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Haghighi AH, Ahmadi A, Askari R, Shahrabadi H, Moody JA, Miller JM, Clemente F, Gentil P. A three-arm randomized controlled trial of aerobic and resistance training in women with spinal cord injuries: Effects on physical fitness and pulmonary function. Heliyon 2024; 10:e32538. [PMID: 39040233 PMCID: PMC11260952 DOI: 10.1016/j.heliyon.2024.e32538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 06/04/2024] [Accepted: 06/05/2024] [Indexed: 07/24/2024] Open
Abstract
Background This study aimed to investigate the effects of different volumes of aerobic training (AT) and resistance training (RT) during a concurrent exercise training program on selected indicators of physical fitness and pulmonary function in women with spinal cord injury (SCI). Methods Twenty-three inactive females with complete or incomplete SCI from T6 to L5 were divided into three groups: concurrent training with a focus on AT (CTAT; two weekly sessions of AT and one of RT), concurrent training with a focus on RT (CTRT; two weekly sessions of RT and one of AT), and control (CON). Tests were performed before and after an 8-week experimental period for indicators of pulmonary function, aerobic power, endurance performance, muscular strength and endurance, speed, and change of direction. Results Markers of both aerobic and muscular fitness increased in the CTAT and CTRT groups, but not in CON. There were significant differences in aerobic power and endurance performance between the CTAT and CTRT groups, with greater changes in CTAT. Both CTAT and CTRT improved respiratory functions, with no differences between them (p > 0.05). Conclusions CTAT and CTRT improved most of the indicators of physical fitness. However, CTAT should be used to achieve higher aerobic power and endurance without compromising muscle strength.
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Affiliation(s)
| | - Atefeh Ahmadi
- Faculty of Sport Sciences, Hakim Sabzevari University, Sabzevar, 961797648, Iran
| | - Roya Askari
- Faculty of Sport Sciences, Hakim Sabzevari University, Sabzevar, 961797648, Iran
| | - Hadi Shahrabadi
- Faculty of Sport Sciences, Hakim Sabzevari University, Sabzevar, 961797648, Iran
| | - Jeremy A. Moody
- Cardiff School of Sport and Health Science, Cardiff Metropolitan University, Cardiff, UK
- School of Physical Education and Sports, Nişantaşı University, Istanbul, Turkey
| | - Joshua M. Miller
- Department of Kinesiology and Nutrition, University of Illinois, Chicago, IL, 60612, USA
| | - Filipe Clemente
- Escola Superior de Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Viana do Castelo, 4900-347, Portugal
- Research Center in Sports Performance, Recreation, Innovation and Technology (SPRINT), Melgaço, 4960-320, Portugal
- Gdansk University of Physical Education and Sport, 80-336 Gdańsk, Poland
| | - Paulo Gentil
- College of Physical Education and Dance, Federal University of Goias, Goiânia, 74690-900, Brazil
- Hypertension League Federal University of Goias, Goiânia, 74605-050, Brazil
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Stendell L, Stubbs PW, Rogers K, Verhagen AP, Middleton JW, Davis GM, Arora M, Marshall R, Geraghty T, Nunn A, Quel de Oliveira C. Leisure-Time Physical Activity Participation in Middle-Aged and Older Adults With a Spinal Cord Injury in Australia. Int J Public Health 2024; 69:1607276. [PMID: 39022446 PMCID: PMC11251882 DOI: 10.3389/ijph.2024.1607276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 06/19/2024] [Indexed: 07/20/2024] Open
Abstract
Objectives Adults with spinal cord injury (SCI) are often sedentary, increasing their risk of cardiometabolic diseases. Leisure-time Physical Activity (LTPA) is physical activity completed during recreation time for enjoyment. We aimed to quantify LTPA in people ≥45 years with SCI and to explore its relationship with participants' characteristics. Methods This is a secondary analysis on a subset of the Australian International SCI Survey in participants ≥45 years, at least 12 months post-injury. We described levels of LTPA and used multivariable regressions to estimate the associations between participant characteristics and LTPA. Results Of 1,281 participants (mean age: 62.7 years, mean time since injury: 18.7 years; 74% males) 44% reported no participation in LTPA. The average LTPA participation was 197 (SD 352) minutes per week (median: 50). Females (β = -62.3, 95% CI [-112.9, -11.7]), and participants with non-traumatic injuries (β = -105.2, 95% CI [-165.9, -44.6]) performed less LTPA. Time since injury was not associated with moderate-to-heavy LTPA (LR: Probability > F = 0.785). Conclusion LTPA promotion in the SCI population ≥45 years focusing on females and non-traumatic injuries is warranted.
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Affiliation(s)
- Laura Stendell
- Discipline of Physiotherapy, Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Peter W. Stubbs
- Discipline of Physiotherapy, Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Kris Rogers
- Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Arianne P. Verhagen
- Discipline of Physiotherapy, Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - James W. Middleton
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, NSW, Australia
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Glen M. Davis
- Discipline of Exercise and Sport Science, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Mohit Arora
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, NSW, Australia
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Ruth Marshall
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
- South Australian Spinal Cord Injury Service, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Timothy Geraghty
- The Hopkins Centre, Metro South Health and Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
- Queensland Spinal Cord Injuries Service, Division of Rehabilitation, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Andrew Nunn
- Victorian Spinal Cord Service, Austin Health, Heidelberg, VIC, Australia
| | - Camila Quel de Oliveira
- Discipline of Physiotherapy, Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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Nataletti S, Banerjee A, Macaluso R, Prokup S, Jayaraman A, Wong AWK. Developing a mobile exercise program for individuals with Spinal Cord Injury: Stakeholder perceptions of app features and implementation determinants. Disabil Health J 2024:101667. [PMID: 38964938 DOI: 10.1016/j.dhjo.2024.101667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/28/2024] [Accepted: 06/23/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Individuals with Spinal Cord Injury (SCI) often experience physical deconditioning, leading to long-term health challenges. While regular exercise can offer substantial health benefits, adherence to exercise guidelines among individuals with SCI is hindered by barriers such as inaccessibility. Exercise programs using the mobile application (App) tailored to individual needs present a promising solution for promoting exercise adherence among individuals with SCI. OBJECTIVE This study aimed to identify factors contributing to the successful implementation of an app-based home exercise program for individuals with SCI and gather user feedback on app preferences, functionality, and features. METHODS Guided by the Consolidated Framework for Implementation Research (CFIR), twenty-six clinicians completed an expert panel survey to rank factors influencing the implementation of an app-based intervention for increasing exercise adherence for individuals with SCI. CFIR-selected factors and app quality features obtained from the Mobile Application Rating Scale (MARS) framework were discussed in seven focus groups with 23 individuals with SCI, 6 caregivers, and 6 clinicians. RESULTS The expert survey identified adaptability, complexity, evidence strength/quality, relative advantage, knowledge/beliefs about the initiative, and execution as the key CFIR factors that affected the intervention's success. Major themes emerging from focus groups with individuals with SCI and caregivers included usability, instruction and guidelines, user-friendly interface, and clinician interaction. In contrast, clinicians mentioned themes such as the representation of the SCI population, time commitment, accessibility, and equipment. CONCLUSIONS The study highlights the significance of incorporating these determinants into future designs to develop app-based home exercise interventions for individuals with SCI.
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Affiliation(s)
- Sara Nataletti
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA; Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL, 60611, USA.
| | - Anushua Banerjee
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA.
| | - Rebecca Macaluso
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA.
| | - Sara Prokup
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA.
| | - Arun Jayaraman
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA; Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL, 60611, USA; Department of Physical Therapy & Human Movement Sciences, Northwestern University, Chicago, IL, 60611, USA.
| | - Alex W K Wong
- Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL, 60611, USA; Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
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Stendell L, Stubbs PW, Rivera E, Rogers K, Verhagen AP, Davis GM, Middleton JW, de Oliveira CQ. Are Middle- or Older-Aged Adults With a Spinal Cord Injury Engaging in Leisure-Time Physical Activity? A Systematic Review and Meta-Analysis. Arch Rehabil Res Clin Transl 2024; 6:100335. [PMID: 39006108 PMCID: PMC11240020 DOI: 10.1016/j.arrct.2024.100335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/16/2024] Open
Abstract
Objectives To investigate the amount of Leisure-Time Physical Activity (LTPA) that people over 45 years with a spinal cord injury (SCI) performed and to determine the frequency, duration, intensity, and modality of LTPA performed. Data Sources We searched 5 major electronic databases (CINAHL, SCOPUS, EMBASE, MEDLINE, and PubMed) from inception to March 2023. Study Selection Cross-sectional, longitudinal studies and control arm of controlled trials that assessed LTPA in participants over 45 years old, with a SCI. We included 19 studies in the review and 11 in the meta-analysis. Data Extraction We followed the PRISMA checklist for Systematic Reviews. Two review authors independently assessed the risk of bias and extracted data on participants' demographics, injury characteristics, and LTPA participation of the included studies. Risk of bias was assessed using the Joanne Briggs Institute critical appraisal tool for cross-sectional studies. Any conflicts were resolved by a third author. Data Synthesis We found considerable variability in LTPA participation in adults 45 years and older with SCI. An estimated 27%-64% of participants did not take part in any LTPA. A random effects meta-analysis model was completed for studies that reported total or moderate-to-heavy LTPA scores in minutes per week. Overall, participants (n=1675) engaged in 260 [205;329] (mean [95% CI]) mins/week of total LTPA. Those participating in moderate-heavy intensity LTPA (n=364) completed 173 [118; 255] (mean [95% CI]) mins/week. LTPA modalities included walking, wheeling, hand-cycling, basketball, and swimming, among others. Conclusions While many older adults with SCI seem to be meeting the recommended weekly physical activity volume, many still remain sedentary. There was significant variation in reporting of frequency, intensity, and duration of LTPA and reporting on modality was limited. Because of differences in reporting, it was challenging to compare results across studies. Data constraints prevented subgroup analysis of LTPA disparities between paraplegia and tetraplegia.
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Affiliation(s)
- Laura Stendell
- Discipline of Physiotherapy, Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Peter W. Stubbs
- Discipline of Physiotherapy, Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Esminio Rivera
- Discipline of Physiotherapy, Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Kris Rogers
- Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Arianne P. Verhagen
- Discipline of Physiotherapy, Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Glen M. Davis
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - James W. Middleton
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
- The Kolling Institute, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Camila Quel de Oliveira
- Discipline of Physiotherapy, Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Castan A, Bonilla I, Chamarro A, Saurí J. Psychosocial Outcomes Associated With Types and Intensities of Physical Activity in People With Spinal Cord Injury: The Mediating Role of Self-Efficacy and Functionality. J Phys Act Health 2024; 21:481-490. [PMID: 38417424 DOI: 10.1123/jpah.2023-0404] [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: 07/31/2023] [Revised: 12/30/2023] [Accepted: 01/17/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND Low rates of participation and quality of life (QoL) and high rates of psychological distress are common in spinal cord injury (SCI) population. Research has supported the mediating role of self-efficacy and functionality in improving psychosocial outcomes. Furthermore, evidence supports the impact of physical activity (PA) on psychosocial variables, but little is known about the types and intensities of PA. The objective of this study was to determine whether functionality and/or general self-efficacy (GSE) mediate the relationships between the various types of PA: (1) lifestyle and (2) leisure-time physical activity (LTPA); and various intensities of PA: (1) mild, (2) moderate, and (3) heavy PA with participation, psychological distress, and perception of QoL. METHODS The Physical Activity Recall Assessment for SCI, and measures of functionality, GSE, participation, psychological distress, and perception of QoL were administered to 159 participants. Path analysis was performed using Jeffrey's Amazing Statistics Program. RESULTS GSE significantly mediated, and functionality partially significantly mediated, the relationship between LTPA and psychosocial outcomes. GSE and functionality did not mediate the relationship between lifestyle activity and psychosocial outcomes. CONCLUSIONS It is recommended that people with SCI perform LTPA on a regular basis to achieve psychosocial benefits. These programs should be accompanied by strategies to improve GSE.
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Affiliation(s)
- Alex Castan
- Functional Rehabilitation Department, Institut Guttmann Neurorehabilitation Hospital, University Institute attached to the Autonomous University of Barcelona, Spain
- Institute for Health Science Research Germans Trias i Pujol (IGTP), Badalona, Spain
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Spain
| | - Iván Bonilla
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Spain
- Sports Research Institute, Autonomous University of Barcelona, Spain
| | - Andrés Chamarro
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Spain
- Sports Research Institute, Autonomous University of Barcelona, Spain
| | - Joan Saurí
- Institute for Health Science Research Germans Trias i Pujol (IGTP), Badalona, Spain
- Neuropsychology Department, Institut Guttmann Neurorehabilitation Hospital, University Institute attached to the Autonomous University of Barcelona, Spain
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Mercier HW, Solinsky R, Taylor JA. Relationship of cardiometabolic disease risk factors with age and spinal cord injury duration. J Spinal Cord Med 2024; 47:379-386. [PMID: 35485952 PMCID: PMC11044727 DOI: 10.1080/10790268.2022.2065410] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
CONTEXT/OBJECTIVES Cardiometabolic disease (CMD) is increased after spinal cord injury (SCI), with an increased number of CMD risk factors that relate to higher mortality. The study objective was to characterize the relationship of age and injury duration with CMD. DESIGN Retrospective cohort assessment of CMD risks using unbiased recursive partitioning to divide for group comparison: (1) Lowest Risk, (2) Moderate Risk, and (3) Highest Risk based on classification and regression trees predicting CMD diagnosis by age and injury duration. SETTING Academic rehabilitation center laboratory. PARTICIPANTS Adults (N = 103; aged 18-75) with traumatic SCI (C4-L2) of 3 months to 42 years duration. INTERVENTIONS NA. OUTCOME MEASURES CMD risk factors (obesity, insulin resistance, dyslipidemia, and hypertension) using Paralyzed Veterans of America SCI-specific guidelines. RESULTS Obesity was prevalent (82%) and co-occurred with most other risk factors present. Age increased odds for CMD diagnosis by 1.05 per year (P = 0.02) and was directly related to elevated body mass index (BMI, β = 0.42, P < 0.05), fasting glucose (β = 0.58, P < 0.01), and higher systolic blood pressure (β = 0.31, P < 0.10). In contrast, time since injury contributed to lower risk factor count (β = -0.29, P < 0.10) and higher HDL-C (β = 0.50, P < 0.01), and was not related to odds of CMD diagnosis. CONCLUSION While SCI is linked to an increased risk of CMD, age is associated with higher CMD risk. Increased SCI duration related to improvement in individual CMD risk factors but did not decrease overall risk for CMD diagnosis. SCI may not uniformly increase CMD risks and highlight a necessary focus on weight management for risk prevention.
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Affiliation(s)
- Hannah W. Mercier
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- Cardiovascular Research Laboratory, Spaulding Rehabilitation Hospital, Cambridge, Massachusetts, USA
| | - Ryan Solinsky
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- Cardiovascular Research Laboratory, Spaulding Rehabilitation Hospital, Cambridge, Massachusetts, USA
| | - J. Andrew Taylor
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- Cardiovascular Research Laboratory, Spaulding Rehabilitation Hospital, Cambridge, Massachusetts, USA
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Conger SA, Herrmann SD, Willis EA, Nightingale TE, Sherman JR, Ainsworth BE. 2024 Wheelchair Compendium of Physical Activities: An update of activity codes and energy expenditure values. JOURNAL OF SPORT AND HEALTH SCIENCE 2024; 13:18-23. [PMID: 38242594 PMCID: PMC10818147 DOI: 10.1016/j.jshs.2023.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/20/2023] [Accepted: 10/26/2023] [Indexed: 01/21/2024]
Abstract
PURPOSE This paper presents an update of the 2011 Wheelchair Compendium of Physical Activities designed for wheelchair users and is referred to as the 2024 Wheelchair Compendium. The Wheelchair Compendium aims to curate existing knowledge of the energy expenditure for wheelchair physical activities (PAs). METHODS A systematic review of the published energy expenditure of PA for wheelchair users was completed between 2011 and May 2023. We added these data to the 2011 Wheelchair Compendium data that was compiled previously in a systematic review through 2011. RESULTS A total of 47 studies were included, and 124 different wheelchair PA reported energy expenditure values ranging from 0.8 metabolic equivalents for wheelchair users (filing papers, light effort) to 11.8 metabolic equivalents for wheelchair users (Nordic sit skiing). CONCLUSION In introducing the updated 2024 Wheelchair Compendium, we hope to bridge the resource gap and challenge the prevailing narratives that inadvertently exclude wheelchair users from physical fitness and health PAs.
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Affiliation(s)
- Scott A Conger
- Department of Kinesiology, Boise State University, Boise, ID 83725, USA.
| | - Stephen D Herrmann
- Kansas Center for Metabolism and Obesity Research, The University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Erik A Willis
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Tom E Nightingale
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham AL B152TT, UK; Centre for Trauma Sciences Research, University of Birmingham, Edgbaston, Birmingham AL B152TT, UK
| | - Joseph R Sherman
- Kansas Center for Metabolism and Obesity Research, The University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Barbara E Ainsworth
- College of Health Solutions, Arizona State University, Phoenix, AZ 85003, USA; School of Exercise and Health, Shanghai University of Sport, Shanghai 200438, China
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Veith DD, Linde MB, Wiggins CC, Zhao KD, Garlanger KL. Intervention Design of High-Intensity Interval Training in Individuals With Spinal Cord Injury: Narrative Review and Future Perspectives. Top Spinal Cord Inj Rehabil 2023; 29:1-15. [PMID: 38076494 PMCID: PMC10704212 DOI: 10.46292/sci22-00045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Background Individuals with spinal cord injury (SCI) have lower levels of physical activity compared to the nondisabled population. Exercise guidelines recommend moderate or vigorous exercise to improve cardiovascular health and reduce cardiometabolic risk factors in persons with SCI. High-intensity interval training (HIIT) is a popular exercise choice and encompasses brief periods of vigorous exercise paired with intermittent periods of recovery. Objectives This review describes the available literature on HIIT for individuals with SCI, including differences in protocol design and suggested areas of further investigation. Methods Our institution's library system performed the comprehensive search. The primary keywords and phrases used to search included spinal cord injury, high-intensity interval training, tetraplegia, paraplegia, and several other related terms. Results Initially 62 records were screened, and 36 were deemed outside the scope of this review. Twenty-six studies published between 2001 and 2021 fulfilled the eligibility criteria and were divided among two researchers for review and analysis. All records required persons with SCI and a standardized HIIT intervention. Study design varied widely with respect to mode of exercise, prescribed intensity, duration of performance intervals, and session duration. This variability necessitates further investigation into the specifics of a HIIT prescription and the associated outcomes for persons with SCI. Conclusion Standardization of HIIT protocols may lead to more robust conclusions regarding its effects on cardiorespiratory fitness as well as mitigation of cardiometabolic risk factors. Meta-analyses will eventually be needed on proper dosing and session parameters to improve cardiorespiratory fitness and cardiometabolic risk factors.
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Affiliation(s)
- Daniel D. Veith
- Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - Margaux B. Linde
- Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - Chad C. Wiggins
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Kristin D. Zhao
- Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - Kristin L. Garlanger
- Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota
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Alazzam AM, Alrubaye MW, Goldsmith JA, Gorgey AS. Trends in measuring BMR and RMR after spinal cord injury: a comprehensive review. Br J Nutr 2023; 130:1720-1731. [PMID: 37092679 PMCID: PMC10587382 DOI: 10.1017/s0007114523000831] [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: 08/05/2022] [Revised: 03/14/2023] [Accepted: 03/22/2023] [Indexed: 04/25/2023]
Abstract
Studying factors that contribute to our understanding of maintaining normal energy balance are of paramount significance following spinal cord injury (SCI). Accurate determination of energy needs is crucial for providing nutritional guidance and managing the increasing prevalence of malnutrition or obesity after SCI. BMR represents 75-80 % of the total energy expenditure in persons with SCI. Accurately measuring BMR is an important component for calculating total energetic needs in this population. Indirect calorimetry is considered the gold-standard technique for measuring BMR. However, technical challenges may limit its applications in large cohort studies and alternatively rely on prediction equations. Previous work has shown that BMR changes in response to disuse and exercise in the range of 15-120 %. Factors including sex, level of injury and type of assistive devices may influence BMR after SCI. RMR is erroneously used interchangeably for BMR, which may result in overestimation of energetic intake when developing nutritional plans. To address this concern, we comprehensively reviewed studies that conducted BMR (n=15) and RMR (n=22) in persons with SCI. The results indicated that RMR is 9 % greater than BMR in persons with SCI. Furthermore, the SCI-specific prediction equations that incorporated measures of fat-free mass appeared to accurately predict BMR. Overall, the current findings highlighted the significance of measuring BMR as well as encouraging the research and clinical community to effectively establish countermeasures to combat obesity after SCI.
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Affiliation(s)
- Ahmad M. Alazzam
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - Malak W. Alrubaye
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - Jacob A. Goldsmith
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - Ashraf S. Gorgey
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
- Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
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Kimball AL, Petrie MA, McCue PM, Johnson KA, Shields RK. Impaired Glucose Tolerance and Visceral Adipose Tissue Thickness among Lean and Non-Lean People with and without Spinal Cord Injury. J Funct Morphol Kinesiol 2023; 8:123. [PMID: 37606417 PMCID: PMC10443282 DOI: 10.3390/jfmk8030123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 08/23/2023] Open
Abstract
After spinal cord injury (SCI), multiple adaptations occur that influence metabolic health and life quality. Prolonged sitting and inactivity predispose people with SCI to body composition changes, such as increased visceral adipose tissue (VAT) thickness, which is often associated with impaired glucose tolerance. Our goal is to understand whether VAT is an index of leanness, and, secondarily, whether mobility methods influence glucose tolerance for people living with SCI. A total of 15 people with SCI and 20 people without SCI had fasting oral glucose tolerance tests (OGTT) and VAT thickness (leanness) measured during a single session. Glucose was 51% and 67% greater for individuals with SCI relative to those without SCI after 60 and 120 min of an OGTT (p < 0.001). Glucose area under the curve (AUC) was 28%, 34%, and 60% higher for non-lean people with SCI than lean people with SCI and non-lean and lean people without SCI, respectively (p = 0.05, p = 0.009, p < 0.001). VAT was associated with glucose AUC (R2 = 0.23, p = 0.004). Taken together, these findings suggest that leanness, as estimated from VAT, may be an important consideration when developing rehabilitation programs to influence metabolism among people with SCI.
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Affiliation(s)
| | | | | | | | - Richard K. Shields
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, The University of Iowa, Iowa City, IA 52242, USA; (A.L.K.); (M.A.P.); (P.M.M.); (K.A.J.)
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Soleymani H, Jeng B, Abdelmessih B, Cowan R, Motl RW. Accuracy and Precision of Actigraphy and SMARTwheels for Measuring Push Counts Across a Series of Wheelchair Propulsion Trials in Non-disabled Young Adults. INTERNATIONAL JOURNAL OF MEDICAL STUDENTS 2023. [DOI: 10.5195/ijms.2023.1950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Background: There has been a growing interest in “Lifestyle Physical Activity” (LPA) among wheelchair users. LPA can be quantified via “pushes” as an outcome metric. This study examined the accuracy and precision of research-grade devices for counting pushes across a series of wheelchair propulsion trials.
Methods: Eleven non-disabled, young adults completed 19, 1-minute wheelchair propulsion trials at self-selected speeds with a wheelchair equipped with a SMARTwheel (SW) device while being video recorded. Participants also wore 2 ActiGraph accelerometers, one on the wrist and one on the upper arm. Video footage enabled manual counting of the number of pushes (gold standard). Total pushes were averaged across 16 workloads (3 trials of repeated workloads were excluded) for each device and compared to manually counted pushes.
Results: Compared to manually counted pushes, SW demonstrated the greatest accuracy (mean difference [MD] compared to video of 2.3 pushes [4.5% error]) and precision (standard deviation of the mean difference [SDMD]) compared to video of 4 pushes, (Coefficient of Variation [CV] =.04), followed by the upper arm-worn accelerometer (MD of 4.4 pushes [10.4% error] and SDMD of 10, [CV= .06]) and the wrist-worn accelerometer (MD of 12.6 pushes [27.8% error] and SDMD of 13 [CV=.15]).
Conclusions: SW demonstrated greater accuracy and precision than ActiGraph accelerometers placed on the upper arm and wrist. The accelerometer placed on the upper arm was more accurate and precise than the accelerometer placed on the wrist. Future investigations should be conducted to identify the source(s) of inaccuracy among wearable push counters.
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12
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Sacral interface pressure can be alleviated by repositioning with a small-angle change using an automated bed in patients with spinal cord injury. J Tissue Viability 2023; 32:314-320. [PMID: 36894461 DOI: 10.1016/j.jtv.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/20/2023] [Accepted: 02/17/2023] [Indexed: 02/21/2023]
Abstract
AIM OF THE STUDY This study aimed to compare interface pressure and total contact area of the sacral region in different positions, including small-angle changes, in patients with spinal cord injury (SCI). Furthermore, we analyzed the clinical factors influencing pressure to identify the pressure injury (PI) high-risk group. MATERIALS AND METHODS An intervention was conducted for patients with paraplegia (n = 30) with SCI. In the first and second trials, interface pressure and total contact area of the sacral region were recorded from large- and small-angled positions using the automatic repositioning bed, which can change the angle of the back, lateral tilt, and knee. RESULTS Positions with back raised ≥45° showed significantly higher pressure on the sacrum than most other positions. The pressure and contact area differences were statistically insignificant for combinations of small-angled changes <30°. Additionally, the duration of injury (β = 0.51, p = 0.010) and neurological level of injury (NLI) (β = -0.47, p = 0.020) were significant independent predictors of average pressure. Similarly, the duration of injury (β = 0.64, p = 0.001), the Korean version of the spinal cord independence measure-III (β = -0.52, p = 0.017), and body mass index (BMI; β = -0.34, p = 0.041) were significant independent predictors of peak pressure. CONCLUSIONS For repositioning, combinations of small-angle changes <30° effectively reduce pressure on the sacral region in patients with SCI. Lower BMI, longer duration of injury, lower functioning score, and NLI ≥ T7 are predictors of high sacral pressures, which increase the risk for PI. Therefore, patients with these predictors require strict management.
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13
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Zainudin MF, Ahmad Fauzi A. Factors associated with sports participation amongst people with spinal cord injury in a Malaysian tertiary hospital. J Spinal Cord Med 2023; 46:91-98. [PMID: 34292138 PMCID: PMC9897789 DOI: 10.1080/10790268.2021.1950454] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To identify factors that are associated with sports participation following spinal cord injury (SCI). STUDY DESIGN Case-control study. SETTING Spinal Rehabilitation outpatient clinic in a tertiary hospital in Kuala Lumpur, Malaysia. PARTICIPANTS Thirty-one sports participants (SP) and thirty-four non-sports participants (NSP) (N = 65) met the following inclusion criteria; chronic SCI more than one year, age between 18 and 50 years, both traumatic and non-traumatic SCI at C5 level and below, complete or incomplete SCI (AIS A-D) and mobilizing with either manual or motorized wheelchair independently. METHODS Face-to-face interviews were performed with a 22-item self-constructed questionnaire which contained four domains of variables; socio-demographic, SCI-related, environmental and sports-related factors. Data collection was done between June 2017 and May 2018. RESULTS Traumatic SCI, pre-injury interest in sports, pre-injury sports participation, ability to drive own vehicles, and being employed were significantly associated with sports participation post-SCI (p < 0.05). Multiple logistic regression revealed traumatic SCI (p = 0.012, OR 34.70, CI 2.21-545.90) and pre-injury interest in sports (p = 0.046, OR 29.10, CI 1.06-798.95) to be independent predictors of sports participation post-SCI. CONCLUSION Traumatic SCI and pre-injury interest in sports were predictors of sports participation post-SCI. Pre-injury sports participation, being employed, and the ability to drive own vehicles were positively associated with sports participation. Findings from this study suggest a few crucial differences in facilitators and barriers to sports participation in Malaysia compared to other countries.
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Affiliation(s)
- Muhamad Faizal Zainudin
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia,Corresponding to: Muhamad Faizal Zainudin, Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Jalan Universiti, Kuala Lumpur50603, Malaysia.
| | - Aishah Ahmad Fauzi
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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14
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Eitivipart AC, Arora M, Quel de Oliveira C, Heard R, Middleton JW, Davis GM. Assessing physical activity and health-related quality of life in individuals with spinal cord injury: a national survey in Thailand. Disabil Rehabil 2022; 44:7048-7058. [PMID: 34592857 DOI: 10.1080/09638288.2021.1979665] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE This study sought to; (i) investigate the proportion of Thai individuals with spinal cord injury (Thai-SCI) who met SCI-specific physical activity (PA) guidelines, (ii) describe PA and health-related quality of life (HRQOL) of Thai-SCI across different sociodemographic strata, and, (iii) measure the variance in HRQOL associated with the intensity and volume of leisure-time physical activities (LTPA). METHODS Two surveys, measuring PA and HRQOL, were used in this study. Descriptive analysis, parametric and non-parametric tests for comparing two or more groups were used to analyse the data. The relationship between PA levels and HRQOL scores was investigated using Spearman's correlation coefficients. All statistical significance level in this study were set to alpha < 0.05. RESULTS From the 200 participants, 14.5% met aerobic, 20.5% met strength training and 13.5% met both aerobic and strength training SCI-specific PA guidelines. Sedentary Thai-SCI accounted for 49% of the study sample. Thai-SCI spent 132.0 ± 254.3 (mean ± SD) minutes per week on moderate-to-heavy intensity LTPA. Average Physical and Mental Component Summary (PCS and MCS scores) of Thai-SCI were 42.3 ± 7.6 and 49.3 ± 8.4 (mean ± SD), respectively. Increases in average LTPA of moderate-to-heavy intensities were weakly correlated with increases in PCS scores and its sub-domains (r = 0.1-0.3, n = 200, all p < 0.05). CONCLUSION The average time spent on moderate-to-heavy intensity ADLs and LTPA were below SCI-specific PA guidelines and the WHO global recommendations for PA. The proportion of Thai-SCI who were sedentary was high, suggesting immediate action and implementation of strategies to promote PA for Thai-SCI.IMPLICATIONS FOR REHABILITATIONThe proportion of Thai people with spinal cord injury with a sedentary lifestyle was high.Healthcare providers in Thailand must engage to a greater degree in health-related physical activity promotion to effectively deliver physical activity and exercise knowledge to their clients with spinal cord injury.Likely, structured programs of physical activity and exercise deployed by healthcare professionals with the appropriate knowledge and skills might reverse the current trend to sedentary lifestyle in this population.Interventions to improve participation in physical activity and health-related quality of life should be tailored to the individual needs of Thai individuals with a spinal cord injury and might be better delivered seperately.
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Affiliation(s)
- Aitthanatt Chachris Eitivipart
- Discipline of Exercise and Sport Sciences, Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia.,Accessibility and Assistive Technology Research Team, Assistive Technology and Medical Devices Research Center, National Science and Technology Development Agency, Pathum Thani, Thailand
| | - Mohit Arora
- John Walsh Centre for Rehabilitation Research, The Kolling Institute, Royal North Shore Hospital, St. Leonards, Australia.,Faculty of Medicine and Health, Sydney Medical School-Northern, The University of Sydney, Sydney, Australia
| | - Camila Quel de Oliveira
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Robert Heard
- Discipline of Behavioural and Social Sciences in Health, Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| | - James W Middleton
- John Walsh Centre for Rehabilitation Research, The Kolling Institute, Royal North Shore Hospital, St. Leonards, Australia.,Faculty of Medicine and Health, Sydney Medical School-Northern, The University of Sydney, Sydney, Australia
| | - Glen M Davis
- Discipline of Exercise and Sport Sciences, Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
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15
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Energy expenditure and nutrient intake after spinal cord injury: a comprehensive review and practical recommendations. Br J Nutr 2022; 128:863-887. [PMID: 34551839 PMCID: PMC9389429 DOI: 10.1017/s0007114521003822] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Many persons with spinal cord injury (SCI) have one or more preventable chronic diseases related to excessive energetic intake and poor eating patterns. Appropriate nutrient consumption relative to need becomes a concern despite authoritative dietary recommendations from around the world. These recommendations were developed for the non-disabled population and do not account for the injury-induced changes in body composition, hypometabolic rate, hormonal dysregulation and nutrition status after SCI. Because evidence-based dietary reference intake values for SCI do not exist, ensuring appropriate consumption of macronutrient and micronutrients for their energy requirements becomes a challenge. In this compressive review, we briefly evaluate aspects of energy balance and appetite control relative to SCI. We report on the evidence regarding energy expenditure, nutrient intake and their relationship after SCI. We compare these data with several established nutritional guidelines from American Heart Association, Australian Dietary Guidelines, Dietary Guidelines for Americans, Institute of Medicine Dietary Reference Intake, Public Health England Government Dietary Recommendations, WHO Healthy Diet and the Paralyzed Veterans of America (PVA) Clinical Practice Guidelines. We also provide practical assessment and nutritional recommendations to facilitate a healthy dietary pattern after SCI. Because of a lack of strong SCI research, there are currently limited dietary recommendations outside of the PVA guidelines that capture the unique nutrient needs after SCI. Future multicentre clinical trials are needed to develop comprehensive, evidence-based dietary reference values specific for persons with SCI across the care continuum that rely on accurate, individual assessment of energy need.
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16
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Alajam RA, Alqahtani AS, Moon S, Sarmento CVM, Frederick J, Smirnova IV, Liu W. Effects of walking training on risk markers of cardiovascular disease in individuals with chronic spinal cord injury. J Spinal Cord Med 2022; 45:622-630. [PMID: 33443465 PMCID: PMC9246252 DOI: 10.1080/10790268.2020.1853332] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To investigate the effects of an 8-week walking training program on glycemic control, lipid profile, and inflammatory markers in individuals with chronic spinal cord injury (SCI). DESIGN A pilot, single-group, pretest-posttest study. SETTING A neuromuscular research laboratory. PARTICIPANTS Eleven participants with chronic SCI. INTERVENTION An 8-week walking training program using a treadmill, a body weight-supported system, and an assistive gait training device. OUTCOME MEASURES Levels of glycated hemoglobin (HbA1c), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), C-reactive protein (CRP), and interleukin-6 were assessed before and after the walking training. RESULTS Following the walking training, there was a statistically significant decrease in HbA1c level (P<0.01) of uncertain clinical significance. The lipid profile improved after training, as shown by a statistically and clinically significant increase in HDL-C level (P<0.01) and a statistically significant decrease in LDL-C level (P<0.1) of no clinical significance. The ratio of LDL-C to HDL-C was significantly reduced (P<0.01). In regard to inflammatory markers, concentrations of IL-6 showed a significant reduction after training (P=0.05) of unknown clinical significance, while those of CRP trended to decrease (P=0.13). CONCLUSION The findings of this pilot study suggest that an 8-week walking training program may produce favorable changes in risk markers of cardiovascular disease in individuals with chronic SCI as shown by clinically meaningful improvements in HDL-C, and small changes in the right direction, but uncertain clinical significance, in HbA1c, LDL-C and IL-6. A randomized controlled trial is needed to compare the effects of walking training on these outcome measures with those of other exercise modalities suitable for this population, and to see if more prolonged exercise exposure leads to favorable parameters of significant size to justify the exercise modality.
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Affiliation(s)
- Ramzi A. Alajam
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas, United States,Department of Physical Therapy, Jazan University, Jazan, Saudi Arabia,Corresponding author: Ramzi Alajam, Department of Physical Therapy, Faculty of Applied Medical Science, Jazan University, Jazan, Saudi Arabia;
| | - Abdulfattah S. Alqahtani
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas, United States,Department of Health Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Sanghee Moon
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas, United States
| | - Caio V. M. Sarmento
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas, United States,Department of Physical Therapy, California State University, Fresno, California, United States
| | - Jason Frederick
- Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City, Kansas, United States
| | - Irina V. Smirnova
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas, United States
| | - Wen Liu
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas, United States
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17
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Bekhet AH, Jahan AM, Bochkezanian V, Musselman KE, Elsareih AA, Gorgey AS. Effects of Electrical Stimulation Training on Body Composition Parameters After Spinal Cord Injury: A Systematic Review. Arch Phys Med Rehabil 2022; 103:1168-1178. [PMID: 34687676 DOI: 10.1016/j.apmr.2021.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 08/10/2021] [Accepted: 09/05/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine the effects of neuromuscular electrical stimulation (NMES) or functional electrical stimulation (FES), or both, training on different body composition parameters in individuals with spinal cord injury. DATA SOURCES Three independent reviewers searched PubMed, Web of Science, Scopus, Cochrane Central, and Virtual Health Library until March 2020. STUDY SELECTION Studies were included if they applied NMES/FES on the lower limb muscles after spinal cord injury, reported stimulation parameters (frequency, pulse duration, and amplitude of current), and body composition parameters, which included muscle cross-sectional area (CSA), fat-free mass, lean mass (LM), fat mass, visceral adipose tissue, and intramuscular fat. DATA SYNTHESIS A total of 46 studies were included in the final analysis with a total sample size of 414 subjects. NMES loading exercise and FES cycling exercise were commonly used for training. Increases in muscle CSA ranged from 5.7-75%, with an average of 26% (n=33). Fifteen studies reported changes (both increase and decrease) in LM or fat-free mas ranged from -4% to 35%, with an average of less than 5%. Changes in fat mass (n=10) were modest. The effect on ectopic adipose tissue is inconclusive, with 2 studies showing an average reduction in intramuscular fat by 9.9%. Stimulation parameters ranged from 200-1000 μs for pulse duration, 2-60 Hz for the frequency, and 10-200 mA in amplitude. Finally, increase in weekly training volumes after NMES loading exercise resulted in a remarkable increase in percentage changes in LM or muscle CSA. CONCLUSIONS NMES/FES is an effective rehabilitation strategy for muscle hypertrophy and increasing LM. Weekly training volumes are associated with muscle hypertrophy after NMES loading exercise. Furthermore, positive muscle adaptations occur despite the applied stimulation parameters. Finally, the included studies reported wide range of stimulation parameters without reporting rationale for such selection.
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Affiliation(s)
| | - Alhadi M Jahan
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada
| | - Vanesa Bochkezanian
- Department of Exercise and Health Sciences, School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia
| | - Kristin E Musselman
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada; Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada; Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Amr A Elsareih
- Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Ashraf S Gorgey
- Faculty of Physical Therapy, Cairo University, Giza, Egypt; Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VAMC, 1201 Broad Rock Boulevard, Richmond, VA; Virginia Commonwealth University, Department of Physical Medicine & Rehabilitation, Richmond, VA.
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18
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Sutor TW, Ghatas MP, Goetz LL, Lavis TD, Gorgey AS. Exoskeleton Training and Trans-Spinal Stimulation for Physical Activity Enhancement After Spinal Cord Injury (EXTra-SCI): An Exploratory Study. FRONTIERS IN REHABILITATION SCIENCES 2022; 2:789422. [PMID: 35169770 PMCID: PMC8842517 DOI: 10.3389/fresc.2021.789422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/30/2021] [Indexed: 11/30/2022]
Abstract
After spinal cord injury (SCI) physical activity levels decrease drastically, leading to numerous secondary health complications. Exoskeleton-assisted walking (EAW) may be one way to improve physical activity for adults with SCI and potentially alleviate secondary health complications. The effects of EAW may be limited, however, since exoskeletons induce passive movement for users who cannot volitionally contribute to walking. Trans-spinal stimulation (TSS) has shown the potential to enable those with even the most severe SCI to actively contribute to movements during EAW. To explore the effects of EAW training on improving secondary health complications in persons with SCI, participants with chronic (n = 8) were enrolled in an EAW program 2-3 times per week for 12 weeks. Anthropometrics (seated and supine waist and abdominal circumferences (WC and AC), body composition assessment (dual exposure x-ray absorptiometry-derived body fat percent, lean mass and total mass for the total body, legs, and trunk), and peak oxygen consumption (VO2 during a 6-minute walk test [6MWT]) were assessed before and after 12 weeks of EAW training. A subset of participants (n = 3) completed EAW training with concurrent TSS, and neuromuscular activity of locomotor muscles was assessed during a 10-m walk test (10MWT) with and without TSS following 12 weeks of EAW training. Upon completion of 12 weeks of training, reductions from baseline (BL) were found in seated WC (-2.2%, P = 0.036), seated AC (-2.9%, P = 0.05), and supine AC (-3.9%, P = 0.017). Percent fat was also reduced from BL for the total body (-1.4%, P = 0.018), leg (-1.3%, P = 0.018), and trunk (-2%, P = 0.036) regions. No effects were found for peak VO2. The addition of TSS for three individuals yielded individualized responses but generally increased knee extensor activity during EAW. Two of three participants who received TSS were also able to initiate more steps without additional assistance from the exoskeleton during a 10MWT. In summary, 12 weeks of EAW training significantly attenuated markers of obesity relevant to cardiometabolic health in eight men with chronic SCI. Changes in VO2 and neuromuscular activity with vs. without TSS were highly individualized and yielded no overall group effects.
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Affiliation(s)
- Tommy W. Sutor
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire Veteran Affairs Medical Center, Richmond, VA, United States
| | - Mina P. Ghatas
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire Veteran Affairs Medical Center, Richmond, VA, United States
| | - Lance L. Goetz
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire Veteran Affairs Medical Center, Richmond, VA, United States
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, United States
| | - Timothy D. Lavis
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire Veteran Affairs Medical Center, Richmond, VA, United States
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, United States
| | - Ashraf S. Gorgey
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire Veteran Affairs Medical Center, Richmond, VA, United States
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, United States
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19
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Li J, Van Der Pol W, Eraslan M, McLain A, Cetin H, Cetin B, Morrow C, Carson T, Yarar-Fisher C. Comparison of the gut microbiome composition among individuals with acute or long-standing spinal cord injury vs. able-bodied controls. J Spinal Cord Med 2022; 45:91-99. [PMID: 32496944 PMCID: PMC8890582 DOI: 10.1080/10790268.2020.1769949] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective: Compare the gut microbiome composition among individuals with acute spinal cord injury (A-SCI), long-standing SCI (L-SCI), vs. able-bodied (AB) controls.Design: Cross-sectional study.Setting: The University of Alabama at Birmingham.Participants: Seven adults with A-SCI (36 ± 12 years, 2F/5M, C4-T10, and American Spinal Injury Association Impairment Scale [AIS] A-D), 25 with L-SCI (46 ± 13 years, 6F/19M, C4-L1, and AIS A-D), and 25 AB controls (42 ± 13 years, 9F/16M).Methods: Stool samples were collected after a median of 7 days and 18 years after injury in the A-SCI and L-SCI groups, respectively. Gut microbiome composition was analyzed using the 16S rRNA sequencing technique and QIIME software. The abundances of bacteria communities among groups were compared using the Kruskal-Wallis test adjusted for age.Results: Several alpha diversity indices were different among groups (Chao1, Observed species, and Phylogenetic Diversity), but not others (Shannon and Simpson). Beta diversity differed among each pair of groups (P < 0.05). A number of microbial communities were differentially abundant among the groups (P < 0.05).Conclusion: Our results revealed differences in the gut microbiome composition among groups. Compared to the AB controls, the SCI groups demonstrated microbiome profiles that shared features linked to metabolic syndrome, inflammation-related bowel disorders, depressive disorders, or antibiotics use, whereas the L-SCI group's microbiome included features linked to reduced physical activity compared to the A-SCI and AB controls. Our results provided preliminary data and a scientific foundation for future studies investigating the impact of the gut microbiome composition on long-term health in individuals with SCI.
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Affiliation(s)
- Jia Li
- Departments of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Aabama
| | - William Van Der Pol
- Center for Clinical and Translational Science, University of Alabama at Birmingham, Birmingham, Aabama
| | - Mualla Eraslan
- Departments of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Aabama
| | - Amie McLain
- Departments of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Aabama
| | - Hatice Cetin
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Turkey
| | - Baris Cetin
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Turkey
| | - Casey Morrow
- Department of Cell, Developmental and Integrative Biology, University of Alabama at Birmingham, Aabama
| | - Tiffany Carson
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Aabama
| | - Ceren Yarar-Fisher
- Departments of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Aabama,Correspondence to: Ceren Yarar-Fisher, PhD. University of Alabama at Birmingham, 503 Shelby Biomedical Research Building 1825 University Blvd., Birmingham, AL35233.
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20
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Invasive and Non-Invasive Approaches of Electrical Stimulation to Improve Physical Functioning after Spinal Cord Injury. J Clin Med 2021; 10:jcm10225356. [PMID: 34830637 PMCID: PMC8625266 DOI: 10.3390/jcm10225356] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/09/2021] [Accepted: 11/12/2021] [Indexed: 12/13/2022] Open
Abstract
This review of literature provides the latest evidence involving invasive and non-invasive uses of electrical stimulation therapies that assist in restoring functional abilities and the enhancement of quality of life in those with spinal cord injuries. The review includes neuromuscular electrical stimulation and functional electrical stimulation activities that promote improved body composition changes and increased muscular strength, which have been shown to improve abilities in activities of daily living. Recommendations for optimizing electrical stimulation parameters are also reported. Electrical stimulation is also used to enhance the skills of reaching, grasping, standing, and walking, among other activities of daily living. Additionally, we report on the use of invasive and non-invasive neuromodulation techniques targeting improved mobility, including standing, postural control, and assisted walking. We attempt to summarize the effects of epidural stimulation on cardiovascular performance and provide a mechanistic explanation to the current research findings. Future trends such as the combination of epidural stimulation and exoskeletal-assisted walking are also discussed.
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21
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Piccinini L, Cimolin V, Storm F, Di Girolamo G, Biffi E, Galli M, Condoluci C. Quantification of the effects of robotic-assisted gait training on upper and lower body strategy during gait in diplegic children with Cerebral Palsy using summary parameters. Comput Methods Biomech Biomed Engin 2021; 25:140-147. [PMID: 34121521 DOI: 10.1080/10255842.2021.1938009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The effects of robotic-assisted gait training on upper and lower body strategy during gait in diplegic children with Cerebral Palsy (CP) were quantified using summary parameters (Upper Body Profile Score (UBPS) and Gait Profile Score (GPS)). Firstly, the upper body strategy during gait was assessed in 73 children with CP and 15 healthy children (Control Group: CG): patients with CP exhibited higher values of most of the summary parameters of the upper body position than the CG. Then, the effects of a robotic-assisted gait training in a sub-group of 35 children by means of UBPS were evaluated. After robotic-assisted gait training program, no significant differences as for the summary parameters (UBPS and GPS). However, considering the specific variables scores, significant improvements are displayed as for the upper body parameter on the sagittal plane (Upper Body Ant/Pst index) and the lower limbs, in particular pelvis (Pelvic Ant/Pst and Pelvic Int/Ext indices) and as for walking velocity. A sort of reorganization of full-body kinematics, especially at upper body and proximal level (pelvis) seems to appear, with a new gait approach, characterised by a better strategy of the upper body associated with a significant improvement of the pelvis movement.
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Affiliation(s)
- Luigi Piccinini
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Veronica Cimolin
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Fabio Storm
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | | | - Emilia Biffi
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Manuela Galli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
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22
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Farkas GJ, Sneij A, Gater DR. Energy Expenditure Following Spinal Cord Injury: A Delicate Balance. Top Spinal Cord Inj Rehabil 2021; 27:92-99. [PMID: 33814887 DOI: 10.46292/sci20-00030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Following a spinal cord injury (SCI), neurogenic obesity results from changes in body composition, physical impairment, and endometabolic physiology and when dietary intake exceeds energy expenditure. Given the postinjury reductions in lean body mass, sympathetic nervous system dysfunction, and anabolic deficiencies, energy balance is no longer in balance, and thereby an obesogenic environment is created that instigates cardiometabolic dysfunction. Accurate determination of metabolic rate can prevent excess caloric intake while promoting positive body habitus and mitigating obesity-related comorbidities. Metabolic rate as determined by indirect calorimetry (IC) has not been adopted in routine clinical care for persons with SCI despite several studies indicating its importance. This article reviews current literature on measured and predicted metabolic rate and energy expenditure after SCI and stresses the importance of IC as standard of care for persons with SCI.
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Affiliation(s)
- Gary J Farkas
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
| | - Alicia Sneij
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
| | - David R Gater
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida.,Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
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Farkas GJ, Sneij A, Gater DR. Dietetics After Spinal Cord Injury: Current Evidence and Future Perspectives. Top Spinal Cord Inj Rehabil 2021; 27:100-108. [PMID: 33814888 DOI: 10.46292/sci20-00031] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Following spinal cord injury (SCI), individuals are at high risk for obesity and several chronic cardiometabolic disorders due to a deterioration in body composition, hypometabolic rate, and endometabolic dysregulation. Countermeasures to the consequences of an SCI include adopting a healthy diet that provides adequate nutrition to maintain good body habitus and cardiometabolic health. A proper diet for individuals with SCI should distribute carbohydrates, protein, and fat to optimize a lower energy intake requirement and should stress foods with low caloric yet high nutrient density. The purpose of this article is to present available evidence on how nutritional status after SCI should advance future research to further develop SCI-specific guidelines for total energy intake, as it relates to percent carbohydrates, protein, fat, and all vitamins and minerals, that take into consideration the adaptations after SCI.
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Affiliation(s)
- Gary J Farkas
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
| | - Alicia Sneij
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
| | - David R Gater
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida.,The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida
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24
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Bombardier CH, Hurt SM, Peters N. A Primary Care Provider's Guide to Depression After Spinal Cord Injury: Is It Normal? Do We Treat It? Top Spinal Cord Inj Rehabil 2021; 26:152-156. [PMID: 33192041 DOI: 10.46292/sci2603-152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Although most people with spinal cord injury (SCI) are emotionally resilient, as a group they are at increased risk of major depressive disorder. Depression tends to be undertreated in people with SCI, perhaps because depression is mistakenly viewed as an expected reaction to severe disability or is confused with grief. Depression and grief are distinguishable, and the Patient Health Questionnaire-9 is a reliable and valid screen for major depression in this population. Major depression can be treated with antidepressants, especially venlafaxine XR, and with psychotherapy, especially cognitive behavioral therapy, focused on helping the person resume activities that were previously enjoyable or meaningful. Structured exercise also may help relieve depressed mood.
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Affiliation(s)
- Charles H Bombardier
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Sean M Hurt
- Department of Internal Medicine, Jefferson University, Philadelphia, Pennsylvania
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Rodríguez-Fernández A, Lobo-Prat J, Font-Llagunes JM. Systematic review on wearable lower-limb exoskeletons for gait training in neuromuscular impairments. J Neuroeng Rehabil 2021; 18:22. [PMID: 33526065 PMCID: PMC7852187 DOI: 10.1186/s12984-021-00815-5] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 01/12/2021] [Indexed: 02/08/2023] Open
Abstract
Gait disorders can reduce the quality of life for people with neuromuscular impairments. Therefore, walking recovery is one of the main priorities for counteracting sedentary lifestyle, reducing secondary health conditions and restoring legged mobility. At present, wearable powered lower-limb exoskeletons are emerging as a revolutionary technology for robotic gait rehabilitation. This systematic review provides a comprehensive overview on wearable lower-limb exoskeletons for people with neuromuscular impairments, addressing the following three questions: (1) what is the current technological status of wearable lower-limb exoskeletons for gait rehabilitation?, (2) what is the methodology used in the clinical validations of wearable lower-limb exoskeletons?, and (3) what are the benefits and current evidence on clinical efficacy of wearable lower-limb exoskeletons? We analyzed 87 clinical studies focusing on both device technology (e.g., actuators, sensors, structure) and clinical aspects (e.g., training protocol, outcome measures, patient impairments), and make available the database with all the compiled information. The results of the literature survey reveal that wearable exoskeletons have potential for a number of applications including early rehabilitation, promoting physical exercise, and carrying out daily living activities both at home and the community. Likewise, wearable exoskeletons may improve mobility and independence in non-ambulatory people, and may reduce secondary health conditions related to sedentariness, with all the advantages that this entails. However, the use of this technology is still limited by heavy and bulky devices, which require supervision and the use of walking aids. In addition, evidence supporting their benefits is still limited to short-intervention trials with few participants and diversity among their clinical protocols. Wearable lower-limb exoskeletons for gait rehabilitation are still in their early stages of development and randomized control trials are needed to demonstrate their clinical efficacy.
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Affiliation(s)
- Antonio Rodríguez-Fernández
- Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Center for Biomedical Engineering, Universitat Politècnica de Catalunya, Diagonal 647, 08028, Barcelona, Spain. .,Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950, Esplugues de Llobregat, Spain.
| | - Joan Lobo-Prat
- Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Center for Biomedical Engineering, Universitat Politècnica de Catalunya, Diagonal 647, 08028, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950, Esplugues de Llobregat, Spain.,ABLE Human Motion, Diagonal 647, 08028, Barcelona, Spain.,Institut de Robòtica i Informàtica Industrial, CSIC-UPC, Llorens i Artigas 4-6, 08028, Barcelona, Spain
| | - Josep M Font-Llagunes
- Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Center for Biomedical Engineering, Universitat Politècnica de Catalunya, Diagonal 647, 08028, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950, Esplugues de Llobregat, Spain.,ABLE Human Motion, Diagonal 647, 08028, Barcelona, Spain
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26
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Štěpánová J, Jakubec L, Neumannová K, Čiháková R, Lehnertová M, Kudláček M. Translation, cross-cultural adaptation, and validation of a semi-structured interview Physical Activity Recall Assessment for People with Spinal Cord Injury in persons with paraplegia. ACTA GYMNICA 2021. [DOI: 10.5507/ag.2020.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Farkas GJ, Gordon PS, Swartz AM, Berg AS, Gater DR. Influence of mid and low paraplegia on cardiorespiratory fitness and energy expenditure. Spinal Cord Ser Cases 2020; 6:110. [PMID: 33328437 DOI: 10.1038/s41394-020-00363-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 11/09/2022] Open
Abstract
STUDY DESIGN Observational, Cross-sectional. OBJECTIVE Examine the influence of mid (MP) and low (LP) paraplegia on cardiorespiratory fitness (CRF), energy expenditure (EE), and physical activity levels (PAL), and compare these data to able-bodied (AB) individuals. SETTING Academic medical center. METHODS Persons with MP (n = 6, T6-T8, 83% male, age: 31 ± 11 y, BMI: 24 ± 7 kg/m2) and LP (n = 5; T10-L1, 100% male, age: 39 ± 11 y, BMI: 26 ± 5 kg/m2) and AB controls (n = 6; 67% male, age: 29 ± 12 y, BMI: 26 ± 5 kg/m2) participated. All participants underwent 45-min of arm-crank exercise where CRF and exercise EE were measured. Basal metabolic rate (BMR) was measured, and total daily EE (TDEE) and PAL were estimated. RESULTS Absolute VO2Peak (MP: 1.6 ± 0.2, LP: 1.9 ± 0.1, AB: 2.5 ± 0.7 l/min), peak metabolic equivalents (MP: 6.8 ± 1.3, LP: 5.7 ± 0.7, AB: 8.8 ± 0.8 METs), peak power output (MP: 72.9 ± 11.5, LP: 86.8 ± 6.1, AB: 121.0 ± 34.8 Watts), and maximal heart rate (MP: 177.7 ± 9.8, LP: 157 ± 13.6, AB: 185.2 ± 8.5 bpm) were significantly different between the three groups (p < 0.05). BMR and TDEE did not significantly differ between the three groups (p > 0.05), whereas exercise EE (MP: 7.8 ± 1.2, LP: 9.5 ± 0.7, AB: 12.4 ± 3.5 kcal/min) and PAL (MP: 1.30 ± 0.04, LP: 1.32 ± 0.04, AB: 1.43 ± 0.06) significantly differed (p < 0.05). In the AB group, 33.3% and 66.7% were classified as sedentary or having low activity levels, respectively, while all persons with paraplegia were classified as sedentary according to PAL classifications. CONCLUSION Individuals with MP and LP have lower CRF, exercise EE, and PALs compared to AB individuals.
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Affiliation(s)
- Gary J Farkas
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Phillip S Gordon
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ann M Swartz
- Department of Kinesiology, University of Wisconsin Milwaukee, Milwaukee, WI, USA
| | - Arthur S Berg
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - David R Gater
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA
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Evaluation of cardiovascular disease risk in individuals with chronic spinal cord injury. Spinal Cord 2020; 59:716-729. [PMID: 33070157 DOI: 10.1038/s41393-020-00566-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/24/2020] [Accepted: 09/29/2020] [Indexed: 01/26/2023]
Abstract
STUDY DESIGN Multicentre, cross-sectional study. OBJECTIVES To identify which markers of obesity, injury characteristics and autonomic function variables are related to cardiovascular disease (CVD) risk after spinal cord injury (SCI), and establish cut-points for detection and risk management. SETTING Eight SCI rehabilitation centres in the Netherlands. METHODS Individuals (n = 257) with a traumatic, chronic (≥10 years) SCI, with age at injury between 18 and 35 years, completed a self-report questionnaire and a one-day visit to a rehabilitation centre for testing. Three anthropometric measures were tested: body mass index (BMI); waist circumference (WC); and waist-to-height ratio (WHtR). Injury characteristics included: American Spinal Injury Association impairment scale (AIS); duration of injury (DOI); and neurological level of injury (LOI). Cardiovascular autonomic function was assessed from peak heart rate during maximal exercise (HRpeak). Systolic arterial pressure (SAP) and aerobic capacity (VO2peak) were also determined. CVD risk was calculated using the Framingham risk score (FRS). RESULTS All anthropometric variables were associated with FRS, with WC showing the strongest correlation (r = 0.41, p < 0.001) and greatest area under the curve (0.73) for 10-year CVD risk (%). WC, DOI, SAP, HRpeak, LOI, and VO2peak (variable importance: 0.81, 1.0, 0.98, 0.98, 0.66, 0.68, respectively) were important predictive variables for 10-year CVD risk in individuals with SCI. CONCLUSIONS We confirm that WC is a simple, practical measure of CVD risk, and along with DOI and markers of cardiovascular autonomic function, plays a role in the increased CVD risk following SCI.
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Wouda MF, Lundgaard E, Becker F, Strøm V. Changes in cardiorespiratory fitness and activity levels over the first year after discharge in ambulatory persons with recent incomplete spinal cord injury. Spinal Cord 2020; 59:354-360. [PMID: 32647328 PMCID: PMC7943418 DOI: 10.1038/s41393-020-0514-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 11/12/2022]
Abstract
Study design Secondary analysis of a clinical trial. Objectives To investigate changes in cardiorespiratory fitness (CRF) and activity level in ambulatory persons with SCI during the first year after discharge from inpatient rehabilitation. Setting Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway. Methods Thirty persons with incomplete SCI, all community walkers (25 males and 5 females, 18–69 years old) were recruited to a clinical trial of a 12 weeks home-based aerobic exercise program of either high or moderate intensity. During the last week of inpatient rehabilitation (baseline), participants performed a maximal exercise test on a treadmill (peak oxygen uptake; peak VO2) and a 6-min walking test (6MWT). Also, total daily energy expenditure (TDEE) and daily amount of steps were measured continuously during 7 days in the participants’ homes. All tests were repeated after 3 and 12 months (post tests). Results Twenty of the 30 clinical trial participants performed baseline and both posttests and are included in this secondary analysis. We found no statistically significant between-group differences in the time course over the first year of either peak VO2, 6MWT, or physical activity outcomes. Therefore, data from both exercise groups and the control group were merged for secondary analyses, revealing statistically significant increase over time in peak VO2, 6MWT, and TDEE. The increase over time in the average daily steps did not reach statistical significance. Conclusions Ambulatory persons with SCI were able to increase their CRF levels over the first year after discharge from inpatient rehabilitation, despite a minimal increase in activity levels.
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Affiliation(s)
- Matthijs F Wouda
- Department of Research, Sunnaas Rehabilitation Hospital, Oslo, Norway.
| | - Eivind Lundgaard
- Department of Research, Sunnaas Rehabilitation Hospital, Oslo, Norway
| | - Frank Becker
- Department of Research, Sunnaas Rehabilitation Hospital, Oslo, Norway.,University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| | - Vegard Strøm
- Department of Research, Sunnaas Rehabilitation Hospital, Oslo, Norway
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Shwetar YJ, Veerubhotla AL, Huang Z, Ding D. Comparative validity of energy expenditure prediction algorithms using wearable devices for people with spinal cord injury. Spinal Cord 2020; 58:821-830. [PMID: 32020039 PMCID: PMC10802177 DOI: 10.1038/s41393-020-0427-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 01/17/2020] [Accepted: 01/20/2020] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional validation study. OBJECTIVES To conduct a literature search for existing energy expenditure (EE) predictive algorithms using ActiGraph activity monitors for manual wheelchairs users (MWUs) with spinal cord injury (SCI), and evaluate their validity using an out-of-sample dataset. SETTING Research institution in Pittsburgh, USA. METHODS A literature search resulted in five articles containing five sets of predictive equations using an ActiGraph activity monitor for MWUs with SCI. Out-of-sample data were collected from 29 MWUs with chronic SCI who were asked to follow an activity protocol while wearing an ActiGraph GT9X Link on the dominant wrist. They also wore a portable metabolic cart which provided the criterion measure for EE. The out-of-sample dataset was used to evaluate the validity of the five sets of EE predictive equations. RESULTS None of the five sets of predictive equations demonstrated equivalence within 20% of the criterion measure based on an equivalence test. The mean absolute error for the five sets of predictive equations ranged from 0.87 to 6.41 kilocalories per minute (kcal min-1) when compared with the criterion measure, and the intraclass correlation estimates ranged from 0.06 to 0.59. The range between the Bland-Altman upper and lower limits of agreement was from 4.70 kcal min-1 to 25.09 kcal min-1. CONCLUSIONS The existing EE predictive equations based on ActiGraph monitors for MWUs with SCI showed varied performance when compared with the criterion measure. Their accuracies may not be sufficient to support future clinical and research use. More work is needed to develop more accurate EE predictive equations for this population.
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Affiliation(s)
- Yousif J Shwetar
- VA Pittsburgh Healthcare System, Human Engineering Research Laboratories, Pittsburgh, PA, USA
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Akhila L Veerubhotla
- VA Pittsburgh Healthcare System, Human Engineering Research Laboratories, Pittsburgh, PA, USA
- Department of Rehabilitation and Science Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Zijian Huang
- VA Pittsburgh Healthcare System, Human Engineering Research Laboratories, Pittsburgh, PA, USA
- Department of Rehabilitation and Science Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dan Ding
- VA Pittsburgh Healthcare System, Human Engineering Research Laboratories, Pittsburgh, PA, USA.
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Rehabilitation and Science Technology, University of Pittsburgh, Pittsburgh, PA, USA.
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Ferri-Caruana A, Millán-González L, García-Massó X, Pérez-Nombela S, Pellicer-Chenoll M, Serra-Añó P. Motivation to Physical Exercise in Manual Wheelchair Users With Paraplegia. Top Spinal Cord Inj Rehabil 2020; 26:1-10. [PMID: 32095063 DOI: 10.1310/sci2601-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Motivation could be considered as a critical factor for being and staying physically active in the spinal cord-injured population. Objectives: Our goals were (1) to describe motivation to exercise in people with paraplegia, comparing those who engage in regular physical exercise with those who do not and (2) to establish whether such motivation is related to the type of physical exercise practiced. Methods: This study was quantitative, cross-sectional descriptive research. One-hundred and six participants with chronic paraplegia completed the Spanish version of the Exercise Motivations Inventory (EMI-2). Participants were divided into the non-exerciser group (NEG) and the exerciser group (EG). EG was subclassified into sports players (SPs) and physical exercisers (PEs). Results: Participants in both EG and NEG presented a similar motivation toward physical exercise. The most important motive to practice or to adhere to exercise in participants with SCI was ill-health avoidance (mean, 8.45; SD, 1.33). Fitness was the second most important motive (ie, nimbleness, flexibility, strength, and endurance). Motives that distinguished EG from NEG included enjoyment and revitalization [t(41.9) = -2.54, p < .05, r = 0.36], competition [t(56.8) = 2.24, p < .05, r = 0.28], and health pressure [t(104) = 3.22, p < .01, r = 0.30]. Furthermore, we found that motivation was related to the type of physical exercise performed. SPs showed a statistically significantly higher score for competition and enjoyment and revitalization than PEs (p < .05). Conclusion: Ill-health avoidance and fitness are the key motivational factors to practice and adhere to physical exercise. Motivation is related to the type of physical exercise performed. Health providers need to understand these factors to promote and sustain long-term adherence to exercise in the SCI population.
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Affiliation(s)
- Ana Ferri-Caruana
- Departamento de Educación Física y Deportes, Facultat de Ciencies de l'Activitat Fisica i l'Esport, Universitat de València, València, Spain
| | - Luís Millán-González
- Departamento de Educación Física y Deportes, Facultat de Ciencies de l'Activitat Fisica i l'Esport, Universitat de València, València, Spain
| | - Xavier García-Massó
- Departament de Didàctica de l'Expressió Musical, Plàstica i Corporal, Universitat de València, Valencia, Spain
| | - Soraya Pérez-Nombela
- E.U. Enfermería y Fisioterapia de Toledo, Universidad de Castilla-La Mancha, Toledo, Spain
| | - Maite Pellicer-Chenoll
- Departamento de Educación Física y Deportes, Facultat de Ciencies de l'Activitat Fisica i l'Esport, Universitat de València, València, Spain
| | - Pilar Serra-Añó
- UBIC Departamento de Fisioterapia, Universitat de València, València, Spain
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D'Andrea S, Minaldi E, Castellini C, Cavallo F, Felzani G, Francavilla S, Francavilla F, Barbonetti A. Independent Association of Erectile Dysfunction and Low Testosterone Levels With Life Dissatisfaction in Men With Chronic Spinal Cord Injury. J Sex Med 2020; 17:911-918. [PMID: 32089485 DOI: 10.1016/j.jsxm.2020.01.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/15/2020] [Accepted: 01/19/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND The loss of global functional independence, along with bladder, bowel, and sexual dysfunctions, may contribute to psychological distress and life dissatisfaction after spinal cord injury (SCI). AIM To explore the relationship of erectile function and androgenic status with life satisfaction, independently from confounders recognizable in spinal cord-injured men. METHODS 100 consecutive men (49 ± 17 years) admitted to a rehabilitation program because of chronic SCI (≥1 year) underwent clinical/biochemical evaluations, including the assessment of life and sexual satisfaction using the Life-Satisfaction Questionnaire-9 (LiSat-9), erectile function using the International Index of Erectile Function-5 (IIEF-5), global and bowel-bladder functional independence using the Spinal Cord Independence Measure (SCIM) and measurement of total testosterone (TT) levels. The free testosterone level was calculated using the Vermeulen formula. OUTCOMES The outcomes include the relationship between sexual health and life satisfaction in men with SCI. RESULTS A LiSat-9 score <4, suggestive for life dissatisfaction, was exhibited by 49% of men. When compared with the life-satisfied group, a significantly higher percentage of them had sexual dissatisfaction and erectile dysfunction (ED); they also exhibited significantly lower levels of TT and calculated free testosterone (cFT) and a more severe impairment of bowel-bladder function. The life satisfaction degree correlated with sexual satisfaction degree, IIEF-5 score, TT, cFT, and bowel-bladder function degree. At the logistic regression model, including sexual LiSat-9 subscore and bowel-bladder SCIM subscore, only the former exhibited a significant negative association with life dissatisfaction. In a further logistic regression model, including the putative key determinants of sexual satisfaction, erectile function, and cFT levels, a higher odd of life dissatisfaction was independently associated both with a lower IIEF-5 score (OR: 0.93; 95% CI: 0.88, 0.98) and lower cFT levels (OR: 0.98; 95% CI: 0.98, 0.99). CLINICAL IMPLICATIONS In men with chronic SCI, assessment of erectile function and testosterone levels can help to predict life satisfaction. STRENGTHS & LIMITATIONS This is the first demonstration of the independent association of androgen deficiency and ED with life satisfaction in men with SCI. Prospective studies are warranted to clarify the cause-effect relationships. CONCLUSIONS In men with SCI, ED and low testosterone levels exhibit a significant independent association with life dissatisfaction; longitudinal intervention studies could explore possible effects of their treatment in improving sexual and life satisfaction in this population. D'Andrea S, Minaldi E, Castellini C, et al. Independent Association of Erectile Dysfunction and Low Testosterone Levels With Life Dissatisfaction in Men With Chronic Spinal Cord Injury. J Sex Med 2020;17:911-918.
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Affiliation(s)
- Settimio D'Andrea
- Andrology Unit, Department of Life, Health and Environment Sciences, University of L'Aquila, L'Aquila, Italy; Spinal Unit, San Raffaele Institute of Sulmona, Sulmona, Italy
| | - Elisa Minaldi
- Andrology Unit, Department of Life, Health and Environment Sciences, University of L'Aquila, L'Aquila, Italy
| | - Chiara Castellini
- Andrology Unit, Department of Life, Health and Environment Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Giorgio Felzani
- Spinal Unit, San Raffaele Institute of Sulmona, Sulmona, Italy
| | - Sandro Francavilla
- Andrology Unit, Department of Life, Health and Environment Sciences, University of L'Aquila, L'Aquila, Italy
| | - Felice Francavilla
- Andrology Unit, Department of Life, Health and Environment Sciences, University of L'Aquila, L'Aquila, Italy
| | - Arcangelo Barbonetti
- Andrology Unit, Department of Life, Health and Environment Sciences, University of L'Aquila, L'Aquila, Italy.
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Brochetti AM, Brose SW, Kuemmel AM, Dang DJ, Bourbeau DJ. Interdisciplinary bodyweight management program for persons with SCI. J Spinal Cord Med 2020; 43:24-30. [PMID: 30517834 PMCID: PMC7006810 DOI: 10.1080/10790268.2018.1547860] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Objective: Persons with spinal cord injury (SCI) have a higher prevalence of being overweight than the general population, which is thought to be due to a variety of metabolic, physiologic and psychological changes. The quality improvement project described in this work was designed to help overweight persons with SCI lose bodyweight through nutrition, exercise, and behavioral management strategies.Methods: Eighteen persons with SCI who were overweight were enrolled in a 12-week interdisciplinary weight management program. Participants were limited to persons at least one-year post-acute SCI with an established overweight status. Measurements, including a person's weight, body mass index, and waist circumference (WaC), were taken at the program's start, at its end, and six months post program.Results: Seventeen out of 18 participants experienced weight loss, (WaC) decreased (P < 0.001), and the program was effective at reducing weight (P < 0.001). Six months following participation in the program participants did experience a significant change in weight or waist size six months post program, thus indicating that subjects did not regain weight after completion of the program.Conclusion: This quality improvement project provided indications of the benefits of an SCI-specific interdisciplinary weight management program. Clinical research evaluating methods for helping persons with SCI achieve a healthy bodyweight is indicated.
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Affiliation(s)
- Amber M. Brochetti
- Department of Spinal Cord Injury, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
| | - Steven W. Brose
- Department of Spinal Cord Injury, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
- Cleveland FES Center, Cleveland, Ohio, USA
- Syracuse VA Medical Center, Syracuse, New York, USA
| | - Angela M. Kuemmel
- Department of Spinal Cord Injury, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
| | - David J. Dang
- Department of Spinal Cord Injury, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Dennis J. Bourbeau
- Department of Spinal Cord Injury, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
- Cleveland FES Center, Cleveland, Ohio, USA
- MetroHealth Medical Center, Cleveland, Ohio, USA
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Holmlund T, Ekblom-Bak E, Franzén E, Hultling C, Wahman K. Intensity of physical activity as a percentage of peak oxygen uptake, heart rate and Borg RPE in motor-complete para- and tetraplegia. PLoS One 2019; 14:e0222542. [PMID: 31794548 PMCID: PMC6890239 DOI: 10.1371/journal.pone.0222542] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 09/01/2019] [Indexed: 12/21/2022] Open
Abstract
Objective The aims were to describe VO2peak, explore the potential influence of anthropometrics, demographics and level of physical activity within each cohort; b) to define common, standardized activities as percentages of VO2peak and categorize these as light, moderate and vigorous intensity levels according to present classification systems, and c) to explore how clinically accessible methods such as heart-rate monitoring and Borg rating of perceived exertion (RPE) correlate or can describe light, moderate and vigorous intensity levels. Design Cross sectional. Setting Rehabilitation facility and laboratory environment. Subjects Sixty-three individuals, thirty-seven (10 women) with motor-complete paraplegia (MCP), T7-T12, and twenty-six (7 women) with motor-complete tetraplegia (MCT), C5-C8. Interventions VO2peak was obtained during a graded peak test until exhaustion, and oxygen uptake during eleven different activities was assessed and categorized using indirect calorimetry. Main outcome measures VO2peak, Absolute and relative oxygen consumption, Borg RPE. Results Absolute VO2peak was significantly higher in men than in women for both groups, with fairly small differences in relative VO2peak. For MCP sex, weight and time spent in vigorous-intensity activity explained 63% of VO2peak variance. For MCT sex and time in vigorous-intensity activity explained 55% of the variance. Moderate intensity corresponds to 61–72% HRpeak and RPE 10–13 for MCP vs. 71–79% HRpeak, RPE 13–14 for MCT. Conclusion Using current classification systems, eleven commonly performed activities were categorized in relative intensity terms, (light, moderate and vigorous) based on percent of VO2peak, HRpeak and Borg RPE. This categorization enables clinicians to better guide persons with SCI to meet required physical activity levels.
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Affiliation(s)
- Tobias Holmlund
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden
- Rehab Station Stockholm/Spinalis R&D Unit, Solna, Sweden
- * E-mail: ,
| | - Elin Ekblom-Bak
- Åstrand Laboratory of Work Physiology, The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Erika Franzén
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
- Allied Health Professionals Function, Function Area Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Claes Hultling
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden
- Spinals Foundation–R&D Unit, Stockholm, Sweden
| | - Kerstin Wahman
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden
- Rehab Station Stockholm/Spinalis R&D Unit, Solna, Sweden
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Williams AMM, Chisholm AE, Lynn A, Malik RN, Eginyan G, Lam T. Arm crank ergometer "spin" training improves seated balance and aerobic capacity in people with spinal cord injury. Scand J Med Sci Sports 2019; 30:361-369. [PMID: 31621945 DOI: 10.1111/sms.13580] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 09/16/2019] [Accepted: 10/08/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is some evidence that upper-body training modalities can improve not only aerobic capacity but also seated balance in people with spinal cord injury (SCI), even in those classified with motor-complete paralysis above T6. Here, we evaluated the effect of arm crank ergometry (ACE) "spin" training on trunk muscle recruitment and its effects on seated balance and aerobic capacity. METHODS Eight individuals with high-level complete and 6 with either a low-level complete or a motor-incomplete SCI participated in this study. Participants completed 5 weeks of a group ACE "spin" training protocol which featured modulations in cadence and resistance as well as back-supported and unsupported bouts. Surface electromyography was used to confirm trunk muscle recruitment during unsupported ACE. Changes in aerobic capacity (peak oxygen consumption) and seated balance control (center of pressure parameters) were assessed at pre- and post-intervention. RESULTS Unsupported ACE was effective for eliciting trunk muscle activity (P < .05). Following training, peak oxygen consumption significantly improved by an average of 16% (P = .005). Static sitting balance significantly improved from pre- to post-intervention, but only when tested with eyes closed as measured by a reduction in area (P = .047) and velocity of center of pressure (P = .013). No significant changes were observed in static sitting balance with eyes open or in dynamic sitting balance. CONCLUSION Group ACE "spin" classes may benefit not only aerobic fitness but also static seated balance control in people with SCI.
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Affiliation(s)
- Alison M M Williams
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada.,Physical Activity Research Centre (PARC), International Collaboration On Repair Discoveries, Vancouver Costal Health Research Institute, Vancouver, British Columbia, Canada
| | - Amanda E Chisholm
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada.,Physical Activity Research Centre (PARC), International Collaboration On Repair Discoveries, Vancouver Costal Health Research Institute, Vancouver, British Columbia, Canada
| | - Andrea Lynn
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada.,Physical Activity Research Centre (PARC), International Collaboration On Repair Discoveries, Vancouver Costal Health Research Institute, Vancouver, British Columbia, Canada
| | - Raza N Malik
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada.,Physical Activity Research Centre (PARC), International Collaboration On Repair Discoveries, Vancouver Costal Health Research Institute, Vancouver, British Columbia, Canada
| | - Gevorg Eginyan
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada.,Physical Activity Research Centre (PARC), International Collaboration On Repair Discoveries, Vancouver Costal Health Research Institute, Vancouver, British Columbia, Canada
| | - Tania Lam
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada.,Physical Activity Research Centre (PARC), International Collaboration On Repair Discoveries, Vancouver Costal Health Research Institute, Vancouver, British Columbia, Canada
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A Systematic Review of the Accuracy of Estimated and Measured Resting Metabolic Rate in Chronic Spinal Cord Injury. Int J Sport Nutr Exerc Metab 2019; 29:548-558. [PMID: 31034249 DOI: 10.1123/ijsnem.2018-0242] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 02/17/2019] [Accepted: 02/25/2019] [Indexed: 11/18/2022]
Abstract
The objective of this systematic review was to examine resting metabolic rate (RMR) measured through indirect calorimetry in adults with chronic spinal cord injury (SCI) and to evaluate the predication equations used for the estimation of RMR in this population. The authors additionally aimed to review the impact of sex and level of injury on RMR. A MEDLINE/PubMed, Google Scholar, Scopus, and Web of Science search was performed for studies published from the database inception to January 2018, identifying 326 articles. On the basis of the inclusion criteria, 22 studies remained for review. All articles that were identified were full-text, English language articles examining adults with chronic SCI who were fasted for a minimum of 8 hr before undergoing RMR through indirect calorimetry for at least 20 min. The measured RMR ranged from 1,256.0 to 1,854.0 kcal/day, whereas the estimated RMR ranged from 1,276.8 to 1,808.0 kcal/day in the chronic SCI population. Seven studies overestimated RMR from 4% to 15%, whereas two studies underestimated RMR from 2% to 17% using prediction equations established for the able-bodied population. Two studies produced SCI-specific equations to estimate RMR. With regard to sex and level of injury, RMR does not differ between individuals with tetraplegia and paraplegia, whereas sex-based differences remain inconclusive, given limited results. These data provide evidence for the use of indirect calorimetry to assess RMR and the need to validate SCI-specific prediction equations in the estimation of RMR.
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Holmlund T, Ekblom-Bak E, Franzén E, Hultling C, Wahman K. Defining accelerometer cut-points for different intensity levels in motor-complete spinal cord injury. Spinal Cord 2019; 58:116-124. [PMID: 31243318 DOI: 10.1038/s41393-019-0308-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 11/10/2022]
Abstract
STUDY DESIGN Descriptive. OBJECTIVE The present aim was to define accelerometer cut-point values for wrist-worn accelerometers to identify absolute- and relative-intensity physical activity (PA) levels in people with motor-complete paraplegics (PP) and tetraplegics (TP). SETTINGS Rehabilitation facility in Sweden. METHODS The participants were 26 (19 men, 7 women) with C5-C8, AIS A and B (TP) and 37 (27 men, 10 women) with T7-T12 (PP), AIS A and B. Wrist-worn accelerometer recordings (Actigraph GT3X+) were taken during seven standardized activities. Oxygen consumption was measured, as well as at-rest and peak effort, with indirect calorimetry. Accelerometer cut-points for absolute and relative intensities were defined using ROC-curve analyses. RESULTS The ROC-curve analyses for accelerometer cut-points revealed good-to-excellent accuracy (AUC >0.8), defining cut-points for absolute intensity (2, 3, 4, 5, 6, 7 METs for PP and 2 to 6 METs for TP) and relative intensity (30, 40, 50, 60, 70, and 80% for PP and 40-80% for TP). The cut-points for moderate-to-vigorous physical activity was defined as ≥9515 vector magnitude counts per minute (VMC) for PP and ≥4887 VMC/min for TP. CONCLUSION This study presents cut-points for wrist-worn accelerometers in both PP and TP, which could be used in clinical practice to describe physical activity patterns and time spent at different intensity levels.
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Affiliation(s)
- Tobias Holmlund
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, 171 77, Stockholm, Sweden. .,Rehab Station Stockholm/Spinalis R&D Unit, Frösundaviks allé 4 169 89, Solna, Sweden.
| | - Elin Ekblom-Bak
- Åstrand Laboratory of Work Physiology, The Swedish School of Sport and Health Sciences, Box 5626, 114 86, Stockholm, Sweden
| | - Erika Franzén
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, 141 83, Stockholm, Sweden.,Allied Health Professionals Function, Function Area Occupational Therapy & Physiotherapy, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Claes Hultling
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Kerstin Wahman
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, 171 77, Stockholm, Sweden.,Rehab Station Stockholm/Spinalis R&D Unit, Frösundaviks allé 4 169 89, Solna, Sweden
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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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van den Akker LE, Holla JFM, Dadema T, Visser B, Valent LJ, de Groot S, Dallinga JM, Deutekom M. Determinants of physical activity in wheelchair users with spinal cord injury or lower limb amputation: perspectives of rehabilitation professionals and wheelchair users. Disabil Rehabil 2019; 42:1934-1941. [DOI: 10.1080/09638288.2019.1577503] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Lizanne E. van den Akker
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Haarlem, The Netherlands
| | - Jasmijn F. M. Holla
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Haarlem, The Netherlands
- Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
| | - Tessa Dadema
- Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Bart Visser
- Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Linda J. Valent
- Department of Research and Development, Heliomare Rehabilitation Centre, Wijk aan Zee, The Netherlands
| | - Sonja de Groot
- Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
- Centre for Human Movement Sciences, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Joan M. Dallinga
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Haarlem, The Netherlands
- Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Marije Deutekom
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Haarlem, The Netherlands
- Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
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Nightingale TE, Gorgey AS. Predicting Basal Metabolic Rate in Men with Motor Complete Spinal Cord Injury. Med Sci Sports Exerc 2019; 50:1305-1312. [PMID: 29315167 DOI: 10.1249/mss.0000000000001548] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE This study aimed to assess the accuracy of existing basal metabolic rate (BMR) prediction equations in men with chronic (>1 yr) spinal cord injury (SCI). The primary aim is to develop new SCI population-specific BMR prediction models, based on anthropometric, body composition, and/or demographic variables that are strongly associated with BMR. METHODS Thirty men with chronic SCI (paraplegic, n = 21, tetraplegic, n = 9) 35 ± 11 yr old (mean ± SD) participated in this cross-sectional study. Criterion BMR values were measured by indirect calorimetry. Body composition (dual-energy x-ray absorptiometry) and anthropometric measurements (circumferences and diameters) were also taken. Multiple linear regression analysis was performed to develop new SCI-specific BMR prediction models. Criterion BMR values were compared with values estimated from six existing and four developed prediction equations. RESULTS Existing equations that use information on stature, weight, and/or age significantly (P < 0.001) overpredicted measured BMR by a mean of 14%-17% (187-234 kcal·d). Equations that used fat-free mass (FFM) accurately predicted BMR. The development of new SCI-specific prediction models demonstrated that the addition of anthropometric variables (weight, height, and calf circumference) to FFM (model 3; r = 0.77), explained 8% more of the variance in BMR than FFM alone (model 1; r = 0.69). Using anthropometric variables, without FFM, explained less of the variance in BMR (model 4; r = 0.57). However, all the developed prediction models demonstrated acceptable mean absolute error ≤6%. CONCLUSION BMR can be more accurately estimated when dual-energy x-ray absorptiometry-derived FFM is incorporated into prediction equations. Using anthropometric measurements provides a promising alternative to improve the prediction of BMR, beyond that achieved by existing equations in persons with SCI.
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Affiliation(s)
- Tom E Nightingale
- Spinal Cord Injury and Disorders Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA.,Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA
| | - Ashraf S Gorgey
- Spinal Cord Injury and Disorders Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA.,Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA
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Kirk TN, Haegele JA. Theory of Planned Behavior in Research Examining Physical Activity Factors Among Individuals With Disabilities: A Review. Adapt Phys Activ Q 2018; 36:1-19. [PMID: 30562474 DOI: 10.1123/apaq.2018-0065] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The theory of planned behavior is a psychological framework designed to examine the relationship between beliefs and volitional behaviors such as physical activity engagement. The purpose of this article was to evaluate the published empirical literature on the use of the theory of planned behavior in the context of physical activity beliefs and behaviors of individuals with disabilities. Electronic-database searches were conducted to identify relevant articles published between 1990 and 2018, yielding 11 articles that met all criteria for inclusion. Data such as population, measures, research design, and results were extracted from qualifying studies. Article quality was addressed using modified versions of the National Institutes of Health's Quality Assessment Tools. In keeping with the theory of planned behavior model, major findings indicate that intention to be physically active has the strongest relationship with physical activity behavior, while the predictive usefulness of belief factors was mixed, among individuals with disabilities.
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Abstract
Context:Previous literature has theorized that alterations in shoulder physical characteristics are present in wheelchair athletes and contribute to shoulder pain and injury. Limited empirical evidence is present that evaluates the effectiveness of a shoulder injury prevention program focusing on improving these altered characteristics.Objective:To evaluate the effectiveness of a 6-week intervention program at improving characteristics that increases the risk of developing pain or shoulder injury.Design:Pretest and posttest.Setting:Home-based and controlled laboratory.Participants:Seven college wheelchair athletes.Interventions:Shoulder range of motion (ROM) and scapular muscle strength were assessed, and a 5-minute injury prevention program was taught to participants. Participants completed the intervention 3 times per week for 6 weeks. Following completion of the program, a postintervention screening was performed.Main OutcomeMeasures:Internal rotation (IR)/external rotation (ER) ROM, retraction strength, and IR/ER strength.Results:Participants experienced a significant improvement in dominant limb shoulder IR ROM (t6 = 3.56,P = .01) with an average increase of 11.4° of IR ROM and a significant improvement in dominant limb shoulder ER ROM (t6 = 2.79,P = .03) with an average increase of 8.0° of ER ROM. There were no significant increases in shoulder IR or ER strength and scapular retraction strength (P > .05).Conclusions:Improvements in ROM have previously been linked to decreases in shoulder pain and injury in other upper-extremity dominant sports by improving scapular kinematics. These results provide evidence that a 6-week strengthening and stretching intervention program may decrease risk factors for shoulder injury in wheelchair basketball athletes.
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Nightingale TE, Moore P, Harman J, Khalil R, Gill RS, Castillo T, Adler RA, Gorgey AS. Body composition changes with testosterone replacement therapy following spinal cord injury and aging: A mini review. J Spinal Cord Med 2018; 41:624-636. [PMID: 28770686 PMCID: PMC6217462 DOI: 10.1080/10790268.2017.1357917] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Context Hypogonadism is a male clinical condition in which the body does not produce enough testosterone. Testosterone plays a key role in maintaining body composition, bone mineral density, sexual function, mood, erythropoiesis, cognition and quality of life. Hypogonadism can occur due to several underlying pathologies during aging and in men with physical disabilities, such as spinal cord injury (SCI). This condition is often under diagnosed and as a result, symptoms undertreated. Methods In this mini-review, we propose that testosterone replacement therapy (TRT) may be a viable strategy to improve lean body mass (LBM) and fat mass (FM) in men with SCI. Evidence Synthesis Supplementing the limited data from SCI cohorts with consistent findings from studies in non-disabled aging men, we present evidence that, relative to placebo, transdermal TRT can increase LBM and reduce FM over 3-36 months. The impact of TRT on bone mineral density and metabolism is also discussed, with particular relevance for persons with SCI. Moreover, the risks of TRT remain controversial and pertinent safety considerations related to transdermal administration are outlined. Conclusion Further research is necessary to help develop clinical guidelines for the specific dose and duration of TRT in persons with SCI. Therefore, we call for more high-quality randomized controlled trials to examine the efficacy and safety of TRT in this population, which experiences an increased risk of cardiometabolic diseases as a result of deleterious body composition changes after injury.
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Affiliation(s)
- Tom E. Nightingale
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA,Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Pamela Moore
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA
| | - Joshua Harman
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA
| | - Refka Khalil
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA
| | - Ranjodh S. Gill
- Endocrinology Service, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA,Endocrine Division, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Teodoro Castillo
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA,Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Robert A. Adler
- Endocrinology Service, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA,Endocrine Division, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Ashraf S. Gorgey
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA,Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA,Correspondence to: Ashraf S. Gorgey, Department of Veterans Affairs, Hunter Holmes McGuire Medical Center, Spinal Cord Injury & Disorders Service, 1201 Broad Rock Boulevard, Richmond, VA 23249, USA.
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Guanziroli E, Cazzaniga M, Colombo L, Basilico S, Legnani G, Molteni F. Assistive powered exoskeleton for complete spinal cord injury: correlations between walking ability and exoskeleton control. Eur J Phys Rehabil Med 2018; 55:209-216. [PMID: 30156088 DOI: 10.23736/s1973-9087.18.05308-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Wearable powered robotic exoskeletons allow patients with complete spinal cord injury (SCI) to practice over-ground real-world gait scenarios. The global functional interaction subject-exoskeleton is a key factor to produce interlimb coordinated movements. Efficacy and efficiency of over-ground walking abilities using powered exoskeletons are related not only to the symbiotic sensory-motor interaction subject-exoskeleton but also to exoskeleton control. AIM Assess if walking ability of motor complete SCI patients at thoracic or lower level, using a wearable powered exoskeleton (ReWalk), can be influenced by different exoskeleton software control. DESIGN Observational study; an open, non-comparative, non-randomized study. SETTING A single neurological rehabilitation center for inpatients and outpatients. POPULATION Fifteen SCI chronic patients (4 females and 11 males) were recruited and divided in two groups: group 1, trained with the first software generation of ReWalk, and group 2, trained with the second software generation, a software upgrade of the previous version. METHODS Subjects were trained during three 60-minute sessions a week, during at least eight weeks using ReWalk, a wearable lower limb powered exoskeleton that allows thoracic or lower level motor-complete individuals with SCI to walk, stand, sit and climb/descend stairs. Outcome measures, collected at the end of the training period wearing the exoskeleton, were: 6-min Walking Test, 10-m Walking Test, and the time necessary to pass from sitting to standing and start to walk (STS-time). For each group Pearson Coefficient was calculated to explore correlations between the subjects' characteristics and gait performance reached at the end of the training period. RESULTS Group 1 showed correlation between performances and weight, height, neurological lesion level, while group 2 showed no correlation between performances weight and height, but correlation only with neurological lesion level. Group 2 covered more distance in 6 min (+124.52%) and required less time (-70.34%) to perform 10 mtWT and to STS-time (-38.25%) if compared to group 1. CONCLUSIONS ReWalk allows chronic complete spinal cord injury patients to perform over-ground walking. Different exoskeleton software control of the smoothness of the gait pattern improves functional outcome, eliminating the relationship between anthropometric factors and gait performances. The smoothness of the kinematic control of the lower limbs of the exoskeleton is a key factor to facilitate human-robot interaction and to increase walking abilities of the subject. CLINICAL REHABILITATION IMPACT To underline how the kinematic control of the exoskeleton influences the walking abilities of the complex system subject-exoskeleton.
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Affiliation(s)
- Eleonora Guanziroli
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy - .,Department of Mechanical and Industrial Engineering, University of Brescia, Brescia, Italy -
| | - Maurizio Cazzaniga
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy
| | - Laura Colombo
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy
| | - Sabrina Basilico
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy
| | - Giovanni Legnani
- Department of Mechanical and Industrial Engineering, University of Brescia, Brescia, Italy
| | - Franco Molteni
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy
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Energy expenditure and muscle activity during lying, sitting, standing, and walking in people with motor-incomplete spinal cord injury. Spinal Cord 2018; 56:1008-1016. [PMID: 29955089 DOI: 10.1038/s41393-018-0167-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 05/28/2018] [Accepted: 05/29/2018] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional exploratory study. OBJECTIVES To determine oxygen uptake (VO2), energy expenditure (EE), and muscle activity (MA) during lying (rest), sitting, standing, and walking among ambulatory individuals with spinal cord Injury (SCI) and to compare VO2, EE, and MA between individuals with different levels of ambulation. SETTING Rehabilitation institution with a spinal cord injury unit. METHODS A total of 22 adults with motor-incomplete SCI, ten in a low-ambulation group (non-functional or household walker) and 12 in a high-ambulation group (community or normal walker). VO2 was measured using indirect calorimetry. EE was expressed in metabolic equivalent of task (MET). MA was measured using a wireless surface electromyography device. RESULTS Mean VO2 was 3.19 ml/kg/min. During lying and sitting, EE was below 1.5 METs for all participants. During standing, three participants of the low-ambulation group and none in the high-ambulation group showed MET values of >1.5. In the walking condition, all participants showed MET values above 1.5. MA during stance was higher compared to the sitting condition and significantly higher in the low-ambulation group compared to the high-ambulation group. CONCLUSION Lying, supported- and unsupported sitting, without moving, appear to be sedentary behaviors for ambulatory individuals with a motor-incomplete SCI (MET values of <1.5 and a lack of MA). Walking, but not standing, is a moderate physical activity (>1.5 METs), which can be used by all individuals with motor-incomplete SCI to interrupt sedentary behavior.
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Effects of moderate- and high-intensity aerobic training program in ambulatory subjects with incomplete spinal cord injury–a randomized controlled trial. Spinal Cord 2018; 56:955-963. [DOI: 10.1038/s41393-018-0140-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 04/05/2018] [Accepted: 04/16/2018] [Indexed: 01/10/2023]
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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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Lester RM, Gorgey AS. Feasibility of robotic exoskeleton ambulation in a C4 person with incomplete spinal cord injury: a case report. Spinal Cord Ser Cases 2018; 4:36. [PMID: 29736262 PMCID: PMC5947854 DOI: 10.1038/s41394-018-0053-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/29/2018] [Accepted: 01/30/2018] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION To determine whether an individual with C4 incomplete spinal cord injury (SCI) with limited hand functions can effectively operate a powered exoskeleton (Ekso) to improve parameters of physical activity as determined by swing-time, up-time, walk-time, and total number of steps. CASE PRESENTATION A 21-year-old male with incomplete chronic (>1 year postinjury) SCI C4, participated in a clinical exoskeleton program to determine the feasibility of standing up and walking with limited hand functions. The participant was invited to attend 3 sessions including fitting, familiarization and gait training separated by one week intervals. Walk-time, up-time and total number of steps were measured during each training session. A complete body composition assessment using dual-energy X-ray absorptiometry (DXA) of the spine, knees and hips was conducted before training.Using a platform walker and cuffing both hands, the participant managed to stand up and ambulate successfully using exoskeleton. Over the course of 2 weeks, maximum walk-time increased from 7 to 17 min and number of steps increased from 83 to 589 steps. The total up-time increased from 19 to 31 min. DISCUSSION Exoskeleton training may be a safe and feasible approach for persons with higher levels of SCI after effectively providing a supportive assistive device for weight shifting. The current case study demonstrates the use of a powered exoskeleton for an individual with high level tetraplegia (C4 and above) and limited hand functions.
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Affiliation(s)
- Robert M. Lester
- Spinal Cord Injury and Disorders Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA USA
| | - Ashraf S. Gorgey
- Spinal Cord Injury and Disorders Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA USA
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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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Mat Rosly M, Halaki M, Hasnan N, Mat Rosly H, Davis GM, Husain R. Leisure time physical activity participation in individuals with spinal cord injury in Malaysia: barriers to exercise. Spinal Cord 2018; 56:806-818. [DOI: 10.1038/s41393-018-0068-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 01/04/2018] [Accepted: 01/15/2018] [Indexed: 01/24/2023]
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