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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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Amiri M, Kangatharan S, Brisbois L, Farahani F, Khasiyeva N, Burley M, Craven BC. Developing and Evaluating Data Infrastructure and Implementation Tools to Support Cardiometabolic Disease Indicator Data Collection. Top Spinal Cord Inj Rehabil 2023; 29:124-141. [PMID: 38174138 PMCID: PMC10759866 DOI: 10.46292/sci23-00018s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Background Assessment of aerobic exercise (AE) and lipid profiles among individuals with spinal cord injury or disease (SCI/D) is critical for cardiometabolic disease (CMD) risk estimation. Objectives To utilize an artificial intelligence (AI) tool for extracting indicator data and education tools to enable routine CMD indicator data collection in inpatient/outpatient settings, and to describe and evaluate the recall of AE levels and lipid profile assessment completion rates across care settings among adults with subacute and chronic SCI/D. Methods A cross-sectional convenience sample of patients affiliated with University Health Network's SCI/D rehabilitation program and outpatients affiliated with SCI Ontario participated. The SCI-HIGH CMD intermediary outcome (IO) and final outcome (FO) indicator surveys were administered, using an AI tool to extract responses. Practice gaps were prospectively identified, and implementation tools were created to address gaps. Univariate and bivariate descriptive analyses were used. Results The AI tool had <2% error rate for data extraction. Adults with SCI/D (n = 251; 124 IO, mean age 61; 127 FO, mean age 55; p = .004) completed the surveys. Fourteen percent of inpatients versus 48% of outpatients reported being taught AE. Fifteen percent of inpatients and 51% of outpatients recalled a lipid assessment (p < .01). Algorithms and education tools were developed to address identified knowledge gaps in patient AE and lipid assessments. Conclusion Compelling CMD health service gaps warrant immediate attention to achieve AE and lipid assessment guideline adherence. AI indicator extraction paired with implementation tools may facilitate indicator deployment and modify CMD risk.
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Affiliation(s)
- Mohammadreza Amiri
- KITE Research Institute, University Health Network, Toronto, ON, Canada
- ICON plc, Burlington, ON, Canada
| | - Suban Kangatharan
- KITE Research Institute, University Health Network, Toronto, ON, Canada
| | - Louise Brisbois
- KITE Research Institute, University Health Network, Toronto, ON, Canada
| | - Farnoosh Farahani
- KITE Research Institute, University Health Network, Toronto, ON, Canada
| | | | | | - B. Catharine Craven
- KITE Research Institute, University Health Network, Toronto, ON, Canada
- Department of Medicine, Temerty Faculty of Medicine, Toronto, ON, Canada
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Reid KF, Storer TW, Pencina KM, Valderrabano R, Latham NK, Wilson L, Ghattas C, Dixon R, Nunes A, Bajdek N, Huang G, Skeels SE, Lin AP, Merugumala SM, Liao HJ, Bouxsein ML, Zafonte RD, Bhasin S. A multimodality intervention to improve musculoskeletal health, function, metabolism, and well-being in spinal cord injury: study protocol for the FIT-SCI randomized controlled trial. BMC Musculoskelet Disord 2022; 23:493. [PMID: 35614404 PMCID: PMC9130453 DOI: 10.1186/s12891-022-05441-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/16/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND A spinal cord injury (SCI) is a devastating, life-changing event that has profoundly deleterious effects on an individual's health and well-being. Dysregulation of neuromuscular, cardiometabolic, and endocrine organ systems following an SCI contribute to excess morbidity, mortality and a poor quality of life. As no effective treatments currently exist for SCI, the development of novel strategies to improve the functional and health status of individuals living with SCI are much needed. To address this knowledge gap, the current study will determine whether a Home-Based Multimodality Functional Recovery and Metabolic Health Enhancement Program that consists of functional electrical stimulation of the lower extremity during leg cycling (FES-LC) plus arm ergometry (AE) administered using behavioral motivational strategies, and testosterone therapy, is more efficacious than FES-LC plus AE and placebo in improving aerobic capacity, musculoskeletal health, function, metabolism, and wellbeing in SCI. METHODS This single-site, randomized, placebo-controlled, parallel group trial will enroll 88 community-dwelling men and women, 19 to 70 years of age, with cervical and thoracic level of SCI, ASIA Impairment Scale grade: A, B, C, or D, 6 months or later after an SCI. Participants randomized to the multimodality intervention will undergo 16 weeks of home-based FES-LC and AE training plus testosterone undecanoate. Testosterone undecanoate injections will be administered by study staff in clinic or by a visiting nurse in the participant's home. The control group will receive 16 weeks of home-based FES-LC and AE exercise plus placebo injections. The primary outcome of this trial is peak aerobic capacity, measured during an incremental exercise testing protocol. Secondary outcomes include whole body and regional lean and adipose tissue mass; muscle strength and power; insulin sensitivity, lipids, and inflammatory markers; SCI functional index and wellbeing (mood, anxiety, pain, life satisfaction and depressive symptoms); and safety. DISCUSSION We anticipate that a multimodality intervention that simultaneously addresses multiple physiological impairments in SCI will result in increased aerobic capacity and greater improvements in other musculoskeletal, metabolic, functional and patient-reported outcomes compared to the control intervention. The findings of this study will have important implications for improving the care of people living with an SCI. TRIAL REGISTRATION ClinicalTrials.gov : ( NCT03576001 ). Prospectively registered: July 3, 2018.
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Affiliation(s)
- K F Reid
- Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - T W Storer
- Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - K M Pencina
- Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - R Valderrabano
- Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - N K Latham
- Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - L Wilson
- Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - C Ghattas
- Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - R Dixon
- Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - A Nunes
- Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - N Bajdek
- Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - G Huang
- Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - S E Skeels
- Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - A P Lin
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - S M Merugumala
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - H J Liao
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - M L Bouxsein
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - R D Zafonte
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - S Bhasin
- Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Raguindin PF, Bertolo A, Zeh RM, Fränkl G, Itodo OA, Capossela S, Bally L, Minder B, Brach M, Eriks-Hoogland I, Stoyanov J, Muka T, Glisic M. Body Composition According to Spinal Cord Injury Level: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10173911. [PMID: 34501356 PMCID: PMC8432215 DOI: 10.3390/jcm10173911] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/16/2021] [Accepted: 08/23/2021] [Indexed: 12/17/2022] Open
Abstract
The level of injury is linked with biochemical alterations and limitations in physical activity among individuals with spinal cord injury (SCI), which are crucial determinants of body composition. We searched five electronic databases from inception until 22 July 2021. The pooled effect estimates were computed using random-effects models, and heterogeneity was calculated using I2 statistics and the chi-squared test. Study quality was assessed using the Newcastle–Ottawa Scale. We pooled 40 studies comprising 4872 individuals with SCI (3991 males, 825 females, and 56 sex-unknown) in addition to chronic SCI (median injury duration 12.3 y, IQR 8.03–14.8). Individuals with tetraplegia had a higher fat percentage (weighted mean difference (WMD) 1.9%, 95% CI 0.6, 3.1) and lower lean mass (WMD −3.0 kg, 95% CI −5.9, −0.2) compared to those with paraplegia. Those with tetraplegia also had higher indicators of central adiposity (WMD, visceral adipose tissue area 0.24 dm2 95% CI 0.05, 0.43 and volume 1.05 L 95% CI 0.14, 1.95), whereas body mass index was lower in individuals with tetraplegia than paraplegia (WMD −0.9 kg/mg2, 95% CI −1.4, −0.5). Sex, age, and injury characteristics were observed to be sources of heterogeneity. Thus, individuals with tetraplegia have higher fat composition compared to paraplegia. Anthropometric measures, such as body mass index, may be inaccurate in describing adiposity in SCI individuals.
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Affiliation(s)
- Peter Francis Raguindin
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland; (O.A.I.); (T.M.); (M.G.)
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207 Nottwil, Switzerland; (A.B.); (R.M.Z.); (G.F.); (S.C.); (M.B.); (I.E.-H.); (J.S.)
- Graduate School for Health Sciences, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
- Correspondence:
| | - Alessandro Bertolo
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207 Nottwil, Switzerland; (A.B.); (R.M.Z.); (G.F.); (S.C.); (M.B.); (I.E.-H.); (J.S.)
| | - Ramona Maria Zeh
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207 Nottwil, Switzerland; (A.B.); (R.M.Z.); (G.F.); (S.C.); (M.B.); (I.E.-H.); (J.S.)
| | - Gion Fränkl
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207 Nottwil, Switzerland; (A.B.); (R.M.Z.); (G.F.); (S.C.); (M.B.); (I.E.-H.); (J.S.)
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Oche Adam Itodo
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland; (O.A.I.); (T.M.); (M.G.)
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207 Nottwil, Switzerland; (A.B.); (R.M.Z.); (G.F.); (S.C.); (M.B.); (I.E.-H.); (J.S.)
- Graduate School for Health Sciences, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Simona Capossela
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207 Nottwil, Switzerland; (A.B.); (R.M.Z.); (G.F.); (S.C.); (M.B.); (I.E.-H.); (J.S.)
| | - Lia Bally
- Department of Diabetes, Endocrinology, Nutritional Medicine, Metabolism, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland;
| | - Beatrice Minder
- Public Health & Primary Care Library, University Library of Bern, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland;
| | - Mirjam Brach
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207 Nottwil, Switzerland; (A.B.); (R.M.Z.); (G.F.); (S.C.); (M.B.); (I.E.-H.); (J.S.)
| | - Inge Eriks-Hoogland
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207 Nottwil, Switzerland; (A.B.); (R.M.Z.); (G.F.); (S.C.); (M.B.); (I.E.-H.); (J.S.)
- Swiss Paraplegic Center, Guido A. Zäch Str. 1, 6207 Nottwil, Switzerland
| | - Jivko Stoyanov
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207 Nottwil, Switzerland; (A.B.); (R.M.Z.); (G.F.); (S.C.); (M.B.); (I.E.-H.); (J.S.)
| | - Taulant Muka
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland; (O.A.I.); (T.M.); (M.G.)
| | - Marija Glisic
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland; (O.A.I.); (T.M.); (M.G.)
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207 Nottwil, Switzerland; (A.B.); (R.M.Z.); (G.F.); (S.C.); (M.B.); (I.E.-H.); (J.S.)
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La Fountaine MF, Cirnigliaro CM, Hobson JC, Lombard AT, Specht AF, Dyson-Hudson TA, Bauman WA. Fenofibrate therapy to lower serum triglyceride concentrations in persons with spinal cord injury: A preliminary analysis of its safety profile. J Spinal Cord Med 2020; 43:704-709. [PMID: 30870136 PMCID: PMC7534379 DOI: 10.1080/10790268.2019.1581694] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Context: Fenofibrate is used to treat elevated serum triglyceride (TG) concentrations (e.g. ≥150 mg/dl). The lipoprotein profile of most individuals with spinal cord injury (SCI) would not satisfy conventional criteria to initiate lipid-lowering therapies. Serum TG concentrations of 115 and 137 mg/dl were recently identified as potential intervention thresholds for persons with a SCI proximal to the 4th and below the 5th thoracic vertebrae, respectively. Fenofibrate therapy has not been tested for safety in persons with SCI. Methods: An open-label trial was performed in 15 persons with SCI to determine the safety profile of 4 months of once-daily fenofibrate (145 mg tablet) treatment when initiated using modified intervention thresholds. Fasting blood tests and a review of systems were performed monthly to determine changes in liver and kidney function, as well as overall health status. Results: Fifteen subjects participated and 4 had an adverse event (e.g. 2 with gastrointestinal distress; 2 with elevated liver enzymes). Three subjects discontinued the trial within the first month and one participant remained in the trial with no further adverse events. Two participants were discontinued from fenofibrate after 2 months after not responding to treatment, as per protocol, and 10 participants completed the 4-month trial without experiencing an adverse event. Conclusion: In persons with SCI, 4 months of fenofibrate therapy initiated at lower threshold serum TG concentrations did not result in an increased incidence of adverse events compared to that reported in the general population. Fenofibrate therapy appears to be well tolerated in persons with SCI.
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Affiliation(s)
- Michael F. La Fountaine
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center for the Medical, Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA,Department of Physical Therapy, School of Health and Medical Sciences, Seton Hall University, South Orange, New Jersey, USA,Departments of Medical Sciences and Neurology, Seton Hall-Hackensack Meridian School of Medicine, South Orange, New Jersey, USA,The Institute for Advanced Study of Rehabilitation and Sports Science, School of Health and Medical Sciences, Seton Hall University, South Orange, New Jersey, USA,Correspondence to: Michael F. La Fountaine, National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, 130 West Kingsbridge Road, Bronx, NY10468, USA; Ph: (718) 584-9000, ext. 3121.
| | - Christopher M. Cirnigliaro
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center for the Medical, Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Joshua C. Hobson
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center for the Medical, Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA,Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA
| | - Alexander T. Lombard
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center for the Medical, Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Adam F. Specht
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center for the Medical, Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Trevor A. Dyson-Hudson
- Kessler Foundation, West Orange, New Jersey, USA,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - William A. Bauman
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center for the Medical, Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA,Departments of Medicine and Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Holm NJ, Møller T, Adamsen L, Dalsgaard LT, Biering-Sorensen F, Schou LH. Health promotion and cardiovascular risk reduction in people with spinal cord injury: physical activity, healthy diet and maintenance after discharge- protocol for a prospective national cohort study and a preintervention- postintervention study. BMJ Open 2019; 9:e030310. [PMID: 31892644 PMCID: PMC6955524 DOI: 10.1136/bmjopen-2019-030310] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 10/24/2019] [Accepted: 11/05/2019] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Spinal cord injury (SCI) predisposes those who suffer from it to physical inactivity and weight gain; consequently, death due to cardiovascular diseases is more frequent among people with SCI than in the general population. The literature documents a consensus about an interdisciplinary multimodal approach for the prevention and treatment of cardiovascular risk factors including overweight and obesity in people with SCI, focusing on diet, physical activity (PA) and behavioural interventions. This study will investigate implementation of recommendations from a recent clinical practice guideline for identification and management of cardiometabolic risk after SCI through multimodal patient education in a subacute clinical setting. METHODS AND ANALYSIS All patients who are aged 18 years or older with an SCI within the previous 12 months and admitted to highly specialised rehabilitation are included, regardless of SCI aetiology or neurological level. A primary study designed as a controlled, pragmatic, preintervention- postintervention study with 6-month follow-up evaluates the effect of the clinical intervention; a prospective national cohort study on body mass index (BMI) serves as a historical control. The intervention consists of a standardised approach to patient education about cardiovascular risk factors, PA and a healthy diet that begins at the outset of primary SCI rehabilitation and is integrated into existing settings and workflows. Outcome measures are collected at admission, discharge and 6 months after discharge and include peak oxygen uptake (VO2peak) (primary outcome), BMI, body composition, metabolic profile, neurological status, level of functioning, depression, quality of life, objective PA (accelerometry), self-reported PA, self-assessed PA ability, shared decision making, and dietary habits. Test-retest reliability of four VO2peak test protocols are investigated, as is test-retest reliability of a multisensor accelerometer in a rehabilitation setting. ETHICS AND DISSEMINATION The project is approved by the Committees on Health Research Ethics in the Capital Region of Denmark on 10 July 2018 (Journal-nr.: H-18018325). The principal investigator obtains informed consent from all participants. The interventions in the project are closely related to existing rehabilitation care, and the risk of pain and discomfort is considered modest. Any unintended events related to the elements of the intervention are reported, according to existing regional procedures. Data are stored in a secure web-based database (Redcap). The primary study and prospective cohort study are registered at Clinicaltrials.gov. Positive and negative results will be submitted to relevant scientific journals related to SCI for publication. Important protocol modifications are reported to the Committees on Health Research Ethics in the Capital Region of Denmark. TRIAL REGISTRATION NUMBERS NCT03689023 and NCT03369080.
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Affiliation(s)
- Nicolaj Jersild Holm
- Neuroscience Center, Clinic for Spinal Cord Injuries, Rigshospitalet, Hornbæk, Denmark
| | - Tom Møller
- Department 9701, The University Hospitals Centre for Health Research, UCSF Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Lis Adamsen
- Department 9701, The University Hospitals Centre for Health Research, UCSF Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Line Trine Dalsgaard
- Neuroscience Center, Clinic for Spinal Cord Injuries, Rigshospitalet, Hornbæk, Denmark
| | - Fin Biering-Sorensen
- Neuroscience Center, Clinic for Spinal Cord Injuries, Rigshospitalet, Hornbæk, Denmark
| | - Lone Helle Schou
- Department of Nursing and Nutrition, University College Copenhagen, Copenhagen, Denmark
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7
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Goodus MT, McTigue DM. Hepatic dysfunction after spinal cord injury: A vicious cycle of central and peripheral pathology? Exp Neurol 2019; 325:113160. [PMID: 31863731 DOI: 10.1016/j.expneurol.2019.113160] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 11/17/2019] [Accepted: 12/18/2019] [Indexed: 02/06/2023]
Abstract
The liver is essential for numerous physiological processes, including filtering blood from the intestines, metabolizing fats, proteins, carbohydrates and drugs, and regulating iron storage and release. The liver is also an important immune organ and plays a critical role in response to infection and injury throughout the body. Liver functions are regulated by autonomic parasympathetic innervation from the brainstem and sympathetic innervation from the thoracic spinal cord. Thus, spinal cord injury (SCI) at or above thoracic levels disrupts major regulatory mechanisms for hepatic functions. Work in rodents and humans shows that SCI induces liver pathology, including hepatic inflammation and fat accumulation characteristic of a serious form of non-alcoholic fatty liver disease (NAFLD) called non-alcoholic steatohepatitis (NASH). This hepatic pathology is associated with and likely contributes to indices of metabolic dysfunction often noted in SCI individuals, such as insulin resistance and hyperlipidemia. These occur at greater rates in the SCI population and can negatively impact health and quality of life. In this review, we will: 1) Discuss acute and chronic changes in human and rodent liver pathology and function after SCI; 2) Describe how these hepatic changes affect systemic inflammation, iron regulation and metabolic dysfunction after SCI; 3) Describe how disruption of the hepatic autonomic nervous system may be a key culprit in post-injury chronic liver pathology; and 4) Preview ongoing and future research that aims to elucidate mechanisms driving liver and metabolic dysfunction after SCI.
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Affiliation(s)
- Matthew T Goodus
- The Belford Center for Spinal Cord Injury, The Ohio State University, Columbus, OH, USA; Department of Neuroscience, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
| | - Dana M McTigue
- The Belford Center for Spinal Cord Injury, The Ohio State University, Columbus, OH, USA; Department of Neuroscience, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
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8
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Kouwijzer I, Valent L, Osterthun R, van der Woude L, de Groot S. Peak power output in handcycling of individuals with a chronic spinal cord injury: predictive modeling, validation and reference values. Disabil Rehabil 2018; 42:400-409. [PMID: 30507314 DOI: 10.1080/09638288.2018.1501097] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To develop and validate predictive models for peak power output to provide guidelines for individualized handcycling graded exercise test protocols for people with spinal cord injury (SCI); and to define reference values.Materials and methods: Power output was measured in 128 handcyclists with SCI during a synchronous handcycling exercise test. Eighty percent of the data was used to develop four linear regression models: two theoretical and two statistical models with peak power output (in W and W/kg) as dependent variable. The other 20% of the data was used to determine agreement between predicted versus measured power output. Reference values were based on percentiles for the whole group.Results: Lesion level, handcycling training hours and sex or body mass index were significant determinants of peak power output. Theoretical models (R2 = 42%) were superior to statistical models (R2=39% for power output in W, R2 = 30% for power output in W/kg). The intraclass correlation coefficients varied between 0.35 and 0.60, depending on the model. Absolute agreement was low.Conclusions: Both models and reference values provide insight in physical capacity of people with SCI in handcycling. However, due to the large part of unexplained variance and low absolute agreement, they should be used with caution. Implications for rehabilitationIndividualization of the graded exercise test protocol is very important to attain the true peak physical capacity in individuals with spinal cord injury.The main determinants to predict peak power output during a handcycling graded exercise test for individuals with a spinal cord injury are lesion level, handcycling training hours and sex or body mass index.The predictive models for peak power output should be used with caution and should not replace a graded exercise test.
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Affiliation(s)
- Ingrid Kouwijzer
- Research and Development, Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands.,Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Amsterdam Rehabilitation Research Center
- Reade, Amsterdam, The Netherlands
| | - Linda Valent
- Research and Development, Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands
| | - Rutger Osterthun
- Tolbrug Rehabilitation Centre, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.,Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Rijndam Rehabilitation Institute, Rotterdam, The Netherlands
| | - Lucas van der Woude
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sonja de Groot
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Amsterdam Rehabilitation Research Center
- Reade, Amsterdam, The Netherlands
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9
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La Fountaine MF, Cirnigliaro CM, Hobson JC, Dyson-Hudson TA, Mc Kenna C, Kirshblum SC, Spungen AM, Bauman WA. Establishing a threshold to predict risk of cardiovascular disease from the serum triglyceride and high-density lipoprotein concentrations in persons with spinal cord injury. Spinal Cord 2018; 56:1051-1058. [PMID: 30089895 PMCID: PMC6219899 DOI: 10.1038/s41393-018-0187-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/20/2018] [Accepted: 07/23/2018] [Indexed: 12/20/2022]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE This report identified the serum triglyceride (TG) concentrations in persons with spinal cord injury (SCI) and able-bodied (AB) individuals that the serum high-density lipoprotein cholesterol (HDL-C) equaled 40 mg/dl, a concentration below which is an independent risk factor for coronary artery disease. METHODS Retrospective analysis was performed on 578 participants: 223 with SCI at or proximal to the 4th thoracic vertebrae (↑T4), 178 with SCI at or distal to the 5th thoracic vertebrae (↓T5), and 177 AB. Different statistical modeling approaches identified the intersecting serum TG concentration with a serum HDL-C concentration equal to 40 mg/dl. Participants were dichotomized into subgroups by TG concentration exceeding (supra) or falling below (sub) the intersecting value and the TG/HDL-C ratios were compared. RESULTS Linear regression analysis revealed that the serum TG concentration that intersects with serum HDL-C concentration at 40 mg/dl was 121 mg/dl in SCI ↑T4 and 137 mg/dl in SCI ↓T5 group. A ROC curve identified the optimal TG concentration as 115 mg/dl in SCI ↑T4 and 137 mg/dl in SCI ↓T5 group with the latter concentration being similar to the AB group (e.g., 137 mg/dl). The TG/HDL-C ratios in the respective ↑T4, ↓T5, and AB supra and subgroups were similar within each group. CONCLUSIONS A lower TG concentration appears to be associated with dyslipidemia in persons with SCI than AB individuals. These findings should prompt clinicians to screen for and consider instituting lifestyle or pharmacological interventions at lower TG concentrations to reduce risk of CVD.
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Affiliation(s)
- Michael F La Fountaine
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA.
- Department of Physical Therapy, School of Health and Medical Sciences, Seton Hall University, South Orange, NJ, USA.
- The Institute for Advanced Study of Rehabilitation and Sports Science, School of Health and Medical Sciences, Seton Hall University, South Orange, NJ, USA.
- Departments of Medical Sciences and Neurology, Hackensack Meridian School of Medicine at Seton Hall University, Nutley, NJ, USA.
| | - Christopher M Cirnigliaro
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Joshua C Hobson
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - Trevor A Dyson-Hudson
- Kessler Foundation, West Orange, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Cristin Mc Kenna
- Kessler Foundation, West Orange, NJ, USA
- Kessler Institute for Rehabilitation, West Orange, NJ, USA
| | - Steven C Kirshblum
- Kessler Foundation, West Orange, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
- Kessler Institute for Rehabilitation, West Orange, NJ, USA
| | - Ann M Spungen
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - William A Bauman
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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10
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Capelari TV, Borin JS, Grigol M, Saccani R, Zardo F, Cechetti F. EVALUATION OF MUSCLE STRENGTH IN MEDULLAR INJURY: A LITERATURE REVIEW. COLUNA/COLUMNA 2017. [DOI: 10.1590/s1808-185120171604179802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To identify the tools used to evaluate muscle strength in subjects with spinal cord injury in both clinical practice and scientific research. Methods: Initially, the literature review was carried out to identify the tools used in scientific research. The search was conducted in the following databases: Virtual Health Library (VHL), Pedro, and PubMed. Studies published between 1990 and 2016 were considered and selected, depicting an evaluation of muscle strength as an endpoint or for characterization of the sample. Next, a survey was carried out with physiotherapists to identify the instruments used for evaluation in clinical practice, and the degree of satisfaction of professionals with respect to them. Results: 495 studies were found; 93 were included for qualitative evaluation. In the studies, we verified the use of manual muscle test with different graduation systems, isokinetic dynamometer, hand-held dynamometer, and manual dynamometer. In clinical practice, the manual muscle test using the motor score recommended by the American Spinal Cord Injury Association was the most used method, despite the limitations highlighted by the physiotherapists interviewed. Conclusion: In scientific research, there is great variation in the methods and tools used to evaluate muscle strength in individuals with spinal cord injury, differently from clinical practice. The tools available and currently used have important limitations, which were highlighted by the professionals interviewed. No instrument depicts direct relationship of muscle strength and functionality of the subject. There is no consensus as to the best method for assessing muscle strength in spinal cord injury, and new instruments are needed that are specific for use in this population.
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Affiliation(s)
| | | | - Melissa Grigol
- Pontifícia Universidade Católica do Rio Grande do Sul, Brazil
| | | | - Franciele Zardo
- Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
| | - Fernanda Cechetti
- Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
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11
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de Groot S, Adriaansen JJ, Tepper M, Snoek GJ, van der Woude LHV, Post MWM. Metabolic syndrome in people with a long-standing spinal cord injury: associations with physical activity and capacity. Appl Physiol Nutr Metab 2016; 41:1190-1196. [PMID: 27806636 DOI: 10.1139/apnm-2016-0269] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study investigated (i) the prevalence of the metabolic syndrome (MetS) in people with a long-standing spinal cord injury (SCI); (ii) whether personal or lesion characteristics are determinants of the MetS; and (iii) the association with physical activity or peak aerobic capacity on the MetS. In a cross-sectional study, persons with SCI (N = 223; time since injury of ≥10 years) were tested. The individual components of the MetS were assessed together with the physical activity measured by the Physical Activity Scale for Individuals with Physical Disabilities (PASIPD), while peak aerobic capacity was tested during a graded wheelchair exercise test on a treadmill. Thirty-nine percent of the participants had MetS. In a multivariate logistic regression analyses and after performing a backward regression analysis, only age and education were significant determinants of the MetS. A 10-year increase in age leads to a 1.5 times more chance to have the MetS. Furthermore, people with a low education will multiply the relative risk of MetS compared with people with high education by almost 2. With and without correcting for confounders, no significant relationship was found between PASIPD or peak aerobic capacity and the MetS. It can be concluded that the prevalence of the MetS is high (39%) in people with a long-standing SCI but is comparable to the general Dutch population. Older people and those with a lower education level are most at risk for the MetS. Physical activity and peak aerobic fitness were not related to the MetS in this group with a long-standing SCI.
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Affiliation(s)
- Sonja de Groot
- a Amsterdam Rehabilitation Research Center/Reade, PO box 58271, 1040 HG Amsterdam, the Netherlands.,b University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, A. Deusinglaan 1, gebouw 3215. Groningen 9713 AV Groningen, the Netherlands
| | - Jacinthe J Adriaansen
- c Brain Center Rudolf Magnus and Center of Excellence in Rehabilitation Medicine, De Hoogstraat Rehabilitation and University Medical Center Utrecht, Rembrandtkade 10 3583 TM Utrecht, the Netherlands
| | - Marga Tepper
- d Center for Rehabilitation, Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1. Fonteinstraat 4 9713 GZ Groningen, the Netherlands
| | - Govert J Snoek
- e Rehabilitation Center Roessingh, Enschede, the Netherlands
| | - Lucas H V van der Woude
- b University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, A. Deusinglaan 1, gebouw 3215. Groningen 9713 AV Groningen, the Netherlands.,d Center for Rehabilitation, Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1. Fonteinstraat 4 9713 GZ Groningen, the Netherlands
| | - Marcel W M Post
- c Brain Center Rudolf Magnus and Center of Excellence in Rehabilitation Medicine, De Hoogstraat Rehabilitation and University Medical Center Utrecht, Rembrandtkade 10 3583 TM Utrecht, the Netherlands.,d Center for Rehabilitation, Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1. Fonteinstraat 4 9713 GZ Groningen, the Netherlands
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12
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Nooijen CFJ, Post MWM, Spooren AL, Valent LJ, Broeksteeg R, Sluis TA, Stam HJ, van den Berg-Emons RJG. Exercise self-efficacy and the relation with physical behavior and physical capacity in wheelchair-dependent persons with subacute spinal cord injury. J Neuroeng Rehabil 2015; 12:103. [PMID: 26586130 PMCID: PMC4653935 DOI: 10.1186/s12984-015-0099-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 11/16/2015] [Indexed: 11/30/2022] Open
Abstract
Background Since physical activity and exercise levels are known to be generally low in persons with spinal cord injury (SCI), there seems to be a need for intervention. Exercise self-efficacy (ESE), the confidence persons have in their ability to be physically active and exercise, is an important and modifiable predictor of physical behavior. The goal of this study was to 1) describe ESE in persons with subacute SCI, 2) to assess ESE in subgroups based on demographic and lesion characteristics, and 3) to explore the relation between ESE and physical behavior and physical capacity. Methods Thirthy-seven persons with subacute SCI who are wheelchair dependent participated. Participants completed the Exercise Self-Efficacy Scale. We recorded age and lesion characteristics, measured physical behavior (physical activity, motility and sedentary day time, n = 35) with an accelerometer-based activity monitor and measured physical capacity (peak power output, n = 28 and peak oxygen uptake, n = 24) during a maximal hand-cycling test. Measurements were performed 2 months prior to discharge from inpatient rehabilitation. Mann-Whitney tests were used to test for differences between subgroups based on age and lesion characteristics and spearman correlations were used to assess the relation between ESE and physical activity and physical capacity. Results Persons with tetraplegia had lower ESE compared to persons with paraplegia (Z = −1.93, p = 0.05). No differences in ESE were found between subgroups based on age and motor completeness of the lesion. In persons with paraplegia, ESE was positively related to peak power output (ρ = 0.58, p = 0.02). The relation of ESE with wheeled physical activity was ρ = 0.36, p = 0.09. Conclusions In persons with SCI who are dependent on a manual wheelchair, lesion level when categorized as paraplegic and tetraplegic affected ESE whereas age categories and completeness categories did not. Persons with tetraplegia were found to have lower confidence with regard to physical activity and exercise indicating that this subgroup can benefit from extra attention in the promotion of physical activity and exercise. In persons with paraplegia, ESE seemed to be lower in persons with less peak power output and less daily physical activity.
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Affiliation(s)
- Carla F J Nooijen
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Marcel W M Post
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands. .,Department of Rehabilitation Medicine, Center for Rehabilitation, University of Groningen, Groningen, The Netherlands. .,University Medical Center Groningen, Groningen, The Netherlands.
| | - Annemie L Spooren
- Adelante Center of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands. .,CAPHRI School for Public Health and Primary Care, Department of Rehabilitation Medicine, Maastricht University, Maastricht, Netherlands.
| | - Linda J Valent
- Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands.
| | | | - Tebbe A Sluis
- Rijndam Rehabilitation Institute, Rotterdam, The Netherlands.
| | - Henk J Stam
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | | | - Rita J G van den Berg-Emons
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
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13
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La Fountaine MF, Cirnigliaro CM, Emmons RR, Kirshblum SC, Galea M, Spungen AM, Bauman WA. Lipoprotein heterogeneity in persons with Spinal Cord Injury: a model of prolonged sitting and restricted physical activity. Lipids Health Dis 2015; 14:81. [PMID: 26215870 PMCID: PMC4517645 DOI: 10.1186/s12944-015-0084-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 07/22/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Persons with spinal cord injury (SCI) often have low levels of physical activity, which predispose to increased adiposity and decreased high density lipoprotein cholesterol (HDL-C) concentrations, and, generally, normal low density lipoprotein cholesterol (LDL-C) concentrations. In spite of the mixed lipoprotein profile, the SCI population has been reported to have an elevated risk of cardiovascular-related morbidity and mortality. Nuclear magnetic resonance spectroscopy may permit a more precise quantification of lipoprotein particle (P) species, enabling a more accurate inference of risk for cardiovascular disease (CVD) in the SCI population. METHODS Fasting blood samples were obtained on 83 persons with chronic SCI and 62 able-bodied (AB) subjects. Fasting plasma insulin (FPI), triglycerides (TG), and P number and size of VLDL (very low density lipoprotein), LDL, and HDL subclasses were determined. AB and SCI subjects were stratified based on HDL-C (i.e., Low <40 and Normal ≥ 40 mg/dl): AB-Normal (n = 48), AB-Low (n = 14), SCI-Normal (n = 49), and SCI-Low (n = 34). Factorial analyses of variance were performed to identify group differences in lipoprotein measurements. Pearson correlations were performed between the number of P by lipoprotein subclass, size, FPI, and TG. RESULTS The SCI-Normal group was not significantly different from the AB-Normal group for body composition, FPI, TG or LP-IR and had negligible differences in the lipoprotein P profile, except for fewer number and smaller size of HDL-P. The SCI-Low group had a similar lipoprotein profile to that of the AB-Low group, but with a lipid P composition associated with a heightened atherogenic risk and greater tendency toward insulin resistance by the Lipoprotein-Insulin Resistance (LP-IR) score. In the SCI-Low group, the decreased number and reduced size of lipoprotein P were more prevalent and may be associated with increased waist circumference (i.e., abdominal adiposity), relatively elevated TG values (compared to the other subgroups), and an underlying subclinical state of insulin resistance. CONCLUSIONS Prolonged sitting and restricted physical activity in individuals with SCI had the most profound effect on the HDL-C and its lipoprotein P subclasses, but not on LDL-C, however its P subclasses were also unfavorably affected but not to the same degree. The quantification of lipoprotein P characteristics may be a potent tool for the determination of risk for CVD in persons with SCI.
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Affiliation(s)
- Michael F La Fountaine
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center of Excellence for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, 130 West Kingsbridge Road, Bronx, NY, 10468, USA.
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- The Institute for Advanced Study of Rehabilitation and Sports Science, School of Health and Medical Sciences, Seton Hall University, South Orange, NJ, USA.
- Department of Physical Therapy, School of Health and Medical Sciences, Seton Hall University, South Orange, NJ, USA.
| | - Christopher M Cirnigliaro
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center of Excellence for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, 130 West Kingsbridge Road, Bronx, NY, 10468, USA
| | - Racine R Emmons
- Department of Kinesiology, William Patterson University, Wayne, NJ, USA
| | - Steven C Kirshblum
- Kessler Institute for Rehabilitation, West Orange, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Marinella Galea
- SCI Medical Service, James J. Peters VA Medical Center, Bronx, NY, USA
| | - Ann M Spungen
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center of Excellence for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, 130 West Kingsbridge Road, Bronx, NY, 10468, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - William A Bauman
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center of Excellence for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, 130 West Kingsbridge Road, Bronx, NY, 10468, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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14
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Peng J, Zeng J, Cai B, Yang H, Cohen MJ, Chen W, Sun MW, Lu CD, Jiang H. Establishment of quantitative severity evaluation model for spinal cord injury by metabolomic fingerprinting. PLoS One 2014; 9:e93736. [PMID: 24727691 PMCID: PMC3984092 DOI: 10.1371/journal.pone.0093736] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 03/06/2014] [Indexed: 11/18/2022] Open
Abstract
Spinal cord injury (SCI) is a devastating event with a limited hope for recovery and represents an enormous public health issue. It is crucial to understand the disturbances in the metabolic network after SCI to identify injury mechanisms and opportunities for treatment intervention. Through plasma 1H-nuclear magnetic resonance (NMR) screening, we identified 15 metabolites that made up an "Eigen-metabolome" capable of distinguishing rats with severe SCI from healthy control rats. Forty enzymes regulated these 15 metabolites in the metabolic network. We also found that 16 metabolites regulated by 130 enzymes in the metabolic network impacted neurobehavioral recovery. Using the Eigen-metabolome, we established a linear discrimination model to cluster rats with severe and mild SCI and control rats into separate groups and identify the interactive relationships between metabolic biomarkers in the global metabolic network. We identified 10 clusters in the global metabolic network and defined them as distinct metabolic disturbance domains of SCI. Metabolic paths such as retinal, glycerophospholipid, arachidonic acid metabolism; NAD-NADPH conversion process, tyrosine metabolism, and cadaverine and putrescine metabolism were included. In summary, we presented a novel interdisciplinary method that integrates metabolomics and global metabolic network analysis to visualize metabolic network disturbances after SCI. Our study demonstrated the systems biological study paradigm that integration of 1H-NMR, metabolomics, and global metabolic network analysis is useful to visualize complex metabolic disturbances after severe SCI. Furthermore, our findings may provide a new quantitative injury severity evaluation model for clinical use.
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Affiliation(s)
- Jin Peng
- Program for Computational Biology, Systems Biology, and Translational Research, Metabolomics and Multidisciplinary Laboratory for Trauma Research, Institute for Disaster and Emergency Medicine, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Sciences, Chengdu, Sichuan Province, China
- Department of Surgery, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
| | - Jun Zeng
- Program for Computational Biology, Systems Biology, and Translational Research, Metabolomics and Multidisciplinary Laboratory for Trauma Research, Institute for Disaster and Emergency Medicine, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Sciences, Chengdu, Sichuan Province, China
- Department of Trauma Surgery, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Sciences, Chengdu, Sichuan Province, China
| | - Bin Cai
- Program for Computational Biology, Systems Biology, and Translational Research, Metabolomics and Multidisciplinary Laboratory for Trauma Research, Institute for Disaster and Emergency Medicine, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Sciences, Chengdu, Sichuan Province, China
- Department of Trauma Surgery, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Sciences, Chengdu, Sichuan Province, China
| | - Hao Yang
- Program for Computational Biology, Systems Biology, and Translational Research, Metabolomics and Multidisciplinary Laboratory for Trauma Research, Institute for Disaster and Emergency Medicine, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Sciences, Chengdu, Sichuan Province, China
- Department of Computational Mathematics and Biostatistics, Metabolomics and Multidisciplinary Laboratory for Trauma Research, Institute for Disaster and Emergency Medicine, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Sciences, Chengdu, Sichuan Province, China
| | - Mitchell Jay Cohen
- Program for Computational Biology, Systems Biology, and Translational Research, Metabolomics and Multidisciplinary Laboratory for Trauma Research, Institute for Disaster and Emergency Medicine, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Sciences, Chengdu, Sichuan Province, China
- Department of Surgery, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
| | - Wei Chen
- Program for Computational Biology, Systems Biology, and Translational Research, Metabolomics and Multidisciplinary Laboratory for Trauma Research, Institute for Disaster and Emergency Medicine, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Sciences, Chengdu, Sichuan Province, China
- Department of Parenteral and Enteral Nutrition, Peking Union Medical College Hospital, Beijing, China
| | - Ming-Wei Sun
- Department of Trauma Surgery, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Sciences, Chengdu, Sichuan Province, China
| | - Charles Damien Lu
- Program for Computational Biology, Systems Biology, and Translational Research, Metabolomics and Multidisciplinary Laboratory for Trauma Research, Institute for Disaster and Emergency Medicine, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Sciences, Chengdu, Sichuan Province, China
| | - Hua Jiang
- Program for Computational Biology, Systems Biology, and Translational Research, Metabolomics and Multidisciplinary Laboratory for Trauma Research, Institute for Disaster and Emergency Medicine, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Sciences, Chengdu, Sichuan Province, China
- Department of Trauma Surgery, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Sciences, Chengdu, Sichuan Province, China
- Department of Computational Mathematics and Biostatistics, Metabolomics and Multidisciplinary Laboratory for Trauma Research, Institute for Disaster and Emergency Medicine, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Sciences, Chengdu, Sichuan Province, China
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15
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de Groot S, Post MW, Snoek GJ, Schuitemaker M, van der Woude LH. Longitudinal association between lifestyle and coronary heart disease risk factors among individuals with spinal cord injury. Spinal Cord 2012. [PMID: 23208541 DOI: 10.1038/sc.2012.153] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate: (1) the course of coronary heart disease risk factors (lipid profiles and body mass index (BMI)) in the first five years after discharge from inpatient spinal cord injury (SCI) rehabilitation and (2) the association between lifestyle (physical activity, self-care related to fitness, smoking, alcohol, body mass and low-fat diet) and coronary heart disease risk factors during that period. DESIGN Prospective cohort study. PARTICIPANTS/METHODS Individuals with SCI (N=130). Total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TG) and BMI were determined at discharge from inpatient rehabilitation and 1 and 5 years after discharge. Using multilevel regression models, the effects of lifestyle (drinking alcohol, smoking, active lifestyle and self-care) on the lipid profiles and BMI were determined. RESULTS After correction for lesion and personal characteristics, no changes in lipid profiles in the five years after discharge were seen, whereas the BMI increased significantly with 1.8 kg m(-2). A high percentage was at risk of cardiovascular disease due to high BMI (63-75%) or HDL (66-95%). The individuals who indicated to maintain their fitness level as good as possible and the individuals with a low BMI showed better lipid profiles. Individuals with a more active lifestyle showed higher HDL levels. Individuals who avoid smoking showed a 1.5 kg m(-2) higher BMI. CONCLUSION Lipid profiles seem to stabilize in the years after discharge from inpatient SCI rehabilitation, whereas the BMI increased. Lifestyle factors associated with a favorable lipid profile and BMI could be identified.
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Affiliation(s)
- S de Groot
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands.
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16
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Buchholz AC, Horrocks J, Martin Ginis KA, Bray SR, Craven BC, Hicks AL, Hayes KC, Latimer AE, McColl MA, Potter PJ, Smith K, Wolfe DL. Changes in traditional chronic disease risk factors over time and their relationship with leisure-time physical activity in people living with spinal cord injury. Appl Physiol Nutr Metab 2012; 37:1072-9. [DOI: 10.1139/h2012-085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
This study examined whether levels of chronic disease risk factors change over time, and whether leisure-time physical activity (LTPA) can explain any of the variation in those risk factors that change, in a sample of community-dwelling people living with spinal cord injury (SCI) in or near Hamilton, Ontario, Canada. LTPA was measured using the Physical Activity Recall Assessment for People with SCI at baseline (n = 76 adults with chronic (≥1 year) paraplegia or tetraplegia), at 6 months (n = 71) and at 18 months (n = 63). Body mass index, waist circumference at the lowest rib (WClowest rib) and iliac crest (WCiliac crest), fat mass, blood pressure, and biochemical data were collected at all 3 time points. Women’s BMI was higher at baseline (least square means (LSM) = 26.2 ± SE = 1.56 kg·m–2, p = 0.0004) and 6 months (25.9 ± 1.6, p = 0.0024) than at 18 months (22.1 ± 1.72). Men’s WClowest ribincreased from baseline (92.1 ± 1.87 cm) to 18 months (93.6 ± 1.87, p = 0.0253). Women who were active vs. inactive at baseline had a lower BMI at 6 months (23.1 ± 2.91 vs. 29.7 ± 2.52, p = 0.0957) and WCiliac crestat 6 months (82.8 ± 6.59 vs. 97.7 ± 5.10, p = 0.0818). Women who were active vs. inactive at 6 months had a lower WCiliac crestat 18 months (73.4 ± 14.3 vs. 102.5 ± 6.41, p = 0.0723). There was little change in traditional risk factors over 18 months. Future studies should extend beyond 18 months in a larger sample, and explore traditional vs. novel risk factors and onset of cardiovascular disease and diabetes in the SCI population.
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Affiliation(s)
- Andrea C. Buchholz
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Julie Horrocks
- Department of Mathematics and Statistics, University of Guelph, Guelph, ON N1G 2W1, Canada
| | | | - Steven R. Bray
- Department of Kinesiology, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - B. Catharine Craven
- Department of Medicine, University of Toronto, and Toronto Rehabilitation Institute, Toronto, ON M6K 2R6, Canada
| | - Audrey L. Hicks
- Department of Kinesiology, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Keith C. Hayes
- Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, ON N6A 3K7, Canada
| | - Amy E. Latimer
- School of Kinesiology and Health Studies, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Mary Ann McColl
- Centre for Health Services and Policy Research, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Patrick J. Potter
- Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, ON N6A 3K7, Canada
| | - Karen Smith
- Department of Physical Medicine and Rehabilitation, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Dalton L. Wolfe
- Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, ON N6A 3K7, Canada
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Nooijen CFJ, de Groot S, Postma K, Bergen MP, Stam HJ, Bussmann JBJ, van den Berg-Emons RJ. A more active lifestyle in persons with a recent spinal cord injury benefits physical fitness and health. Spinal Cord 2011; 50:320-3. [PMID: 22143679 DOI: 10.1038/sc.2011.152] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN A prospective cohort study. OBJECTIVES To study the longitudinal relationship between objectively measured everyday physical activity level, and physical fitness and lipid profile in persons with a recent spinal cord injury (SCI). SETTING A rehabilitation centre in the Netherlands and the participant's home environment. METHODS Data of 30 persons with a recent SCI were collected at the start of active rehabilitation, 3 months later, at discharge from inpatient rehabilitation, and 1 year after discharge. Physical activity level (duration of dynamic activities as % of 24 h) was measured with an accelerometry-based activity monitor. Regarding physical fitness, peak oxygen uptake (VO(2)peak) and peak power output (POpeak) were determined with a maximal wheelchair exercise test, and upper extremity muscle strength was measured with a handheld dynamometer. Fasting blood samples were taken to determine the lipid profile. RESULTS An increase in physical activity level was significantly related to an increase in VO(2)peak and POpeak, and an increase in physical activity level favourably affected the lipid profile. A nonsignificant relation was found with muscle strength. CONCLUSION Everyday physical activity seems to have an important role in the fitness and health of persons with a recent SCI. An increase in physical activity level was associated with an increase in physical fitness and with a lower risk of cardiovascular disease.
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Affiliation(s)
- C F J Nooijen
- Department of Rehabilitation Medicine and Physical Therapy, Erasmus Medical Center, Rotterdam, The Netherlands.
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Gorgey AS, Chiodo AE, Zemper ED, Hornyak JE, Rodriguez GM, Gater DR. Relationship of spasticity to soft tissue body composition and the metabolic profile in persons with chronic motor complete spinal cord injury. J Spinal Cord Med 2010; 33:6-15. [PMID: 20397439 PMCID: PMC2853330 DOI: 10.1080/10790268.2010.11689669] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Accepted: 06/29/2009] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND/OBJECTIVE To determine the effects of spasticity on anthropometrics, body composition (fat mass [FM] and fat-free mass [FFM]), and metabolic profile (energy expenditure, plasma glucose, insulin concentration, and lipid panel) in individuals with motor complete spinal cord injury (SCI). METHODS Ten individuals with chronic motor complete SCI (age, 33 +/- 7 years; BMI, 24 +/- 4 kg/m2; level of injury, C6-T11; American Spinal Injury Association A and B) underwent waist and abdominal circumferences to measure trunk adiposity. After the first visit, the participants were admitted to the general clinical research center for body composition (FFM and FM) assessment using dual energy x-ray absorptiometry. After overnight fasting, resting metabolic rate (RMR) and metabolic profile (plasma glucose, insulin, and lipid profile) were measured. Spasticity of the hip, knee, and ankle flexors and extensors was measured at 6 time points over 24 hours using the Modified Ashworth Scale. RESULTS Knee extensor spasticity was negatively correlated to abdominal circumferences (r = -0.66, P = 0.038). After accounting for leg or total FFM, spasticity was negatively related to abdominal circumference (r = -0.67, P = 0.03). Knee extensor spasticity was associated with greater total %FFM (r = 0.64; P = 0.048), lower % FM (r = -0.66; P = 0.03), and lower FM to FFM ratio. Increased FFM (kg) was associated with higher RMR (r = 0.89; P = 0.0001). Finally, spasticity may indirectly influence glucose homeostasis and lipid profile by maintaining FFM (r = -0.5 to -0.8, P < 0.001). CONCLUSION Significant relationships were noted between spasticity and variables of body composition and metabolic profile in persons with chronic motor complete SCI, suggesting that spasticity may play a role in the defense against deterioration in these variables years after injury. The exact mechanism is yet to be determined.
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Affiliation(s)
- Ashraf S Gorgey
- Spinal Cord Injury and Disorders Service, Hunter Holmes McGuire VA Medical Center, 1201 Broad Rock Boulevard, Richmond, VA 23249, USA.
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Cardiovascular Disease in Persons with Spinal Cord Dysfunction—An Update on Select Topics. Phys Med Rehabil Clin N Am 2009; 20:737-47. [DOI: 10.1016/j.pmr.2009.06.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Johnston TE, Smith BT, Mulcahey MJ, Betz RR, Lauer RT. A randomized controlled trial on the effects of cycling with and without electrical stimulation on cardiorespiratory and vascular health in children with spinal cord injury. Arch Phys Med Rehabil 2009; 90:1379-88. [PMID: 19651272 DOI: 10.1016/j.apmr.2009.02.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Revised: 02/18/2009] [Accepted: 02/24/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To examine the cardiorespiratory/vascular effects of cycling with and without functional electrical stimulation (FES) in children with spinal cord injury (SCI). DESIGN Randomized controlled trial. SETTING Pediatric referral hospital. PARTICIPANTS Children with SCI (N=30), ages 5 to 13 years, with injury levels from C4 to T11, and American Spinal Injury Association grades A, B, or C. INTERVENTIONS Children were randomly assigned to 1 of 3 groups: FES leg cycling exercise, passive leg cycling, or noncycling control group receiving electrical stimulation therapy. After receiving instruction on the use of the equipment, children exercised for 1 hour 3 times per week for 6 months at home with parental supervision. MAIN OUTCOME MEASURES Oxygen uptake (Vo(2)) during an incremental arm ergometry test, resting heart rate, forced vital capacity, and a fasting lipid profile. RESULTS There were no differences (P>.05) between groups after 6 months of exercise when comparing pre- and postvalues. However, there were differences between groups for some variables when examining percent change. The FES cycling group showed an improvement (P=.035) in Vo(2) (16.2%+/-25.0%) as compared with the passive cycling group (-28.7%+/-29.1%). For lipid levels, the electrical stimulation-only group showed declines (P=.032) in cholesterol levels (-17.1%+/-8.5%) as compared with the FES cycling group (4.4%+/-20.4%). CONCLUSIONS Cycling with FES led to gains in Vo(2), whereas electrical stimulation alone led to improvements in cholesterol.
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Affiliation(s)
- Therese E Johnston
- Department of Physical Therapy, University of the Sciences in Philadelphia, Philadelphia, PA 19104, USA.
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de Lira CAB, Vancini RL, Minozzo FC, Sousa BS, Dubas JP, Andrade MS, Steinberg LL, da Silva AC. Relationship between aerobic and anaerobic parameters and functional classification in wheelchair basketball players. Scand J Med Sci Sports 2009; 20:638-43. [PMID: 19793219 DOI: 10.1111/j.1600-0838.2009.00934.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Participation in sports for individuals with disabilities continues to gain popularity. In order to provide fair and equitable competition among persons with different disabilities and functional capacity, a separate functional classification system has been devised for each sport. The aims of the present study were to evaluate aerobic and anaerobic performance of wheelchair basketball athletes and verify a correlation with the International Wheelchair Basketball Federation functional classification system. For this, 17 highly trained male Brazilian basketball wheelchair athletes (25.4+/-4.4 years) from the national team who had taken part in the Athens 2004 Paralympic Games were assessed. These athletes were submitted to cardiopulmonary exercise testing and Wingate-like 30-s sprint test using upper limbs. The present study demonstrated that the functional classification score correlated with relative (r=0.90; P<0.0001) and absolute peak power (r=0.50; P=0.0353) and absolute mean power (r=0.93; P<0.0001) obtained from the Wingate-like 30-s sprint test and also correlated with absolute O(2) peak (r=0.68; P=0.0026) and O(2) at ventilatory threshold (r=0.71; P=0.0014), measured on cardiopulmonary exercise testing. Therefore, our findings support the functional classification created to classify athletes' functional capability on the court, which also correlated with aerobic and anaerobic performance parameters of the elite wheelchair basketball players.
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Affiliation(s)
- C A B de Lira
- Department of Physiology, Universidade Federal de São Paulo, São Paulo, Brazil.
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Current world literature. Trauma and rehabilitation. Curr Opin Neurol 2008; 21:762-4. [PMID: 18989123 DOI: 10.1097/wco.0b013e32831cbb85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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