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Kimball AL, Petrie MA, McCue PM, Johnson KA, Shields RK. Impaired Glucose Tolerance and Visceral Adipose Tissue Thickness among Lean and Non-Lean People with and without Spinal Cord Injury. J Funct Morphol Kinesiol 2023; 8:123. [PMID: 37606417 PMCID: PMC10443282 DOI: 10.3390/jfmk8030123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 08/23/2023] Open
Abstract
After spinal cord injury (SCI), multiple adaptations occur that influence metabolic health and life quality. Prolonged sitting and inactivity predispose people with SCI to body composition changes, such as increased visceral adipose tissue (VAT) thickness, which is often associated with impaired glucose tolerance. Our goal is to understand whether VAT is an index of leanness, and, secondarily, whether mobility methods influence glucose tolerance for people living with SCI. A total of 15 people with SCI and 20 people without SCI had fasting oral glucose tolerance tests (OGTT) and VAT thickness (leanness) measured during a single session. Glucose was 51% and 67% greater for individuals with SCI relative to those without SCI after 60 and 120 min of an OGTT (p < 0.001). Glucose area under the curve (AUC) was 28%, 34%, and 60% higher for non-lean people with SCI than lean people with SCI and non-lean and lean people without SCI, respectively (p = 0.05, p = 0.009, p < 0.001). VAT was associated with glucose AUC (R2 = 0.23, p = 0.004). Taken together, these findings suggest that leanness, as estimated from VAT, may be an important consideration when developing rehabilitation programs to influence metabolism among people with SCI.
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Affiliation(s)
| | | | | | | | - Richard K. Shields
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, The University of Iowa, Iowa City, IA 52242, USA; (A.L.K.); (M.A.P.); (P.M.M.); (K.A.J.)
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Petrie MA, Kimball AL, Shields RK. Acute Low Force Electrically Induced Exercise Modulates Post Prandial Glycemic Markers in People with Spinal Cord Injury. J Funct Morphol Kinesiol 2022; 7:jfmk7040089. [PMID: 36278750 PMCID: PMC9624321 DOI: 10.3390/jfmk7040089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 11/29/2022] Open
Abstract
Regular exercise involves daily muscle contractions helping metabolize up to 70% of daily ingested glucose. Skeletal muscle increases glucose uptake through two distinct pathways: insulin signaling pathway and muscle contraction mediated AMPK pathway. People with paralysis are unable to contract their muscles which atrophy, transform into insulin resistant glycolytic muscle, and develop osteoporosis. Our goal is to determine if low force electrically induced exercise (LFE) will modulate the post prandial insulin and glucose response in people with and without spinal cord injury (SCI). 18 people with SCI and 23 without SCI (Non-SCI) participated in an assessment of metabolic biomarkers during passive sitting (CTL) and a bout of LFE delivered to the quadriceps/hamstring muscle groups after a glucose challenge. Baseline fasting insulin (p = 0.003) and lactate (p = 0.033) levels were higher in people with SCI, but glucose levels (p = 0.888) were similar compared to the non-SCI population. After 1-h of muscle contractions using LFE, heart rate increased (p < 0.001), capillary glucose decreased (p = 0.004), insulin decreased (p < 0.001), and lactate increased (p = 0.001) in the SCI population. These findings support that LFE attenuates certain metabolic blood biomarkers during a glucose challenge and may offer a lifestyle strategy to regulate metabolic responses after eating among people with SCI.
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Petrie MA, Kimball AL, Lee J, McCue PM, Johnson KA, Sharma A, Taylor EB, Shields RK. Low Frequency Electrically Induced Muscle Exercise Modulates Glucose Tolerance and Uric Acid Levels in People with SCI. FASEB J 2019. [DOI: 10.1096/fasebj.2019.33.1_supplement.868.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Michael A Petrie
- Physical Therapy and Rehabilitation ScienceUniversity of IowaIowa CityIA
| | - Amy L Kimball
- Physical Therapy and Rehabilitation ScienceUniversity of IowaIowa CityIA
| | - Jinhyun Lee
- Physical Therapy and Rehabilitation ScienceUniversity of IowaIowa CityIA
| | - Patrick M McCue
- Physical Therapy and Rehabilitation ScienceUniversity of IowaIowa CityIA
| | - Kristin A Johnson
- Physical Therapy and Rehabilitation ScienceUniversity of IowaIowa CityIA
| | | | | | - Richard K Shields
- Physical Therapy and Rehabilitation ScienceUniversity of IowaIowa CityIA
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Affiliation(s)
- Amy L. Kimball
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA
| | - Patrick M. McCue
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA
| | - Michael A. Petrie
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA
| | - Richard K. Shields
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA
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Wise AC, Boutin MA, Knodel EM, Proudfoot JA, Lane BP, Evans ML, Suttner DM, Kimball AL. Heliox Adjunct Therapy for Neonates With Congenital Diaphragmatic Hernia. Respir Care 2018; 63:1147-1153. [PMID: 29789411 DOI: 10.4187/respcare.06079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Congenital diaphragmatic hernia remains a complex disease with significant morbidity and mortality. Hypercarbia is a common derangement in this population, which often requires escalating ventilator support. By decreasing airway turbulence and enhancing CO2 removal, inhaled helium-oxygen mixture (heliox) has the potential to improve ventilation and thereby decrease ventilator support and its associated lung injury. METHODS Retrospective cohort review of all neonates with congenital diaphragmatic hernia treated at Rady Children's Hospital San Diego during 2011-2015. Clinical characteristics were compared between the infants who were treated with heliox and those who did not receive this intervention. To analyze the effect of heliox in the subgroup that received this treatment, ventilator settings and arterial blood gas values were compared before and after starting heliox by using paired t tests. RESULTS During the study period, 45 neonates with congenital diaphragmatic hernia were admitted to our neonatal ICU, 28 received heliox, and 27 were analyzed. During heliox treatment, PaCO2 levels decreased from 68 to 49 mm Hg (P < .001), amplitude decreased from 33 to 23 cm H2O (P < .001), ventilator frequency decreased from 28 to 23 breaths/min (P = .02), FIO2 decreased from 0.52 to 0.40 (P < .01), and pH increased from 7.3 to 7.4 (P < .001). CONCLUSIONS The addition of heliox to the standard practice of permissive hypercapnia facilitated improvement in gas exchange, which allowed a decrease in ventilator settings and oxygen exposure, both of which are known to contribute to lung injury in this population. A prospective trial is needed to more clearly define the acute and long-term impacts of this treatment.
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Affiliation(s)
- Audra C Wise
- Division of Neonatology, Rady Children's Hospital San Diego, University of California San Diego, San Diego, California.
| | - Mallory A Boutin
- Division of Neonatology, Rady Children's Hospital San Diego, University of California San Diego, San Diego, California
| | - Ellen M Knodel
- Division of Neonatology, Rady Children's Hospital San Diego, University of California San Diego, San Diego, California
| | - James A Proudfoot
- Clinical and Translational Research Institute, University of California San Diego, San Diego, California
| | - Brian P Lane
- Division of Neonatology, Rady Children's Hospital San Diego, University of California San Diego, San Diego, California
| | - Marva L Evans
- Division of Neonatology, Rady Children's Hospital San Diego, University of California San Diego, San Diego, California
| | - Denise M Suttner
- Division of Neonatology, Rady Children's Hospital San Diego, University of California San Diego, San Diego, California
| | - Amy L Kimball
- Division of Neonatology, Rady Children's Hospital San Diego, University of California San Diego, San Diego, California
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Abstract
Reduced physical activity is a primary risk factor for increased morbidity and mortality. People with spinal cord injury (SCI) have reduced activity for a lifetime, as they cannot volitionally activate affected skeletal muscles. We explored whether low-force and low-frequency stimulation is a viable strategy to enhance systemic energy expenditure in people with SCI. PURPOSE This study aimed to determine the effects of low stimulation frequency (1 and 3 Hz) and stimulation intensity (50 and 100 mA) on energy expenditure in people with SCI. We also examined the relationship between body mass index and visceral adipose tissue on energy expenditure during low-frequency stimulation. METHODS Ten individuals with complete SCI underwent oxygen consumption monitoring during electrical activation of the quadriceps and hamstrings at 1 and 3 Hz and at 50 and 100 mA. We calculated the difference in energy expenditure between stimulation and rest and estimated the number of days that would be necessary to burn 1 lb of body fat (3500 kcal) for each stimulation protocol (1 vs 3 Hz). RESULTS Both training frequencies induced a significant increase in oxygen consumption above a resting baseline level (P < 0.05). Energy expenditure positively correlated with stimulus intensity (muscle recruitment) and negatively correlated with adiposity (reflecting the insulating properties of adipose tissue). We estimated that 1 lb of body fat could be burned more quickly with 1 Hz training (58 d) as compared with 3 Hz training (87 d) if an identical number of pulses were delivered. CONCLUSION Low-frequency stimulation increased energy expenditure per pulse and may be a feasible option to subsidize physical activity to improve metabolic status after SCI.
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Affiliation(s)
- Jessica R Woelfel
- 1Carver College of Medicine, University of Iowa, Iowa City, IA; and 2Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA
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Petrie MA, Kimball AL, McHenry CL, Suneja M, Yen CL, Sharma A, Shields RK. Distinct Skeletal Muscle Gene Regulation from Active Contraction, Passive Vibration, and Whole Body Heat Stress in Humans. PLoS One 2016; 11:e0160594. [PMID: 27486743 PMCID: PMC4972309 DOI: 10.1371/journal.pone.0160594] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 07/21/2016] [Indexed: 12/24/2022] Open
Abstract
Skeletal muscle exercise regulates several important metabolic genes in humans. We know little about the effects of environmental stress (heat) and mechanical stress (vibration) on skeletal muscle. Passive mechanical stress or systemic heat stress are often used in combination with many active exercise programs. We designed a method to deliver a vibration stress and systemic heat stress to compare the effects with active skeletal muscle contraction. Purpose: The purpose of this study is to examine whether active mechanical stress (muscle contraction), passive mechanical stress (vibration), or systemic whole body heat stress regulates key gene signatures associated with muscle metabolism, hypertrophy/atrophy, and inflammation/repair. Methods: Eleven subjects, six able-bodied and five with chronic spinal cord injury (SCI) participated in the study. The six able-bodied subjects sat in a heat stress chamber for 30 minutes. Five subjects with SCI received a single dose of limb-segment vibration or a dose of repetitive electrically induced muscle contractions. Three hours after the completion of each stress, we performed a muscle biopsy (vastus lateralis or soleus) to analyze mRNA gene expression. Results: We discovered repetitive active muscle contractions up regulated metabolic transcription factors NR4A3 (12.45 fold), PGC-1α (5.46 fold), and ABRA (5.98 fold); and repressed MSTN (0.56 fold). Heat stress repressed PGC-1α (0.74 fold change; p < 0.05); while vibration induced FOXK2 (2.36 fold change; p < 0.05). Vibration similarly caused a down regulation of MSTN (0.74 fold change; p < 0.05), but to a lesser extent than active muscle contraction. Vibration induced FOXK2 (p < 0.05) while heat stress repressed PGC-1α (0.74 fold) and ANKRD1 genes (0.51 fold; p < 0.05). Conclusion: These findings support a distinct gene regulation in response to heat stress, vibration, and muscle contractions. Understanding these responses may assist in developing regenerative rehabilitation interventions to improve muscle cell development, growth, and repair.
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Affiliation(s)
- Michael A. Petrie
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, United States of America
| | - Amy L. Kimball
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, United States of America
| | - Colleen L. McHenry
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, United States of America
| | - Manish Suneja
- Department of Internal Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, United States of America
- Department of Veterans Affairs, VA Medical Center, Iowa City, Iowa, United States of America
| | - Chu-Ling Yen
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, United States of America
| | - Arpit Sharma
- Department of Biochemistry, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, United States of America
| | - Richard K. Shields
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, United States of America
- Department of Veterans Affairs, VA Medical Center, Iowa City, Iowa, United States of America
- * E-mail:
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Kimball AL, Woelfel JR, Shields RK. Low Force Muscle Activity Regulates Energy Expenditure after Spinal Cord Injury. Med Sci Sports Exerc 2015. [DOI: 10.1249/01.mss.0000478437.25224.2c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kimball AL, Shields RK. Whole Body Heat Exposure Modulates Acute Glucose Homeostasis. Med Sci Sports Exerc 2014. [DOI: 10.1249/01.mss.0000495112.06143.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
OBJECTIVE To determine whether medications commonly used in the management of gastroesophageal reflux reduce the frequency of apnea in premature infants. STUDY DESIGN We reviewed the medical records of all infants </=36 weeks' gestational age at birth who were treated in 2 neonatal intensive care units from 1990 through 1999 and identified those who received the antireflux medications cisapride or metoclopramide in association with apnea. We averaged the frequency of apnea during the 5 days before and the 5 days after antireflux treatment was started and compared these 2 periods by paired analysis. RESULTS There were 164 separate courses of treatment with either cisapride or metoclopramide in 132 patients. There were 3.6 +/- 3.2 apneic episodes per day during the 5 days before treatment and 4.0 +/- 3.4 apneic episodes per day during the 5 days after treatment (P =.048). When evaluated separately, neither cisapride nor metoclopramide reduced the frequency of apnea. Stratification for documented reflux (by radiographic contrast or by pH probe analysis), concomitant use of methylxanthines or ranitidine, developmental age, feeding volume, and respiratory support did not identify a subgroup of patients whose apnea improved with antireflux treatment. CONCLUSION Antireflux medications do not reduce the frequency of apnea in premature infants.
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Affiliation(s)
- A L Kimball
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City 84132, USA
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