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Rigoli A, Francis L, Nicholson M, Weber G, Redhead J, Iyer P. A systematic review of the effects of robotic exoskeleton training on energy expenditure and body composition in adults with spinal cord injury. Int J Rehabil Res 2024; 47:64-74. [PMID: 38616768 DOI: 10.1097/mrr.0000000000000626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Metabolic diseases disproportionately affect people with spinal cord injury (SCI). Increasing energy expenditure and remodeling body composition may offset deleterious consequences of SCI to improve cardiometabolic health. Evidence is emerging that robotic exoskeleton use increases physical activity in SCI, but little is known about its effects on energy expenditure and body composition. This study therefore aimed to evaluate the impact of robotic exoskeleton training on body composition and energy expenditure in adults with SCI. A systematic literature review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Five databases were searched to retrieve studies meeting pre-set eligibility criteria: adults with SCI, interventions evaluating the effects of robotic exoskeleton devices on body composition or energy expenditure. The PEDro scale guided quality assessments with findings described narratively. Of 2163 records, 10 studies were included. Robotic exoskeleton training does not significantly improve energy expenditure compared to other exercise interventions. Significant changes ( P < 0.05) in body composition, particularly reduced fat mass, however, were reported. High variability seen with the interventions was coupled with poor quality of the studies. While robotic exoskeleton interventions may propose modest cardiometabolic benefits in adults with SCI, further robust trials in larger samples are needed to strengthen these findings.
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Affiliation(s)
- Alessandra Rigoli
- The University of Sydney, Nutrition and Dietetics Group, Susan Wakil School of Nursing and Midwifery, The Charles Perkins Centre
| | - Lucinda Francis
- The University of Sydney, Nutrition and Dietetics Group, Susan Wakil School of Nursing and Midwifery, The Charles Perkins Centre
| | - Margaret Nicholson
- The University of Sydney, Nutrition and Dietetics Group, Susan Wakil School of Nursing and Midwifery, The Charles Perkins Centre
| | | | | | - Priya Iyer
- The University of Sydney, Nutrition and Dietetics Group, Susan Wakil School of Nursing and Midwifery, The Charles Perkins Centre
- Royal Rehab, Sydney, New South Wales, Australia
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LaVela SL, Wu J, Harris AH, Frayne SM, Nevedal AL, Arnow KD, Barreto NB, Davis K, Eisenberg D. Physical and emotional consequences of excess weight as experienced by individuals with spinal cord injuries. J Spinal Cord Med 2024; 47:412-422. [PMID: 36448929 PMCID: PMC11044741 DOI: 10.1080/10790268.2022.2097994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
CONTEXT/OBJECTIVE Excess weight has the potential to carry a substantial physical and emotional burden. A better understanding of perceived consequences of excess weight may facilitate the development of patient-centered programs and interventions to promote weight management efforts in persons with spinal cord injury (SCI). The study objective was to describe consequences of excess weight from the personal perspectives of individuals with SCI. DESIGN Descriptive qualitative design using in-depth semi-structured interviews and thematic analysis. SETTING Veterans Health Administration (VHA) SCI System of Care. PARTICIPANTS Individuals with SCI (n-33). OUTCOME MEASURES Key themes from thematic analysis. RESULTS Participants were male (61%), ranged from 29 to 84 years of age, and about half had tetraplegia (55%). Five themes were identified that demonstrate negative consequences of excess weight experienced by individuals with SCI, including: (1) physical health conditions (including chronic conditions and SCI secondary conditions), (2) physical symptoms (such as pain, discomfort, and fatigue), (3) movement challenges, (4) appearance-related concerns, and (5) emotional impacts. CONCLUSIONS Carrying excess weight is concerning to individuals with SCI and in terms of consequences such onset or exacerbation of chronic conditions, SCI secondary conditions, physical symptoms, e.g. pain, movement impairment (including hampered mobility, difficult transfers and self-care), image/appearance concerns (e.g. body image, clothing misfit), and negative emotions (e.g. unhappy, sad, depressed). Our findings may inform SCI healthcare providers about the consequences of excess weight as experienced by individuals with SCI, highlighting what matters most to persons with SCI and guiding a patient-centered approach to weight management in this population.
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Affiliation(s)
- Sherri L. LaVela
- Center of Innovation for Complex Chronic Care, VA Edward Hines Jr., Hines, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Justina Wu
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Alex H.S. Harris
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine, Stanford, California, USA
| | - Susan M. Frayne
- Center of Innovation for Complex Chronic Care, VA Edward Hines Jr., Hines, Illinois, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Andrea L. Nevedal
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Katherine D. Arnow
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine, Stanford, California, USA
| | - Nicolas B. Barreto
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine, Stanford, California, USA
| | - Kristen Davis
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine, Stanford, California, USA
| | - Dan Eisenberg
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine, Stanford, California, USA
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Farkas GJ, Caldera LJ, Nash MS. Assessing the efficacy of duration and intensity prescription for physical activity in mitigating cardiometabolic risk after spinal cord injury. Curr Opin Neurol 2023; 36:531-540. [PMID: 37865846 DOI: 10.1097/wco.0000000000001206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
PURPOSE OF REVIEW Spinal cord injury (SCI) heightens susceptibility to cardiometabolic risk (CMR), predisposing individuals to cardiovascular disease. This monograph aims to assess the optimal duration and intensity of physical activity (PA) for managing CMR factors, particularly obesity, after SCI and provide modality-specific PA durations for optimal energy expenditure. RECENT FINDINGS PA guidelines recommend at least 150 min/week of moderate-intensity activity. However, non-SCI literature supports the effectiveness of engaging in vigorous-intensity PA (≥6 METs) and dedicating 250-300 min/week (≈2000 kcal/week) to reduce CMR factors. Engaging in this volume of PA has shown a dose-response relationship, wherein increased activity results in decreased obesity and other CMR factors in persons without SCI. SUMMARY To optimize cardiometabolic health, individuals with SCI require a longer duration and higher intensity of PA to achieve energy expenditures comparable to individuals without SCI. Therefore, individuals with SCI who can engage in or approach vigorous-intensity PA should prioritize doing so for at least 150 min/wk. At the same time, those unable to reach such intensities should engage in at least 250-300 min/week of PA at a challenging yet comfortable intensity, aiming to achieve an optimal intensity level based on their abilities. Given the potential to decrease CMR after SCI, increasing PA duration and intensity merits careful consideration in future SCI PA directives.
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Affiliation(s)
- Gary J Farkas
- Department of Physical Medicine and Rehabilitation, University of Miami
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis
| | - Lizeth J Caldera
- Department of Physical Medicine and Rehabilitation, University of Miami
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis
| | - Mark S Nash
- Department of Physical Medicine and Rehabilitation, University of Miami
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis
- The Miami Project to Cure Paralysis, Department of Neurological Surgery
- Department of Physical Therapy, University of Miami, Miami, FL, USA
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Araneda OF, Rosales-Antequera C, Contreras-Briceño F, Tuesta M, Rossi-Serrano R, Magalhães J, Viscor G. Systemic and Pulmonary Inflammation/Oxidative Damage: Implications of General and Respiratory Muscle Training in Chronic Spinal-Cord-Injured Patients. BIOLOGY 2023; 12:828. [PMID: 37372113 DOI: 10.3390/biology12060828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/03/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023]
Abstract
Chronic spinal cord injury affects several respiratory-function-related parameters, such as a decrease in respiratory volumes associated with weakness and a tendency to fibrosis of the perithoracic muscles, a predominance of vagal over sympathetic action inducing airway obstructions, and a difficulty in mobilizing secretions. Altogether, these changes result in both restrictive and obstructive patterns. Moreover, low pulmonary ventilation and reduced cardiovascular system functionality (low venous return and right stroke volume) will hinder adequate alveolar recruitment and low O2 diffusion, leading to a drop in peak physical performance. In addition to the functional effects described above, systemic and localized effects on this organ chronically increase oxidative damage and tissue inflammation. This narrative review describes both the deleterious effects of chronic spinal cord injury on the functional effects of the respiratory system as well as the role of oxidative damage/inflammation in this clinical context. In addition, the evidence for the effect of general and respiratory muscular training on the skeletal muscle as a possible preventive and treatment strategy for both functional effects and underlying tissue mechanisms is summarized.
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Affiliation(s)
- Oscar F Araneda
- Integrative Laboratory of Biomechanics and Physiology of Effort (LIBFE), Kinesiology School, Faculty of Medicine, Universidad de los Andes, Monseñor Álvaro del Portillo, Las Condes, Santiago 12455, Chile
| | - Cristián Rosales-Antequera
- Physical Medicine and Rehabilitation Unit, Clínica Universidad de los Andes, Santiago 8320000, Chile
- Physiology Section, Department of Cell Biology, Physiology, and Immunology, Faculty of Biology, Universitat de Barcelona, 08028 Barcelona, Spain
| | - Felipe Contreras-Briceño
- Laboratory of Exercise Physiology, Department of Health Science, Faculty of Medicine, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna #4860, Santiago 7820436, Chile
- Millennium Institute for Intelligent Healthcare Engineering, Av. Vicuña Mackenna #4860, Santiago 7820436, Chile
| | - Marcelo Tuesta
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago 7591538, Chile
| | - Rafael Rossi-Serrano
- Physical Medicine and Rehabilitation Unit, Clínica Universidad de los Andes, Santiago 8320000, Chile
| | - José Magalhães
- Laboratory of Metabolism and Exercise (LaMetEx), Research Centre in Physical Activity, Health and Leisure (CIAFEL), Laboratory for Integrative and Translational Research in Population Health (ITR), Faculty of Sport, University of Porto, 4200-450 Porto, Portugal
| | - Ginés Viscor
- Physiology Section, Department of Cell Biology, Physiology, and Immunology, Faculty of Biology, Universitat de Barcelona, 08028 Barcelona, Spain
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McMillan DW, Bigford GE, Farkas GJ. The Physiology of Neurogenic Obesity: Lessons from Spinal Cord Injury Research. Obes Facts 2023; 16:313-325. [PMID: 37231872 PMCID: PMC10427964 DOI: 10.1159/000530888] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 04/25/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND A spinal cord injury (SCI) from trauma or disease impairs sensorimotor pathways in somatic and autonomic divisions of the nervous system, affecting multiple body systems. Improved medical practices have increased survivability and life expectancy after SCI, allowing for the development of extensive metabolic comorbidities and profound changes in body composition that culminate in prevalent obesity. SUMMARY Obesity is the most common cardiometabolic component risk in people living with SCI, with a diagnostic body mass index cutoff of 22 kg/m2 to account for a phenotype of high adiposity and low lean mass. The metameric organization of specific divisions of the nervous system results in level-dependent pathology, with resulting sympathetic decentralization altering physiological functions such as lipolysis, hepatic lipoprotein metabolism, dietary fat absorption, and neuroendocrine signaling. In this manner, SCI provides a unique opportunity to study in vivo the "neurogenic" components of certain pathologies that otherwise are not readily observable in other populations. We discuss the unique physiology of neurogenic obesity after SCI, including the altered functions mentioned above as well as structural changes such as reduced skeletal muscle and bone mass and increased lipid deposition in the adipose tissue, skeletal muscle, bone marrow, and liver. KEY MESSAGE The study of neurogenic obesity after SCI gives us a unique neurological perspective on the physiology of obesity. The lessons learned from this field can guide future research and advancements to inform the study of obesity in persons with and without SCI.
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Affiliation(s)
- David W. McMillan
- Christine E. Lynn Rehabilitation Center for The Miami Project to Cure Paralysis at UHealth/Jackson Memorial, Miami, FL, USA
- Department of Neurological Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Gregory E. Bigford
- Christine E. Lynn Rehabilitation Center for The Miami Project to Cure Paralysis at UHealth/Jackson Memorial, Miami, FL, USA
- Department of Neurological Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Gary J. Farkas
- Christine E. Lynn Rehabilitation Center for The Miami Project to Cure Paralysis at UHealth/Jackson Memorial, Miami, FL, USA
- Department of Physical Medicine and Rehabilitation, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
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Jung KS, Hutchinson MJ, Chotiyarnwong C, Kusumawardani MK, Yoon SH, Mikami Y, Laohasinnarong P, Tinduh D, Prachgosin P, Narasinta I, Chotiyarnwong P, Utami DA, Umemoto Y, Tajima F, Goosey-Tolfrey VL. Dissonance in views between healthcare professionals and adults with a spinal cord injury with their understanding and interpretation of exercise intensity for exercise prescription. BMJ Open Sport Exerc Med 2023; 9:e001487. [PMID: 36919123 PMCID: PMC10008421 DOI: 10.1136/bmjsem-2022-001487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 03/12/2023] Open
Abstract
Objectives To evaluate the difference between healthcare professionals (HCPs) and adults with spinal cord injury (SCI) in Asia regarding knowledge and interpretation of 'exercise intensity' for aerobic exercise prescription. Methods and study design A survey was distributed to practising HCP and adults with SCI. It was completed in participants' local language on topics related to the importance of exercise frequency, intensity, time and type; methods for monitoring and terms related to exercise intensity prescription. χ2 analysis was used to detect differences in HCP or those with SCI. Results 121 HCP and 107 adults with an SCI ≥1 years (C1-L4) participated. Responses revealed 61% of all HCP ranked 'intensity' being most important whereas only 38% respondents from the SCI group ranked it as high importance (p=0.008). For those with SCI, 'frequency' was most important (61%) which was significantly higher than the 45% selected by HCPs (p=0.030). Of the 228 respondents on average only 34% believed that the terms, 'moderate' and 'vigorous' provided enough information for aerobic exercise intensity prescription. HCP most often used HR methods compared with the SCI group (90% vs 54%; p<0.01). Both groups frequently used the subjective measures of exercise intensity, for example, Ratings of Perceived Exertion (8%3 vs 76% for HCP and SCI), HCP also frequently used speed (81%) and SCI also frequently relied on 'the affect' or feelings while exercising (69%). Conclusions These differences must be considered when developing clinical-practice exercise guidelines and health referral educational pathways for adults with SCI in Asia.
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Affiliation(s)
- Kyung Su Jung
- Medical Center for Health Promotion and Sport Science, Wakayama Medical University, Wakayama, Japan
| | - Mike J Hutchinson
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Chayaporn Chotiyarnwong
- Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Martha K Kusumawardani
- Department of Physical Medicine and Rehabilitation, Universitas Airlangga, Dr Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Seung-Hyun Yoon
- Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Yukio Mikami
- Department of Rehabilitation Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Phairin Laohasinnarong
- Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Damayanti Tinduh
- Department of Physical Medicine and Rehabilitation, Universitas Airlangga, Dr Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Pannika Prachgosin
- Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Inggar Narasinta
- Department of Physical Medicine and Rehabilitation, Universitas Airlangga, Dr Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Pojchong Chotiyarnwong
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ditaruni A Utami
- Department of Physical Medicine and Rehabilitation, Universitas Airlangga, Dr Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Yasonori Umemoto
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
| | - Fumihiro Tajima
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
| | - Vicky L Goosey-Tolfrey
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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Stojic S, Eriks-Hoogland I, Gamba M, Valido E, Minder B, Chatelan A, Karagounis LG, Ballesteros M, Díaz C, Brach M, Stoyanov J, Diviani N, Rubinelli S, Perret C, Glisic M. Mapping of Dietary Interventions Beneficial in the Prevention of Secondary Health Conditions in Spinal Cord Injured Population: A Systematic Review. J Nutr Health Aging 2023; 27:524-541. [PMID: 37498100 DOI: 10.1007/s12603-023-1937-6] [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] [Received: 05/11/2023] [Accepted: 06/06/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVES Individuals with spinal cord injury are at risk of secondary health conditions (SHC) that develop as a consequence of autonomic dysfunction, prolonged oxidative stress and inflammation, and physical inactivity coupled with inadequate energy and nutritional intake. SHC can be debilitating and even life-threatening, and its prevention remains one of the major challenges in the continuum of medical care of aging SCI population. An unhealthy diet is a major driver of inflammation, oxidative stress, and unfavourable metabolic status and may be a practical preventive target to tackle increased SHC risk post-injury. AIMS To provide a catalogue of dietary interventions beneficial in prevention of SHC among individuals with SCI by conducting a systematic review of the literature on dietary interventions and dietary supplementation in promoting health and well-being after the injury. In addition, we aimed to provide a summary of observational studies exploring the association between habitual diet (macro- and micronutrients intake and dietary patterns) and health patterns following the injury. METHOD This review was registered at PROSPERO (University of York) with registration number CRD42022373773. Four medical databases (EMBASE.com, MEDLINE [Ovid], Cochrane CENTRAL, and Web of Science Core Collection) and Google Scholar were searched from inception until 11th July 2022. Studies were included if they were clinical trials or observational studies conducted in adult individuals with SCI and provided information of interest. Based on strength of the study design and risk of bias assessment (using the NIH tool), we classified studies from Level 1 (most reliable studies) to Level 4 (least reliable studies). RESULTS Of 12,313 unique citations, 47 articles (based on 43 original studies) comprising 32 interventional (22 RCTs, 3 NRCT, and 7 pre-post studies) and 11 observational studies (2 cohort studies, 2 case-control, 1 post-intervention follow-up study, and 6 cross-sectional studies) were included in the present systematic review. Twenty studies (46.5%) were classified as Level 1 or 2, indicating high/moderate methodological quality. Based on those studies, dietary strategies including high protein diet, intermittent fasting, balanced diet in combination with physical conditioning and electrical stimulation, and dietary supplementation including alpha-lipoic acid, creatine, vitamin D, and cranberry-derived supplements and probiotics were mapped as the most promising in prevention of SHC among individuals with SCI. CONCLUSIONS To develop timely and effective preventive strategies targeting major SHC (e.g., cardiometabolic diseases, urinary tract infections) in SCI, further research is warranted to confirm the effectiveness of dietary strategies/interventions identified through the current systematic review of the literature.
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Affiliation(s)
- S Stojic
- PD. Dr Marija Glisic, Swiss Paraplegic Research, Guido A. Zäch Str. 4, 6207 Nottwil, Switzerland, and
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Recent Updates in Nutrition After Spinal Cord Injury: 2015 Through 2021. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022. [DOI: 10.1007/s40141-022-00367-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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The Diagnosis and Management of Cardiometabolic Risk and Cardiometabolic Syndrome after Spinal Cord Injury. J Pers Med 2022; 12:jpm12071088. [PMID: 35887592 PMCID: PMC9320035 DOI: 10.3390/jpm12071088] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/19/2022] [Accepted: 06/21/2022] [Indexed: 11/23/2022] Open
Abstract
Individuals with spinal cord injuries (SCI) commonly present with component risk factors for cardiometabolic risk and combined risk factors for cardiometabolic syndrome (CMS). These primary risk factors include obesity, dyslipidemia, dysglycemia/insulin resistance, and hypertension. Commonly referred to as “silent killers”, cardiometabolic risk and CMS increase the threat of cardiovascular disease, a leading cause of death after SCI. This narrative review will examine current data and the etiopathogenesis of cardiometabolic risk, CMS, and cardiovascular disease associated with SCI, focusing on pivotal research on cardiometabolic sequelae from the last five years. The review will also provide current diagnosis and surveillance criteria for cardiometabolic disorders after SCI, a novel obesity classification system based on percent total body fat, and lifestyle management strategies to improve cardiometabolic health.
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Evans NH, Suri C, Field-Fote EC. Walking and Balance Outcomes Are Improved Following Brief Intensive Locomotor Skill Training but Are Not Augmented by Transcranial Direct Current Stimulation in Persons With Chronic Spinal Cord Injury. Front Hum Neurosci 2022; 16:849297. [PMID: 35634208 PMCID: PMC9130633 DOI: 10.3389/fnhum.2022.849297] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/25/2022] [Indexed: 11/30/2022] Open
Abstract
Motor training to improve walking and balance function is a common aspect of rehabilitation following motor-incomplete spinal cord injury (MISCI). Evidence suggests that moderate- to high-intensity exercise facilitates neuroplastic mechanisms that support motor skill acquisition and learning. Furthermore, enhancing corticospinal drive via transcranial direct current stimulation (tDCS) may augment the effects of motor training. In this pilot study, we investigated whether a brief moderate-intensity locomotor-related motor skill training (MST) circuit, with and without tDCS, improved walking and balance outcomes in persons with MISCI. In addition, we examined potential differences between within-day (online) and between-day (offline) effects of MST. Twenty-six adults with chronic MISCI, who had some walking ability, were enrolled in a 5-day double-blind, randomized study with a 3-day intervention period. Participants were assigned to an intensive locomotor MST circuit and concurrent application of either sham tDCS (MST+tDCSsham) or active tDCS (MST+tDCS). The primary outcome was overground walking speed measured during the 10-meter walk test. Secondary outcomes included spatiotemporal gait characteristics (cadence and stride length), peak trailing limb angle (TLA), intralimb coordination (ACC), the Berg Balance Scale (BBS), and the Falls Efficacy Scale-International (FES-I) questionnaire. Analyses revealed a significant effect of the MST circuit, with improvements in walking speed, cadence, bilateral stride length, stronger limb TLA, weaker limb ACC, BBS, and FES-I observed in both the MST+tDCSsham and MST+tDCS groups. No differences in outcomes were observed between groups. Between-day change accounted for a greater percentage of the overall change in walking outcomes. In persons with MISCI, brief intensive MST involving a circuit of ballistic, cyclic locomotor-related skill activities improved walking outcomes, and selected strength and balance outcomes; however, concurrent application of tDCS did not further enhance the effects of MST.
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Affiliation(s)
- Nicholas H. Evans
- Shepherd Center, Crawford Research Institute, Atlanta, GA, United States
- Department of Applied Physiology, Georgia Institute of Technology, Atlanta, GA, United States
| | - Cazmon Suri
- Shepherd Center, Crawford Research Institute, Atlanta, GA, United States
| | - Edelle C. Field-Fote
- Shepherd Center, Crawford Research Institute, Atlanta, GA, United States
- Department of Applied Physiology, Georgia Institute of Technology, Atlanta, GA, United States
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States
- *Correspondence: Edelle C. Field-Fote,
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Itodo OA, Flueck JL, Raguindin PF, Stojic S, Brach M, Perret C, Minder B, Franco OH, Muka T, Stucki G, Stoyanov J, Glisic M. Physical activity and cardiometabolic risk factors in individuals with spinal cord injury: a systematic review and meta-analysis. Eur J Epidemiol 2022; 37:335-365. [PMID: 35391647 PMCID: PMC9187578 DOI: 10.1007/s10654-022-00859-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
Abstract
Physical inactivity in individuals with spinal cord injury (SCI) has been suggested to be an important determinant of increased cardiometabolic disease (CMD) risk. However, it remains unclear whether physically active SCI individuals as compared to inactive or less active individuals have truly better cardiometabolic risk profile. We aimed to systematically review and quantify the association between engagement in regular physical activity and/or exercise interventions and CMD risk factors in individuals with SCI. Four medical databases were searched and studies were included if they were clinical trials or observational studies conducted in adult individuals with SCI and provided information of interest. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was applied to rate the certainty of evidence. Of 5816 unique citations, 11 randomized clinical trials, 3 non-randomized trial and 32 cross-sectional studies comprising more than 5500 SCI individuals were included in the systematic review. In meta-analysis of RCTs and based on evidence of moderate certainty, physical activity in comparison to control intervention was associated with: (i) better glucose homeostasis profile [WMD of glucose, insulin and Assessment of Insulin Resistance (HOMA-IR) were - 3.26 mg/dl (95% CI - 5.12 to - 1.39), - 3.19 μU/ml (95% CI - 3.96 to - 2.43)] and - 0.47 (95% CI - 0.60 to - 0.35), respectively], and (ii) improved cardiorespiratory fitness [WMD of relative and absolute oxygen uptake relative (VO2) were 4.53 ml/kg/min (95% CI 3.11, 5.96) and 0.26 L/min (95% CI 0.21, 0.32) respectively]. No differences were observed in blood pressure, heart rate and lipids (based on evidence of low/moderate certainty). In meta-analysis of cross-sectional studies and based on the evidence of very low to low certainty, glucose [WMD - 3.25 mg/dl (95% CI - 5.36, - 1.14)], insulin [- 2.12 μU/ml (95% CI - 4.21 to - 0.03)] and total cholesterol [WMD - 6.72 mg/dl (95% CI - 13.09, - 0.34)] were lower and HDL [WMD 3.86 mg/dl (95% CI 0.66, 7.05)] and catalase [0.07 UgHb-1 (95% CI 0.03, 0.11)] were higher in physically active SCI individuals in comparison to reference groups. Based on limited number of cross-sectional studies, better parameters of systolic and diastolic cardiac function and lower carotid intima media thickness were found in physically active groups. Methodologically sound clinical trials and prospective observational studies are required to further elaborate the impact of different physical activity prescriptions alone or in combination with other life-style interventions on CMD risk factors in SCI individuals.
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Affiliation(s)
- Oche Adam Itodo
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207, Nottwil, Switzerland
- Graduate School for Health Sciences, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | | | - Peter Francis Raguindin
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207, Nottwil, Switzerland
- Graduate School for Health Sciences, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Stevan Stojic
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207, Nottwil, Switzerland
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Mirjam Brach
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207, Nottwil, Switzerland
| | - Claudio Perret
- Sports Medicine, Swiss Paraplegic Centre Nottwil, 6207, Nottwil, Switzerland
| | - Beatrice Minder
- Public Health and Primary Care Library, University Library of Bern, University of Bern, Bern, Switzerland
| | - Oscar H Franco
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Taulant Muka
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Gerold Stucki
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207, Nottwil, Switzerland
| | - Jivko Stoyanov
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207, Nottwil, Switzerland
| | - Marija Glisic
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207, Nottwil, Switzerland.
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland.
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12
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Chiou SY, Clarke E, Lam C, Harvey T, Nightingale TE. Effects of Arm-Crank Exercise on Fitness and Health in Adults With Chronic Spinal Cord Injury: A Systematic Review. Front Physiol 2022; 13:831372. [PMID: 35392374 PMCID: PMC8982085 DOI: 10.3389/fphys.2022.831372] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/15/2022] [Indexed: 12/15/2022] Open
Abstract
Individuals with spinal cord injury (SCI) may benefit less from exercise training due to consequences of their injury, leading to lower cardiorespiratory fitness and higher risks of developing cardiovascular diseases. Arm-crank exercise (ACE) is the most common form of volitional aerobic exercise used by people with SCI outside a hospital. However, evidence regarding the specific effects of ACE alone on fitness and health in adults with SCI is currently lacking. Hence, this review aimed to determine the effects of ACE on cardiorespiratory fitness, body composition, cardiovascular disease (CVD) risk factors, motor function, health-related quality of life (QoL), and adverse events in adults with chronic SCI. Inclusion criteria were: inactive adults (≥18 years) with chronic SCI (>12 months post injury); used ACE alone as an intervention; measured at least one of the following outcomes; cardiorespiratory fitness, body composition, cardiovascular disease risk factors, motor function, health-related QoL, and adverse events. Evidence was synthesized and appraised using GRADE. Eighteen studies with a combined total of 235 participants having an injury between C4 to L3 were included. There was a moderate certainty of the body of evidence on ACE improving cardiorespiratory fitness. Exercise prescriptions from the included studies were 30-40 min of light to vigorous-intensity exercise, 3-5 times per week for 2-16 weeks. GRADE confidence ratings were very low for ACE improving body composition, CVD risks factors, motor function, or health-related QoL. No evidence suggests ACE increases the risk of developing shoulder pain or other injuries. Overall, this review recommends adults with chronic SCI should engage in regular ACE to improve cardiorespiratory fitness. More high-quality, larger-scale studies are needed to increase the level of evidence of ACE in improving cardiorespiratory fitness and to determine the effects of ACE on other outcomes. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/display_reco rd.php?ID=CRD42021221952], identifier [CRD42021221952].
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Affiliation(s)
- Shin Yi Chiou
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, United Kingdom
| | - Emma Clarke
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Chi Lam
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Tom Harvey
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Tom E. Nightingale
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- Centre for Trauma Sciences Research, University of Birmingham, Birmingham, United Kingdom
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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13
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Eisenberg D, LaVela SL, Frayne SM, Chen R, Barreto NB, Wu J, Nevedal AL, Davis K, Arnow KD, Harris AH. Rates, Variability, and Predictors of Screening for Obesity: Are Individuals with Spinal Cord Injury Being Overlooked? Obes Facts 2022; 15:451-457. [PMID: 35263742 PMCID: PMC9209967 DOI: 10.1159/000523917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/24/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Individuals with spinal cord injury (SCI) are vulnerable to obesity. Annual obesity screening using body mass index (BMI) is the standard of care mandated by US Veterans Health Administration (VHA) guidelines. Our objective was to determine the rates, variability, and predictors of guideline-concordant annual screening for obesity, given potential challenges of height and weight measurements in individuals with SCI. METHODS This is a cross-sectional retrospective study using US national VA databases. We identified all VHA patients with chronic SCI in the fiscal year (FY) 2019, their treating facility and frequency of recorded height and weight. We applied mixed-effects logistic regression models to assess associations between annual BMI screening and patient- and facility-level characteristics. RESULTS Of 20,978 individuals with chronic SCI in VHA in FY19, guideline-concordant annual BMI screening was lacking in 37.9%. Accounting for facility-level factors (geographic region, SCI facility type, volume of patients with SCI treated at the facility), a mixed-effects logistic regression model demonstrated that lack of annual obesity screening was significantly associated with older patient age (p < 0.001) and fewer outpatient encounters (p < 0.001) but not other patient-level factors such as sex, race, level of injury, or rurality. The rate of obesity screening among different facilities within VHA varied widely from 11.1% to 75.7%. CONCLUSION A large proportion of persons with SCI receiving care in VHA do not receive guideline-concordant annual obesity screening, an especially acute problem in some facilities. Older patients with fewer outpatient encounters are more likely to be missed. To inform the design of interventions to improve identification and documentation of obesity, further study is needed to assess potential barriers to obesity screening in the population with SCI.
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Affiliation(s)
- Dan Eisenberg
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford School of Medicine, Stanford, California, USA
- *Dan Eisenberg,
| | - Sherri L. LaVela
- Center of Innovation for Complex Chronic Care, VA Edward Hines Jr., Hines, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Susan M. Frayne
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA
- Department of Medicine, Stanford School of Medicine, Stanford, California, USA
| | - Rui Chen
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford School of Medicine, Stanford, California, USA
| | - Nicolas B. Barreto
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford School of Medicine, Stanford, California, USA
| | - Justina Wu
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Andrea L. Nevedal
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Kristen Davis
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford School of Medicine, Stanford, California, USA
| | - Katherine D. Arnow
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford School of Medicine, Stanford, California, USA
| | - Alex H.S. Harris
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford School of Medicine, Stanford, California, USA
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14
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Nash MS, Farkas GJ, Tiozzo E, Gater DR. Exercise to mitigate cardiometabolic disorders after spinal cord injury. Curr Opin Pharmacol 2021; 62:4-11. [PMID: 34864560 DOI: 10.1016/j.coph.2021.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 10/21/2021] [Indexed: 01/14/2023]
Abstract
The cardiometabolic disorder (CMD) is a syndrome caused by coalescing of cardiovascular, endocrine, pro-thrombotic, and inflammatory health risks. Together, these risks confer a hazard as health-threatening as coronary artery disease or type2 diabetes, whether an individual has a diagnosis of coronary disease or diabetes, or not. CMD is most often defined by three or more of five clinically assessed risk components, notably obesity, insulin resistance, hypertension, hypertriglyceridemia, and depressed high-density lipoprotein cholesterol. Evidence currently suggests that worldwide CMD is expanding at a pandemic rate, and it is known that people living with spinal cord injuries (SCI) qualify for the diagnosis at more than 50% of the prevalence of a non-disabled cohort. A recent evidence-based guideline warned of the current state of CMD following SCI and recommended early lifestyle intervention incorporating exercise and prudent nutrition as a first-line disease countermeasure. This monograph will define the CMD following SCI, explore its underlying pathophysiology, and provide evidence that recommends exercise for CMD health hazards after SCI.
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Affiliation(s)
- Mark S Nash
- Department of Neurological Surgery, The University of Miami Miller School of Medicine, Miami, FL 33136, USA; Department of Physical Medicine & Rehabilitation, The University of Miami Miller School of Medicine, Miami, FL 33136, USA; Department of Physical Therapy, The University of Miami Miller School of Medicine, Miami, FL 33136, USA; The Miami Project to Cure Paralysis, The University of Miami Miller School of Medicine, Miami, FL 33136, USA.
| | - Gary J Farkas
- Department of Physical Medicine & Rehabilitation, The University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Eduard Tiozzo
- Department of Physical Medicine & Rehabilitation, The University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - David R Gater
- Department of Neurological Surgery, The University of Miami Miller School of Medicine, Miami, FL 33136, USA; Department of Physical Medicine & Rehabilitation, The University of Miami Miller School of Medicine, Miami, FL 33136, USA; The Miami Project to Cure Paralysis, The University of Miami Miller School of Medicine, Miami, FL 33136, USA
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15
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McMillan DW, Astorino TA, Correa MA, Nash MS, Gater DR. Virtual Strategies for the Broad Delivery of High Intensity Exercise in Persons With Spinal Cord Injury: Ongoing Studies and Considerations for Implementation. Front Sports Act Living 2021; 3:703816. [PMID: 34423292 PMCID: PMC8377288 DOI: 10.3389/fspor.2021.703816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/08/2021] [Indexed: 11/13/2022] Open
Abstract
Spinal cord injury (SCI) results in a multitude of metabolic co-morbidities that can be managed by exercise. As in the non-injured population, manipulation of exercise intensity likely allows for fruitful optimization of exercise interventions targeting metabolic health in persons with SCI. In this population, interventions employing circuit resistance training (CRT) exhibit significant improvements in outcomes including cardiorespiratory fitness, muscular strength, and blood lipids, and recent exploration of high intensity interval training (HIIT) suggests the potential of this strategy to enhance health and fitness. However, the neurological consequences of SCI result in safety considerations and constrain exercise approaches, resulting in the need for specialized exercise practitioners. Furthermore, transportation challenges, inaccessibility of exercise facilities, and other barriers limit the translation of high intensity “real world” exercise strategies. Delivering exercise via online (“virtual”) platforms overcomes certain access barriers while allowing for broad distribution of high intensity exercise despite the limited number of population-specific exercise specialists. In this review, we initially discuss the need for “real world” high intensity exercise strategies in persons with SCI. We then consider the advantages and logistics of using virtual platforms to broadly deliver high intensity exercise in this population. Safety and risk mitigation are considered first followed by identifying strategies and technologies for delivery and monitoring of virtual high intensity exercise. Throughout the review, we discuss approaches from previous and ongoing trials and conclude by giving considerations for future efforts in this area.
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Affiliation(s)
- David W McMillan
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, UHealth/Jackson Memorial, Miami, FL, United States.,Department of Physical Medicine & Rehabilitation, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States
| | - Todd A Astorino
- Department of Kinesiology, California State University San Marcos, San Marcos, CA, United States
| | - Michael A Correa
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, UHealth/Jackson Memorial, Miami, FL, United States
| | - Mark S Nash
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, UHealth/Jackson Memorial, Miami, FL, United States.,Department of Physical Medicine & Rehabilitation, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States.,Department of Neurological Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States
| | - David R Gater
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, UHealth/Jackson Memorial, Miami, FL, United States.,Department of Physical Medicine & Rehabilitation, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States
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16
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Jacobs KA, McMillan DW, Maher JL, Bilzon JLJ, Nash MS. Neither Postabsorptive Resting Nor Postprandial Fat Oxidation Are Related to Peak Fat Oxidation in Men With Chronic Paraplegia. Front Nutr 2021; 8:703652. [PMID: 34381805 PMCID: PMC8349992 DOI: 10.3389/fnut.2021.703652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/28/2021] [Indexed: 11/22/2022] Open
Abstract
The peak rate of fat oxidation (PFO) achieved during a graded exercise test is an important indicator of metabolic health. In healthy individuals, there is a significant positive association between PFO and total daily fat oxidation (FO). However, conditions resulting in metabolic dysfunction may cause a disconnect between PFO and non-exercise FO. Ten adult men with chronic thoracic spinal cord injury (SCI) completed a graded arm exercise test. On a separate day following an overnight fast (≥ 10 h), they rested for 60 min before ingesting a liquid mixed meal (600 kcal; 35% fat, 50% carbohydrate, 15% protein). Expired gases were collected and indirect calorimetry data used to determine FO at rest, before and after feeding, and during the graded exercise test. Participants had “good” cardiorespiratory fitness (VO2peak: 19.2 ± 5.2 ml/kg/min) based on normative reference values for SCI. There was a strong positive correlation between PFO (0.30 ± 0.08 g/min) and VO2peak (r = 0.86, p = 0.002). Additionally, postabsorptive FO at rest was significantly and positively correlated with postprandial peak FO (r = 0.77, p = 0.01). However, PFO was not significantly associated with postabsorptive FO at rest (0.08 ± 0.02 g/min; p = 0.97), postprandial peak FO (0.10 ± 0.03 g/min; p = 0.43), or incremental area under the curve postprandial FO (p = 0.22). It may be advantageous to assess both postabsorptive FO at rest and PFO in those with SCI to gain a more complete picture of their metabolic flexibility and long-term metabolic health.
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Affiliation(s)
- Kevin A Jacobs
- Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL, United States
| | - David W McMillan
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, UHealth/Jackson Memorial, Miami, FL, United States.,Department of Physical Medicine and Rehabilitation, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States
| | | | | | - Mark S Nash
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, UHealth/Jackson Memorial, Miami, FL, United States.,Department of Physical Medicine and Rehabilitation, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States.,Departments of Neurological Surgery and Physical Therapy, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States
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17
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Gater DR, Farkas GJ, Tiozzo E. Pathophysiology of Neurogenic Obesity After Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2021; 27:1-10. [PMID: 33814879 PMCID: PMC7983633 DOI: 10.46292/sci20-00067] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Individuals with a spinal cord injury (SCI) have a unique physiology characterized by sarcopenia, neurogenic osteoporosis, neurogenic anabolic deficiency, sympathetic dysfunction, and blunted satiety associated with their SCI, all of which alter energy balance and subsequently body composition. The distinct properties of "neurogenic obesity" place this population at great risk for metabolic dysfunction, including systemic inflammation, hyperglycemia, dyslipidemia, and hypertension. The purpose of this article is to demonstrate the relationship between neurogenic obesity and the metabolic syndrome after SCI, highlighting the mechanisms associated with adipose tissue pathology and those respective comorbidities. Additionally, representative studies of persons with SCI will be provided to elucidate the severity of the problem and to prompt greater vigilance among SCI specialists as well as primary care providers in order to better manage the epidemic from a public health perspective.
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Affiliation(s)
- David R. Gater
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida
| | - Gary J. Farkas
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
| | - Eduard Tiozzo
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
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