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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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Holm NJ, Møller T, Schou LH, Biering-Sørensen F. Monitoring outcome measures for cardiometabolic disease during rehabilitation and follow-up in people with spinal cord injury. Spinal Cord 2024; 62:125-132. [PMID: 38326463 DOI: 10.1038/s41393-023-00956-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 10/16/2023] [Accepted: 12/20/2023] [Indexed: 02/09/2024]
Abstract
STUDY DESIGN Controlled pragmatic intervention with follow-up. OBJECTIVES To describe cardiometabolic risk outcomes after a pragmatic intervention implemented into standard spinal cord injury (SCI) rehabilitation. SETTING Inpatient SCI rehabilitation in East-Denmark. PARTICIPANTS Inpatients, >18 years, having sustained a SCI within the last 12 months at admission to rehabilitation, regardless of etiology, neurological level or completeness of the lesion or mobility status. METHODS Patient education on health promotion was guided by evidence and included feedback on peak oxygen uptake (VO2peak) (primary outcome measure), body mass index (BMI), Dual energy X-ray absorptiometry and metabolic profile (secondary outcome measures). Paired t-tests, non-parametric tests and Analysis of Variance (ANOVA) were used for analyzes. VO2peak and BMI were compared to historical data. RESULTS VO2peak increased significantly from admission to discharge but did not exceed historical data despite a minimal clinical important difference. BMI decreased significantly during rehabilitation (p < 0.001) followed by a significant increase after discharge (p = 0.006). There was a trend that people with American Spinal Injury Association Impairment Scale (AIS) D SCI increased lean mass to nearly normal values. Criteria for pre-diabetes or diabetes were present in 28.5% and dyslipidemia in 45% of the participants 44.2 days after time of injury. CONCLUSIONS Despite improvements during rehabilitation, outcome measures were worse than recommended, and most outcome measures worsened at follow up, even in people with an AIS D SCI. Meaningful support regarding exercise and diet when tackling altered life circumstances is needed after discharge.
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Affiliation(s)
- Nicolaj J Holm
- Rigshospitalet, Neuroscience Center, Department for Spinal Cord and Brain Injuries, Hornbæk, Denmark.
| | - Tom Møller
- University Hospitals Centre for Health Care Research, University hospital Copenhagen, Rigshospitalet, Denmark
| | - Lone H Schou
- University College Copenhagen, Department of Nursing and Nutrition, Copenhagen, Denmark
| | - Fin Biering-Sørensen
- Rigshospitalet, Neuroscience Center, Department for Spinal Cord and Brain Injuries, Hornbæk, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Sacks H, Wu M, Carter C, Karamitopoulos M. Parasport: Effects on Musculoskeletal Function and Injury Patterns. J Bone Joint Surg Am 2022; 104:1760-1768. [PMID: 35975928 DOI: 10.2106/jbjs.21.01504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Sports participation can improve gait, muscle strength, and functional abilities in patients with a wide variety of disabilities. Para athletes are also at substantial risk for injury during sports participation. ➤ Ambulant athletes with cerebral palsy are at risk for soft-tissue injuries about the knee as well as foot and ankle injuries. Wheelchair athletes are at risk for osteoporotic fractures and shoulder girdle injuries. Limb-deficient athletes are prone to low back pain and overuse injuries of the contralateral extremity. ➤ Para athletes are vulnerable to abuse during sports participation, and physicians should promptly report any possible abuse or mistreatment. ➤ Orthopaedic surgeons should understand disability and sport-specific risk factors for injury in para athletes in order to initiate early management and injury prevention protocols.
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Affiliation(s)
- Hayley Sacks
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
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Schultz KR, Mona LR, Cameron RP. Mental Health and Spinal Cord Injury: Clinical Considerations for Rehabilitation Providers. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022; 10:131-139. [PMID: 35502271 PMCID: PMC9046713 DOI: 10.1007/s40141-022-00349-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 10/25/2022]
Abstract
Purpose of Review Assessing and addressing the mental and behavioral health concerns of individuals with SCI during rehabilitation is crucial, as untreated mental health distress can lead to reduced gains in rehabilitation and poor overall health. This review provides an overview of the latest research on prevalence rates of common mental and behavioral health concerns in the SCI population, highlighting disability-specific factors that may impact traditional assessment and treatment of mental health concerns. Recent Findings While those with SCI are at a heightened risk for experiencing mental health distress, overall, the majority of those with SCI adapt well, and live a full and meaningful life. Summary Rehabilitation psychologists are a vital aspect of rehabilitation teams, as they can address behavioral health and mental health concerns that may impede patients achieving their rehabilitation goals.
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Affiliation(s)
- Katlin R Schultz
- VA Long Beach Healthcare System, SCI/D Service (07/128) 5901 E 7th Street, Long Beach, CA 90822 USA
| | - Linda R Mona
- VA Long Beach Healthcare System, SCI/D Service (07/128) 5901 E 7th Street, Long Beach, CA 90822 USA
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Weber L, Voldsgaard NH, Holm NJ, Schou LH, Biering-Sørensen F, Møller T. Exploring the contextual transition from spinal cord injury rehabilitation to the home environment: a qualitative study. Spinal Cord 2021; 59:336-346. [PMID: 33564119 PMCID: PMC7943422 DOI: 10.1038/s41393-020-00608-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 12/04/2020] [Accepted: 12/04/2020] [Indexed: 11/16/2022]
Abstract
Study design Explorative qualitative study based on an interpretative phenomenological approach. Objectives This study explored the possibility of transferring knowledge and skills from a spinal cord injury (SCI) unit to the home environment; the individual and structural factors that potentially influenced this transfer; and its compatibility with a meaningful everyday life. Setting Hospital-based rehabilitation unit and community in Denmark. Methods Fourteen individuals with SCI were selected with maximum variation according to age, sex, marital status, and level of injury. In-depth, semi-structured interviews were conducted in the participants’ homes, 2–10 months after discharge from an SCI unit. Data analysis involved taking an interpretative phenomenological approach combined with a template analysis and applying the transfer of training theory to the discussion. Results Transitioning from the SCI unit to the home environment involved a multidimensional change of context in which most of the participants’ previous life roles had changed. This overarching theme had a decisive influence on: balancing loss and acceptance, facing external structural barriers, and the strength of social relationships when the knowledge and skills acquired at the unit were applied in a meaningful everyday life. Conclusions Transition from the SCI unit to the home environment is influenced by a multidimensional change of context that may restrict the use of acquired skills post-discharge, provide distant prospects for tertiary health promotion, and aggravate the experience of loss in people with SCI. Maintaining relationships is a strong mediator for transferring skills and re-establishing a meaningful everyday life.
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Affiliation(s)
- Lene Weber
- The University Hospitals Centre for Health Research (UCSF), Rigshospitalet, Copenhagen University Hospital, Department, 9701, Copenhagen, Denmark. .,Research Unit on Brain Injury Rehabilitation Copenhagen (RUBRIC), Department of Neurorehabilitation, Traumatic Brain Injury Unit, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Nanna Hoffgaard Voldsgaard
- The University Hospitals Centre for Health Research (UCSF), Rigshospitalet, Copenhagen University Hospital, Department, 9701, Copenhagen, Denmark
| | - Nicolaj Jersild Holm
- Department of Spinal Cord Injuries, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lone Helle Schou
- Department of Nursing and Nutrition, University College Copenhagen, Copenhagen, Denmark
| | - Fin Biering-Sørensen
- Department of Spinal Cord Injuries, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Tom Møller
- The University Hospitals Centre for Health Research (UCSF), Rigshospitalet, Copenhagen University Hospital, Department, 9701, Copenhagen, Denmark
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The test-retest reliability of individualized VO 2peak test modalities in people with spinal cord injury undergoing rehabilitation. Spinal Cord 2020; 59:82-91. [PMID: 32887906 DOI: 10.1038/s41393-020-00540-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Test-retest study. OBJECTIVE To describe the test-retest reliability of an individualized approach for peak oxygen uptake (VO2peak) testing in a clinical context, accommodating inpatients with heterogeneous levels of physical functioning. SETTING Inpatient rehabilitation. METHOD Test-retest on two types of devices (recumbent stepper and arm-crank ergometer) with two predefined protocols of varying load increments on each device. No participants performed all four test modalities. VO2peak, respiratory exchange ratio (RER), peak workload, and the reason for termination were reported. Of 23 participants included, 21 completed the test-retest procedure. Participants were inpatients, ≥18 years, who sustained a spinal cord injury (SCI) within the last 12 months at the time of admission. The median age was 52 years and 74% were male. Median time since injury at the time of the first test (T1) was 5.5 months. Seventeen were classified as American Spinal Injury Association Impairment Scale D. Intraclass correlation coefficients (ICC) and Bland-Altman plots for VO2peak was calculated to determine intra- and intertester reliability of VO2peak. RESULTS Mean VO2peak obtained at T1 was 1.91 L/min (95%CI: 1.31-2.51); 1.26 L/min and 2.69 L/min for the recumbent stepper protocols; 0.61 L/min and 1.39 L/min for the arm-crank ergometer protocols. ICC for intra- and intertester reliability was 0.997 (95%CI: 0.986-0.999) and 0.994 (95%CI: 0.978-0.998) respectively. Bland-Altman plots showed a mean difference of -0.005 (SD 0,12) for overall test-retest. CONCLUSION Test-retest reliability was high. Mean VO2peak at discharge from rehabilitation was higher than previously reported and individualized test modalities seemed to yield more optimal results in a heterogenous and representative sample during rehabilitation.
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Liu S, Wu D, Sun X, Fan Y, Zha R, Jalali A, Teli M, Sano T, Siegel A, Sudo A, Agarwal M, Robling A, Li BY, Yokota H. Mechanical stimulations can inhibit local and remote tumor progression by downregulating WISP1. FASEB J 2020; 34:12847-12859. [PMID: 32744779 DOI: 10.1096/fj.202000713rr] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 07/09/2020] [Accepted: 07/17/2020] [Indexed: 12/27/2022]
Abstract
Mechanical stimulations can prevent bone loss, but their effects on the tumor-invaded bone or solid tumors are elusive. Here, we evaluated the effect of knee loading, dynamic loads applied to the knee, on metastasized bone and mammary tumors. In a mouse model, tumor cells were inoculated to the mammary fat pad or the proximal tibia. Daily knee loading was then applied and metabolic changes were monitored mainly through urine. Urine samples were also collected from human subjects before and after step aerobics. The result showed that knee loading inhibited tumor progression in the loaded tibia. Notably, it also reduced remotely the growth of mammary tumors. In the urine, an altered level of cholesterol was observed with an increase in calcitriol, which is synthesized from a cholesterol derivative. In urinary proteins, knee loading in mice and step aerobics in humans markedly reduced WNT1-inducible signaling pathway protein 1, WISP1, which leads to poor survival among patients with breast cancer. In the ex vivo breast cancer tissue assay, WISP1 promoted the growth of cancer fragments and upregulated tumor-promoting genes, such as Runx2, MMP9, and Snail. Collectively, the present preclinical and human study demonstrated that mechanical stimulations, such as knee loading and step aerobics, altered urinary metabolism and downregulated WISP1. The study supports the benefit of mechanical stimulations for locally and remotely suppressing tumor progression. It also indicated the role of WISP1 downregulation as a potential mechanism of loading-driven tumor suppression.
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Affiliation(s)
- Shengzhi Liu
- Department of Biomedical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
| | - Di Wu
- Department of Biomedical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA.,Department of Pharmacology, School of Pharmacy, Harbin Medical University, Harbin, China
| | - Xun Sun
- Department of Biomedical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA.,Department of Pharmacology, School of Pharmacy, Harbin Medical University, Harbin, China
| | - Yao Fan
- Department of Biomedical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA.,Department of Pharmacology, School of Pharmacy, Harbin Medical University, Harbin, China
| | - Rongrong Zha
- Department of Biomedical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA.,Department of Pharmacology, School of Pharmacy, Harbin Medical University, Harbin, China
| | - Aydin Jalali
- Department of Biomedical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
| | - Meghana Teli
- Department of Biomedical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
| | - Tomohiko Sano
- Department of Biomedical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA.,Department of Orthopedic Surgery, Mie University, Mie, Japan
| | - Amanda Siegel
- Integrated Nanosystems Development Institute, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA.,Department of Chemistry and Chemical Biology, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
| | - Akihiro Sudo
- Department of Orthopedic Surgery, Mie University, Mie, Japan
| | - Mangilal Agarwal
- Integrated Nanosystems Development Institute, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA.,Department of Mechanical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
| | - Alexander Robling
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN, USA.,Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Bai-Yan Li
- Department of Pharmacology, School of Pharmacy, Harbin Medical University, Harbin, China
| | - Hiroki Yokota
- Department of Biomedical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA.,Department of Pharmacology, School of Pharmacy, Harbin Medical University, Harbin, China.,Integrated Nanosystems Development Institute, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA.,Department of Mechanical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA.,Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN, USA.,Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, USA.,Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN, USA
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