Cardiometabolic risk profiles in pre- versus postmenopausal women with spinal cord injury:: preliminary findings

OBJECTIVE

To compare the cardiometabolic risk (CMR) profile of premenopausal and postmenopausal women with spinal cord injury (SCI).

METHOD

Post hoc analysis of a multicenter cross-sectional study assessing CMR. Seventeen women with ASIA Impairment Scale (AIS) A or B SCI between C5 and T12 were stratified into 2 groups according to menopausal status (11 premenopausal vs 6 postmenopausal women). Data collected included demographic, social, medical, menopausal, hormone use, and menstrual histories. Assessments included physical, anthropometric, and blood pressure measures; fasting serum total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), and hemoglobin A1C (Hb1Ac); calculated low-density lipoprotein (LDL-C); and an oral glucose tolerance test.

RESULTS

The premenopausal group had a mean age of 32.4 years compared with 56.0 years in the postmenopausal group. Similar group findings included body mass index (BMI) (22.4 vs 22.2), HDL-C (52.5 vs 53 mg/dL), HbA1c (4.9 vs 5.1%), fasting blood glucose (FBG) (79.3 vs 84.8 mg/dL), and systolic blood pressure (SBP) (104.6 vs 111.8 mm Hg). TG, TC and LDL-C were significantly higher in postmenopausal group (55.7 vs 101.8 mg/dL, P = .01; 158.3 vs 191.6 mg/dL, P = .04; 94.7 vs 118.2 mg/dL, P = .04).

CONCLUSIONS

The findings from this study suggest that postmenopausal women with SCI have CMR trends similar to those observed in nondisabled women, characterized by increases in TG, TC, and LDL-C despite favorable BMIs and glycemic indices. Even though the present study includes significant limitations, future evidence may also suggest that heightened surveillance and guideline-driven interventions are indicated for perimenopausal and postmenopausal women with SCI.

Addressing the nonexercise part of the activity continuum: a more realistic and achievable approach to activity programming for adults with mobility disability?

Participation in physical activity is fundamental for the maintenance of metabolic health and the prevention of major chronic diseases, particularly type 2 diabetes and cardiovascular disease. A whole-of-day approach to physical activity promotion is increasingly advocated and includes not only increasing moderate-intensity physical activity but also reducing sedentary time and increasing light-intensity activity (the "nonexercise" part of the activity continuum). This whole-of-day approach to tackling the challenge of inactivity may be particularly relevant for adults with mobility disabilities, who are among the most inactive segment of the population. Focusing on nonexercise activity by striving to reduce sedentary time and increase light-intensity activity may be a more successful place to begin to change behavior in someone with mobility disability. This article discusses what is known about the metabolic health consequences of sedentary behavior and light-intensity activity in adults with and without mobility disability. The concept of inactivity physiology is presented, along with possible applications or evidence from studies with adults with mobility disability. Mobility disability discussions and examples focus on stroke and spinal cord injury. Finally, clinical implications and future research directions related to sedentary behavior in adults with mobility disability are discussed.

Comparison of methods to assess energy expenditure and physical activity in people with spinal cord injury

OBJECTIVE

To compare different methods of assessing energy expenditure (EE) and physical activity (PA) in people with spinal cord injury (SCI) under community-dwelling conditions.

METHODS

A reference standard encompassing the doubly labelled water (DLW) technique, heart rate monitoring (FLEX-HR), a multi-sensor armband (SenseWear Armband (SWA)), and two PA recall questionnaires were employed in 14 people with SCI to estimate EE and leisure-time PA.

RESULTS

Mean total daily energy expenditure (TDEE) assessed by DLW, FLEX-HR, and SWA were 9817 ± 2491 kJ/day, 8498 ± 1516 kJ/day, and 11414 ± 3242 kJ/day, respectively. Physical activity energy expenditure (PAEE) quantified by DLW was 2841 ± 1626 kJ/day, 2935 ± 1732 kJ/day estimated from FLEX-HR, and 2773 ± 2966 kJ/day derived from SWA. After converting the PA recall questionnaire data to EE in kJ/day, PAEE for the Physical Activity Recall Assessment for People with Spinal Cord Injury (PARA-SCI) was 2339 ± 1171 kJ/day and for Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) 749 ± 1026 kJ/day. DLW-quantified PAEE was moderately associated with PARA-SCI (R(2) = 0.62, P < 0.05), but not with the other estimates of PAEE (R(2) ranged between 0.13 and 0.30, P > 0.05).

CONCLUSION

Our findings revealed that the PARA-SCI recall questionnaire was the best estimate of PAEE compared to the reference standard DLW approach. Although the between-method variability for SWA, FLEX-HR, and PASIPD-derived PAEE was small, there was a weak association between these methods and the criterion DLW technique. The best estimate of DLW-quantified TDEE was by FLEX-HR. SWA significantly overestimated TDEE in this population.

Cardiovascular disease, SCI and exercise: unique risks and focused countermeasures

PURPOSE

To summarise the spinal cord injury (SCI) specific profile of three cardiovascular disease risk factors (CVD): fasting dyslipidaemia, postprandial lipidaemia and vascular inflammation and to summarise exercise prescriptions that may attenuate each.

METHOD

NA.

RESULTS

NA.

CONCLUSIONS

At least three CVD risk factors have unique profiles in the SCI population. Fasting dyslipidaemia is characterised in the SCI population by depressed HDL cholesterol and normal or low total cholesterol. In the post-prandial state, persons with SCI exhibit an exaggerated triglyceride rise and delayed clearance compared to non-disabled persons. Finally, vascular inflammation, as indexed by C-reactive protein, is markedly elevated in SCI. Exercise may improve each, although the specific prescriptions differs. Fasting dyslipidaemia responds to 8 weeks of moderate intensity aerobic exercise performed 5 days weekly for 30 min daily. Post-prandial lipaemia treatment requires daily moderate or vigorous aerobic exercise, as the effect dissipates day by day. The daily exercise duration is proportional to fitness level, with total caloric expenditure emphasised rather than time. Finally, attenuating vascular inflammation in non-disabled persons requires moderate or vigorous exercise performed for ≥12 months, 5 days weekly for ≥45 min; with aerobic exercise plus resistance training more effective than aerobic exercise alone.