1
|
Craven BC, Souza WH, Jaglal S, Gibbs J, Wiest MJ, Sweet SN, Athanasopoulos P, Lamontagne ME, Boag L, Patsakos E, Wolfe D, Hicks A, Maltais DB, Best KL, Gagnon D. Reducing endocrine metabolic disease risk in adults with chronic spinal cord injury: strategic activities conducted by the Ontario-Quebec RIISC team. Disabil Rehabil 2023:1-13. [PMID: 38018518 DOI: 10.1080/09638288.2023.2284223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 11/10/2023] [Indexed: 11/30/2023]
Abstract
PURPOSE The Rehabilitation Interventions for Individuals with a Spinal Cord Injury in the Community (RIISC) team aimed to develop and evaluate innovative rehabilitation interventions to identify endocrine metabolic disease (EMD) risk, intending to reduce the frequency and severity of EMD related morbidity and mortality among adults living with chronic spinal cord injury or disease (SCI/D). MATERIALS AND METHODS An interprovincial team from Ontario and Quebec reviewed available EMD literature and evidence syntheses and completed an inventory of health services, policies and practices in SCI/D care. The review outcomes were combined with expert opinion to create an EMD risk model to inform health service transformation. RESULTS EMD risk and mortality are highly prevalent among adults with chronic SCI/D. In stark contrast, few rehabilitation interventions target EMD outcomes. The modelled solution proposes: 1) abandoning single-disease paradigms and examining a holistic perspective of the individual's EMD risk, and 2) developing and disseminating practice-based research approaches in outpatient community settings. CONCLUSIONS RIISC model adoption could accelerate EMD care optimization, and ultimately inform the design of large-scale longitudinal pragmatic trials likely to improve health outcomes. Linking the RIISC team activities to economic evaluations and policy deliverables will strengthen the relevance and impact among policymakers, health care providers and patients.
Collapse
Affiliation(s)
- Beverley Catharine Craven
- Toronto Rehabilitation Institute, Lyndhurst Centre, University Health Network, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Wagner Henrique Souza
- Kite Research Institute, University Health Network, Lyndhurst Centre, Toronto, Canada
| | - Susan Jaglal
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Jenna Gibbs
- Department of Kinesiology and Physical Education, McGill University, Montreal, Canada
| | | | - Shane N Sweet
- Department of Kinesiology & Physical Education, McGill University, Montreal, Canada
| | - Peter Athanasopoulos
- Senior Manager Public Policy and Government Relations, Spinal Cord Injury Ontario, Toronto, Canada
| | | | - Lynn Boag
- University of Guelph, Guelph, Canada
| | - Eleni Patsakos
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Dalton Wolfe
- Department of Physical Medicine and Rehabilitation, Western University, Parkwood Institute Research, London, Canada
| | - Audrey Hicks
- Department of Kinesiology, McMaster University, Hamilton, Canada
| | - Désirée B Maltais
- Department of Rehabilitation, Physiotherapy Program, Laval University, Quebec City, Canada
| | - Krista Lynn Best
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Dany Gagnon
- School of Rehabilitation, Université de Montréal, Montréal, Canada
- Centre for Interdisciplinary Research in Rehabilitation, Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal (IURDPM), Montréal, Canada
- Rehabilitation, Université de Montréal, École de Réadaptation, Montréal, Canada
| |
Collapse
|
2
|
Alazzam AM, Alrubaye MW, Goldsmith JA, Gorgey AS. Trends in measuring BMR and RMR after spinal cord injury: a comprehensive review. Br J Nutr 2023; 130:1720-1731. [PMID: 37092679 PMCID: PMC10587382 DOI: 10.1017/s0007114523000831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 03/14/2023] [Accepted: 03/22/2023] [Indexed: 04/25/2023]
Abstract
Studying factors that contribute to our understanding of maintaining normal energy balance are of paramount significance following spinal cord injury (SCI). Accurate determination of energy needs is crucial for providing nutritional guidance and managing the increasing prevalence of malnutrition or obesity after SCI. BMR represents 75-80 % of the total energy expenditure in persons with SCI. Accurately measuring BMR is an important component for calculating total energetic needs in this population. Indirect calorimetry is considered the gold-standard technique for measuring BMR. However, technical challenges may limit its applications in large cohort studies and alternatively rely on prediction equations. Previous work has shown that BMR changes in response to disuse and exercise in the range of 15-120 %. Factors including sex, level of injury and type of assistive devices may influence BMR after SCI. RMR is erroneously used interchangeably for BMR, which may result in overestimation of energetic intake when developing nutritional plans. To address this concern, we comprehensively reviewed studies that conducted BMR (n=15) and RMR (n=22) in persons with SCI. The results indicated that RMR is 9 % greater than BMR in persons with SCI. Furthermore, the SCI-specific prediction equations that incorporated measures of fat-free mass appeared to accurately predict BMR. Overall, the current findings highlighted the significance of measuring BMR as well as encouraging the research and clinical community to effectively establish countermeasures to combat obesity after SCI.
Collapse
Affiliation(s)
- Ahmad M. Alazzam
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - Malak W. Alrubaye
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - Jacob A. Goldsmith
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - Ashraf S. Gorgey
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
- Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| |
Collapse
|
3
|
Fenton JM, King JA, Hoekstra SP, Valentino SE, Phillips SM, Goosey-Tolfrey VL. Protocols aiming to increase muscle mass in persons with motor complete spinal cord injury: a systematic review. Disabil Rehabil 2022; 45:1433-1443. [PMID: 35465798 DOI: 10.1080/09638288.2022.2063420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE The purpose of this review was to compare all intervention modalities aimed at increasing skeletal muscle mass (SMM) in the paralysed limbs of persons with chronic (>1-year post-injury), motor complete spinal cord injury (SCI). MATERIALS AND METHODS A systematic review of EMBASE, MEDLINE, Scopus, and SPORTDiscus databases was conducted from inception until December 2021. Published intervention studies aimed to increase SMM (measured by magnetic resonance imaging, computed tomography, ultrasound, muscle biopsy, or lean soft tissue mass by dual X-ray absorptiometry) in the paralysed limbs of adults (>18 years) with SCI were included. RESULTS Fifty articles were included that, overall, demonstrated a high risk of bias. Studies were categorised into six groups: neuromuscular electrical stimulation (NMES) with and without external resistance, functional electrical stimulation cycling, walking- and standing-based interventions, pharmacological treatments, and studies that compared or combined intervention modalities. Resistance training (RT) using NMES on the quadriceps produced the largest and most consistent increases in SMM of all intervention modalities. CONCLUSIONS Current evidence suggests that clinical practise aiming to increase SMM in the paralysed limbs of persons with motor complete SCI should perform NMES-RT. However, more high-quality randomised control trials are needed to determine how training variables, such as exercise volume and intensity, can be optimised for increasing SMM. Implications for rehabilitationPersons with spinal cord injury (SCI) experience severe reductions in skeletal muscle mass (SMM) post-injury, which may exacerbate their risk of obesity and metabolic disease.Out of all exercise and non-exercise-based interventions, this systematic review shows that neuromuscular electrical stimulation-based resistance training demonstrates the most robust and consistent evidence for increasing skeletal muscle mass in the paralysed limbs of adults with motor complete spinal cord injury.The findings from this review can be used to inform evidence-based practise for exercise practitioners, as well as direct future research focused on increasing muscle mass in this population.
Collapse
Affiliation(s)
- Jordan M. Fenton
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- Peter Harrison Centre for Disability Sport, Loughborough University, Loughborough, UK
| | - James A. King
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
| | - Sven P. Hoekstra
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- Peter Harrison Centre for Disability Sport, Loughborough University, Loughborough, UK
| | | | - Stuart M. Phillips
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Victoria L. Goosey-Tolfrey
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- Peter Harrison Centre for Disability Sport, Loughborough University, Loughborough, UK
| |
Collapse
|
4
|
Gorgey AS, Khalil RE, Gill R, Khan R, Adler RA. Effects of dose de-escalation following testosterone treatment and evoked resistance exercise on body composition, metabolic profile, and neuromuscular parameters in persons with spinal cord injury. Physiol Rep 2021; 9:e15089. [PMID: 34713983 PMCID: PMC8554770 DOI: 10.14814/phy2.15089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/29/2021] [Accepted: 10/06/2021] [Indexed: 11/24/2022] Open
Abstract
The dose de-escalation (DD) effects of testosterone and evoked resistance training (RT) on body composition, cardiometabolic, and neuromuscular variables were investigated. Thirteen men with chronic complete spinal cord injury (SCI) were followed for additional 16 weeks after receiving either testosterone treatment only (TT) or TT+RT. During the 16-week DD period, the TT+RT group underwent a program of once weekly electrical stimulation with gradually decreasing ankle weights and testosterone patches of 2 mg day-1 (TT+RT group). The TT only group did not receive any intervention throughout the detraining period (no-TT group). Body composition was tested using anthropometrics, dual energy X-ray absorptiometry, and magnetic resonance imaging. After an overnight fast, basal metabolic rate (BMR), lipid panel, serum testosterone, inflammatory biomarkers, glucose effectiveness, and insulin sensitivity were measured. Finally, peak isometric and isokinetic torques were measured only in the TT+RT group. All measurements were conducted at the beginning and at the end of DD. Absolute thigh muscle cross-sectional areas (CSAs) demonstrated interaction effects (p < 0.05) between the TT+RT (-8.15%, -6.5%) and no-TT (2.3%, 4.4%) groups. Similarly, absolute knee extensor muscle CSA demonstrated interaction effects (p < 0.05) between the TT+RT (-11%, -7.0%) and no-TT (2.6%, 3.8%) groups. There was a trend (p = 0.07) of increasing visceral adipose tissue (VAT) CSAs in the TT+RT (18%) and in the no-TT (16% cm2 ) groups. There was an interaction (p = 0.005) between TT+RT (decreased by 3.7%) and no-TT groups (increased by 9.0%) in BMR. No interactions were evident between groups over time for biomarkers related to carbohydrate, lipid metabolism, or inflammation. Finally, there were no changes (p > 0.05) in peak isometric or isokinetic torques and rise time following 16 weeks of the DD period in the TT+RT group. TT+RT during 16 weeks of DD was minimally effective at preventing detraining relative to no-TT on muscle size, BMR, and VAT. However, neuromuscular gains were successfully maintained.
Collapse
Affiliation(s)
- Ashraf S. Gorgey
- Spinal Cord Injury and Disorders CenterHunter Holmes McGuire VAMCRichmondVirginiaUSA
- Department of Physical Medicine & RehabilitationVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Refka E. Khalil
- Spinal Cord Injury and Disorders CenterHunter Holmes McGuire VAMCRichmondVirginiaUSA
| | - Ranjodh Gill
- Endocrinology ServiceHunter Holmes McGuire VA Medical CenterRichmondVirginiaUSA
- Endocrine DivisionVirginia Commonwealth University School of MedicineRichmondVirginiaUSA
| | - Rehan Khan
- Radiology ServiceHunter Holmes McGuire VA Medical CenterRichmondVirginiaUSA
| | - Robert A. Adler
- Endocrinology ServiceHunter Holmes McGuire VA Medical CenterRichmondVirginiaUSA
- Endocrine DivisionVirginia Commonwealth University School of MedicineRichmondVirginiaUSA
| |
Collapse
|
5
|
Goldsmith JA, Ennasr AN, Farkas GJ, Gater DR, Gorgey AS. Role of exercise on visceral adiposity after spinal cord injury: a cardiometabolic risk factor. Eur J Appl Physiol 2021; 121:2143-2163. [PMID: 33891156 DOI: 10.1007/s00421-021-04688-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/10/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE Visceral adipose tissue (VAT) is associated with cardiometabolic disease risk in able-bodied (AB) populations. However, the underlying mechanisms of VAT-induced disease risk are unknown in persons with spinal cord injury (SCI). Potential mechanisms of VAT-induced cardiometabolic dysfunction in persons with SCI include systemic inflammation, liver adiposity, mitochondrial dysfunction, and anabolic deficiency. Moreover, how exercise interventions impact these mechanisms associated with VAT-induced cardiometabolic dysfunction are still being explored. METHODS A search for relevant scientific literature about the effects of exercise on VAT and cardiometabolic health was conducted on the PubMed database. Literature from reference lists was also included when appropriate. RESULTS Both aerobic and resistance exercise training beneficially impact health and VAT mass via improving mitochondrial function, glucose effectiveness, and inflammatory signaling in SCI and AB populations. Specifically, aerobic exercise appears to also modulate cellular senescence in AB populations and animal models, while resistance exercise seems to augment anabolic signaling in persons with SCI. CONCLUSIONS The current evidence supports regular engagement in exercise to reduce VAT mass and the adverse effects on cardiometabolic health in persons with SCI. Future research is needed to further elucidate the precise mechanisms by which VAT negatively impacts health following SCI. This will likely facilitate the development of rehabilitation protocols that target VAT reduction in persons with SCI.
Collapse
Affiliation(s)
- Jacob A Goldsmith
- Spinal Cord Injury and Disorders Center, Central Virginia VA Health Care System, 1201 Broad Rock Boulevard, Richmond, VA, 23249, USA
| | - Areej N Ennasr
- Spinal Cord Injury and Disorders Center, Central Virginia VA Health Care System, 1201 Broad Rock Boulevard, Richmond, VA, 23249, USA
| | - Gary J Farkas
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - David R Gater
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Ashraf S Gorgey
- Spinal Cord Injury and Disorders Center, Central Virginia VA Health Care System, 1201 Broad Rock Boulevard, Richmond, VA, 23249, USA. .,Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, 23298, USA.
| |
Collapse
|
6
|
Gorgey AS, Ennasr AN, Farkas GJ, Gater DR. Anthropometric Prediction of Visceral Adiposity in Persons With Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2021; 27:23-35. [PMID: 33814881 DOI: 10.46292/sci20-00055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Over two-thirds of persons with spinal cord injury (SCI) experience neurogenic obesity-induced cardiometabolic syndrome (CMS) and other chronic comorbidities. Obesity is likely to impede social and recreational activities, impact quality of life, and impose additional socioeconomic burdens on persons with SCI. Advances in imaging technology facilitate the mapping of adiposity and its association with the cardiometabolic profile after SCI. Central adiposity or central obesity is characterized by increased waist (WC) and abdominal circumferences (AC) as well as visceral adipose tissue (VAT). A number of studies, while relying on expensive imaging techniques, have reported direct associations of both central obesity and VAT in imposing significant health risks after SCI. The mechanistic role of central obesity on cardiometabolic heath in persons with SCI has yet to be identified, despite the knowledge that it has been designated as an independent risk factor for cardiometabolic dysfunction and premature mortality in other clinical populations. In persons with SCI, the distribution of adipose tissue has been suggested to be a function of sex, level of injury, and age. To date, there is no SCI-specific WC or AC cutoff value to provide anthropometric prediction of VAT and diagnostic capability of persons at risk for central obesity, CMS, and cardiovascular disease after SCI. The purpose of the current review is to summarize the factors contributing to visceral adiposity in persons with SCI and to develop an SCI-specific anthropometric prediction equation for this population. Furthermore, a proposed WC cutoff will be discussed as a surrogate index for central obesity, CMS, and cardiovascular disorders after SCI.
Collapse
Affiliation(s)
- Ashraf S Gorgey
- Spinal Cord Injury and Disorders Center, Central Virginia VA Health Care System, Richmond, Virginia.,Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia
| | - Areej N Ennasr
- Spinal Cord Injury and Disorders Center, Central Virginia VA Health Care System, Richmond, Virginia
| | - Gary J Farkas
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
| | - David R Gater
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida.,Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia
| |
Collapse
|