Accuracy of bioelectrical impedance analysis and skinfold thickness in the assessment of body composition in people with chronic spinal cord injury

Impact of the Mediterranean Diet on Athletic Performance, Muscle Strength, Body Composition, and Antioxidant Markers in Both Athletes and Non-Professional Athletes: A Systematic Review of Intervention Trials

Background: The Mediterranean Diet (MD) has gained attention for its potential benefits in enhancing athletic performance and overall health. This systematic review aims to evaluate the effects of the MD on athletic performance, strength, body composition, and metabolic markers in both athletes and non-professional athletes. Methods: The review included seven studies with a total of 116 participants, ranging from professional handball players to non-professional strength athletes. The studies assessed various aspects of athletic performance, including strength, power, endurance, and body composition. Results: The main key findings from the review showed that MD may improve muscle endurance and power, as well as anaerobic performance in CrossFit athletes, and MD was associated with enhanced strength performance, including increased vertical jump height, hand grip strength, and shuttle run performance. The results on the impact on body composition were mixed, with some studies showing improvements in fat-free mass and skeletal muscle mass, while others found no significant changes. The MD also demonstrated positive effects on several markers, such as increased plasma total antioxidant activity and decreased markers of oxidative stress and inflammation. Conclusions: In conclusion, while the MD seems to represent a viable dietary strategy for enhancing athletic performance and overall health, more rigorous studies are necessary to clarify its impact across diverse athletic populations.

Effects of two external cooling strategies on physiological and perceptual responses of athletes with tetraplegia during and after exercise in the heat

Athletes with tetraplegia may experience marked hyperthermia while exercising under environmental heat stress due to their limited ability to dissipate heat through evaporative means. This study investigated the effectiveness of two external cooling strategies (i.e., spraying water onto the body surface or using a cooling vest) on physiological and perceptual variables in tetraplegic athletes during and after an aerobic exercise session in a hot environment. Nine male wheelchair rugby players performed an incremental test to determine their maximum aerobic power output. After that, they were subjected to three experimental trials in a counter-balanced order: control (CON, no body cooling), cooling vest (CV), and water spraying (WS). During these trials, they performed 30 min of a submaximal exercise (at 65% of their maximum aerobic power) inside an environmental chamber set to maintain the dry-bulb temperature at 32 °C. The following variables were recorded at regular intervals during the exercise and for an additional 30 min following the exertion (i.e., post-exercise recovery) with the participants also exposed to 32 °C: body core temperature (TCORE), skin temperature (TSKIN), heart rate (HR), rating of perceived exertion (RPE), thermal comfort (TC), and thermal sensation (TS). While exercising in CON conditions, the tetraplegic athletes had the expected increases in TCORE, TSKIN, HR, RPE, and TC and TS scores. HR, TC, and TS decreased gradually toward pre-exercise values after the exercise, whereas TCORE and TSKIN remained stable at higher values. Using a cooling vest decreased the temperature measured only on the chest and reduced the scores of RPE, TC, and TS during and after exercise but did not influence the other physiological responses of the tetraplegic athletes. In contrast, spraying water onto the athletes' body surface attenuated the exercise-induced increase in TSKIN, led to lower HR values during recovery, and was also associated with better perception during and after exercise. We conclude that water spraying is more effective than the cooling vest in attenuating physiological strain induced by exercise-heat stress. However, although both external cooling strategies do not influence exercise hyperthermia, they improve the athletes' thermal perception and reduce perceived exertion.

The effect of breathing exercises and mindset with or without cold exposure on mental and physical health in persons with a spinal cord injury-a protocol for a three-arm randomised-controlled trial

STUDY DESIGN

A three-arm randomized controlled trial.

OBJECTIVES

To investigate the effects of the Wim Hof Method (WHM), with (WHM-C) and without cold exposure (WHM-NC), on mental and physical health in persons with chronic spinal cord injury (SCI).

SETTING

Rehabilitation centre (assessments and once-weekly intervention sessions) and home-based (daily intervention sessions).

METHODS

Sixty adults with chronic SCI will be randomised (1:1:1) to one of three groups: participants in the intervention groups (i.e., WHM-C and WHM-NC) will engage in a 7-week intervention, with one weekly practice session at the rehabilitation centre and a daily WHM session at home. WHM-NC will consist of breathing exercises and mindset, while participants in WHM-C will partake in breathing exercises, mindset and cold exposure. Participants allocated to usual care (UC) will not receive the WHM intervention. The primary outcome is mental health reported via the Mental Health Inventory (MHI)-5, while secondary outcomes include circulating inflammatory and metabolic marker concentration, pulmonary function, body composition, sleep quality, spasticity, chronic pain and psychological stress.

ETHICS AND DISSEMINATION

Ethics approval has been obtained from the medical ethics committee of the Máxima Medical Centre (Veldhoven, the Netherlands; identifier: w22.069). If shown efficacious in improving mental health, as well as physical health, in persons with chronic SCI, the low cost and accessibility of the WHM allows it to be directly implemented in SCI rehabilitation.

TRIAL REGISTRATION NUMBER

NCT05704322.

Validation of bioimpedance phase angle in lower extremity of male patients with chronic spinal cord injury

[Purpose] This study aimed to evaluate the relationship between lower extremity phase angle and muscle thickness/echo intensity in males with chronic spinal cord injury. It also compared bioelectrical impedance analysis measurements to investigate skeletal muscle degeneration between individuals with spinal cord injury and healthy controls. [Participants and Methods] This cross-sectional study included 12 male patients with chronic spinal cord injury and 14 healthy male controls. We used bioelectrical impedance analysis and ultrasonography to measure the lower extremity phase angle and muscle thickness/echo intensity of the rectus femoris muscle, respectively. We also compared the bioelectrical impedance analysis measurements between individuals with spinal cord injury and healthy controls. [Results] Lower extremity phase angle was strongly correlated with muscle thickness and echo intensity of the rectus femoris muscle in individuals with spinal cord injury. All measures differed significantly between individuals with spinal cord injury and healthy controls. [Conclusion] These findings suggest that lower extremity phase angle is a valuable skeletal muscle indicator in spinal cord injury. Furthermore, bioelectrical impedance analysis revealed degeneration of the lower extremity skeletal muscles in individuals with chronic spinal cord injury.

Bioelectrical impedance vector analysis and body composition in cervical spinal cord injury: A pilot study

Introduction

Body composition assessment in cervical spinal cord injury (c-SCI) individuals is important to monitor the fat free-mass (FFM) loss, due to immobilization, or gain, due to exercise practice. Single frequency bioelectrical impedance analysis (SF-BIA) is low in cost, simple and easy.

Objectives

The aims of this study are: to evaluate the concordance between the FFM values obtained using dual X-ray absorptiometry (DXA) and the three SF-BIA previous predictive equations; and to test the applicability of the bioelectrical impedance vector analysis (BIVA).

Methods

Twenty-three c-SCI males were divided into two groups: Physically active (PA; n = 13; at least 150 min/week) and non-active individuals (NPA) and were assessed by DXA and SF-BIA simultaneously.

Results

FFM values were similar between groups PA and NPA. Considering all participants, FFM values obtained by Kocina and Heyward (>11%) and Sun (<15.4%) predictive equations were different when compared to DXA (p < 0.01). However, Buchholz's et al. predictive equation showed FFM values similar to DXA, but presented poor concordance (<7%, p = 0.99; concordance coefficient = 0.85). BIVA showed consistency in ellipse distribution using FFM obtained using Buchholz et al. predictive equation.

Conclusions

The use of non-specific BIA equations can lead to misinterpretation in FFM values in male c-SCI individuals. Predictive equations for this group need to be developed.

Predicting resting energy expenditure in people with chronic spinal cord injury

STUDY DESIGN

Cross-sectional study.

OBJECTIVES

The aims of this study were (1) to validate the two recently developed SCI-specific REE equations; (2) to develop new prediction equations to predict REE in a general population with SCI.

SETTING

University, the Netherlands.

METHODS

Forty-eight community-dwelling men and women with SCI were recruited (age: 18-75 years, time since injury: ≥12 months). Body composition was measured by dual-energy X-ray absorptiometry (DXA), single-frequency bioelectrical impedance analysis (SF-BIA) and skinfold thickness. REE was measured by indirect calorimetry. Personal and lesion characteristics were collected. SCI-specific REE equations by Chun et al. [1] and by Nightingale and Gorgey [2] were validated. New equations for predicting REE were developed using multivariate regression analysis.

RESULTS

Prediction equations by Chun et al. [1] and by Nightingale and Gorgey [2] significantly underestimated REE (Chun et al.: -11%; Nightingale and Gorgey: -11%). New equations were developed for predicting REE in the general population of people with SCI using FFM measured by SF-BIA and Goosey-Tolfrey et al. skinfold equation (R² = 0.45-0.47; SEE = 200 kcal/day). The new equations showed proportional bias (p < 0.001) and wide limits of agreement (LoA, ±23%).

CONCLUSIONS

Prediction equations by Chun et al. [1] and by Nightingale and Gorgey [2] significantly underestimated REE and showed large individual variations in a general population with SCI. The newly developed REE equations showed proportional bias and a wide LoA (±23%) which limit the predictive power and accuracy to predict REE in the general population with SCI. Alternative methods for measuring REE need to be investigated.

The Diagnosis and Management of Cardiometabolic Risk and Cardiometabolic Syndrome after Spinal Cord Injury

Individuals with spinal cord injuries (SCI) commonly present with component risk factors for cardiometabolic risk and combined risk factors for cardiometabolic syndrome (CMS). These primary risk factors include obesity, dyslipidemia, dysglycemia/insulin resistance, and hypertension. Commonly referred to as "silent killers", cardiometabolic risk and CMS increase the threat of cardiovascular disease, a leading cause of death after SCI. This narrative review will examine current data and the etiopathogenesis of cardiometabolic risk, CMS, and cardiovascular disease associated with SCI, focusing on pivotal research on cardiometabolic sequelae from the last five years. The review will also provide current diagnosis and surveillance criteria for cardiometabolic disorders after SCI, a novel obesity classification system based on percent total body fat, and lifestyle management strategies to improve cardiometabolic health.