator that regulates the genes involved in energy metabolism and mitochondrial biogenesis (peroxisome proliferator-activated receptor (PPAR) coactivator 1 alpha [PGC-1α]), in muscles in men with chronic motor-complete spinal cord injury (SCI). SETTINGS Clinical trial at a Medical Center. METHODS Nine men with chronic motor-complete SCI participated in functional electrical stimulation lower extremity cycling (FES-LEC; n = 4) or arm cycling ergometer (arm-cycling ergometer [ACE]; n = 5) 5 days/week for 16 weeks. Whole body composition was measured by dual energy X-ray absorptiometry. An intravenous glucose tolerance test was performed to measure glucose effectiveness (Sg) and insulin sensitivity (Si). Muscle biopsies of the right vastus lateralis (VL) and triceps muscles were collected one week prior to and post the exercise training intervention. RESULTS Neither training intervention altered body composition or carbohydrate metabolism. GLUT-4 increased by 3.8 fold in the VL after FES training and increased 0.6 fold in the triceps after ACE training. PGC-1α increased by 2.3 fold in the VL after FES training and 3.8 fold in the triceps after ACE training. AMPK increased by 3.4 fold in the VL after FES training and in the triceps after ACE training. CONCLUSION FES-LEC and ACE training were associated with greater protein expressions in the trained muscles by effectively influencing the abundance of GLUT-4, AMPK and PGC-1α. Thus, FES-LEC training of paralyzed muscle can modulate protein expression similar to that of trained and innervated muscle.
Collapse
Affiliation(s)
- Ashraf S. Gorgey
- Spinal Cord Injury Service and Disorders; Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA,Department of Physical Medicine and Rehabilitation; Virginia Commonwealth University, Richmond, VA, USA,Correspondence to: Ashraf S. Gorgey, Director of Spinal Cord Injury Research, Department of Veterans Affairs, Hunter Holmes McGuire Medical Center, Spinal Cord Injury & Disorders Service, 1201 Broad Rock Boulevard, Richmond, VA 23249.
| | - Zachary A. Graham
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, NY, USA,Icahn School of Medicine at Mt. Sinai, Medicine, New York City, NY, USA
| | - William A. Bauman
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, NY, USA,Icahn School of Medicine at Mt. Sinai, Medicine, New York City, NY, USA
| | - Christopher Cardozo
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, NY, USA,Icahn School of Medicine at Mt. Sinai, Medicine, New York City, NY, USA
| | - David R. Gater
- Department of Physical Medicine and Rehabilitation, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| |
Collapse
|
11
|
Begue G, Raue U, Jemiolo B, Trappe S. DNA methylation assessment from human slow- and fast-twitch skeletal muscle fibers. J Appl Physiol (1985) 2017; 122:952-967. [PMID: 28057818 DOI: 10.1152/japplphysiol.00867.2016] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 12/07/2016] [Accepted: 12/30/2016] [Indexed: 11/22/2022] Open
Abstract
A new application of the reduced representation bisulfite sequencing method was developed using low-DNA input to investigate the epigenetic profile of human slow- and fast-twitch skeletal muscle fibers. Successful library construction was completed with as little as 15 ng of DNA, and high-quality sequencing data were obtained with 32 ng of DNA. Analysis identified 143,160 differentially methylated CpG sites across 14,046 genes. In both fiber types, selected genes predominantly expressed in slow or fast fibers were hypomethylated, which was supported by the RNA-sequencing analysis. These are the first fiber type-specific methylation data from human skeletal muscle and provide a unique platform for future research.NEW & NOTEWORTHY This study validates a low-DNA input reduced representation bisulfite sequencing method for human muscle biopsy samples to investigate the methylation patterns at a fiber type-specific level. These are the first fiber type-specific methylation data reported from human skeletal muscle and thus provide initial insight into basal state differences in myosin heavy chain I and IIa muscle fibers among young, healthy men.
Collapse
Affiliation(s)
- Gwénaëlle Begue
- Human Performance Laboratory, Ball State University, Muncie, Indiana
| | - Ulrika Raue
- Human Performance Laboratory, Ball State University, Muncie, Indiana
| | - Bozena Jemiolo
- Human Performance Laboratory, Ball State University, Muncie, Indiana
| | - Scott Trappe
- Human Performance Laboratory, Ball State University, Muncie, Indiana
| |
Collapse
|
12
|
Yarar-Fisher C, Bickel CS, Kelly NA, Stec MJ, Windham ST, McLain AB, Oster RA, Bamman MM. Heightened TWEAK-NF-κB signaling and inflammation-associated fibrosis in paralyzed muscles of men with chronic spinal cord injury. Am J Physiol Endocrinol Metab 2016; 310:E754-61. [PMID: 26931128 PMCID: PMC4888537 DOI: 10.1152/ajpendo.00240.2015] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 02/18/2016] [Indexed: 12/17/2022]
Abstract
Individuals with long-standing spinal cord injury (SCI) often present with extreme muscle atrophy and impaired glucose metabolism at both the skeletal muscle and whole body level. Persistent inflammation and increased levels of proinflammatory cytokines in the skeletal muscle are potential contributors to dysregulation of glucose metabolism and atrophy; however, to date no study has assessed the effects of long-standing SCI on their expression or intracellular signaling in the paralyzed muscle. In the present study, we assessed the expression of genes (TNFαR, TNFα, IL-6R, IL-6, TWEAK, TWEAK R, atrogin-1, and MuRF1) and abundance of intracellular signaling proteins (TWEAK, TWEAK R, NF-κB, and p-p65/p-50/105) that are known to mediate inflammation and atrophy in skeletal muscle. In addition, based on the effects of muscle inflammation on promotion of skeletal muscle fibrosis, we assessed the degree of fibrosis between myofibers and fascicles in both groups. For further insight into the distribution and variability of muscle fiber size, we also analyzed the frequency distribution of SCI fiber size. Resting vastus lateralis (VL) muscle biopsy samples were taken from 11 men with long-standing SCI (≈22 yr) and compared with VL samples from 11 able-bodied men of similar age. Our results demonstrated that chronic SCI muscle has heightened TNFαR and TWEAK R gene expression and NF-κB signaling (higher TWEAK R and phospho-NF-κB p65) and fibrosis, along with substantial myofiber size heterogeneity, compared with able-bodied individuals. Our data suggest that the TWEAK/TWEAK R/NF-κB signaling pathway may be an important mediator of chronic inflammation and fibrotic adaptation in SCI muscle.
Collapse
Affiliation(s)
- Ceren Yarar-Fisher
- Department of Physical Medicine and Rehabilitation, UAB Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, Alabama; and
| | - C Scott Bickel
- Physical Therapy, UAB Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, Alabama; and
| | - Neil A Kelly
- Departments of Cell, Developmental, and Integrative Biology, UAB Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, Alabama; and
| | - Michael J Stec
- Departments of Cell, Developmental, and Integrative Biology, UAB Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, Alabama; and
| | - Samuel T Windham
- Surgery, and UAB Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, Alabama; and
| | - Amie B McLain
- Department of Physical Medicine and Rehabilitation, UAB Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, Alabama; and
| | - Robert A Oster
- Medicine/Division of Preventive Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Marcas M Bamman
- Departments of Cell, Developmental, and Integrative Biology, Medicine/Division of Preventive Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama; Geriatric Research, Education, and Clinical Center, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
| |
Collapse
|
13
|
Graham ZA, Qin W, Harlow LC, Ross NH, Bauman WA, Gallagher PM, Cardozo CP. Focal adhesion kinase signaling is decreased 56 days following spinal cord injury in rat gastrocnemius. Spinal Cord 2015; 54:502-9. [PMID: 26481700 DOI: 10.1038/sc.2015.183] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 08/21/2015] [Accepted: 09/03/2015] [Indexed: 12/25/2022]
Abstract
STUDY DESIGN Descriptive study. OBJECTIVES The goal of this study was to determine the effects of spinal cord injury (SCI) on aspects of the focal adhesion kinase (FAK) signaling pathway 56 days post injury in rat gastrocnemius. SETTING This study was conducted in Bronx, NY, USA. METHODS Three-month-old male Wistar rats were exposed to either a sham surgery (n=10) or complete T4 spinal cord transection (n=10). Rats were killed 56 days following surgery and the muscle was collected. Following homogenization, proteins of the FAK pathway were analyzed by western immunoblotting or reverse transcription-qPCR. In addition, cellular markers for proteins that target the degradation of FAK were investigated. RESULTS SCI resulted in significantly lower levels of total and phosphorylated FAK, cSrc and p70S6k, and a trend for increased FRNK protein expression. SCI did not change levels of the α7 or β1 integrin subunits, total or phosphorylated ERK1/2, phosphorylated Akt and TSC2 or total p70S6k. SCI resulted in a greater expression of total Akt. mRNA expression of FAK and the α7 or β1 integrins remained unchanged between sham and SCI groups. Caspase-3/7 activity and Trim72 mRNA and protein expression remained unchanged following SCI. CONCLUSION SCI results in diminished FAK signaling and is independent of ERK1/2 and Akt. SCI has no effect on mRNA levels for genes encoding components of the focal adhesion 56 days after injury.
Collapse
Affiliation(s)
- Z A Graham
- James J. Peters Veterans Affairs Medical Center, National Center of Excellence for the Medical Consequences of Spinal Cord Injury, Bronx, NY, USA.,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - W Qin
- James J. Peters Veterans Affairs Medical Center, National Center of Excellence for the Medical Consequences of Spinal Cord Injury, Bronx, NY, USA.,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - L C Harlow
- James J. Peters Veterans Affairs Medical Center, National Center of Excellence for the Medical Consequences of Spinal Cord Injury, Bronx, NY, USA
| | - N H Ross
- James J. Peters Veterans Affairs Medical Center, National Center of Excellence for the Medical Consequences of Spinal Cord Injury, Bronx, NY, USA
| | - W A Bauman
- James J. Peters Veterans Affairs Medical Center, National Center of Excellence for the Medical Consequences of Spinal Cord Injury, Bronx, NY, USA.,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - P M Gallagher
- Applied Physiology Laboratory, University of Kansas, Lawrence, KS, USA
| | - C P Cardozo
- James J. Peters Veterans Affairs Medical Center, National Center of Excellence for the Medical Consequences of Spinal Cord Injury, Bronx, NY, USA.,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Pharmacology and Systems Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
14
|
Graham ZA, Gallagher PM, Cardozo CP. Focal adhesion kinase and its role in skeletal muscle. J Muscle Res Cell Motil 2015; 36:305-15. [PMID: 26142360 PMCID: PMC4659753 DOI: 10.1007/s10974-015-9415-3] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 06/15/2015] [Indexed: 10/23/2022]
Abstract
Skeletal muscle has a remarkable ability to respond to different physical stresses. Loading muscle through exercise, either anaerobic or aerobic, can lead to increases in muscle size and function while, conversely, the absence of muscle loading stimulates rapid decreases in size and function. A principal mediator of this load-induced change is focal adhesion kinase (FAK), a downstream non-receptor tyrosine kinase that translates the cytoskeletal stress and strain signals transmitted across the cytoplasmic membrane by integrins to activate multiple anti-apoptotic and cell growth pathways. Changes in FAK expression and phosphorylation have been found to correlate to specific developmental states in myoblast differentiation, muscle fiber formation and muscle size in response to loading and unloading. With the capability to regulate costamere formation, hypertrophy and glucose metabolism, FAK is a molecule with diverse functions that are important in regulating muscle cell health.
Collapse
Affiliation(s)
- Zachary A Graham
- Center of Excellence for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, 130 W. Kingsbridge Rd., Bronx, NY, 10468, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Christopher P Cardozo
- Center of Excellence for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, 130 W. Kingsbridge Rd., Bronx, NY, 10468, USA.
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Pharmacology and Systems Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| |
Collapse
|