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Craven BC, Souza WH, Jaglal S, Gibbs J, Wiest MJ, Sweet SN, Athanasopoulos P, Lamontagne ME, Boag L, Patsakos E, Wolfe D, Hicks A, Maltais DB, Best KL, Gagnon D. Reducing endocrine metabolic disease risk in adults with chronic spinal cord injury: strategic activities conducted by the Ontario-Quebec RIISC team. Disabil Rehabil 2024; 46:4835-4847. [PMID: 38018518 DOI: 10.1080/09638288.2023.2284223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 09/17/2023] [Accepted: 11/10/2023] [Indexed: 11/30/2023]
Abstract
PURPOSE The Rehabilitation Interventions for Individuals with a Spinal Cord Injury in the Community (RIISC) team aimed to develop and evaluate innovative rehabilitation interventions to identify endocrine metabolic disease (EMD) risk, intending to reduce the frequency and severity of EMD related morbidity and mortality among adults living with chronic spinal cord injury or disease (SCI/D). MATERIALS AND METHODS An interprovincial team from Ontario and Quebec reviewed available EMD literature and evidence syntheses and completed an inventory of health services, policies and practices in SCI/D care. The review outcomes were combined with expert opinion to create an EMD risk model to inform health service transformation. RESULTS EMD risk and mortality are highly prevalent among adults with chronic SCI/D. In stark contrast, few rehabilitation interventions target EMD outcomes. The modelled solution proposes: 1) abandoning single-disease paradigms and examining a holistic perspective of the individual's EMD risk, and 2) developing and disseminating practice-based research approaches in outpatient community settings. CONCLUSIONS RIISC model adoption could accelerate EMD care optimization, and ultimately inform the design of large-scale longitudinal pragmatic trials likely to improve health outcomes. Linking the RIISC team activities to economic evaluations and policy deliverables will strengthen the relevance and impact among policymakers, health care providers and patients.
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Affiliation(s)
- Beverley Catharine Craven
- Toronto Rehabilitation Institute, Lyndhurst Centre, University Health Network, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Wagner Henrique Souza
- Kite Research Institute, University Health Network, Lyndhurst Centre, Toronto, Canada
| | - Susan Jaglal
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Jenna Gibbs
- Department of Kinesiology and Physical Education, McGill University, Montreal, Canada
| | | | - Shane N Sweet
- Department of Kinesiology & Physical Education, McGill University, Montreal, Canada
| | - Peter Athanasopoulos
- Senior Manager Public Policy and Government Relations, Spinal Cord Injury Ontario, Toronto, Canada
| | | | - Lynn Boag
- University of Guelph, Guelph, Canada
| | - Eleni Patsakos
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Dalton Wolfe
- Department of Physical Medicine and Rehabilitation, Western University, Parkwood Institute Research, London, Canada
| | - Audrey Hicks
- Department of Kinesiology, McMaster University, Hamilton, Canada
| | - Désirée B Maltais
- Department of Rehabilitation, Physiotherapy Program, Laval University, Quebec City, Canada
| | - Krista Lynn Best
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Dany Gagnon
- School of Rehabilitation, Université de Montréal, Montréal, Canada
- Centre for Interdisciplinary Research in Rehabilitation, Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal (IURDPM), Montréal, Canada
- Rehabilitation, Université de Montréal, École de Réadaptation, Montréal, Canada
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Pelletier C. Exercise prescription for persons with spinal cord injury: a review of physiological considerations and evidence-based guidelines. Appl Physiol Nutr Metab 2023; 48:882-895. [PMID: 37816259 DOI: 10.1139/apnm-2023-0227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
Persons with spinal cord injury (SCI) experience gains in fitness, physical and mental health from regular participation in exercise and physical activity. Due to changes in physiological function of the cardiovascular, nervous, and muscular systems, general population physical activity guidelines and traditional exercise prescription methods are not appropriate for the SCI population. Exercise guidelines specific to persons with SCI recommend progressive training beginning at 20 min of moderate to vigorous intensity aerobic exercise twice per week transitioning to 30 min three times per week, with strength training of the major muscle groups two times per week. These population-specific guidelines were designed considering the substantial barriers to physical activity for persons with SCI and can be used to frame an individual exercise prescription. Rating of perceived exertion (i.e., perceptually regulated exercise) is a practical way to indicate moderate to vigorous intensity exercise in community settings. Adapted exercise modes include arm cycle ergometry, hybrid arm-leg cycling, and recumbent elliptical equipment. Body weight-supported treadmill training and other rehabilitation modalities may improve some aspects of health and fitness for people with SCI if completed at sufficient intensity. Disability-specific community programs offer beneficial opportunities for persons with SCI to experience quality exercise opportunities but are not universally available.
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Affiliation(s)
- Chelsea Pelletier
- School of Health Sciences, Faculty of Human and Health Sciences, University of Northern British Columbia, Prince George, BC, Canada
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Peters J, Halloran K, Focht M, Huang K, Kersh M, Rice I. Cardiorespiratory Responses to an Acute Bout of High Intensity Interval Training and Moderate Intensity Continuous Training on a Recumbent Handcycle in People With Spinal Cord Injury: A Within-Subject Design. Top Spinal Cord Inj Rehabil 2023; 29:16-26. [PMID: 38076492 PMCID: PMC10704215 DOI: 10.46292/sci23-00026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Objectives To compare acute cardiorespiratory responses during high intensity interval training (HIIT) and moderate intensity continuous training (MICT) on a recumbent handcycle in persons with spinal cord injury (PwSCI). Methods Eleven males and nine females with chronic SCI (T3 - L5), aged 23 (9) years, participated in this within-subject design. Based off peak power outputs from an incremental test to exhaustion, participants engaged in a HIIT and MICT session at matched workloads on a recumbent handcycle. Workloads (Joules), time, oxygen uptake (VO2), metabolic equivalent of task (MET), heart rate (HR), and energy expenditure (kcal) were recorded during HIIT and MICT. Results Total workload was similar across HIIT (87820 ± 24021 Joules) and MICT sessions (89044 ± 23696 Joules; p > .05). HIIT (20.00 [.03] minutes) was shorter in duration than MICT (23.20 [2.56]; p < .01). Average VO2 (20.96 ± 4.84 vs. 129.38 ± 19.13 mL/kg/min O2), MET (7.54 ± 2.00 vs. 6.21 ± 1.25), and HR (146.26 ± 13.80 vs. 129.38 ± 19.13 beats per minute) responses were significantly greater during HIIT than MICT (p < .01). Participants burned significantly more kilocalories during HIIT (128.08 ± 35.65) than MICT (118.93 ± 29.58; p < .01) and at a faster rate (6.40 ± 1.78 [HIIT] vs. 5.09 ± 1.14 [MICT] kcal/min; p < .01). Conclusion HIIT elicits greater increases in oxygen uptake and HR than MICT in PwSCI. In significantly less time, HIIT also burned more calories than MICT.
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Affiliation(s)
- Joseph Peters
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign
- The Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign
- Disability Resources and Educational Services, University of Illinois at Urbana-Champaign
| | - Kellie Halloran
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign
| | - Michael Focht
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign
| | - Kathryn Huang
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign
| | - Mariana Kersh
- The Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign
| | - Ian Rice
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign
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4
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Hutchinson MJ, Paulson TAW, Leicht CA, Bennett H, Eston R, Goosey-Tolfrey VL. Oxygen uptake and heart rate responses to 4 weeks of RPE-guided handcycle training. Eur J Appl Physiol 2023; 123:1965-1973. [PMID: 37119361 PMCID: PMC10460742 DOI: 10.1007/s00421-023-05210-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 04/17/2023] [Indexed: 05/01/2023]
Abstract
PURPOSE To investigate the efficacy of using Ratings of Perceived Exertion (RPE) to prescribe and regulate a 4-week handcycle training intervention. METHODS Thirty active adults, untrained in upper body endurance exercise, were divided into three groups to complete a 4-week intervention: (i) RPE-guided training (n = 10; 2 female), (ii) power output (PO)-guided (n = 10; 2 female) training, or (iii) non-training control (n = 10; 4 female). Training groups performed three sessions of handcycling each week. Oxygen uptake ([Formula: see text]), heart rate (HR), and Feeling Scale (FS) rating were collected during training sessions. RPE-guided training was performed at RPE 13. PO-guided training was matched for percentage of peak PO per session, based upon that achieved by the RPE-guided training group. RESULTS There were no differences in percentage of peak [Formula: see text] (66 ± 13% vs 61 ± 9%, p = 0.22), peak HR (75 ± 8% vs 71 ± 6%, p = 0.11) or FS rating (1.2 ± 1.9 vs 0.8 ± 1.6, p = 0.48) between RPE- and PO-guided training, respectively. The average coefficient of variation in percentage of peak HR between consecutive training sessions was 2.8% during RPE-guided training, and 3.4% during PO-guided training. CONCLUSION Moderate-vigorous intensity handcycling exercise can be prescribed effectively using RPE across a chronic training intervention, suggesting utility for practitioners in a variety of rehabilitation settings.
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Affiliation(s)
- Michael J Hutchinson
- British Paralympic Association, London, UK
- Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | | | - Christof A Leicht
- Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Hunter Bennett
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia.
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, Australia.
| | - Roger Eston
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, Australia
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Halloran KM, Peters J, Focht MDK, Rice I, Kersh ME. Propulsion kinetics of recumbent handcycling during high and moderate intensity exercise. J Biomech 2023; 156:111672. [PMID: 37336187 DOI: 10.1016/j.jbiomech.2023.111672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 05/25/2023] [Accepted: 06/02/2023] [Indexed: 06/21/2023]
Abstract
People with spinal cord injuries (PwSCI) are at high risk of developing cardiovascular disease (CVD). While regular exercise can reduce risk of CVD, PwSCI face various barriers to exercise, including high rates of upper limb injuries, especially in the shoulder. Handcycling high intensity interval training (HIIT), which consists of periods of high intensity exercise followed by rest, is a potential exercise solution, but the musculoskeletal safety of HIIT is still unknown. In this study, we characterized three-dimensional continuous applied forces at the handle during handcycling HIIT and moderate intensity continuous training (MICT). These applied forces can give an early indication of joint loading, and therefore injury risk, at the shoulder. In all three directions (tangential, radial, and lateral), the maximum applied forces during HIIT were larger than those in MICT at all timepoints, which may indicate higher contact forces and loads on the shoulder during HIIT compared to MICT. The tangential and radial forces peaked twice in a propulsion cycle, while the lateral forces peaked once. Throughout the exercises, the location of tangential peak 2 and radial peak 1 was later in HIIT compared to MICT. This difference in maximum force location could indicate either altered kinematics or muscular fatigue at the end of the exercise protocol. These changes in kinematics should be more closely examined using motion capture or other modeling techniques. If we combine this kinetic data with kinematic data during propulsion, we can create musculoskeletal models that more accurately predict contact forces and injury risk during handcycling HIIT in PwSCI.
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Affiliation(s)
- Kellie M Halloran
- Department of Mechanical Science and Engineering, University of Illinois Urbana-Champaign, USA
| | - Joseph Peters
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, USA
| | - Michael D K Focht
- Department of Mechanical Science and Engineering, University of Illinois Urbana-Champaign, USA
| | - Ian Rice
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, USA
| | - Mariana E Kersh
- Department of Mechanical Science and Engineering, University of Illinois Urbana-Champaign, USA; Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, USA; Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, USA.
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Liao F, Jan YK. Assessing skin blood flow function in people with spinal cord injury using the time domain, time–frequency domain and deep learning approaches. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2023.104790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
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7
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Hansen RK, Samani A, Laessoe U, Handberg A, Mellergaard M, Figlewski K, Thijssen DHJ, Gliemann L, Larsen RG. Rowing exercise increases cardiorespiratory fitness and brachial artery diameter but not traditional cardiometabolic risk factors in spinal cord-injured humans. Eur J Appl Physiol 2023; 123:1241-1255. [PMID: 36781425 PMCID: PMC9924870 DOI: 10.1007/s00421-023-05146-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 01/26/2023] [Indexed: 02/15/2023]
Abstract
PURPOSE This study assessed the effects of upper-body rowing exercise on cardiorespiratory fitness, traditional cardiometabolic risk factors, and vascular health in individuals with spinal cord injury (SCI). METHODS Seventeen male and female adults with chronic (> 1 yr) motor-complete and incomplete SCI (level of injury: C4-L3) were randomized to control (CON, n = 9) or exercise (UBROW, n = 8). Participants in UBROW performed 12-week, 3 weekly sessions of 30-min upper-body ergometer rowing exercise, complying with current exercise guidelines for SCI. Cardiorespiratory fitness ([Formula: see text]O2peak), traditional risk factors (lipid profile, glycemic control) as well as inflammatory and vascular endothelium-derived biomarkers (derived from fasting blood samples) were measured before and after 6 (6W) and 12 weeks (12W). Brachial artery resting diameter and flow-mediated dilation (FMD) were determined by ultrasound as exploratory outcomes. RESULTS UBROW increased [Formula: see text]O2peak from baseline (15.1 ± 5.1 mL/kg/min; mean ± SD) to 6W (16.5 ± 5.3; P < 0.01) and 12W (17.5 ± 6.1; P < 0.01). UBROW increased resting brachial artery diameter from baseline (4.80 ± 0.72 mm) to 12W (5.08 ± 0.91; P < 0.01), with no changes at 6W (4.96 ± 0.91), and no changes in CON. There were no significant time-by-group interactions in traditional cardiometabolic blood biomarkers, or in unadjusted or baseline diameter corrected FMD. Explorative analyses revealed inverse correlations between changes (∆12W-baseline) in endothelin-1 and changes in resting diameter (r = - 0.56) and FMD% (r = - 0.60), both P < 0.05. CONCLUSION These results demonstrate that 12 weeks of upper-body rowing complying with current exercise guidelines for SCI improves cardiorespiratory fitness and increases resting brachial artery diameter. In contrast, the exercise intervention had no or only modest effects on traditional cardiometabolic risk factors. The study was registered at Clinicaltrials.gov (N-20190053, May 15, 2020).
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Affiliation(s)
- Rasmus Kopp Hansen
- Department of Health Science and Technology, Sport Sciences - Performance and Technology, Aalborg University, Aalborg, Selma Lagerløfs Vej 249, 9260, Gistrup, Denmark.
- Department of Research and Development, University College of Northern Jutland, Aalborg, Denmark.
| | - Afshin Samani
- Department of Health Science and Technology, Sport Sciences - Performance and Technology, Aalborg University, Aalborg, Selma Lagerløfs Vej 249, 9260, Gistrup, Denmark
| | - Uffe Laessoe
- Department of Research and Development, University College of Northern Jutland, Aalborg, Denmark
| | - Aase Handberg
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Maiken Mellergaard
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Dick H J Thijssen
- Department of Medical BioSciences, Radboud University Medical Centre, Nijmegen, The Netherlands
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - Lasse Gliemann
- The August Krogh Section for Human Physiology, Department of Nutrition, Exercise and Sports, University Of Copenhagen, Copenhagen, Denmark
| | - Ryan Godsk Larsen
- Department of Health Science and Technology, Sport Sciences - Performance and Technology, Aalborg University, Aalborg, Selma Lagerløfs Vej 249, 9260, Gistrup, Denmark
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8
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Liao F, Zhao H, Lin CF, Chen P, Chen P, Onyemere K, Jan YK. Application of Multiscale Sample Entropy in Assessing Effects of Exercise Training on Skin Blood Flow Oscillations in People with Spinal Cord Injury. ENTROPY (BASEL, SWITZERLAND) 2023; 25:e25040690. [PMID: 37190478 PMCID: PMC10138099 DOI: 10.3390/e25040690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/27/2023] [Accepted: 04/14/2023] [Indexed: 05/17/2023]
Abstract
Spinal cord injury (SCI) causes a disruption of autonomic nervous regulation to the cardiovascular system, leading to various cardiovascular and microvascular diseases. Exercise training is an effective intervention for reducing risk for microvascular diseases in healthy people. However, the effectiveness of exercise training on improving microvascular function in people with SCI is largely unknown. The purpose of this study was to compare blood flow oscillations in people with spinal cord injury and different physical activity levels to determine if such a lifestyle might influence skin blood flow. A total of 37 participants were recruited for this study, including 12 athletes with SCI (ASCI), 9 participants with SCI and a sedentary lifestyle (SSCI), and 16 healthy able-bodied controls (AB). Sacral skin blood flow (SBF) in response to local heating at 42 °C for 50 min was measured using laser Doppler flowmetry. The degree of the regularity of blood flow oscillations (BFOs) was quantified using a multiscale entropy approach. The results showed that BFO was significantly more irregular in ASCI and AB compared to SSCI during the maximal vasodilation period. Our results also demonstrate that the difference in the regularity of BFOs between original SBF signal and phase-randomized surrogate time series was larger in ASCI and AB compared to SSCI. Our findings indicate that SCI causes a loss of complexity of BFOs and exercise training may improve complexity in people with SCI. This study demonstrates that multiscale entropy is a sensitive method for detecting differences between different categories of people with SCI and might be able to detect effects of exercise training related to skin blood flow.
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Affiliation(s)
- Fuyuan Liao
- Department of Biomedical Engineering, Xi'an Technological University, Xi'an 710021, China
| | - Hengyang Zhao
- School of Electronic Information Engineering, Xi'an Technological University, Xi'an 710021, China
| | - Cheng-Feng Lin
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Panpan Chen
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | | | | | - Yih-Kuen Jan
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
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Maher JL, Whitmarsh C, Smith P, Taylor H, Fard A, Bilzon J. Feasibility study of high-intensity interval training to reduce cardiometabolic disease risks in individuals with acute spinal cord injury. BMJ Open 2023; 13:e068507. [PMID: 36737096 PMCID: PMC9900054 DOI: 10.1136/bmjopen-2022-068507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Individuals ageing with spinal cord injury (SCI) experience an accelerated trajectory of diseases and disorders, such as cardiovascular disease and diabetes, that resemble those experienced with ageing alone. Currently, an evidence-based approach toward managing this problem does not exist and therefore the purpose of this study is to determine the feasibility of conducting a high-intensity exercise intervention in individuals with acute (<6 months postinjury) SCI to improve cardiometabolic health. METHODS AND ANALYSIS We will conduct a single-centre, two parallel-arm, randomised feasibility study of a high-intensity interval training (HIIT) intervention in individuals with acute SCI. We will enrol 40 individuals (20 intervention, 20 control) with acute SCI attending inpatient rehabilitation at Salisbury District Hospital. Participants will be randomly allocated to the intervention group (HIIT) or control group for 18 weeks. Both groups will participate in standard care throughout the duration of the study. The HIIT group only will also perform supervised HIIT exercise on an arm cycle ergometer three times per week. Over the course of the intervention, most participants will be discharged from the hospital, and at this time, an arm cycle ergometer will be installed in their home and the intervention will transition into outpatient care. We will assess cardiorespiratory fitness, glycaemic control, lipid profile and body habitus as well as qualitative assessments of acceptability at weeks 0, 9 and 18 with the primary outcome being the feasibility of a full Randomised Controlled Trial (RCT). ETHICS AND DISSEMINATION This study will inform a longer-term, definitive, multicentre RCT to establish the impact of this exercise intervention in maintaining the cardiometabolic health of patients during the acute phase following SCI. Results will be disseminated in different formats including peer-reviewed journal articles, conference presentations and internet media, to a wide audience including clinicians, researchers and individuals with SCI. TRIAL REGISTRATION NUMBER ISRCTN57514022.
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Affiliation(s)
| | - Catherine Whitmarsh
- Duke of Cornwall Spinal Treatment Centre, Salisbury NHS Foundation Trust, Salisbury, UK
| | - Paula Smith
- Department of Psychology, University of Bath, Bath, UK
| | - Hazel Taylor
- Research Design Service, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Aram Fard
- Duke of Cornwall Spinal Treatment Centre, Salisbury NHS Foundation Trust, Salisbury, UK
| | - James Bilzon
- Department for Health, University of Bath, Bath, UK
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10
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Li G, Lv Y, Su Q, You Q, Yu L. The effect of aerobic exercise on pulse wave velocity in middle-aged and elderly people: A systematic review and meta-analysis of randomized controlled trials. Front Cardiovasc Med 2022; 9:960096. [PMID: 36061566 PMCID: PMC9433655 DOI: 10.3389/fcvm.2022.960096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/28/2022] [Indexed: 11/24/2022] Open
Abstract
A growing body of research examines the effect of aerobic exercise on pulse wave velocity (PWV) in middle-aged and elderly people, while findings of available studies were conflicting. The aim of this study was to explore the effect of aerobic exercise on PWV in middle-aged and elderly people. Searches were performed in PubMed, Web of Science, and EBSCO databases. Cochrane risk assessment tool was used to evaluate the methodological quality of the included literature. We included studies that satisfied the following criteria: (1) eligible studies should be randomized controlled trials (RCTs); (2) eligible studies should include both an intervention and a control group; (3) eligible studies should use the middle-aged or elderly people as subjects; and (4) eligible studies should use PWV as the outcome measure. From 972 search records initially identified, 11 studies with a total of 12 exercise groups (n = 245) and 11 control groups (n = 239) were eligible for meta-analysis. There was a significant effect of aerobic exercise on reducing PWV in middle-aged and elderly people [weighted mean difference (WMD), –0.75 (95% CI, –1.21 to –0.28), p = 0.002]. Specifically, a higher intensity [vigorous-intensity, –0.74 (–1.34 to –0.14), p = 0.02; moderate-intensity, –0.68 (–1.49 to 0.12), p = 0.10], a younger age [45 years ≤ age < 60 years, –0.57 (–0.78 to –0.37), p < 0.00001; age ≥ 60 years, –0.91 (–2.10 to 0.27), p = 0.13], a better health status [healthy, –1.19 (–2.06 to –0.31), p = 0.008; diseased, –0.32 (–0.64 to –0.01), p = 0.04], and a lower basal body mass index (BMI) [BMI < 25, –1.19 (–2.06 to –0.31), p = 0.008; 25 ≤ BMI < 30, –0.52 (–0.92 to –0.12), p = 0.01; BMI ≥ 30, –0.09 (–0.93 to 0.76), p = 0.84] were associatedwith larger reductions in PWV. Aerobic exercise, especially vigorous-intensity aerobic exercise, contributed to reducing PWV in middle-aged and elderly people. The effect of aerobic exercise on improving PWV was associated with characteristics of the participants. Specifically, a younger age, a better health status, and a lower basal BMI contributed to more significant reductions in PWV.
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Affiliation(s)
- Gen Li
- Key Laboratory of Physical Fitness and Exercise, Ministry of Education, Beijing Sport University, Beijing, China
- Department of Strength and Conditioning Training, Beijing Sport University, Beijing, China
| | - Yuanyuan Lv
- Key Laboratory of Physical Fitness and Exercise, Ministry of Education, Beijing Sport University, Beijing, China
- China Institute of Sport and Health Science, Beijing Sport University, Beijing, China
| | - Qing Su
- Ersha Sports Training Center of Guangdong Province, Guangzhou, China
| | - Qiuping You
- Sports Coaching College, Beijing Sport University, Beijing, China
| | - Laikang Yu
- Key Laboratory of Physical Fitness and Exercise, Ministry of Education, Beijing Sport University, Beijing, China
- Department of Strength and Conditioning Training, Beijing Sport University, Beijing, China
- *Correspondence: Laikang Yu,
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11
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Farkas GJ, Burton AM, McMillan DW, Sneij A, Gater DR. The Diagnosis and Management of Cardiometabolic Risk and Cardiometabolic Syndrome after Spinal Cord Injury. J Pers Med 2022; 12:1088. [PMID: 35887592 PMCID: PMC9320035 DOI: 10.3390/jpm12071088] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/19/2022] [Accepted: 06/21/2022] [Indexed: 11/23/2022] Open
Abstract
Individuals with spinal cord injuries (SCI) commonly present with component risk factors for cardiometabolic risk and combined risk factors for cardiometabolic syndrome (CMS). These primary risk factors include obesity, dyslipidemia, dysglycemia/insulin resistance, and hypertension. Commonly referred to as "silent killers", cardiometabolic risk and CMS increase the threat of cardiovascular disease, a leading cause of death after SCI. This narrative review will examine current data and the etiopathogenesis of cardiometabolic risk, CMS, and cardiovascular disease associated with SCI, focusing on pivotal research on cardiometabolic sequelae from the last five years. The review will also provide current diagnosis and surveillance criteria for cardiometabolic disorders after SCI, a novel obesity classification system based on percent total body fat, and lifestyle management strategies to improve cardiometabolic health.
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Affiliation(s)
- Gary J. Farkas
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Miami Miller, Miami, FL 33136, USA; (A.S.); (D.R.G.J.)
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA;
| | - Adam M. Burton
- School of Medicine, University of Miami Miller, Miami, FL 33136, USA;
| | - David W. McMillan
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA;
- The Miami Project to Cure Paralysis, School of Medicine, University of Miami Miller, Miami, FL 33136, USA
| | - Alicia Sneij
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Miami Miller, Miami, FL 33136, USA; (A.S.); (D.R.G.J.)
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA;
| | - David R. Gater
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Miami Miller, Miami, FL 33136, USA; (A.S.); (D.R.G.J.)
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA;
- School of Medicine, University of Miami Miller, Miami, FL 33136, USA;
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12
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Itodo OA, Flueck JL, Raguindin PF, Stojic S, Brach M, Perret C, Minder B, Franco OH, Muka T, Stucki G, Stoyanov J, Glisic M. Physical activity and cardiometabolic risk factors in individuals with spinal cord injury: a systematic review and meta-analysis. Eur J Epidemiol 2022; 37:335-365. [PMID: 35391647 PMCID: PMC9187578 DOI: 10.1007/s10654-022-00859-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
Abstract
Physical inactivity in individuals with spinal cord injury (SCI) has been suggested to be an important determinant of increased cardiometabolic disease (CMD) risk. However, it remains unclear whether physically active SCI individuals as compared to inactive or less active individuals have truly better cardiometabolic risk profile. We aimed to systematically review and quantify the association between engagement in regular physical activity and/or exercise interventions and CMD risk factors in individuals with SCI. Four medical databases were searched and studies were included if they were clinical trials or observational studies conducted in adult individuals with SCI and provided information of interest. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was applied to rate the certainty of evidence. Of 5816 unique citations, 11 randomized clinical trials, 3 non-randomized trial and 32 cross-sectional studies comprising more than 5500 SCI individuals were included in the systematic review. In meta-analysis of RCTs and based on evidence of moderate certainty, physical activity in comparison to control intervention was associated with: (i) better glucose homeostasis profile [WMD of glucose, insulin and Assessment of Insulin Resistance (HOMA-IR) were - 3.26 mg/dl (95% CI - 5.12 to - 1.39), - 3.19 μU/ml (95% CI - 3.96 to - 2.43)] and - 0.47 (95% CI - 0.60 to - 0.35), respectively], and (ii) improved cardiorespiratory fitness [WMD of relative and absolute oxygen uptake relative (VO2) were 4.53 ml/kg/min (95% CI 3.11, 5.96) and 0.26 L/min (95% CI 0.21, 0.32) respectively]. No differences were observed in blood pressure, heart rate and lipids (based on evidence of low/moderate certainty). In meta-analysis of cross-sectional studies and based on the evidence of very low to low certainty, glucose [WMD - 3.25 mg/dl (95% CI - 5.36, - 1.14)], insulin [- 2.12 μU/ml (95% CI - 4.21 to - 0.03)] and total cholesterol [WMD - 6.72 mg/dl (95% CI - 13.09, - 0.34)] were lower and HDL [WMD 3.86 mg/dl (95% CI 0.66, 7.05)] and catalase [0.07 UgHb-1 (95% CI 0.03, 0.11)] were higher in physically active SCI individuals in comparison to reference groups. Based on limited number of cross-sectional studies, better parameters of systolic and diastolic cardiac function and lower carotid intima media thickness were found in physically active groups. Methodologically sound clinical trials and prospective observational studies are required to further elaborate the impact of different physical activity prescriptions alone or in combination with other life-style interventions on CMD risk factors in SCI individuals.
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Affiliation(s)
- Oche Adam Itodo
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207, Nottwil, Switzerland
- Graduate School for Health Sciences, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | | | - Peter Francis Raguindin
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207, Nottwil, Switzerland
- Graduate School for Health Sciences, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Stevan Stojic
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207, Nottwil, Switzerland
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Mirjam Brach
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207, Nottwil, Switzerland
| | - Claudio Perret
- Sports Medicine, Swiss Paraplegic Centre Nottwil, 6207, Nottwil, Switzerland
| | - Beatrice Minder
- Public Health and Primary Care Library, University Library of Bern, University of Bern, Bern, Switzerland
| | - Oscar H Franco
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Taulant Muka
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Gerold Stucki
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207, Nottwil, Switzerland
| | - Jivko Stoyanov
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207, Nottwil, Switzerland
| | - Marija Glisic
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207, Nottwil, Switzerland.
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland.
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13
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Selph SS, Skelly AC, Wasson N, Dettori JR, Brodt ED, Ensrud E, Elliot D, Dissinger KM, McDonagh M. Physical Activity and the Health of Wheelchair Users: A Systematic Review in Multiple Sclerosis, Cerebral Palsy, and Spinal Cord Injury. Arch Phys Med Rehabil 2021; 102:2464-2481.e33. [PMID: 34653376 DOI: 10.1016/j.apmr.2021.10.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/10/2021] [Accepted: 10/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To understand the benefits and harms of physical activity in people who may require a wheelchair with a focus on people with multiple sclerosis (MS), cerebral palsy (CP), and spinal cord injury (SCI). DATA SOURCES Searches were conducted in MEDLINE, Cumulative Index to Nursing and Allied Health, PsycINFO, Cochrane CENTRAL, and Embase (January 2008 through November 2020). STUDY SELECTION Randomized controlled trials, nonrandomized trials, and cohort studies of observed physical activity (at least 10 sessions on 10 days) in participants with MS, CP, and SCI. DATA EXTRACTION We conducted dual data abstraction, quality assessment, and strength of evidence. Measures of physical functioning are reported individually where sufficient data exist and grouped as "function" where data are scant. DATA SYNTHESIS No studies provided evidence for prevention of cardiovascular conditions, development of diabetes, or obesity. Among 168 included studies, 44% enrolled participants with MS (38% CP, 18% SCI). Studies in MS found walking ability may be improved with treadmill training and multimodal exercises; function may be improved with treadmill, balance exercises, and motion gaming; balance is likely improved with balance exercises and may be improved with aquatic exercises, robot-assisted gait training (RAGT), motion gaming, and multimodal exercises; activities of daily living (ADL), female sexual function, and spasticity may be improved with aquatic therapy; sleep may be improved with aerobic exercises and aerobic fitness with multimodal exercises. In CP, balance may be improved with hippotherapy and motion gaming; function may be improved with cycling, treadmill, and hippotherapy. In SCI, ADL may be improved with RAGT. CONCLUSIONS Depending on population and type of exercise, physical activity was associated with improvements in walking, function, balance, depression, sleep, ADL, spasticity, female sexual function, and aerobic capacity. Few harms of physical activity were reported in studies. Future studies are needed to address evidence gaps and to confirm findings.
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Affiliation(s)
- Shelley S Selph
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon.
| | | | - Ngoc Wasson
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon
| | | | | | - Erik Ensrud
- Department of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Diane Elliot
- Department of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Kristin M Dissinger
- Department of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Marian McDonagh
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon
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14
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Soriano JE, Romac R, Squair JW, Barak OF, Sarafis ZK, Lee AH, Coombs GB, Vaseghi B, Grant C, Charbonneau R, Mijacika T, Krassioukov A, Ainslie PN, Larkin-Kaiser KA, Phillips A, Dujic Z. Passive leg cycling increases activity of the cardiorespiratory system in people with tetraplegia. Appl Physiol Nutr Metab 2021; 47:269-277. [PMID: 34739759 DOI: 10.1139/apnm-2021-0523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Individuals with cervical spinal cord injury (SCI) are at an increased risk for cardiovascular disease. Exercise is well-established for preventing cardiovascular disease, however, there are limited straightforward and safe exercise approaches for increasing the activity of the cardiorespiratory system after cervical SCI. The objective of this study was to investigate the cardiorespiratory response to passive leg cycling in people with cervical SCI. Beat-by-beat blood pressure, heart rate, and cerebral blood flow were measured before and throughout 10 minutes of cycling in 11 people with SCI. Femoral artery flow-mediated dilation was also assessed before and immediately after passive cycling. Safety was monitored throughout all study visits. Passive cycling elevated systolic blood pressure (5±2 mmHg), mean arterial pressure (5±3 mmHg), stroke volume (2.4±0.8 mL), heart rate (2±1 beats/min) and cardiac output (0.3±0.07 L/min; all p<0.05). Minute ventilation (0.67±0.23 L/min), tidal volume (70±30 mL) and end-tidal PO2 (2.6±1.23 mmHg) also increased (all p<0.05). Endothelial function was improved immediately after exercise (1.62±0.13%, p<0.01). Passive cycling resulted in one incidence of autonomic dysreflexia. Therefore, passive leg cycling increased the activity of the cardiorespiratory system, improved endothelial function, indicating it may be a beneficial exercise intervention for the cardiovascular and respiratory systems in people with cervical SCI. Novelty: ● Passive leg cycling increases the activity of the cardiorespiratory system and improves markers of cardiovascular health in cervical SCI. ● Passive leg cycling exercise is an effective, low-cost, practical, alternative exercise modality for people with cervical SCI.
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Affiliation(s)
- Jan Elaine Soriano
- University of Calgary, 2129, Departments of Physiology and Pharmacology, Cardiac Sciences & Clinical Neurosciences, Calgary, Alberta, Canada;
| | - Rinaldo Romac
- Clinical Hospital Center Split, Department of Neurology, Split, Croatia;
| | - Jordan W Squair
- University of Calgary, 2129, Departments of Physiology and Pharmacology, Cardiac Sciences & Clinical Neurosciences, Calgary, Alberta, Canada.,University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada;
| | - Otto F Barak
- University of Novi Sad, 84981, Faculty of Medicine, Novi Sad, Serbia;
| | - Zoe K Sarafis
- University of British Columbia, Faculty of Medicine , Vancouver, Canada.,ETH Zurich, 27219, Department of Health Sciences and Technology, Zurich, Switzerland;
| | - Amanda Hx Lee
- University of British Columbia, Faculty of Medicine , Vancouver, British Columbia, Canada.,University of British Columbia, Department of Experimental Medicine, Vancouver, British Columbia, Canada;
| | - Geoff B Coombs
- The University of British Columbia Okanagan, 97950, Centre for Heart, Lung, and Vascular Health, Kelowna, British Columbia, Canada;
| | - Bita Vaseghi
- University of Calgary, 2129, Departments of Physiology and Pharmacology, Cardiac Sciences & Clinical Neurosciences, Calgary, Alberta, Canada.,University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada;
| | - Christopher Grant
- University of Calgary, 2129, Department of Clinical Neurosciences, Calgary, Alberta, Canada;
| | - Rebecca Charbonneau
- University of Calgary, 2129, Department of Clinical Neurosciences, Calgary, Alberta, Canada;
| | - Tanja Mijacika
- University of Split, 74422, Department of Integrative Physiology, Split, Croatia;
| | - Andrei Krassioukov
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada.,The University of British Columbia, 8166, Division of Physical Medicine & Rehabilitation, Vancouver, British Columbia, Canada.,G F Strong Rehabilitation Hospital, 103221, Vancouver, British Columbia, Canada;
| | - Philip N Ainslie
- University of British Columbia, Centre for Heart, Lung and Vascular Health, Kelowna, British Columbia, Canada;
| | - Kelly A Larkin-Kaiser
- University of Calgary, Departments of Physiology and Pharmacology, Cardiac Sciences, & Clinical Neurosciences, Calgary, Alberta, Canada;
| | - Aaron Phillips
- University of Calgary, 2129, Departments of Physiology and Pharmacology, Cardiac Sciences & Clinical Neurosciences, Calgary, Canada, T2N 1N4;
| | - Zeljko Dujic
- University of Split School of Medicine, Department of Integrative Physiology, Split, Splitsko-dalmatinska, Croatia;
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15
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Alrashidi AA, Nightingale TE, Currie KD, Hubli M, MacDonald MJ, Hicks AL, Oh P, Craven BC, Krassioukov AV. Exercise Improves Cardiorespiratory Fitness, but Not Arterial Health, after Spinal Cord Injury: The CHOICES Trial. J Neurotrauma 2021; 38:3020-3029. [PMID: 34314235 DOI: 10.1089/neu.2021.0071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Arterial stiffness, as measured by carotid-femoral pulse wave velocity (cfPWV), is elevated after spinal cord injury (SCI). In the uninjured population, exercise training has been shown to reduce arterial stiffness. In a randomized, multi-center clinical trial, we evaluated the impact of two exercise interventions on cardiovascular disease risk factors in persons with chronic SCI. A total of 46 adults with motor-complete SCI with neurological levels of injury between the fourth cervical and sixth thoracic spinal cord segments (C4-T6) were randomly assigned to either body-weight-supported treadmill training (BWSTT) or arm-cycle ergometer training (ACET). Participants trained 3 days per week for 24 weeks. Exercise session duration progressed gradually to reach 30 and 60 min for ACET and BWSTT, respectively. The primary outcome was arterial stiffness, assessed by cfPWV, and was measured at baseline, 12 weeks of training, and at 24 weeks. Secondary outcomes included cardiorespiratory fitness (CRF) and cardiometabolic health measures and were measured before and after completion of training. Fourteen participants per intervention arm completed the exercise intervention. Our results show no effect of either exercise intervention on arterial stiffness (p = 0.07) and cardiometabolic health measures (p > 0.36). However, peak oxygen uptake increased with ACET compared with BWSTT (p = 0.04). The findings of this trial demonstrate that although 24 weeks of upper-body exercise improved CRF in persons with motor-complete SCI ≥T6, neither intervention resulted in improvements in arterial stiffness or cardiometabolic health measures. ClinicalTrials.gov identifier: NCT01718977.
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Affiliation(s)
- Abdullah A Alrashidi
- International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada.,Experimental Medicine, Department of Medicine, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,Department of Physical Therapy, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Tom E Nightingale
- International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada.,School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Katharine D Currie
- International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada.,Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - Michèle Hubli
- International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada.,Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | | | - Audrey L Hicks
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Paul Oh
- Department of Medicine University Health Network, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Beverley Catharine Craven
- Department of Medicine University Health Network, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Andrei V Krassioukov
- International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada.,Experimental Medicine, Department of Medicine, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,GF Strong Rehabilitation Center, Vancouver Coastal Health, Vancouver, British Columbia, Canada
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16
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The ability of heart rate or perceived exertion to predict oxygen uptake varies across exercise modes in persons with tetraplegia. Spinal Cord 2021; 59:1247-1255. [PMID: 34462547 DOI: 10.1038/s41393-021-00670-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 05/14/2021] [Accepted: 07/02/2021] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Descriptive study. OBJECTIVES To examine grouped and intra-individual relationships between 1) exercise intensity and heart rate (EI-HR); 2) EI and oxygen uptake (EI-VO2); 3) VO2 and HR (VO2-HR); and 4) perceived exertion and VO2 (PE-VO2) in persons with tetraplegia (C4/5-C8) during different modes of exercise. SETTING Community in Winnipeg, Canada. METHODS Participants exercised at 3 graded intensities during arm ergometry (ERG), wheeling indoors on cement (MWC), or hand-cycling outdoors (HC). EI (Watts, km/hr) and VO2, HR and PE were recorded. RESULTS 22 persons completed ERG, 14/22 also completed MWC and 5/22 completed ERG, MWC and HC. Regression analysis of grouped data showed a significant relationship between EI-VO2 but not for EI-HR or HR-VO2. Intra-individual analyses showed a strong correlation (r or ρ > 0.7) for VO2-HR for 16/22 during ERG. In the participants completing multiple exercise modes, a strong VO2-HR relationship was present in 12/14 in ERG, but in only 6/14 in MWC. The 5 persons exercising with all 3 modes had a strong HR-VO2 relationship in 5/5 for ERG, 2/5 in MWC and 1/5 in HC. A strong relationship for PE-VO2 was observed in a higher proportion of participants (versus HR-VO2) during MWC (9/14) and HC (2/4). CONCLUSION Within the same individual, the HR-VO2 relationship varies across modes, despite exercising over similar ranges of steady-state VO2. HR appears less able to predict VO2 compared to PE. Based on these new findings, systematic investigation of the HR-VO2 relationship across modes of exercise in tetraplegia is warranted.
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17
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Peters J, Abou L, Rice LA, Dandeneau K, Alluri A, Salvador AF, Rice I. The effectiveness of vigorous training on cardiorespiratory fitness in persons with spinal cord injury: a systematic review and meta-analysis. Spinal Cord 2021; 59:1035-1044. [PMID: 34274948 DOI: 10.1038/s41393-021-00669-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 11/09/2022]
Abstract
DESIGN Systematic review and meta-analysis. BACKGROUND AND PURPOSE Traditional forms of upper-body moderate intensity exercise consistently provide little cardiovascular benefits for persons with spinal cord injury (PwSCI). Explorations of new training methods are vital to improve cardiovascular fitness among PwSCI. This study sought to evaluate the effectiveness of vigorous training on cardiorespiratory fitness in PwSCI. METHODS Database search through PubMed, Web of Science, Scopus, SportDiscus, and Cumulative Index of Nursing and Allied Health Literature (CINAHL) was conducted from the databases' inception to November 2020 to identify relevant exercise studies with PwSCI. Two independent reviewers screened articles for inclusion. Data were extracted from included studies and methodological quality evaluated. RESULTS Sixteen trials (eight pre-post trials and eight controlled trials [CTs]) with a total of 145 participants were analyzed. Results from pre-post studies revealed significant improvements in cardiorespiratory fitness following high-intensity interval training (HIIT) (Peak Oxygen Uptake [VO2peak], standardized mean difference [SMD] = 0.81; 95% CI 0.23-1.39; P < 0.01 and Peak Power Output [PPO], SMD = 0.91; 95% CI 0.32-1.5; P < 0.01) and circuit resistance training (CRT) (VO2peak, MD = 0.38; 95% CI 0.19-0.57; P < 0.01 and PPO, MD = 20.17; 95% CI 8.26-32.08; P < 0.01). Meta-analysis of CTs did not demonstrate significant improvements in cardiorespiratory fitness following vigorous training interventions in comparison to lower intensity training interventions. CONCLUSION Evidence from HIIT and CRT interventions suggest benefits for cardiovascular functions; however, vigorous training was not more beneficial than other forms of endurance training. More CTs are needed to better understand the effectiveness of vigorous training on cardiorespiratory fitness in PwSCI.
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Affiliation(s)
- Joseph Peters
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
| | - Libak Abou
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Laura A Rice
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Kady Dandeneau
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Aditya Alluri
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Amadeo Felix Salvador
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Ian Rice
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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18
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Pathak S, Slovarp L, Clary MS, Jetté ME. Laryngeal Chemoreflex in Health and Disease: A Review. Chem Senses 2021; 45:823-831. [PMID: 33247587 DOI: 10.1093/chemse/bjaa069] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The larynx plays a key role in airway protection via the laryngeal chemoreflex (LCR). This involuntary reflex can be evoked when hazardous substances activate mucosal receptors, which send signals to be processed within the brainstem. Although the LCR is meant to be protective, the reflex can become hyperstimulated, even to benign stimuli, which can result in pathological disorders, such as chronic cough and inducible laryngeal obstruction. In this review, we will outline the mechanism of the LCR and its associated pathological disorders.
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Affiliation(s)
- Shivani Pathak
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Laurie Slovarp
- School of Speech, Language, Hearing, & Occupational Sciences, University of Montana, Missoula, MT, USA
| | - Matthew S Clary
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Marie E Jetté
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado, Aurora, CO, USA
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19
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Aerobic fitness is a potential crucial factor in protecting paralympic athletes with locomotor impairments from atherosclerotic cardiovascular risk. SPORT SCIENCES FOR HEALTH 2021. [DOI: 10.1007/s11332-020-00698-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Abstract
Purpose
To test the hypothesis that aerobic fitness is inversely related to the risk of atherosclerotic cardiovascular disease (ACVD) in athletes with locomotor impairments deriving from health conditions, such as spinal cord injury (SCI), lower limb amputation, cerebral palsy, poliomyelitis, and other health conditions different from the previous ones.
Methods
A total of 68 male athletes who competed in either summer or winter Paralympic games were divided in two health conditions groups (35 with SCI, mean age 37.2 ± 8.0 years, and 33 with different health conditions, mean age 37.8 ± 9.9 years) and in four sport type groups (skill, power, intermittent—mixed metabolism—and endurance). They were evaluated through anthropometric and blood pressure measurements, laboratory blood tests, and graded cardiopulmonary maximal arm cranking exercise test, with oxygen uptake peak (VO2peak) measurement. Cardiovascular risk profile was assessed in each athlete.
Results
The prevalence of ACVD-risk factors in the overall population was 20.6% for hypertension; 47% and 55.9% for high values of total and LDL cholesterol, respectively; 22.1% for reduce glucose tolerance; and 8.8% for obesity. No difference was found between athletes with and without SCI, while the prevalence of obesity was significantly higher in those practicing skill sports (22.7%, p = 0.035), which was the sport type group with Paralympic athletes with the lowest VO2peak (22.5 ± 5.70 ml kg−1 min−1). VO2peak was lower in athletes with SCI than those with different health conditions (28.6 ± 10.0 vs 33.6 ± 8.9 ml kg−1 min−1p = 0.03), and in those with 3–4 risk factors (19.09 ± 5.34 ml kg−1 min−1) than those with 2 risk factors (27.1 ± 5.50 ml kg−1 min−1), 1 risk factor (31.6 ± 8.55 ml kg−1 min−1), or none (36.4 ± 8.76 ml kg−1 min−1) (p < 0.001).
Conclusions
The present study suggests that having higher VO2peak seems to offer greater protection against ACVD in individuals with a locomotor impairment. Prescribing physical exercise at an intensity similar to that of endurance and intermittent sports should become a fundamental tool to promote health among people with a locomotor impairment.
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20
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Liu S, Wang Y, Niebauer J. Effect of Exercise on Cardiovascular Function Following Spinal Cord Injury: A REVIEW. J Cardiopulm Rehabil Prev 2021; 41:13-18. [PMID: 32796491 DOI: 10.1097/hcr.0000000000000534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Spinal cord injury (SCI) is associated with a reduced level of physical activity, deterioration of patient body composition, metabolic profile, quality of life, and psychological functioning. As a result, risk of cardiovascular disease (CVD) increases and CVD-related death occurs at an earlier age than in individuals without SCI. Regular participation in exercise has been shown to exert beneficial effects also in patients with SCI. In this review, we analyze and discuss the effects of regular exercise training in SCI on cardiovascular function, autonomic function of the cardiovascular system, arterial stiffness, metabolism, inflammation, and gene expression.
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Affiliation(s)
- Shujia Liu
- Departments of Spine and Spinal Cord Surgery (Dr Liu) and Clinical Laboratory (Dr Wang), Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China; Faculty of Rehabilitation Medicine, Capital Medical University, Beijing, China (Drs Liu and Wang); Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, and Institute of Sports Medicine, Prevention and Rehabilitation, University Hospital Salzburg, Salzburg, Austria (Dr Niebauer)
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21
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Farrow M, Nightingale TE, Maher J, McKay CD, Thompson D, Bilzon JL. Effect of Exercise on Cardiometabolic Risk Factors in Adults With Chronic Spinal Cord Injury: A Systematic Review. Arch Phys Med Rehabil 2020; 101:2177-2205. [DOI: 10.1016/j.apmr.2020.04.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 03/27/2020] [Accepted: 04/11/2020] [Indexed: 12/14/2022]
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Hansen RK, Samani A, Laessoe U, Handberg A, Larsen RG. Effect of wheelchair-modified rowing exercise on cardiometabolic risk factors in spinal cord injured wheelchair users: protocol for a randomised controlled trial. BMJ Open 2020; 10:e040727. [PMID: 33067301 PMCID: PMC7569950 DOI: 10.1136/bmjopen-2020-040727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/09/2020] [Accepted: 09/15/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Cardiovascular and metabolic diseases are a growing concern for individuals with spinal cord injury (SCI). Physical inactivity contributes to cardiometabolic morbidity and mortality in the SCI population. However, previous studies have shown mixed results regarding the effects of exercise on cardiometabolic risk factors in individuals with SCI. This discrepancy could be influenced by insufficient exercise stimuli. Recent guidelines recommend 30 min of moderate-to-vigorous intensity aerobic exercise, three times per week, for improvement in cardiometabolic health in individuals with SCI. However, to date, no studies have implemented an exercise intervention matching the new recommendations to examine the effects on cardiometabolic risk factors. Therefore, the primary objective of this study is to determine the effects of 12 weeks of wheelchair user-modified upper-body rowing exercise on both traditional (constituents of the metabolic syndrome) and novel (eg, vascular structure and function) cardiometabolic risk factors in manual wheelchair users with SCI. METHODS AND ANALYSIS A randomised controlled trial will compare 12 weeks of upper-body rowing exercise, 30 min three times per week, with a control group continuing their normal lifestyle. Outcome measurements will be performed immediately before (baseline), after 6 weeks (halfway), 12 weeks of training (post) and 6 months after the termination of the intervention period (follow-up). Outcomes will include inflammatory (eg, C reactive protein) and metabolic biomarkers determined from venous blood (with serum fasting insulin as primary outcome), body composition, arterial blood pressure, cardiorespiratory fitness level, brachial artery vascular structure and function and autonomic nervous system function. ETHICS AND DISSEMINATION This trial is reported to the Danish Data Protection Agency (J.nr. 2019-899/10-0406) and approved by the Committees on Health Research Ethics in The North Denmark Region on 12 December 2019 (J.nr. N-20190053). The principal investigator will collect written informed consent from all participants prior to inclusion. Irrespective of study outcomes, the results will be submitted to peer-reviewed scientific journals for publication. TRIAL REGISTRATION NUMBER NCT04390087.
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Affiliation(s)
- Rasmus Kopp Hansen
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Department of Research and Development, University College of Northern Jutland (UCN), Aalborg, Denmark
| | - Afshin Samani
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Uffe Laessoe
- Department of Research and Development, University College of Northern Jutland (UCN), Aalborg, Denmark
- Physical Therapy Department, University College of Northern Jutland (UCN), Aalborg, Denmark
| | - Aase Handberg
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ryan Godsk Larsen
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Koontz AM, Garfunkel CE, Crytzer TM, Anthony SJ, Nindl BC. Feasibility, acceptability, and preliminary efficacy of a handcycling high-intensity interval training program for individuals with spinal cord injury. Spinal Cord 2020; 59:34-43. [PMID: 32908194 PMCID: PMC7854955 DOI: 10.1038/s41393-020-00548-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 08/28/2020] [Accepted: 08/31/2020] [Indexed: 01/17/2023]
Abstract
Study Design: Pilot non-randomized clinical trial Objectives: To examine the feasibility, acceptability and preliminary efficacy of performing handcycling high intensity interval training (HIIT) for six weeks in wheelchair users with spinal cord injury. Setting: Participant’s home Methods: Participants completed pre and post graded exercise stress tests, exercise surveys and six weeks of handcycling HIIT. The HIIT program consisted of two weekly, 25 minute supervised at-home sessions (2-3 min warm-up, then 10 intervals of cycling with a ratio of 1 minute work at 90% peak power output (PPO) to 1 minute recovery at 0-20% PPO, then 2-3 min cool-down). Real-time power output and heart rate were recorded via sensors and a bike computer. The sensor data were analyzed to evaluate training efficacy. Results: Seven of the 10 enrolled participants (70%) completed the study. All but one completed the required 12 sessions. The participants met at least one of the HIIT target intensity criteria in 76 out of 89 total sessions (85.4%) performed. Participants expressed a high level of enjoyment on the Physical Activity Enjoyment Scale, mean (SD) = 114.8 (11.3), and satisfaction with the overall experience. Five of the seven participants (71%) who completed the study felt an increase in endurance, function and health. Objective physiological changes showed mixed results. Conclusions: Six weeks of handcycling HIIT appears to be safe, feasible and acceptable. A longer HIIT work interval may be needed to elicit significant physiological responses. Future investigation of the feasibility and efficacy of differing HIIT parameters is needed.
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Affiliation(s)
- Alicia M Koontz
- Department of Veterans Affairs, Rehabilitation Research and Development Service, Human Engineering Research Laboratories, Pittsburgh, PA, USA. .,Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA. .,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Cecile E Garfunkel
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Theresa M Crytzer
- Department of Veterans Affairs, Rehabilitation Research and Development Service, Human Engineering Research Laboratories, Pittsburgh, PA, USA.,Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA.,Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Steven J Anthony
- Division of Endocrinology and Metabolism, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bradley C Nindl
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
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Mercier HW, Picard G, Taylor JA, Vivodtzev I. Gains in aerobic capacity with whole-body functional electrical stimulation row training and generalization to arms-only exercise after spinal cord injury. Spinal Cord 2020; 59:74-81. [PMID: 32719528 PMCID: PMC7855132 DOI: 10.1038/s41393-020-0527-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Longitudinal study in adults (n = 27; 19-40 years old) with tetraplegic or paraplegic spinal cord injury (SCI). OBJECTIVES Determine physiological adaptations and generalizable fitness effects of 6 months of whole-body exercise training using volitional arm and functional electrical stimulation (FES) leg rowing. SETTING Outpatient hospital-based exercise facility and laboratory. METHODS Participants enrolled in hybrid FES-row training (FESRT) and performed peak exercise tests with arms-only (AO; baseline and 6 months) and FES rowing (baseline, 3, 6 months). RESULTS Participants demonstrated increased aerobic capacity (VO2peak) after FESRT (p < 0.001, np2 = 0.56) that tended to be higher when assessed with FES than AO rowing tests (0.15 ± 0.20 vs. 0.04 ± 0.22 L/min; p = 0.10). Changes in FES and AO VO2peak were significantly correlated (r = 0.55; p < 0.01), and 11 individuals demonstrated improvements (>6%) on both test formats. Younger age was the only difference between those who showed generalization of training effects and those who did not (mean age 26.6 ± 5.6 vs. 32.0 ± 5.7 years; p < 0.05) but changes in FES VO2peak correlated to time since injury in individuals <2 years post-SCI (r = -0.51, p < 0.01, n = 24). Lastly, VO2peak improvements were greater during the first 3 months vs. months 4-6 (+7.0% vs. +3.9%; p < 0.01) which suggests early training adaptations during FESRT. CONCLUSIONS Gains in aerobic capacity after whole-body FESRT are better reflected during FES-row testing format. They relate to high-intensity exercise and appear early during training, but they may not generalize to equivalent increases in AO exercise in all individuals with SCI.
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Affiliation(s)
- Hannah W Mercier
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA. .,Spaulding Rehabilitation Hospital, Cardiovascular Research Laboratory, Cambridge, MA, USA.
| | - Glen Picard
- Spaulding Rehabilitation Hospital, Cardiovascular Research Laboratory, Cambridge, MA, USA
| | - J Andrew Taylor
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.,Spaulding Rehabilitation Hospital, Cardiovascular Research Laboratory, Cambridge, MA, USA
| | - Isabelle Vivodtzev
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.,Spaulding Rehabilitation Hospital, Cardiovascular Research Laboratory, Cambridge, MA, USA.,Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France
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25
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Astorino TA, Hicks AL, Bilzon JLJ. Viability of high intensity interval training in persons with spinal cord injury-a perspective review. Spinal Cord 2020; 59:3-8. [PMID: 32483336 DOI: 10.1038/s41393-020-0492-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 05/17/2020] [Accepted: 05/19/2020] [Indexed: 11/10/2022]
Abstract
Spinal cord injury (SCI) leads to loss of sensory and motor function below the level of injury leading to paralysis and limitations to locomotion. Therefore, persons with SCI face various challenges in engaging in regular physical activity, which leads to a reduction in physical fitness, increases in body fat mass, and reduced physical and mental health status. Moderate intensity continuous training (MICT) is recommended to enhance physical fitness and overall health status in this population, but it is not always effective in promoting these benefits. High intensity interval training (HIIT) has been promoted as an alternative to MICT in individuals with SCI due to its documented efficacy in healthy able-bodied individuals as well as those with chronic disease. However, the body of knowledge concerning its application in this population is limited and mostly composed of studies with small and homogeneous samples. The aim of this review was to summarize the existing literature regarding the efficacy of HIIT on changes in health- and fitness-related outcomes in this population, denote potential adverse responses to HIIT, describe how participants perceive this modality of exercise training, and identify the overall feasibility of interval training in persons with SCI.
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Affiliation(s)
- Todd A Astorino
- Department of Kinesiology, CSU-San Marcos, San Marcos, CA, USA.
| | - Audrey L Hicks
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
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26
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Martin Ginis KA, West CR. From guidelines to practice: development and implementation of disability-specific physical activity guidelines. Disabil Rehabil 2020; 43:3432-3439. [PMID: 32394734 DOI: 10.1080/09638288.2020.1757167] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: Among people with physical disabilities, one of the most frequently-cited barriers to physical activity participation is a lack of basic information on what to do. Likewise, rehabilitation professionals often cite a lack of knowledge about what to recommend or prescribe, as their primary reason for not promoting physical activity to clients with disabilities. The development and implementation of disability-specific physical activity guidelines are important steps toward addressing informational barriers. This paper describes the reasoning behind disability-specific physical activity guidelines, the gold-standard process used to develop disability-specific guidelines for people with spinal cord injury and multiple sclerosis, and the "who, what, and how" of behavioural interventions and messaging to support people with disabilities in achieving physical activity guidelines.Materials and Methods: Not Applicable.Results: Not Applicable.Conclusions: The needs, values and preferences of people with disabilities must be taken into consideration when undertaking a disability-specific guideline development process. Guidelines can play an important role in physical activity promotion, but behavioural and other interventions are required to address the myriad physical activity barriers faced by people with disabilities.Implications for RehabilitationPeople with and without disabilities can achieve significant fitness and health benefits from activity well below the WHO's 150 minutes/week guideline.Disability-specific physical activity guidelines can alleviate informational barriers for people who want to get active and rehabilitation professionals who want to promote physical activity.Behavioural and other interventions are needed to support people's efforts to achieve physical activity guidelines.A physiotherapist-delivered intervention has shown promise for increasing physical activity in adults with a physical disability.
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Affiliation(s)
- Kathleen A Martin Ginis
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC, Canada.,School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada.,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Kelowna, BC, Canada.,Centre for Chronic Disease Prevention and Management, University of British Columbia, Vancouver, Canada
| | - Christopher R West
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Kelowna, BC, Canada.,Centre for Chronic Disease Prevention and Management, University of British Columbia, Vancouver, Canada.,Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, BC, Canada
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27
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Goodus MT, McTigue DM. Hepatic dysfunction after spinal cord injury: A vicious cycle of central and peripheral pathology? Exp Neurol 2019; 325:113160. [PMID: 31863731 DOI: 10.1016/j.expneurol.2019.113160] [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: 07/07/2019] [Revised: 11/17/2019] [Accepted: 12/18/2019] [Indexed: 02/06/2023]
Abstract
The liver is essential for numerous physiological processes, including filtering blood from the intestines, metabolizing fats, proteins, carbohydrates and drugs, and regulating iron storage and release. The liver is also an important immune organ and plays a critical role in response to infection and injury throughout the body. Liver functions are regulated by autonomic parasympathetic innervation from the brainstem and sympathetic innervation from the thoracic spinal cord. Thus, spinal cord injury (SCI) at or above thoracic levels disrupts major regulatory mechanisms for hepatic functions. Work in rodents and humans shows that SCI induces liver pathology, including hepatic inflammation and fat accumulation characteristic of a serious form of non-alcoholic fatty liver disease (NAFLD) called non-alcoholic steatohepatitis (NASH). This hepatic pathology is associated with and likely contributes to indices of metabolic dysfunction often noted in SCI individuals, such as insulin resistance and hyperlipidemia. These occur at greater rates in the SCI population and can negatively impact health and quality of life. In this review, we will: 1) Discuss acute and chronic changes in human and rodent liver pathology and function after SCI; 2) Describe how these hepatic changes affect systemic inflammation, iron regulation and metabolic dysfunction after SCI; 3) Describe how disruption of the hepatic autonomic nervous system may be a key culprit in post-injury chronic liver pathology; and 4) Preview ongoing and future research that aims to elucidate mechanisms driving liver and metabolic dysfunction after SCI.
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Affiliation(s)
- Matthew T Goodus
- The Belford Center for Spinal Cord Injury, The Ohio State University, Columbus, OH, USA; Department of Neuroscience, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
| | - Dana M McTigue
- The Belford Center for Spinal Cord Injury, The Ohio State University, Columbus, OH, USA; Department of Neuroscience, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
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28
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Morse LR, Biering-Soerensen F, Carbone LD, Cervinka T, Cirnigliaro CM, Johnston TE, Liu N, Troy KL, Weaver FM, Shuhart C, Craven BC. Bone Mineral Density Testing in Spinal Cord Injury: 2019 ISCD Official Position. J Clin Densitom 2019; 22:554-566. [PMID: 31501005 DOI: 10.1016/j.jocd.2019.07.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 07/29/2019] [Indexed: 02/06/2023]
Abstract
Spinal cord injury (SCI) causes rapid osteoporosis that is most severe below the level of injury. More than half of those with motor complete SCI will experience an osteoporotic fracture at some point following their injury, with most fractures occurring at the distal femur and proximal tibia. These fractures have devastating consequences, including delayed union or nonunion, cellulitis, skin breakdown, lower extremity amputation, and premature death. Maintaining skeletal integrity and preventing fractures is imperative following SCI to fully benefit from future advances in paralysis cure research and robotic-exoskeletons, brain computer interfaces and other evolving technologies. Clinical care has been previously limited by the lack of consensus derived guidelines or standards regarding dual-energy X-ray absorptiometry-based diagnosis of osteoporosis, fracture risk prediction, or monitoring response to therapies. The International Society of Clinical Densitometry convened a task force to establish Official Positions for bone density assessment by dual-energy X-ray absorptiometry in individuals with SCI of traumatic or nontraumatic etiology. This task force conducted a series of systematic reviews to guide the development of evidence-based position statements that were reviewed by an expert panel at the 2019 Position Development Conference in Kuala Lumpur, Malaysia. The resulting the International Society of Clinical Densitometry Official Positions are intended to inform clinical care and guide the diagnosis of osteoporosis as well as fracture risk management of osteoporosis following SCI.
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Affiliation(s)
- Leslie R Morse
- Department of Rehabilitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA.
| | - Fin Biering-Soerensen
- Clinic for Spinal Cord Injuries, Neuroscience Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Laura D Carbone
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA; Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Tomas Cervinka
- Department of Physiotherapy and Rehabilitation, Faculty of Health and Welfare, Satakunta University of Applied Sciences, Pori, Finland
| | - Christopher M Cirnigliaro
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Therese E Johnston
- Department of Physical Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA
| | - Nan Liu
- Department of Rehabilitation Medicine and Osteoporosis and Metabolic Bone Disease Center, Peking University Third Hospital, Beijing, China
| | - Karen L Troy
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Frances M Weaver
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA; Department of Public Health Sciences, Stritch School of Medicine, Loyola University, Maywood, IL, USA
| | - Christopher Shuhart
- Swedish Bone Health and Osteoporosis Center, Swedish Medical Group, Seattle WA, USA
| | - Beverley C Craven
- Neural Engineering and Therapeutics Team, KITE Research Institute - University Health Network, Department of Medicine, University of Toronto, Toronto, Ontario Canada
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McMillan DW, Maher JL, Jacobs KA, Mendez AJ, Nash MS, Bilzon JLJ. Influence of upper-body continuous, resistance or high-intensity interval training (CRIT) on postprandial responses in persons with spinal cord injury: study protocol for a randomised controlled trial. Trials 2019; 20:497. [PMID: 31409383 PMCID: PMC6693181 DOI: 10.1186/s13063-019-3583-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 07/16/2019] [Indexed: 01/07/2023] Open
Abstract
Background Chronic spinal cord injury (SCI) increases morbidity and mortality associated with cardiometabolic diseases, secondary to increases in central adiposity, hyperlipidaemia and impaired glucose tolerance. While upper-body Moderate Intensity Continuous Training (MICT) improves cardiorespiratory fitness, its effects on cardiometabolic component risks in adults with SCI appear relatively modest. The aim of this study is to assess the acute effects of Continuous Resistance Training (CRT), High Intensity Interval Training (HIIT), MICT and rest (CON) on fasting and postprandial systemic biomarkers and substrate utilisation. Methods Eleven healthy, chronic SCI (> 1 year, ASIA A-C) men will be recruited. Following preliminary testing, each will complete four experimental conditions, where they will report to the laboratory following an ~ 10-h overnight fast. A venous blood sample will be drawn and expired gases collected to estimate resting metabolic rate (RMR). In order to ensure an isocaloric exercise challenge, each will complete CRT first, with the remaining three conditions presented in randomised order: (1) CRT, ~ 45 min of resistance manoeuvres (weight lifting) interspersed with low-resistance, high-speed arm-crank exercise; (2) CON, seated rest; (3) MICT, ~ 45 min constant arm-crank exercise at a resistance equivalent to 30–40% peak power output (PPO) and; (4) HIIT, ~ 35 min arm-crank exercise with the resistance alternating every 2 min between 10% PPO and 70% PPO. After each ~ 45-min condition, participants will ingest a 2510-kJ liquid test meal (35% fat, 50% carbohydrate, 15% protein). Venous blood and expired gas samples will be collected at the end of exercise and at regular intervals for 120 min post meal. Discussion This study should establish the acute effects of different forms of exercise on fasting and postprandial responses in chronic SCI male patients. Measures of glucose clearance, insulin sensitivity, lipid and inflammatory biomarker concentrations will be assessed and changes in whole-body substrate oxidation estimated from expired gases. Trial registration ClinicalTrials.gov, ID: NCT03545867. Retrospectively registered on 1 June 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3583-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David W McMillan
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Kinesiology and Sport Sciences, University of Miami, Miami, FL, USA
| | - Jennifer L Maher
- 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
| | - Kevin A Jacobs
- Department of Kinesiology and Sport Sciences, University of Miami, Miami, FL, USA
| | - Armando J Mendez
- Division of Endocrinology, Diabetes and Metabolism, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mark S Nash
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Physical Medicine and 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.
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Physical Exercise for Individuals With Spinal Cord Injury: Systematic Review Based on the International Classification of Functioning, Disability, and Health. J Sport Rehabil 2019; 28:505-516. [DOI: 10.1123/jsr.2017-0185] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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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.
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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
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Nightingale TE, Walhin JP, Thompson D, Bilzon JLJ. Biomarkers of cardiometabolic health are associated with body composition characteristics but not physical activity in persons with spinal cord injury. J Spinal Cord Med 2019; 42:328-337. [PMID: 28901220 PMCID: PMC6522924 DOI: 10.1080/10790268.2017.1368203] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To examine (i) the associations between physical activity dimensions, cardiorespiratory fitness and body composition and, (ii) the associations between physical activity dimensions, cardiorespiratory fitness, body composition and biomarkers of cardiometabolic health in persons with spinal cord injury (SCI). METHODS A cross-sectional prospective cohort study with 7-day follow-up was conducted. Body composition, cardiorespiratory fitness and biomarkers of cardiometabolic health were measured in thirty-three participants with SCI (> 1 year post injury). Physical activity dimensions were objectively assessed over 7-days. RESULTS Activity energy expenditure (r =.43), physical activity level (r =.39), and moderate-to-vigorous physical activity (MVPA) (r =.48) were significantly (P < 0.001) associated with absolute (L/min) peak oxygen uptake (⩒O2 peak). ⩒O2 peak was significantly higher in persons performing ≥150 MVPA minutes/week compared to <40 minutes/week (P = 0.003). Individual physical activity dimensions were not significantly associated with biomarkers of cardiometabolic health. However, body composition characteristics (BMI, waist and hip circumference) showed significant (P < 0.04), moderate (r >.30) associations with parameters of metabolic regulation, lipid profiles and inflammatory biomarkers. Relative ⩒O2 peak (ml/kg/min) was moderately associated with only insulin sensitivity (r = 0.37, P = 0.03). CONCLUSIONS Physical activity dimensions are associated with cardiorespiratory fitness; however, stronger and more consistent associations suggest that poor cardiometabolic health is associated with higher body fat content. Given these findings, the regulation of energy balance should be an important consideration for researchers and clinicians looking to improve cardiometabolic health in persons with SCI.
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Affiliation(s)
- Tom E Nightingale
- Department for Health, University of Bath, Bath, BA2 7AY, UK,Spinal Cord Injury and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, US,Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, US
| | | | - Dylan Thompson
- Department for Health, University of Bath, Bath, BA2 7AY, UK
| | - James LJ Bilzon
- Department for Health, University of Bath, Bath, BA2 7AY, UK,Correspondence to: Professor James LJ Bilzon, Department for Health, University of Bath, Bath, BA2 7AY, UK.
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Hisham H, Justine M, Hussain H, Hasnan N, Manaf H. Effects of Graded Exercises Integrated with Education on Physical Fitness, Exercise SelfEfficacy, and Activity Levels in People with Spinal Cord Injury: A Quasi-Experimental Study Protocol. Asian Spine J 2019; 13:577-583. [PMID: 30866621 PMCID: PMC6680025 DOI: 10.31616/asj.2018.0172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 12/13/2018] [Indexed: 11/23/2022] Open
Abstract
Study Design A quasi-experimental single-blinded study. Purpose To investigate the effects of ‘graded exercise integrated with education’ on physical fitness, exercise self-efficacy (ESE), and physical activity (PA) levels among subacute and chronic wheelchair-dependent paraplegia patients. Overview of Literature Most of the chronic spinal cord injury (SCI) patients had low physical fitness due to a sedentary lifestyle and lack of ESE after discharge from a rehabilitation program. Education may encourage them to engage with exercise to regain and maintain their physical fitness. However, there is a lack of research to support the effects of exercise integrated with education after an SCI. Methods A total of 44 participants will be assigned to either the experimental group (graded exercise integrated with education) or active control (conventional physical therapy). The experimental group will receive graded strength and aerobic exercise training according to their progression criteria. They will attend an education program during and after the rehabilitation program. The control group will only receive conventional physical therapy during their in-rehabilitation program. This study will be conducted during a period of 16 weeks, consisting of 8 weeks of in-rehabilitation and 8 weeks post-rehabilitation. Statistical analysis will be performed using the IBM SPSS ver. 21.0 (IBM Corp., Armonk, NY, USA) at a significance level of p≤0.05. Results The primary outcome measures will be upper-limb isokinetic strength, isometric grip strength, and cardiorespiratory fitness. The secondary outcomes will be ESE and PA levels. Conclusions An intervention that combines exercise training and education may be warranted to enhance the physical fitness, ESE, and PA levels in SCI patients. This trial was registered with ClinicalTrials.gov (NCT03420170).
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Affiliation(s)
- Hafifi Hisham
- Centre for Physiotherapy, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam Campus, Selangor, Malaysia.,Pusat Rehabilitasi PERKESO, Melaka, Malaysia
| | - Maria Justine
- Centre for Physiotherapy, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam Campus, Selangor, Malaysia
| | | | - Nazirah Hasnan
- Department of Rehabilitation Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Haidzir Manaf
- Centre for Physiotherapy, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam Campus, Selangor, Malaysia.,Clinical and Rehabilitation Exercise Research Group, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam Campus, Selangor, Malaysia
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Hemodynamic and cardiorespiratory responses to various arm cycling regimens in men with spinal cord injury. Spinal Cord Ser Cases 2019; 5:2. [PMID: 30675386 DOI: 10.1038/s41394-018-0145-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 12/04/2018] [Accepted: 12/10/2018] [Indexed: 12/13/2022] Open
Abstract
Study design Repeated measures within-subjects crossover study. Objectives High intensity interval exercise (HIIE) elicits higher oxygen consumption (VO2) and heart rate (HR) versus moderate intensity continuous exercise (MICE) in men with spinal cord injury (SCI). No study has compared hemodynamic responses to HIIE versus MICE in SCI. In this study, we determined hemodynamic and cardiorespiratory responses to different bouts of arm cycling in men with SCI. Setting Human Performance Laboratory, San Diego, CA. Methods Five men (age and injury duration = 42.6 ± 16.1 yr and 9.9 ± 7.6 yr) with SCI participated in the study. VO2peak and peak power output were initially assessed. Subsequent visits included MICE, HIIE, sprint interval exercise (SIE), and a no-exercise control (CON). Energy expenditure was matched across modes and equal to 100 ± 10 kcal. During the bouts, cardiac output (CO), stroke volume (SV), HR, and VO2 were measured. Results Heart rate, SV, and CO increased in response to all exercise bouts and were higher during exercise versus CON. During HIIE and SIE, heart rate approached 90% of maximum, and stroke volume increased by 40% which was higher (p < 0.05) versus MICE and CON. In addition, exercise led to a two (MICE) to threefold increase in CO (HIIE and SIE) although it was not different from CON. VO2 during SIE and HIIE was higher (p < 0.05) versus MICE. Conclusions Similar to results in non-disabled populations, HIIE and SIE elicit near-maximal values of SV and CO.
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Krassioukov AV, Currie KD, Hubli M, Nightingale TE, Alrashidi AA, Ramer L, Eng JJ, Ginis KAM, MacDonald MJ, Hicks A, Ditor D, Oh P, Verrier MC, Craven BC. Effects of exercise interventions on cardiovascular health in individuals with chronic, motor complete spinal cord injury: protocol for a randomised controlled trial [Cardiovascular Health/Outcomes: Improvements Created by Exercise and education in SCI (CHOICES) Study]. BMJ Open 2019; 9:e023540. [PMID: 30612110 PMCID: PMC6326283 DOI: 10.1136/bmjopen-2018-023540] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Recent studies demonstrate that cardiovascular diseases and associated complications are the leading cause of morbidity and mortality in individuals with spinal cord injury (SCI). Abnormal arterial stiffness, defined by a carotid-to-femoral pulse wave velocity (cfPWV) ≥10 m/s, is a recognised risk factor for heart disease in individuals with SCI. There is a paucity of studies assessing the efficacy of conventional training modalities on arterial stiffness and other cardiovascular outcomes in this population. Therefore, this study aims to compare the efficacy of arm cycle ergometry training (ACET) and body weight-supported treadmill training (BWSTT) on reducing arterial stiffness in individuals with chronic motor complete, high-level (above the sixth thoracic segment) SCI. METHODS AND ANALYSIS This is a multicentre, randomised, controlled, clinical trial. Eligible participants will be randomly assigned (1:1) into either ACET or BWSTT groups. Sixty participants with chronic (>1 year) SCI will be recruited from three sites in Canada (Vancouver, Toronto and Hamilton). Participants in each group will exercise three times per week up to 30 min and 60 min for ACET and BWSTT, respectively, over the period of 6 months. The primary outcome measure will be change in arterial stiffness (cfPWV) from baseline. Secondary outcome measures will include comprehensive assessments of: (1) cardiovascular parameters, (2) autonomic function, (3) body composition, (4) blood haematological and metabolic profiles, (5) cardiorespiratory fitness and (6) quality of life (QOL) and physical activity outcomes. Outcome measures will be assessed at baseline, 3 months, 6 months and 12 months (only QOL and physical activity outcomes). Statistical analyses will apply linear-mixed modelling to determine the training (time), group (ACET vs BWSTT) and interaction (time × group) effects on all outcomes. ETHICS AND DISSEMINATION Ethical approval was obtained from all three participating sites. Primary and secondary outcome data will be submitted for publication in peer-reviewed journals and widely disseminated. TRIAL REGISTRATION NUMBER NCT01718977; Pre-results. TRIAL STATUS Recruitment for this study began on January 2013 and the first participant was randomized on April 2013. Recruitment stopped on October 2018.
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Affiliation(s)
- Andrei V Krassioukov
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, British Columbia, Canada
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Katharine D Currie
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - Michèle Hubli
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
- Balgrist University Hospital, University of Zurich, Zurich, Swaziland
| | - Tom E Nightingale
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Abdullah A Alrashidi
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Medicine, Experimental Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Physical Therapy Department, King Fahd Medical City, Riyadh, Saudi Arabia
| | - Leanne Ramer
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
- Biomedical Physiology and Kinesiology, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Janice J Eng
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, British Columbia, Canada
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kathleen A Martin Ginis
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
- Southern Medical Program, School of Health & Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | | | - Audrey Hicks
- Spinal Cord Injury Centre, McMaster University, Hamilton, Ontario, Canada
| | - Dave Ditor
- Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Paul Oh
- Department of Medicine University Health Network, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Molly C Verrier
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Beverly Catharine Craven
- Department of Medicine University Health Network, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
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Coombs GB, Barak OF, Phillips AA, Mijacika T, Sarafis ZK, Lee AHX, Squair JW, Bammert TD, DeSouza NM, Gagnon D, Krassioukov AV, Dujic Z, DeSouza CA, Ainslie PN. Acute heat stress reduces biomarkers of endothelial activation but not macro- or microvascular dysfunction in cervical spinal cord injury. Am J Physiol Heart Circ Physiol 2018; 316:H722-H733. [PMID: 30575438 DOI: 10.1152/ajpheart.00693.2018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Cardiovascular diseases (CVD) are highly prevalent in spinal cord injury (SCI), and peripheral vascular dysfunction might be a contributing factor. Recent evidence demonstrates that exposure to heat stress can improve vascular function and reduce the risk of CVD in uninjured populations. We therefore aimed to examine the extent of vascular dysfunction in SCI and the acute effects of passive heating. Fifteen participants with cervical SCI and 15 uninjured control (CON) participants underwent ultrasound assessments of vascular function and venous blood sampling for biomarkers of endothelial activation (i.e., CD62e+) and apoptosis (i.e., CD31+/42b-) before and after a 60-min exposure to lower limb hot water immersion (40°C). In SCI, macrovascular endothelial function was reduced in the brachial artery [SCI: 4.8 (3.2)% vs. CON: 7.6 (3.4)%, P = 0.04] but not the femoral artery [SCI: 3.7 (2.6)% vs. CON: 4.0 (2.1)%, P = 0.70]. Microvascular function, via reactive hyperemia, was ~40% lower in SCI versus CON in both the femoral and brachial arteries ( P < 0.01). Circulating concentrations of CD62e+ were elevated in SCI versus CON [SCI: 152 (106) microparticles/µl vs. CON: 58 (24) microparticles/µl, P < 0.05]. In response to heating, macrovascular and microvascular function remained unchanged, whereas increases (+83%) and decreases (-93%) in antegrade and retrograde shear rates, respectively, were associated with heat-induced reductions of CD62e+ concentrations in SCI to levels similar to CON ( P = 0.05). These data highlight the potential of acute heating to provide a safe and practical strategy to improve vascular function in SCI. The chronic effects of controlled heating warrant long-term testing. NEW & NOTEWORTHY Individuals with cervical level spinal cord injury exhibit selectively lower flow-mediated dilation in the brachial but not femoral artery, whereas peak reactive hyperemia was lower in both arteries compared with uninjured controls. After 60 min of lower limb hot water immersion, femoral artery blood flow and shear patterns were acutely improved in both groups. Elevated biomarkers of endothelial activation in the spinal cord injury group decreased with heating, but these biomarkers remained unchanged in controls.
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Affiliation(s)
- Geoff B Coombs
- Centre for Heart, Lung and Vascular Health, University of British Columbia Okanagan , Kelowna, British Columbia , Canada
| | - Otto F Barak
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Aaron A Phillips
- Departments of Physiology and Pharmacology, Cardiac Sciences, Clinical Neurosciences, Hotchkiss Brain Institute, Libin Cardiovascular Institute, University of Calgary, Alberta, Canada
| | - Tanja Mijacika
- Department of Integrative Physiology, School of Medicine, University of Split , Split , Croatia
| | - Zoe K Sarafis
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia , Vancouver, British Columbia , Canada
| | - Amanda H X Lee
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia , Vancouver, British Columbia , Canada
| | - Jordan W Squair
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia , Vancouver, British Columbia , Canada
| | - Tyler D Bammert
- Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado , Boulder, Colorado
| | - Noah M DeSouza
- Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado , Boulder, Colorado
| | - Daniel Gagnon
- Cardiovascular Prevention and Rehabilitation Centre, Montreal Heart Institute Research Centre, Département de pharmacologie et physiologie, Faculté de Médecine, Université de Montréal , Montreal, Quebec , Canada
| | - Andrei V Krassioukov
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia , Vancouver, British Columbia , Canada.,Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia , Vancouver, British Columbia , Canada
| | - Zeljko Dujic
- Department of Integrative Physiology, School of Medicine, University of Split , Split , Croatia
| | - Christopher A DeSouza
- Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado , Boulder, Colorado
| | - Philip N Ainslie
- Centre for Heart, Lung and Vascular Health, University of British Columbia Okanagan , Kelowna, British Columbia , Canada.,International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia , Vancouver, British Columbia , Canada
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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.
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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
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Impact of Regular Physical Activity on Adipocytokines and Cardiovascular Characteristics in Spinal Cord–Injured Subjects. Arch Phys Med Rehabil 2018; 99:1561-1567.e1. [DOI: 10.1016/j.apmr.2018.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/07/2018] [Accepted: 02/13/2018] [Indexed: 11/22/2022]
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Kaźmierczak K, Lisiński P. Leisure time physical activity of people with chronic spinal cord injuries. Clin Neurol Neurosurg 2018; 170:7-12. [PMID: 29715578 DOI: 10.1016/j.clineuro.2018.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 04/02/2018] [Accepted: 04/08/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the nature of LTPA performed by patients with incomplete spinal cord injury a minimum of 12 months after injury. Therefore, the study investigates the impact of injury location on the form and frequency of LTPA, time between injury and commencement of LTPA, motivations to undertake such physical activity, as well as factors which reduce participation. PATIENT AND METHODS The study included 75 patients aged 18-60. The number of patients according to injury location was as follows: 25 cervical (C = 25), 25 thoracial (Th = 25) and 25 lumbar (L = 25) spine injuries. Data concerning injury type and location was obtained from the patients' medical records and included results of clinical examinations and neuroimaging. To evaluate LTPA, a custom questionnaire was designed, and functional mobility assessments were obtained with the Barthel Index (BI). RESULTS The study demonstrated that LTPA participation among examined SCI patients declined. At the time of the study, more than half of the patients (65%) declared participation in physical activity, mainly in the form of individually performed exercises. However, the frequency of LTPA was significantly lower compared with the period prior to injury (59% of persons). Engagement in LTPA was determined based on functional mobility, and the latter was measured with BI (r = 0.42, p < 0.001). More than half of the subjects (60%) were physically active within the first three years post injury. Exercising sessions occurred usually 3 to 5 times per week (40%). The motivating factors for committing to LTPA primarily included subjects' independent decisions (35%), followed by encouragement from another disabled person (20%). Barriers preventing from LTPA were related to architecture and transportation, and they accounted for 58% of cases where no LTPA was performed. CONCLUSIONS Spinal cord injury negatively impacts LTPA by reducing its frequency. Functional mobility of patients with spinal cord injury determines their participation levels in LTPA. The first three years after injury is the period during which engagement and commitment to LTPA is developed.
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Affiliation(s)
- Katarzyna Kaźmierczak
- Department and Clinic for Physiotherapy, Rheumatology and Rehabilitation, Karol Marcinkowski University of Medical Sciences, 28 czerwca 1956r. No 135/147, 61-545, Poznań, Poland.
| | - Przemysław Lisiński
- Department and Clinic for Physiotherapy, Rheumatology and Rehabilitation, Karol Marcinkowski University of Medical Sciences, 28 czerwca 1956r. No 135/147, 61-545, Poznań, Poland.
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Nightingale TE, Walhin JP, Thompson D, Bilzon JLJ. Impact of Exercise on Cardiometabolic Component Risks in Spinal Cord-injured Humans. Med Sci Sports Exerc 2018; 49:2469-2477. [PMID: 28753161 PMCID: PMC5704648 DOI: 10.1249/mss.0000000000001390] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Purpose Spinal cord injury (SCI) creates a complex pathology, characterized by low levels of habitual physical activity and an increased risk of cardiometabolic disease. This study aimed to assess the effect of a moderate-intensity upper-body exercise training intervention on biomarkers of cardiometabolic component risks, adipose tissue metabolism, and cardiorespiratory fitness in persons with SCI. Methods Twenty-one inactive men and women with chronic (>1 yr) SCI (all paraplegic injuries) 47 ± 8 yr of age (mean ± SD) were randomly allocated to either a 6-wk prescribed home-based exercise intervention (INT; n = 13) or control group (CON; n = 8). Participants assigned to the exercise group completed 4 × 45-min moderate-intensity (60%–65% peak oxygen uptake (V˙O2peak)) arm-crank exercise sessions per week. At baseline and follow-up, fasted and postload blood samples (collected during oral glucose tolerance tests) were obtained to measure metabolic regulation and biomarkers of cardiovascular disease. Abdominal subcutaneous adipose tissue biopsies were also obtained, and cardiorespiratory fitness was assessed. Results Compared with CON, INT significantly decreased (P = 0.04) serum fasting insulin (Δ, 3.1 ± 10.7 pmol·L−1 for CON and −12.7 ± 18.7 pmol·L−1 for INT) and homeostasis model assessment of insulin resistance (HOMA2-IR; Δ, 0.06 ± 0.20 for CON and −0.23 ± 0.36 for INT). The exercise group also increased V˙O2peak (Δ, 3.4 mL·kg−1·min−1; P ≤ 0.001). Adipose tissue metabolism, composite insulin sensitivity index (C-ISIMatsuda), and other cardiovascular disease risk biomarkers were not different between groups. Conclusions Moderate-intensity upper-body exercise improved aspects of metabolic regulation and cardiorespiratory fitness. Changes in fasting insulin and HOMA2-IR, but not C-ISIMatsuda, suggest improved hepatic but not peripheral insulin sensitivity after 6 wk of exercise training in persons with chronic paraplegia.
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Affiliation(s)
- Tom E Nightingale
- Department for Health, University of Bath, Bath, Somerset, UNITED KINGDOM
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Nightingale TE, Bilzon J. Cardiovascular Health Benefits of Exercise in People With Spinal Cord Injury: More Complex Than a Prescribed Exercise Intervention? Arch Phys Med Rehabil 2018; 97:1038. [PMID: 27233990 DOI: 10.1016/j.apmr.2016.02.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 02/16/2016] [Indexed: 10/21/2022]
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Lu H, Zhang LH, Yang L, Tang PF. The PI3K/Akt/FOXO3a pathway regulates regeneration following spinal cord injury in adult rats through TNF-α and p27kip1 expression. Int J Mol Med 2018; 41:2832-2838. [PMID: 29436581 DOI: 10.3892/ijmm.2018.3459] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 12/20/2017] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to elucidate the expression and role of the phosphatidylinositol 3‑kinase (PI3K)/Akt/forkhead box O3 (FOXO3a) pathway in the regeneration of the spinal cord following spinal cord injury (SCI), and its regulatory effect on tumor necrosis factor (TNF)-α and cyclin-dependent kinase inhibitor 1B (p27kip1) expression. Firstly, in a Sprague-Dawley rat model of SCI, western blot analysis revealed that the protein levels of PI3K, phosphorylated Akt and FOXO3a were markedly inhibited compared with those in the sham control group. In vitro experiments were also conducted, in which primary dissociated cultures of rat dorsal spinal cord cells were induced with lipopolysaccharide (LPS; 4 µg/ml). The downregulation of PI3K using LY294002 markedly suppressed cell viability, reduced the protein levels of FOXO3a and p27kip1, and increased TNF-α protein production in the LPS-induced spinal cord cells. In addition, when the LPS-induced spinal cord cells were infected with FOXO3a adenoviral vectors, the overexpression of FOXO3 markedly promoted cell proliferation, activated p27kip1 protein levels and inhibited TNF-α protein production in the spinal cord cells. These results suggest that the PI3K/Akt/FOXO3a pathway regulates regeneration following SCI in adult rats via its modulatory effects on TNF-α and p27kip1 expression.
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Affiliation(s)
- Honghui Lu
- Department of Orthopaedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100853, P.R. China
| | - Li-Hai Zhang
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Lin Yang
- Department of Orthopaedics, The Third Hospital of Beijing Municipal Corps, Chinese People's Armed Police Forces, Beijing 100141, P.R. China
| | - Pei-Fu Tang
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing 100853, P.R. China
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Pelletier CA, Omidvar M, Miyatani M, Giangregorio L, Craven BC. Participation in moderate-to-vigorous leisure time physical activity is related to decreased visceral adipose tissue in adults with spinal cord injury. Appl Physiol Nutr Metab 2018; 43:139-144. [PMID: 29017016 DOI: 10.1139/apnm-2017-0304] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2023]
Abstract
Increased visceral adiposity places individuals with chronic spinal cord injury (SCI) at increased risk of cardiometabolic disease. The purpose of this study was to identify if people with chronic SCI who participate in any moderate- to vigorous-intensity leisure time physical activity (LTPA) have lower visceral adipose tissue (VAT) area compared with those who report none. Participants included 136 adult men (n = 100) and women (n = 36) with chronic (mean (±SD) 15.6 ± 11.3 years post-injury) tetraplegia (n = 66) or paraplegia (n = 70) recruited from a tertiary rehabilitation hospital. VAT area was assessed via whole-body dual-energy X-ray absorptiometry using a Hologic densitometer and the manufacturer's body composition software. Moderate-to-vigorous LTPA was assessed using the Leisure Time Physical Activity Questionnaire for People with SCI (LTPAQ-SCI) or the Physical Activity Recall Assessment for People with SCI (PARA-SCI). Summary scores were dichotomized into any or no participation in moderate-to-vigorous LTPA to best represent the intensity described in current population-specific physical-activity guidelines. Data were analyzed using univariate and multiple regression analyses to identify the determinants of VAT. Overall, the model explained 67% of the variance in VAT area and included time post-injury, age-at-injury, android/gynoid ratio, waist circumference, and moderate-to-vigorous LTPA. Participation in any moderate-to-vigorous LTPA was significantly (95% confidence interval: -34.71 to -2.61, p = 0.02) associated with VAT after controlling for injury-related and body-composition correlates. Moderate-to-vigorous LTPA appears to be related to lower VAT area, suggesting potential for LTPA to reduce cardiometabolic disease risk among individuals with chronic SCI.
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Affiliation(s)
- Chelsea A Pelletier
- a Toronto Rehabilitation Institute - University Health Network, Brain and Spinal Cord Rehabilitation Program, Toronto, ON M4G 3V9, Canada
| | - Maryam Omidvar
- a Toronto Rehabilitation Institute - University Health Network, Brain and Spinal Cord Rehabilitation Program, Toronto, ON M4G 3V9, Canada
| | - Masae Miyatani
- a Toronto Rehabilitation Institute - University Health Network, Brain and Spinal Cord Rehabilitation Program, Toronto, ON M4G 3V9, Canada
| | - Lora Giangregorio
- a Toronto Rehabilitation Institute - University Health Network, Brain and Spinal Cord Rehabilitation Program, Toronto, ON M4G 3V9, Canada
- b Department of Kinesiology, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - B Catharine Craven
- a Toronto Rehabilitation Institute - University Health Network, Brain and Spinal Cord Rehabilitation Program, Toronto, ON M4G 3V9, Canada
- c Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada
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Vik LC, Lannem AM, Rak BM, Stensrud T. Health status of regularly physically active persons with spinal cord injury. Spinal Cord Ser Cases 2017; 3:17099. [PMID: 29423302 PMCID: PMC5798931 DOI: 10.1038/s41394-017-0033-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 10/16/2017] [Accepted: 10/17/2017] [Indexed: 11/09/2022] Open
Abstract
Study design A non-controlled cross-sectional study. Objectives To make a descriptive examination of health status in persons with paraplegia and tetraplegia who exercise regularly according to Canadian guidelines. Settings Sunnaas Rehabilitation Hospital and the Norwegian School of Sport Sciences. Methods Eighteen persons (men/women = 9/9), aged 41‒72 years with spinal cord injury (SCI), who exercise regularly were included. Post-injury years ranged from 4 to 48 years. Clinical examination of body composition, bone mineral density (BMD), forced vital capacity (FVC), forced expiratory volume in one second (FEV1), diffusion capacity (DLCO), cardiorespiratory fitness (VO2max), and self-reported quality of life (QOL) obtained by questionnaire was performed. Lung function results are presented as % predicted and VO2max as absolute values relative to body weight. All results are given as median and range. Results Persons with paraplegia (n = 13) were defined as overweight with fat mass 42% (25‒51). BMD 1.047 g cm−2 (0.885‒1.312) was within normal range. FVC 95% predicted (60‒131), FEV1 90% predicted (61‒119), DLCO 77% predicted (56‒103), and VO2max 16.66 ml kg−1 min−1 (12.15‒25.28) defined good aerobic capacity according to age controlled reference values (18). Persons with tetraplegia (n = 5) were slightly overweight with fat mass 35% (26‒47). BMD 1.122 g cm−2 (1.095‒1.299) was within normal range. FVC 72% predicted (46‒91), FEV1 75% predicted (43‒83), DLCO 67% predicted (56‒84), and VO2max 16.70 ml kg−1 min−1 (9.91‒21.01) defined excellent aerobic capacity according to reference values (18). QOL was ranked as median 7.5 (0‒10 scale). Conclusions Persons with SCI who exercise regularly following the Canadian guidelines responded with rather positive associations for health outcomes. Additional research is needed to strengthen our findings.
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Affiliation(s)
- Lene C Vik
- 1Norwegian School of Sport Sciences, Oslo, Norway.,2Sunnaas Rehabilitation Hospital, Nesodden, Norway
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Lieberman JA, McClelland JW, Goff DC, Racine E, Dulin MF, Bauman WA, Niemeier J, Hirsch MA, Norton HJ, Moore CG. Nutrition education for cardiovascular disease prevention in individuals with spinal cord injuries: study protocol for a randomized controlled trial. Trials 2017; 18:584. [PMID: 29202852 PMCID: PMC5716386 DOI: 10.1186/s13063-017-2263-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 10/12/2017] [Indexed: 12/15/2022] Open
Abstract
Background Individuals with chronic spinal cord injuries (SCIs) have an increased prevalence of cardiovascular disease (CVD) and associated risk factors compared with age-matched control subjects. Exercise has been shown to improve selected CVD risk factors in individuals with SCI, but using nutrition education as an intervention has not been evaluated in this population. This paper describes our research plan for evaluating the effect of nutrition education on individuals with SCI. In the present study, called Eat Smart, Live Better, we are using a randomized controlled design to test an intervention adapted from an existing evidence-based program that showed a positive effect on nutrition knowledge and behavior of older adults from the general population. There will be an inpatient group (n = 100) and a community group (n = 100). The aims of our study are to compare the intervention and control groups for (1) changes in nutritional behavior, nutritional knowledge, and dietary quality by participants in the program; (2) levels of adiposity and metabolic CVD risk factors at 12-month follow-up; and (3) differential effects among individuals with SCI in the acute rehabilitation setting and those living in the community. Methods/design This is a randomized controlled trial of nutrition education. The treatment groups receive six nutrition education sessions. The control groups receive the one “standard of care” nutrition lecture that is required by the Commission on Accreditation of Rehabilitation Facilities. Treatment groups include both an inpatient group, comprising patients who have been admitted to an acute rehabilitation facility because of their recent SCI, and an outpatient group, consisting of community-dwelling adults who are at least 1 year after their SCI. A total of 200 participants will be randomized 1:1 to the intervention or control group, stratified by location (acute rehabilitation facility or community dwelling). Discussion To our knowledge, this will be the first reported study of nutrition education in individuals with SCI. The low cost and feasibility of the intervention, if shown to improve nutritional behavior, suggests that it could be implemented in rehabilitation facilities across the country. This has the potential of lowering the burden of CVD and CVD risk factors in this high-risk population. Trial registration ClinicalTrials.gov, NCT02368405. Registered on February 10, 2015.
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Affiliation(s)
- Jesse A Lieberman
- Carolinas Rehabilitation, 1100 Blythe Boulevard, Charlotte, NC, 28203, USA.
| | | | - David C Goff
- National, Heart, Lung, and Blood Institute, 6701 Rockledge Drive, Suite 8030, Bethesda, MD, 20892, USA
| | - Elizabeth Racine
- University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC, 28223, USA
| | - Michael F Dulin
- University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC, 28223, USA
| | - William A Bauman
- James J. Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY, 10468, USA
| | - Janet Niemeier
- Carolinas Rehabilitation, 1100 Blythe Boulevard, Charlotte, NC, 28203, USA
| | - Mark A Hirsch
- Carolinas Rehabilitation, 1100 Blythe Boulevard, Charlotte, NC, 28203, USA
| | - H James Norton
- Carolinas Medical Center, 1000 Blythe Boulevard, Charlotte, NC, 28203, USA
| | - Charity G Moore
- Center for Outcomes Research and Evaluation, Carolinas HealthCare System, 1540 Garden Terrace Road, Charlotte, NC, 28203, USA
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Gibbs JC, Gagnon DH, Bergquist AJ, Arel J, Cervinka T, El-Kotob R, Maltais DB, Wolfe DL, Craven BC. Rehabilitation Interventions to modify endocrine-metabolic disease risk in Individuals with chronic Spinal cord injury living in the Community (RIISC): A systematic review and scoping perspective. J Spinal Cord Med 2017; 40:733-747. [PMID: 28703038 PMCID: PMC5778937 DOI: 10.1080/10790268.2017.1350341] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
CONTEXT Endocrine-metabolic disease (EMD) risk following spinal cord injury (SCI) is associated with significant multi-morbidity (i.e. fracture, diabetes, heart disease), mortality, and economic burden. It is unclear to what extent rehabilitation interventions can modify EMD risk and improve health status in community-dwelling adults with chronic SCI. OBJECTIVES To characterize rehabilitation interventions and summarize evidence on their efficacy/effectiveness to modify precursors to EMD risk in community-dwelling adults with chronic SCI. METHODS Systematic searches of MEDLINE PubMed, EMBASE Ovid, CINAHL, CDSR, and PsychInfo were completed. All randomized, quasi-experimental, and prospective controlled trials comparing rehabilitation/therapeutic interventions with control/placebo interventions in adults with chronic SCI were eligible. Two authors independently selected studies and abstracted data. Mean differences of change from baseline were reported for EMD risk outcomes. The GRADE approach was used to rate the quality of evidence. RESULTS Of 489 articles identified, 16 articles (11 studies; n=396) were eligible for inclusion. No studies assessed the effects of rehabilitation interventions on incident fragility fractures, heart disease, and/or diabetes. Individual studies reported that exercise and/or nutrition interventions could improve anthropometric indices, body composition/adiposity, and biomarkers. However, there were also reports of non-statistically significant between-group differences. CONCLUSIONS There was very low-quality evidence that rehabilitation interventions can improve precursors to EMD risk in community-dwelling adults with chronic SCI. The small number of studies, imprecise estimates, and inconsistency across studies limited our ability to make conclusions. A high-quality longitudinal intervention trial is needed to inform community-based rehabilitation strategies for EMD risk after chronic SCI.
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Affiliation(s)
- Jenna C. Gibbs
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada,University Health Network-Toronto Rehabilitation Institute, Lyndhurst Centre, Toronto, ON, Canada,Correspondence to: Dr. Jenna Gibbs, University of Waterloo, Department of Kinesiology, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - Dany H. Gagnon
- Université de Montréal, École de Réadaptation, Montréal, QC, Canada
| | - Austin J. Bergquist
- University Health Network-Toronto Rehabilitation Institute, Lyndhurst Centre, Toronto, ON, Canada
| | - Jasmine Arel
- Université de Montréal, École de Réadaptation, Montréal, QC, Canada
| | - Tomas Cervinka
- University Health Network-Toronto Rehabilitation Institute, Lyndhurst Centre, Toronto, ON, Canada
| | - Rasha El-Kotob
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada,University Health Network-Toronto Rehabilitation Institute, Lyndhurst Centre, Toronto, ON, Canada
| | | | - Dalton L. Wolfe
- Department of Physical Medicine and Rehabilitation, Western University, London, ON, Canada,Lawson Health Research Institute, Parkwood Institute Research, London, ON, Canada
| | - B. Catharine Craven
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada,University Health Network-Toronto Rehabilitation Institute, Lyndhurst Centre, Toronto, ON, Canada,Department of Medicine, University of Toronto, Toronto, ON, Canada
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Best KL, Arbour-Nicitopoulos KP, Sweet SN. Community-based physical activity and wheelchair mobility programs for individuals with spinal cord injury in Canada: Current reflections and future directions. J Spinal Cord Med 2017; 40:777-782. [PMID: 28872428 PMCID: PMC5778941 DOI: 10.1080/10790268.2017.1367363] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
RATIONALE A clear need has been identified to find strategies and opportunities, beyond services provided during rehabilitation, to enhance community-based mobility and leisure-time physical activity (LTPA) participation among members of the spinal cord injury (SCI) population. METHOD This review of existing mobility and LTPA programs that are available for individuals with SCI in Canada reflects the authors' current knowledge of existing evidence-based and community-based programs. The authors aim to highlight the gaps between existing programs and future needs. RESULTS The major gaps identified in this brief clinical report include the need for: community-based mobility training programs, patient reported outcomes, assessment of long-term impact of programs, identifying the best approaches for program delivery, and developing researcher-stakeholder partnerships. CONCLUSION Evidence-based mobility programs and community-based LTPA do exist, and the available research shows their promise. Despite the growing research for LTPA and mobility programs among adults with SCI, many gaps remain. Additional partnerships, community engagement practices, service program funding and health policy changes are needed to address the highlighted gaps to optimize community-based programs and enhance the lives of adults with SCI.
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Affiliation(s)
- Krista L. Best
- Department of Rehabilitation, Université Laval, Québec, QC, Canada,Centre for interdisciplinary research in rehabilitation and social integration (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Institut de réadaptation en déficience physique de Québec (IRDPQ), Québec, QC, Canada,Correspondence to: Krista L. Best, Department of Rehabilitation, Université Laval, Québec, QC, Canada. Centre for interdisciplinary research in rehabilitation and social integration (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Institut de réadaptation en déficience physique de Québec (IRDPQ), Québec, QC, Canada.
| | | | - Shane N. Sweet
- Department of Kinesiology & Physical Education, McGill University, Montreal, QC, Canada,Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
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van der Scheer JW, Hutchinson MJ, Paulson T, Martin Ginis KA, Goosey-Tolfrey VL. Reliability and Validity of Subjective Measures of Aerobic Intensity in Adults With Spinal Cord Injury: A Systematic Review. PM R 2017; 10:194-207. [DOI: 10.1016/j.pmrj.2017.08.440] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 08/03/2017] [Accepted: 08/14/2017] [Indexed: 01/23/2023]
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La Fountaine MF, Cirnigliaro CM, Azarelo F, Hobson JC, Tascione O, Swonger KN, Dyson-Hudson T, Bauman WA. Cutaneous microvascular perfusion responses to insulin iontophoresis are differentially affected by insulin resistance after spinal cord injury. Exp Physiol 2017; 102:1234-1244. [PMID: 28671307 DOI: 10.1113/ep086239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 06/29/2017] [Indexed: 01/06/2023]
Abstract
NEW FINDINGS What is the central question of this study? What impact does insulin resistance have on cutaneous perfusion responses to insulin iontophoresis in vascular beds with markedly reduced or functionally ablated sympathetic nervous system vasomotor function resulting from spinal cord injury? What is the main finding and its importance? Persons with spinal cord injury have sublesional microvascular endothelial dysfunction, as indicated by a blunted cutaneous perfusion response to acetylcholine iontophoresis, and the presence of insulin resistance has a further confounding effect on endothelium-mediated changes to cutaneous perfusion in the lower extremities. Endothelium-mediated mechanisms that regulate skin blood flow might play an integral role in optimizing skin perfusion in vascular beds with sympathetic nervous system vasomotor impairment, such as in spinal cord injury (SCI). Insulin is a vasoactive hormone and second messenger of nitric oxide that facilitates endothelium-mediated dilatation. The effects of insulin resistance (IR) on sublesional cutaneous perfusion responses to insulin provocation have yet to be described in persons with SCI. Persons with SCI and an able-bodied (AB) cohort were divided into subgroups based upon fasting plasma insulin concentration cut-offs for IR (≥13.13 mIU ml-1 ) or insulin sensitivity (IS; <13.13 mIU ml-1 ), as follows: AB, IS (ABIS, n = 21); SCI, IS (SCIS, n = 21); AB, IR (ABIR, n = 9); and SCI, IR (SCIR, n = 11). Laser Doppler flowmetry characterized peak blood perfusion unit (BPU) responses (percentage change from baseline) to insulin, acetylcholine or placebo iontophoresis in the lower extremities; BPU responses were log10 transformed to facilitate comparisons, and the net insulin response (NetIns) BPU response was calculated (insulin minus placebo BPU response). The NetIns was significantly greater in both IS groups compared with their corresponding IR group. The acetylcholine-mediated BPU responses in the SCI subgroups were significantly lower than those in the ABIS group. The proportional BPU responses of NetIns to acetylcholine in the IS cohorts (i.e. ABIS and SCIS) were significantly greater (P < 0.05) than that of each IR subgroup. The presence of IR has a confounding effect on sublesional microvascular endothelium-mediated cutaneous perfusion responses to provocation. Preservation of endothelial sensitivity to its agonists appears to be an important modifiable risk factor to optimize cutaneous perfusion in the lower extremities of persons with SCI.
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Affiliation(s)
- Michael F La Fountaine
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA.,School of Health and Medical Sciences, Seton Hall University, South Orange, NJ, USA.,The Institute for Advanced Study of Rehabilitation and Sports Science, School of Health and Medical Sciences, Seton Hall University, South Orange, NJ, USA
| | - Christopher M Cirnigliaro
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Frank Azarelo
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Joshua C Hobson
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Oriana Tascione
- State University of New York Downstate College of Medicine, Brooklyn, NY, USA
| | - Kirsten N Swonger
- Department of Chemical and Biomolecular Engineering, Tulane University, New Orleans, LA, USA
| | - Trevor Dyson-Hudson
- Kessler Foundation, West Orange, NJ, USA.,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - William A Bauman
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, 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
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Nightingale TE, Metcalfe RS, Vollaard NB, Bilzon JL. Exercise Guidelines to Promote Cardiometabolic Health in Spinal Cord Injured Humans: Time to Raise the Intensity? Arch Phys Med Rehabil 2017; 98:1693-1704. [DOI: 10.1016/j.apmr.2016.12.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 12/15/2016] [Indexed: 10/20/2022]
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