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Patsakos EM, Bailey KA, Ditor DS. Exploring the Lived Experiences of Individuals With Spinal Cord Injury During the COVID-19 Pandemic. Inquiry 2024; 61:469580241226827. [PMID: 38263725 PMCID: PMC10807388 DOI: 10.1177/00469580241226827] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 12/09/2023] [Accepted: 01/02/2024] [Indexed: 01/25/2024]
Abstract
The global spread of severe acute respiratory syndrome coronavirus 2019 (COVID-19) has affected over 100 countries and has led to the tragic loss of life, overwhelmed health care systems and severely impacted the global economy. Specifically, individuals living with spinal cord injury (SCI) are particularly vulnerable during the COVID-19 pandemic as they often face adverse impacts on their health, emotional well-being, community participation, and life expectancy. The objective of this study was to investigate the lived experience of individuals with SCI during the COVID-19 pandemic in Ontario, Canada. An exploratory design with a qualitative descriptive approach was used to address the study objective. Nine semi-structured interviews were conducted with individuals with traumatic and non-traumatic SCI (37-69 years, C3-L5, AIS A-D, and 5-42 years post-injury). Using reflexive thematic analysis, the following themes were created: (1) Caregiver exposure to COVID-19; (2) Staying physically active in quarantine; (3) Living in social isolation; (4) Difficulty obtaining necessary medical supplies; (5) Access to health services and virtual care during COVID-19; and (6) Fighting COVID-19 misinformation. This is one of the first studies to explore the impact of COVID-19 on individuals living with SCI in Ontario. This study contributes to a greater understanding of the challenges faced by individuals living with SCI and provides insight into how to better support and respond to the specific and unique needs of individuals with SCI and their families during a national emergency or pandemic.
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Affiliation(s)
| | | | - David S. Ditor
- Brock University, St. Catharines, ON, Canada
- Brock-Niagara Centre for Health and Well-being, St. Catharines, ON, Canada
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Butchart S, Candow DG, Forbes SC, Mang CS, Gordon JJ, Ko J, Deprez D, Chilibeck PD, Ditor DS. Effects of Creatine Supplementation and Progressive Resistance Training in Stroke Survivors. Int J Exerc Sci 2022; 15:1117-1132. [PMID: 35992184 PMCID: PMC9362889] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The purpose was to investigate the effects of progressive resistance training (PRT) and creatine supplementation in stroke survivors. Participants were randomized to one of two groups: creatine (n = 5; 51 ± 16y) or placebo (n = 3; 73 ± 8y) during 10 weeks of supervised PRT. Prior to and following PRT and supplementation, assessments were made for body composition (lean tissue and fat mass), muscle thickness, muscle strength (1-repetition maximum), functional exercise capacity (6-minute walk test, Berg Balance Scale; BBS), cognition (Montreal Cognitive Assessment; MoCA), and symptoms of anxiety (Generalized Anxiety Disorder Assessment-7; GAD-7) and depression (Center for Epidemiological Studies Depression Scale; CES-D). There were time main effects for leg press strength (increased; p = 0.001), chest press strength (increased; p = 0.003), elbow flexor muscle thickness (increased; p = 0.007), BBS (increased; p = 0.002), MoCA (increased; p = 0.031) and CES-D (decreased; p = 0.045). There was a group x time interaction for the 6 minute walk test (p = 0.039). The creatine group significantly increased walking distance over time (p = 0.002) with no change in the placebo group (p = 0.120). Ten weeks of PRT had some positive effects on measures of muscle strength and size, balance, cognition and depression. The addition of creatine to PRT significantly improved walking performance in stroke survivors.
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Affiliation(s)
- Sara Butchart
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, SK, CANADA
| | - Darren G Candow
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, SK, CANADA
| | - Scott C Forbes
- Department of Physical Education Studies, Brandon University, Brandon, MB, CANADA
| | - Cameron S Mang
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, SK, CANADA
| | - Julianne J Gordon
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, CANADA
| | - Jongbum Ko
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, SK, CANADA
- Department of Physical Education Studies, Brandon University, Brandon, MB, CANADA
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, CANADA
- Department of Kinesiology, Brock University, St. Catharines, ON, CANADA
| | - Dalton Deprez
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, SK, CANADA
- Department of Physical Education Studies, Brandon University, Brandon, MB, CANADA
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, CANADA
- Department of Kinesiology, Brock University, St. Catharines, ON, CANADA
| | - Philip D Chilibeck
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, CANADA
| | - David S Ditor
- Department of Kinesiology, Brock University, St. Catharines, ON, CANADA
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Seliman M, Dragan M, Connolly M, Ditor DS. The Impact of Mindfulness Therapy on Sexual Satisfaction in Couples Living with Neurological Disabilities: A Phenomenological Analysis of a Single Case. Sex Disabil 2022. [DOI: 10.1007/s11195-022-09738-y] [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: 10/18/2022]
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Kathnelson JD, Kurtz Landy CM, Tamim H, Ditor DS, Gage WH. Utilizing the Delphi Method to Assess Issues of Sexuality for Men Living with Spinal Cord Injury. Sex Disabil 2021. [DOI: 10.1007/s11195-020-09673-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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5
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Allison DJ, Agudelo AR, Chan BCF, Ditor DS, Loh E. Cannabinoids and an anti-inflammatory diet for the treatment of neuropathic pain after spinal cord injury (The CATNP Study): study protocol for a randomized controlled trial. Spinal Cord 2020; 59:112-122. [PMID: 32612213 DOI: 10.1038/s41393-020-0508-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 12/17/2022]
Abstract
STUDY DESIGN Multicenter, randomized, double-blind, placebo controlled, clinical trial. OBJECTIVE The objective of this paper is to evaluate the effectiveness of cannabinoids and an anti-inflammatory diet, alone and in combination, for the management of neuropathic pain (NP) after spinal cord injury (SCI). SETTING Two Canadian SCI rehabilitation centers. METHODS A sample of 144 individuals with SCI will receive either an anti-inflammatory diet, cannabinoids or a placebo for 6 weeks. Following this, a combined effect of these treatments will be evaluated for a further 6 weeks. The primary outcome measure will be the change in NP as assessed by the numeric rating scale (NRS). Secondary outcomes will include changes in inflammation, mood, sleep, spasticity, cost-effectiveness, and function. CONCLUSION This study will assess the efficacy of an anti-inflammatory diet and cannabinoids (individually and in combination) for the treatment of NP following SCI. Results may reveal a cost-effective, side-effect free intervention strategy which could be utilized for the long-term management of NP following SCI.
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Affiliation(s)
- David J Allison
- Lawson Health Research Institute, London, ON, Canada. .,Department of Kinesiology, McMaster University, Hamilton, ON, Canada. .,Parkwood Institute, London, ON, Canada. .,Western University, London, ON, Canada.
| | - Alexandria Roa Agudelo
- Lawson Health Research Institute, London, ON, Canada.,Parkwood Institute, London, ON, Canada.,Western University, London, ON, Canada
| | - Brian C F Chan
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - David S Ditor
- Department of Kinesiology, Brock University, St. Catharines, ON, Canada
| | - Eldon Loh
- Lawson Health Research Institute, London, ON, Canada.,Parkwood Institute, London, ON, Canada.,Western University, London, ON, Canada
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D. Kathnelson J, Kurtz Landy CM, S. Ditor D, Tamim H, H. Gage W. Examining the psychological and emotional experience of sexuality for men after spinal cord injury. Cogent Psychology 2020. [DOI: 10.1080/23311908.2020.1722355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
| | | | - David S. Ditor
- Department of Kinesiology, Brock University, St. Catharines, Canada
| | - Hala Tamim
- Department of Kinesiology and Health Science, York University, Toronto, Canada
| | - William H. Gage
- Department of Kinesiology and Health Science, York University, Toronto, Canada
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Donia SA, Allison DJ, Gammage KL, Ditor DS. The effects of acute aerobic exercise on mood and inflammation in individuals with multiple sclerosis and incomplete spinal cord injury. NeuroRehabilitation 2019; 45:117-124. [PMID: 31450521 DOI: 10.3233/nre-192773] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 01/06/2023]
Abstract
BACKGROUND Spinal cord injury (SCI) and multiple sclerosis (MS) are associated with increased risks of depression. Acute exercise may improve mood in these populations via its affect on inflammation. OBJECTIVE To determine if acute exercise can positively affect mood in individuals with SCI and MS, and whether exercise-induced changes in inflammation contribute to such improvements. METHODS Thirteen participants completed 30 minutes of moderate-intensity exercise. Mood data (POMS questionnaire) and blood samples were taken before and after exercise, and blood was analyzed for inflammatory mediators and kynurenine pathway metabolites. RESULTS There was a significant reduction in total mood disturbance (TMD) pre to post-exercise, and pre to one-hour post-exercise. There was a significant decrease in TNF-α from pre to post-exercise, with further reductions one-hour post-exercise. There were no correlations between changes in TMD and changes in inflammation. However, changes in certain cytokines showed significant or trending correlations with changes in subsets of the POMS. Likewise, there was a trend for a correlation between exercise-induced changes in KYN/TRP and depression (p = 0.096). CONCLUSIONS Acute exercise can positively affect mood after SCI and MS, and this change may be partially accounted for by exercise-induced changes in inflammation. This relationship may be, in part, kynurenine pathway-dependent.
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Affiliation(s)
- Scott A Donia
- Department of Kinesiology, Brock University, St. Catharines, ON, Canada.,Brock-Niagara Centre for Health and Well-being, Brock University, St. Catharines, ON, Canada
| | - David J Allison
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Kimberley L Gammage
- Department of Kinesiology, Brock University, St. Catharines, ON, Canada.,Brock-Niagara Centre for Health and Well-being, Brock University, St. Catharines, ON, Canada
| | - David S Ditor
- Department of Kinesiology, Brock University, St. Catharines, ON, Canada.,Brock-Niagara Centre for Health and Well-being, Brock University, St. Catharines, ON, Canada
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8
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Snyder KJ, Patsakos E, White J, Ditor DS. Accessible exercise equipment and individuals with multiple sclerosis: Aerobic demands and preferences. NeuroRehabilitation 2019; 45:359-367. [PMID: 31796702 DOI: 10.3233/nre-192861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 11/15/2022]
Abstract
BACKGROUND Although exercise training has benefits for individuals with multiple sclerosis (MS), research regarding the type of exercise equipment that requires the greatest aerobic demand, and consumer-based preferences, is lacking. OBJECTIVE To determine the aerobic demands of various pieces of accessible exercise equipment and consumer-based preferences on several domains. METHODS Ten individuals with moderate-severity MS had their VO2 measured during 10 minutes of moderate-intensity arm ergometry (AE), body-weight support treadmill training (BWSTT), recumbent arm-leg exercise (NuStep), FES-arm exercise (RT300), FES-leg exercise (RT300) and FES arm-leg exercise (RT200). VO2peak test was also measured on the NuStep and the RT200. Equipment preferences were determined by questionnaire after moderate exercise sessions. RESULTS AE required a lower VO2 compared to the NuStep (p = 0.02), and FES-arm exercise required a lower VO2 compared to the NuStep (p = 0.01) and FES arm-leg exercise (p = 0.04). There was no difference in VO2peak when using the NuStep or FES arm-leg exercise. AE was perceived as safer than BWSTT, but otherwise there were no preferences for any equipment. CONCLUSIONS For individuals with moderate-severity MS, arm-only exercise requires less aerobic demands than combined arm-leg exercise at a moderate intensity. Perceived risks may be greater when exercise requires a transfer, upright positioning, or assistance.
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Affiliation(s)
- Kaitlyn J Snyder
- Department of Kinesiology, Brock University, St. Catharines, Ontario, Canada.,Brock-Niagara Centre for Health and Well-being, Brock University, St. Catharines, Ontario, Canada
| | - Eleni Patsakos
- Department of Kinesiology, Brock University, St. Catharines, Ontario, Canada.,Brock-Niagara Centre for Health and Well-being, Brock University, St. Catharines, Ontario, Canada
| | - John White
- Department of Kinesiology, Brock University, St. Catharines, Ontario, Canada.,Brock-Niagara Centre for Health and Well-being, Brock University, St. Catharines, Ontario, Canada
| | - David S Ditor
- Department of Kinesiology, Brock University, St. Catharines, Ontario, Canada.,Brock-Niagara Centre for Health and Well-being, Brock University, St. Catharines, Ontario, Canada
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Allison DJ, Beaudry KM, Thomas AM, Josse AR, Ditor DS. Changes in nutrient intake and inflammation following an anti-inflammatory diet in spinal cord injury. J Spinal Cord Med 2019; 42:768-777. [PMID: 30277850 PMCID: PMC6830248 DOI: 10.1080/10790268.2018.1519996] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective: The objective of the current study was to describe the observed changes in nutrient intakes following a 3-month anti-inflammatory diet, and to explore potential relationships between the change in nutrients and the change in various inflammatory mediators.Design: A secondary analysis of a prior randomized controlled clinical trial.Setting: Individuals with SCI within the Niagara region.Participants: Twenty individuals with various levels and severities of SCI.Intervention: Three-month anti-inflammatory diet.Outcome Measures: The change in nutrient intake and corresponding changes to various inflammatory mediators.Results: The treatment group demonstrated a significant reduction in fat intake (P = 0.02), a significant increase in protein intake (P = 0.02), and no change in carbohydrates (P = 0.23) or energy intake (P = 0.10). The treatment group showed a significant increase in some nutrients with established anti-inflammatory properties including vitamins A, C, and E, and omega-3 fatty acids (P < 0.01). Significant reductions in proinflammatory nutrients were observed including trans fatty acids (P = 0.05), caffeine (P < 0.01), and sodium (P = 0.02). The treatment group also showed significant reductions in the proinflammatory mediators interferon-y (P = 0.01), interleukin-1β (P < 0.01), and interleukin-6 (P < 0.05). Further, several proinflammatory mediators were negatively correlated with anti-inflammatory nutrients, including vitamin A, carotenoids, omega-3 fatty acids, and zinc.Conclusion: This study provides evidence that dietary alterations are effective at reducing chronic inflammation in individuals with SCI and provides a preliminary assessment of the related nutrient changes.
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Affiliation(s)
- David J. Allison
- Department of Kinesiology, Brock University, St Catharines, Ontario, Canada,Brock-Niagara Centre for Health and Well-being, Brock University, St Catharines, Ontario, Canada,Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Canada,Correspondence to: David J. Allison, Department of Kinesiology, Faculty of Science, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada.
| | | | - Aysha M. Thomas
- Department of Kinesiology, Brock University, St Catharines, Ontario, Canada
| | - Andrea R. Josse
- Department of Kinesiology, Brock University, St Catharines, Ontario, Canada
| | - David S. Ditor
- Department of Kinesiology, Brock University, St Catharines, Ontario, Canada,Brock-Niagara Centre for Health and Well-being, Brock University, St Catharines, Ontario, Canada
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10
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Sharif H, La Fountaine MF, Wecht JM, Ditor DS. A call to reevaluate cardiac autonomic assessment after spinal cord injury. Am J Physiol Heart Circ Physiol 2018; 315:H1088-H1090. [PMID: 30141980 DOI: 10.1152/ajpheart.00453.2018] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This "Perspectives" article puts forward the notion that measuring heart rate variability, or other forms of cardiac autonomic regulation, after spinal cord injury must be performed during a test of autonomic stress. Resting values of heart rate variability are often similar to those obtained from able-bodied individuals, which may therefore be falsely interpreted as normal or healthy autonomic regulation. However, evidence shows that despite normal resting values, cardiac autonomic control is impaired when individual with spinal cord injury are subjected to a cold face test, head-up tilt, or recovery from exercise. Accordingly, examination of cardiac autonomic function must be performed during an autonomic challenge, as resting measures do not accurately reflect the state of cardiovascular regulation after spinal cord injury and can provide false information.
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Affiliation(s)
- Hisham Sharif
- Department of Molecular, Cellular and Biomedical Sciences, City University of New York School of Medicine , New York.,Department of Kinesiology, Brock Univeristy, St. Catharines, Ontario, Canada
| | - Michael F La Fountaine
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, New York.,Department of Physical Therapy, School of Health and Medical Sciences, Seton Hall University, South Orange, New Jersey.,Departments of Medical Sciences and Neurology, Hackensack Meridian School of Medicine at Seton Hall University, Nutley, New Jersy
| | - Jill M Wecht
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, New York
| | - David S Ditor
- Department of Kinesiology, Brock Univeristy, St. Catharines, Ontario, Canada
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11
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Ginis KAM, van der Scheer JW, Latimer-Cheung AE, Barrow A, Bourne C, Carruthers P, Bernardi M, Ditor DS, Gaudet S, de Groot S, Hayes KC, Hicks AL, Leicht CA, Lexell J, Macaluso S, Manns PJ, McBride CB, Noonan VK, Pomerleau P, Rimmer JH, Shaw RB, Smith B, Smith KM, Steeves JD, Tussler D, West CR, Wolfe DL, Goosey-Tolfrey VL. Correction: Evidence-based scientific exercise guidelines for adults with spinal cord injury: an update and a new guideline. Spinal Cord 2018; 56:1114. [DOI: 10.1038/s41393-018-0194-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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12
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Bailey KA, Lenz K, Allison DJ, Ditor DS. Barriers and facilitators to adhering to an anti-inflammatory diet for individuals with spinal cord injuries. Health Psychol Open 2018; 5:2055102918798732. [PMID: 30202539 PMCID: PMC6122254 DOI: 10.1177/2055102918798732] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The purpose of this study was to explore the barriers and facilitators of an anti-inflammatory diet in people with spinal cord injury. Six participants (age range of 23-68 years, three women and three men) who had previously completed an anti-inflammatory diet study were interviewed. Facilitators identified were family support, autonomy over meal choice, peer support, health benefits gained, and implementation of adherence strategies. The main barriers discussed were lack of motivation after study period ended, social events, diet expenses, and lack of knowledge about the diet. Several health benefits including reductions in pain, edema, and improvements in cognition and mobility were reported.
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Allison DJ, Gabriel DA, Klentrou P, Josse AR, Ditor DS. The Influence of Chronic Inflammation on Peripheral Motor Nerve Conduction Following Spinal Cord Injury: A Randomized Clinical Trial. Top Spinal Cord Inj Rehabil 2018; 23:377-385. [PMID: 29339913 DOI: 10.1310/sci16-00045] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 01/28/2023]
Abstract
Objective: To examine the potential influence of chronic inflammation on peripheral motor nerve function in vivo following spinal cord injury (SCI). Methods: This study was part of a randomized, parallel-group, controlled clinical trial. The study included 20 participants with varying levels and severities of SCI randomized (3:2) to either a treatment group, consisting of a 12-week anti-inflammatory diet program, or control group. Outcome measures were assessed at baseline, 1 month, and 3 months and consisted of measures of motor nerve conduction velocity (NCV) and amplitude as well as markers of inflammation as assessed by various pro- and anti-inflammatory cytokines. Results: Despite a significant reduction in inflammation in the treatment group, 2-way repeated measures analysis of variance (ANOVA) showed no significant Group × Time interaction for motor NCV (p = .77) or M-wave amplitude (p = .61). Further, the change in motor NCV and M-wave amplitude were not shown to be associated with the change in inflammatory mediators as assessed via a backwards elimination multiple regression analysis. Conclusion: These results suggest that at physiologically relevant concentrations, inflammatory mediators may not have a substantial influence on peripheral motor nerve conduction in vivo following SCI. Future studies may still be warranted to examine the potential for central effects.
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Affiliation(s)
- David J Allison
- Department of Kinesiology, Brock University, St Catharines, Ontario, Canada.,Brock-Niagara Centre for Health and Well-being, St Catharines, Ontario, Canada
| | - David A Gabriel
- Department of Kinesiology, Brock University, St Catharines, Ontario, Canada
| | - Panagiota Klentrou
- Department of Kinesiology, Brock University, St Catharines, Ontario, Canada
| | - Andrea R Josse
- Department of Kinesiology, Brock University, St Catharines, Ontario, Canada
| | - David S Ditor
- Department of Kinesiology, Brock University, St Catharines, Ontario, Canada.,Brock-Niagara Centre for Health and Well-being, St Catharines, Ontario, Canada
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14
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El-Kotob R, Craven BC, Mathur S, Ditor DS, Oh P, Miyatani M, Verrier MC. Assessing Heart Rate Variability As a Surrogate Measure of Cardiac Autonomic Function in Chronic Traumatic Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2018; 24:28-36. [PMID: 29434458 DOI: 10.1310/sci17-00002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 12/20/2022]
Abstract
Background: Although cardiac autonomic dysfunction is a contributing factor for cardiovascular disease development in individuals with a spinal cord injury (SCI), it remains poorly understood. Heart rate variability (HRV) analysis has the potential to non-invasively assess the cardiac autonomic nervous system. The study objectives are (a) to determine if there are differences in HRV measures across neurological level of impairment (NLI) and American Spinal Cord Injury Association Impairment Scale (AIS) subgroups, and (b) to determine if there is a relationship between HRV frequency measures (low frequency [LF] and high frequency [HF]) at rest. Methods: We conducted a secondary data analysis of a primary data set from a published cross-sectional study of electrocardiogram recordings of 56 subjects (44 men and 12 women, mean age ± SD = 46.75 ± 12.44 years) with a chronic traumatic SCI (C1-T12, AIS A-D, ≥2 years post injury). HRV was analyzed using time and frequency domain measures. Results: There were no significant HRV differences across NLI and AIS subgroups. The LF and HF indices were positively correlated in the entire sample (r = 0.708, p < .0001) and among impairment subgroups. Conclusion: No differences were observed in the HRV time and frequency measures when compared across NLI and AIS subgroups. The results were considered inconclusive, since possible explanations include inadequate sample size as well as other physiological considerations. A positive correlation was found between LF and HF when assessed at rest. The relationship between LF and HF may not necessarily represent a rebalanced autonomic nervous system, but it does question the utility of solely measuring LF:HF at rest in persons with chronic SCI.
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Affiliation(s)
- Rasha El-Kotob
- University Health Network, Toronto Rehabilitation Institute, Lyndhurst Centre, Toronto, Ontario, Canada.,Graduate Department of Rehabilitation Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - B Catharine Craven
- University Health Network, Toronto Rehabilitation Institute, Lyndhurst Centre, Toronto, Ontario, Canada.,Department of Medicine, Division of Physical Medicine & Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Sunita Mathur
- University Health Network, Toronto Rehabilitation Institute, University Centre, Toronto, Ontario, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - David S Ditor
- Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Paul Oh
- University Health Network, Toronto Rehabilitation Institute, Rumsey Centre, Toronto, Ontario, Canada.,Department of Medicine, Clinical Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Masae Miyatani
- University Health Network, Toronto Rehabilitation Institute, Lyndhurst Centre, Toronto, Ontario, Canada
| | - Mary C Verrier
- University Health Network, Toronto Rehabilitation Institute, Lyndhurst Centre, Toronto, Ontario, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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15
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Martin Ginis KA, van der Scheer JW, Latimer-Cheung AE, Barrow A, Bourne C, Carruthers P, Bernardi M, Ditor DS, Gaudet S, de Groot S, Hayes KC, Hicks AL, Leicht CA, Lexell J, Macaluso S, Manns PJ, McBride CB, Noonan V, Pomerleau P, Rimmer JH, Shaw RB, Smith B, Smith KM, Steeves J, Tussler D, West CR, Wolfe DL, Goosey-Tolfrey VL. Response to correspondence from the ESSA Statement authors. Spinal Cord 2018; 56:409-411. [PMID: 29348688 DOI: 10.1038/s41393-017-0051-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 12/10/2017] [Accepted: 12/13/2017] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | - Andy Barrow
- Paralympian and Inspirational Speaker, London, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Pierre Pomerleau
- Institut de Réadaptation en Déficience Physique de Québec, Ville de Québec, Canada
| | | | - Robert B Shaw
- University of British Columbia, British Columbia, Canada
| | | | | | - John Steeves
- ICORD University of British Columbia, Vancouver, Canada
| | - Dot Tussler
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK
| | | | - Dalton L Wolfe
- Parkwood Institute, Lawson Health Research Institute, Ontario, Canada
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Martin Ginis KA, van der Scheer JW, Latimer-Cheung AE, Barrow A, Bourne C, Carruthers P, Bernardi M, Ditor DS, Gaudet S, de Groot S, Hayes KC, Hicks AL, Leicht CA, Lexell J, Macaluso S, Manns PJ, McBride CB, Noonan VK, Pomerleau P, Rimmer JH, Shaw RB, Smith B, Smith KM, Steeves JD, Tussler D, West CR, Wolfe DL, Goosey-Tolfrey VL. Evidence-based scientific exercise guidelines for adults with spinal cord injury: an update and a new guideline. Spinal Cord 2017; 56:308-321. [PMID: 29070812 DOI: 10.1038/s41393-017-0017-3] [Citation(s) in RCA: 231] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 09/14/2017] [Accepted: 09/20/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To describe the process and outcomes of using a new evidence base to develop scientific guidelines that specify the type and minimum dose of exercise necessary to improve fitness and cardiometabolic health in adults with spinal cord injury (SCI). SETTING International. METHODS Using Appraisal of Guidelines, Research and Evaluation (AGREE) II reporting criteria, steps included (a) determining the guidelines' scope; (b) conducting a systematic review of relevant literature; (c) holding three consensus panel meetings (European, Canadian and International) to formulate the guidelines; (d) obtaining stakeholder feedback; and (e) process evaluation by an AGREE II consultant. Stakeholders were actively involved in steps (c) and (d). RESULTS For cardiorespiratory fitness and muscle strength benefits, adults with a SCI should engage in at least 20 min of moderate to vigorous intensity aerobic exercise 2 times per week AND 3 sets of strength exercises for each major functioning muscle group, at a moderate to vigorous intensity, 2 times per week (strong recommendation). For cardiometabolic health benefits, adults with a SCI are suggested to engage in at least 30 min of moderate to vigorous intensity aerobic exercise 3 times per week (conditional recommendation). CONCLUSIONS Through a systematic, rigorous, and participatory process involving international scientists and stakeholders, a new exercise guideline was formulated for cardiometabolic health benefits. A previously published SCI guideline was endorsed for achieving fitness benefits. These guidelines represent an important step toward international harmonization of exercise guidelines for adults with SCI, and a foundation for developing exercise policies and programs for people with SCI around the world.
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Affiliation(s)
| | | | | | - Andy Barrow
- Paralympian and Inspirational Speaker, London, UK
| | | | | | | | | | - Sonja Gaudet
- Spinal Cord Injury British Columbia, Vancouver, Canada
| | | | | | | | | | | | | | | | | | | | - Pierre Pomerleau
- Institut de Réadaptation en Déficience Physique de Québec, Ville de Québec, Canada
| | | | | | | | | | | | - Dot Tussler
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK
| | | | - Dalton L Wolfe
- Parkwood Institute, Lawson Health Research Institute, London, Canada
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17
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Vause TDR, Allison DJ, Vause T, Tekok-Kilic A, Ditor DS, Min JK. Comparison of a Web-Based Teaching Tool and Traditional Didactic Learning for In Vitro Fertilization Patients: A Preliminary Randomized Controlled Trial. J Obstet Gynaecol Can 2017; 40:588-594. [PMID: 29054507 DOI: 10.1016/j.jogc.2017.08.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 08/10/2017] [Accepted: 08/11/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objective of this prospective RCT was to compare the efficacy of a web-based teaching tool to traditional didactic teaching in IVF patients. METHODS Forty women undergoing their first IVF cycle were randomly allocated to an interactive web-based teaching session or a nurse-led didactic teaching session. The primary outcome measure was participant knowledge regarding the IVF process, risks, and logistics assessed before and after the respective teaching session. Secondary outcomes included patient stress, assessed before and after the respective teaching session, and patient satisfaction, assessed following the respective teaching session and on the day of embryo transfer (following implementation of the teaching protocol). RESULTS Both groups demonstrated similar and significant improvements in knowledge and stress after exposure to their respective teaching sessions. The web-based group was significantly more satisfied than the didactic teaching group. Web-based teaching was also shown to be equally effective for participants of high versus low income and education status for knowledge, stress, and satisfaction. CONCLUSION This study provides preliminary support for the use of web-based teaching as an equally effective tool for increasing knowledge and reducing stress compared to traditional didactic teaching in IVF patients, with the added benefit of increased patient satisfaction.
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Affiliation(s)
| | - David J Allison
- Faculty of Applied Health Sciences, Brock University, St. Catharines, ON
| | - Tricia Vause
- Department of Child and Youth Studies, Brock University, St. Catharines, ON
| | - Ayda Tekok-Kilic
- Department of Child and Youth Studies, Brock University, St. Catharines, ON
| | - David S Ditor
- Faculty of Applied Health Sciences, Brock University, St. Catharines, ON.
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18
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van der Scheer JW, Martin Ginis KA, Ditor DS, Goosey-Tolfrey VL, Hicks AL, West CR, Wolfe DL. Effects of exercise on fitness and health of adults with spinal cord injury: A systematic review. Neurology 2017; 89:736-745. [PMID: 28733344 DOI: 10.1212/wnl.0000000000004224] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 05/15/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To synthesize and appraise research testing the effects of exercise interventions on fitness, cardiometabolic health, and bone health among adults with spinal cord injury (SCI). METHODS Electronic databases were searched (1980-2016). Included studies employed exercise interventions for a period ≥2 weeks, involved adults with acute or chronic SCI, and measured fitness (cardiorespiratory fitness, power output, or muscle strength), cardiometabolic health (body composition or cardiovascular risk factors), or bone health outcomes. Evidence was synthesized and appraised using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). RESULTS A total of 211 studies met the inclusion criteria (22 acute, 189 chronic). For chronic SCI, GRADE confidence ratings were moderate to high for evidence showing exercise can improve all of the reviewed outcomes except bone health. For acute SCI, GRADE ratings were very low for all outcomes. For chronic SCI, there was low to moderate confidence in the evidence showing that 2-3 sessions/week of upper body aerobic exercise at a moderate to vigorous intensity for 20-40 minutes, plus upper body strength exercise (3 sets of 10 repetitions at 50%-80% 1-repetition maximum for all large muscle groups), can improve cardiorespiratory fitness, power output, and muscle strength. For chronic SCI, there was low to moderate confidence in the evidence showing that 3-5 sessions per week of upper body aerobic exercise at a moderate to vigorous intensity for 20-44 minutes can improve cardiorespiratory fitness, muscle strength, body composition, and cardiovascular risk. CONCLUSIONS Exercise improves fitness and cardiometabolic health of adults with chronic SCI. The evidence on effective exercise types, frequencies, intensities, and durations should be used to formulate exercise guidelines for adults with SCI.
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Affiliation(s)
- Jan W van der Scheer
- From the School for Sports, Exercise and Health Sciences (J.W.v.d.S., V.L.G.-T.), Peter Harrison Centre for Disability Sport, National Centre for Sport and Exercise Medicine, Loughborough University, UK; School of Health and Exercise Sciences (K.A.M.G.), University of British Columbia, Kelowna; ICORD (K.A.M.G., C.R.W.) and School of Kinesiology (C.R.W.), University of British Columbia, Vancouver; Department of Kinesiology (D.S.D.), Brock University, St. Catharines; Department of Kinesiology (A.L.H.), McMaster University, Hamilton; and Parkwood Institute (D.L.W.), Lawson Health Research Institute, London, Canada
| | - Kathleen A Martin Ginis
- From the School for Sports, Exercise and Health Sciences (J.W.v.d.S., V.L.G.-T.), Peter Harrison Centre for Disability Sport, National Centre for Sport and Exercise Medicine, Loughborough University, UK; School of Health and Exercise Sciences (K.A.M.G.), University of British Columbia, Kelowna; ICORD (K.A.M.G., C.R.W.) and School of Kinesiology (C.R.W.), University of British Columbia, Vancouver; Department of Kinesiology (D.S.D.), Brock University, St. Catharines; Department of Kinesiology (A.L.H.), McMaster University, Hamilton; and Parkwood Institute (D.L.W.), Lawson Health Research Institute, London, Canada.
| | - David S Ditor
- From the School for Sports, Exercise and Health Sciences (J.W.v.d.S., V.L.G.-T.), Peter Harrison Centre for Disability Sport, National Centre for Sport and Exercise Medicine, Loughborough University, UK; School of Health and Exercise Sciences (K.A.M.G.), University of British Columbia, Kelowna; ICORD (K.A.M.G., C.R.W.) and School of Kinesiology (C.R.W.), University of British Columbia, Vancouver; Department of Kinesiology (D.S.D.), Brock University, St. Catharines; Department of Kinesiology (A.L.H.), McMaster University, Hamilton; and Parkwood Institute (D.L.W.), Lawson Health Research Institute, London, Canada
| | - Victoria L Goosey-Tolfrey
- From the School for Sports, Exercise and Health Sciences (J.W.v.d.S., V.L.G.-T.), Peter Harrison Centre for Disability Sport, National Centre for Sport and Exercise Medicine, Loughborough University, UK; School of Health and Exercise Sciences (K.A.M.G.), University of British Columbia, Kelowna; ICORD (K.A.M.G., C.R.W.) and School of Kinesiology (C.R.W.), University of British Columbia, Vancouver; Department of Kinesiology (D.S.D.), Brock University, St. Catharines; Department of Kinesiology (A.L.H.), McMaster University, Hamilton; and Parkwood Institute (D.L.W.), Lawson Health Research Institute, London, Canada
| | - Audrey L Hicks
- From the School for Sports, Exercise and Health Sciences (J.W.v.d.S., V.L.G.-T.), Peter Harrison Centre for Disability Sport, National Centre for Sport and Exercise Medicine, Loughborough University, UK; School of Health and Exercise Sciences (K.A.M.G.), University of British Columbia, Kelowna; ICORD (K.A.M.G., C.R.W.) and School of Kinesiology (C.R.W.), University of British Columbia, Vancouver; Department of Kinesiology (D.S.D.), Brock University, St. Catharines; Department of Kinesiology (A.L.H.), McMaster University, Hamilton; and Parkwood Institute (D.L.W.), Lawson Health Research Institute, London, Canada
| | - Christopher R West
- From the School for Sports, Exercise and Health Sciences (J.W.v.d.S., V.L.G.-T.), Peter Harrison Centre for Disability Sport, National Centre for Sport and Exercise Medicine, Loughborough University, UK; School of Health and Exercise Sciences (K.A.M.G.), University of British Columbia, Kelowna; ICORD (K.A.M.G., C.R.W.) and School of Kinesiology (C.R.W.), University of British Columbia, Vancouver; Department of Kinesiology (D.S.D.), Brock University, St. Catharines; Department of Kinesiology (A.L.H.), McMaster University, Hamilton; and Parkwood Institute (D.L.W.), Lawson Health Research Institute, London, Canada
| | - Dalton L Wolfe
- From the School for Sports, Exercise and Health Sciences (J.W.v.d.S., V.L.G.-T.), Peter Harrison Centre for Disability Sport, National Centre for Sport and Exercise Medicine, Loughborough University, UK; School of Health and Exercise Sciences (K.A.M.G.), University of British Columbia, Kelowna; ICORD (K.A.M.G., C.R.W.) and School of Kinesiology (C.R.W.), University of British Columbia, Vancouver; Department of Kinesiology (D.S.D.), Brock University, St. Catharines; Department of Kinesiology (A.L.H.), McMaster University, Hamilton; and Parkwood Institute (D.L.W.), Lawson Health Research Institute, London, Canada
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19
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Dance DL, Chopra A, Campbell K, Ditor DS, Hassouna M, Craven BC. Exploring daily blood pressure fluctuations and cardiovascular risk among individuals with motor complete spinal cord injury: a pilot study. J Spinal Cord Med 2017; 40:405-414. [PMID: 27813450 PMCID: PMC5537957 DOI: 10.1080/10790268.2016.1236161] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Clinically silent autonomic dysfunction with bowel and bladder care, are postulated to contribute to cardiovascular disease after chronic spinal cord injury (SCI). OBJECTIVE We describe the frequency and severity of dysreflexic episodes, termed transient blood pressure elevations (T-BPE) over 48 hours in adults with cervical or high-thoracic motor-complete SCI. SETTING Tertiary SCI Rehabilitation Centre in Toronto, Canada. PARTICIPANTS Individuals with chronic SCI, C1-T3 AIS A or B, >1 year post-injury, living in the community (n=19). OUTCOME MEASURES Data were obtained via 48-hour ambulatory blood pressure (BP) and heart rate (HR) monitoring, with data captured at 10-minute intervals and a concurrent diary describing activities of daily living, and bladder/bowel routines. T-BPE were defined as a ≥ 40 mmHg elevation in systolic blood pressure (SBP) above the participant's supine baseline. Severe (≥ 60-79 mmHg) and Extreme ≥80 mmHg elevations in SBP were described. RESULTS Thirteen participants experienced T-BPE within the assessment period, with 7/13 experiencing "severe", and 3/13 experiencing "extreme" SBP elevations. The median number of T-BPE was 8 (IQR = 3), and the mean ± SD SBP during T-BPE was 150 ± 16 mmHg, These T-BPE were verified as dysreflexic events using a conservative definition of a >40 mmHg increase in SBP, with a concurrent 10 bpm decrease in HR, above the 48-hour average SBP, yielding 12/19 participants with T-BPE. CONCLUSIONS T-BPE were frequent, often with severe or extreme elevations in SBP, despite few reported symptoms. Recognition and management of these dysreflexic events associated with T-BPE are needed, which may ameliorate cardiovascular disease risk.
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Affiliation(s)
- Derry L. Dance
- Department of Medicine, University of Toronto, Toronto, ON, Canada,Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Amit Chopra
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Kent Campbell
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - David S. Ditor
- Department of Physical Education and Kinesiology, Brock University, St. Catharines, ON, Canada
| | - Magdy Hassouna
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada,Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - B. Catharine Craven
- Department of Medicine, University of Toronto, Toronto, ON, Canada,Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada,Correspondence to: B. Catharine Craven, Lyndhurst Centre, Toronto Rehabilitation Institute-UHN 520 Sutherland Drive, Toronto, ON, M4G 3V9, Canada.
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20
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Au JS, Ditor DS, MacDonald MJ, Stöhr EJ. Carotid artery longitudinal wall motion is associated with local blood velocity and left ventricular rotational, but not longitudinal, mechanics. Physiol Rep 2016; 4:4/14/e12872. [PMID: 27440745 PMCID: PMC4962076 DOI: 10.14814/phy2.12872] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 06/28/2016] [Indexed: 11/24/2022] Open
Abstract
Recent studies have identified a predictable movement pattern of the common carotid artery wall in the longitudinal direction. While there is evidence that the magnitude of this carotid artery longitudinal wall motion (CALM) is sensitive to cardiovascular health status, little is known about the determinants of CALM. The purpose of this integrative study was to evaluate the contribution of left ventricular (LV) cardiac motion and local blood velocity to CALM. Simultaneous ultrasound measurements of CALM, common carotid artery mean blood velocity (MBV), and left ventricular motion were performed in ten young, healthy individuals (6 males; 22 ± 1 years). Peak anterograde CALM occurred at a similar time as peak MBV (18.57 ± 3.98% vs. 18.53 ± 2.81% cardiac cycle; t‐test: P = 0.94; ICC: 0.79, P < 0.01). The timing of maximum retrograde CALM displacement was different, but related, to both peak apical (41.00 ± 7.81% vs. 35.33 ± 5.79% cardiac cycle; t‐test: P < 0.01; ICC: 0.79, P < 0.01) and basal rotation (41.80 ± 6.12% vs. 37.30 ± 5.66% cardiac cycle; t‐test: P < 0.01; ICC: 0.74, P < 0.01) with peak cardiac displacements preceding peak CALM displacements in both cases. The association between basal rotation and retrograde CALM was further supported by strong correlations between their peak magnitudes (r = −0.70, P = 0.02), whereas the magnitude of septal longitudinal displacement was not associated with peak CALM (r = 0.11, P = 0.77). These results suggest that the rotational mechanical movement of the LV base may be closely associated with longitudinal mechanics in the carotid artery. This finding may have important implications for interpreting the complex relationship between ventricular and vascular function.
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Affiliation(s)
- Jason S Au
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - David S Ditor
- Department of Kinesiology, Brock University, St. Catharines, Ontario, Canada
| | | | - Eric J Stöhr
- Discipline of Physiology & Health, Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, Wales, UK
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21
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Bailey KA, Gammage KL, van Ingen C, Ditor DS. “My body was my temple”: a narrative revealing body image experiences following treatment of a spinal cord injury. Disabil Rehabil 2016; 39:1886-1892. [DOI: 10.1080/09638288.2016.1211753] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- K. Alysse Bailey
- Brock-Niagara Centre for Health & Well-Being, Faculty of Applied Health Sciences, Brock University, Saint Catharines, ON, Canada
| | - Kimberley L. Gammage
- Brock-Niagara Centre for Health & Well-Being, Department of Kinesiology, Brock University, Saint Catharines, ON, Canada
| | - Cathy van Ingen
- Department of Kinesiology, Brock University, Saint Catharines, ON, Canada
| | - David S. Ditor
- Brock-Niagara Centre for Health & Well-Being, Department of Kinesiology, Brock University, Saint Catharines, ON, Canada
- Department of Kinesiology, Brock University, Saint Catharines, ON, Canada
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22
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Allison DJ, Josse AR, Gabriel DA, Klentrou P, Ditor DS. Targeting inflammation to influence cognitive function following spinal cord injury: a randomized clinical trial. Spinal Cord 2016; 55:26-32. [PMID: 27324320 DOI: 10.1038/sc.2016.96] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 04/29/2016] [Accepted: 05/17/2016] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN This study was a randomized, parallel-group, controlled clinical trial. OBJECTIVES The purpose of this study was to examine the efficacy of targeting inflammation as a means of improving cognitive function in individuals with spinal cord injury. SETTING Participants were recruited from the Niagara region of Ontario Canada and all testing occurred on-site at Brock University. METHODS Indices of memory and verbal learning were assessed by means of the California Verbal Learning Test (CVLT). Inflammation and concentrations of neuroactive compounds related to the kynurenine pathway were assessed via a number of pro- and anti-inflammatory cytokines, as well as tryptophan, kynurenine and several large neutral amino acids. All assessments were performed at baseline as well as at 1 month and 3 months during a 3-month intervention by means of an anti-inflammatory diet. RESULTS Despite a reduction in inflammation, all measures of the CVLT, including list A, trial 1 (P=0.48), learning slope (P=0.46), long delay free recall (P=0.83), intrusions (P=0.61) and repetitions (P=0.07), showed no significant group × time interaction. CONCLUSION It may be possible that the reduction in inflammation achieved in the current study was insufficient to induce substantial changes in indices of verbal learning and memory. Alternatively, as these participants likely underwent years of previous chronic inflammation, the underlying hippocampal damage may have negated potential improvements induced by acute reductions in inflammation.
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Affiliation(s)
- D J Allison
- Department of Kinesiology, Brock University, St Catharines, Ontario, Canada.,Brock-Niagara Centre for Health and Well-Being, St Catharines, Ontario, Canada
| | - A R Josse
- Department of Kinesiology, Brock University, St Catharines, Ontario, Canada
| | - D A Gabriel
- Department of Kinesiology, Brock University, St Catharines, Ontario, Canada
| | - P Klentrou
- Department of Kinesiology, Brock University, St Catharines, Ontario, Canada
| | - D S Ditor
- Department of Kinesiology, Brock University, St Catharines, Ontario, Canada.,Brock-Niagara Centre for Health and Well-Being, St Catharines, Ontario, Canada
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23
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Allison DJ, Thomas A, Beaudry K, Ditor DS. Targeting inflammation as a treatment modality for neuropathic pain in spinal cord injury: a randomized clinical trial. J Neuroinflammation 2016; 13:152. [PMID: 27316678 PMCID: PMC4912827 DOI: 10.1186/s12974-016-0625-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 06/13/2016] [Indexed: 12/30/2022] Open
Abstract
Background The purpose of the present study was to examine the effectiveness of an anti-inflammatory intervention as a treatment for neuropathic pain following spinal cord injury (SCI). Methods This randomized, parallel-group, controlled clinical trial (NCT02099890) examined 20 participants with varying levels and severities of SCI, randomized (3:2) to either a 12-week anti-inflammatory diet, or control group. Outcome measures consisted of self-determined indices of pain as assessed using the neuropathic pain questionnaire (NPQ) and markers of inflammation as assessed by various pro- and anti-inflammatory cytokines, as well as the eicosanoids PGE2 and LTB4. Results A significant group × time interaction was found for sensory pain scores (p < 0.01). A Mann-Whitney test revealed that the change scores (3-month baseline) were significantly different between groups for IFN-y (U = 13.0, p = 0.01), IL-1β (U = 14.0, p = 0.01), and IL-2 (U = 12.0, p = 0.01). A Friedman test revealed the treatment group had a significant reduction in IFN-y (x2 = 8.67, p = 0.01), IL-1β (x2 = 17.78, p < 0.01), IL-6 (x2 = 6.17, p < 0.05), while the control group showed no significant change in any inflammatory mediator. A stepwise backward elimination multiple regression analysis showed that the change in sensory neuropathic pain was a function of the change in the proinflammatory cytokines IL-2 and IFN-y, as well as the eicosanoid PGE2 (R = 0.689, R2 = 0.474). Conclusions Overall, the results of the study demonstrate the efficacy of targeting inflammation as a means of treating neuropathic pain in SCI, with a potential mechanism relating to the reduction in proinflammatory cytokines and PGE2. Trial registration ClinicalTrials.gov, NCT02099890 Electronic supplementary material The online version of this article (doi:10.1186/s12974-016-0625-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David J Allison
- Department of Kinesiology, Brock University, St Catharines, Ontario, L2S 3A1, Canada. .,Brock-Niagara Centre for Health and Well-being, St Catharines, Ontario, L2T 1W4, Canada.
| | - Aysha Thomas
- Department of Kinesiology, Brock University, St Catharines, Ontario, L2S 3A1, Canada
| | - Kayleigh Beaudry
- Department of Kinesiology, Brock University, St Catharines, Ontario, L2S 3A1, Canada
| | - David S Ditor
- Department of Kinesiology, Brock University, St Catharines, Ontario, L2S 3A1, Canada.,Brock-Niagara Centre for Health and Well-being, St Catharines, Ontario, L2T 1W4, Canada
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24
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Bailey KA, Gammage KL, van Ingen C, Ditor DS. Managing the stigma: Exploring body image experiences and self-presentation among people with spinal cord injury. Health Psychol Open 2016; 3:2055102916650094. [PMID: 28070405 PMCID: PMC5193263 DOI: 10.1177/2055102916650094] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Using modified constructivist grounded theory, the purpose of this study was to explore body image experiences in people with spinal cord injury. Nine participants (five women, four men) varying in age (21–63 years), type of injury (C3-T7; complete and incomplete), and years post-injury (4–36 years) took part in semi-structured in-depth interviews. The following main categories were found: appearance, weight concerns, negative functional features, impact of others, body disconnection, hygiene and incontinence, and self-presentation. Findings have implications for the health and well-being of those living with a spinal cord injury.
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Affiliation(s)
- K Alysse Bailey
- Faculty of Applied Health Sciences, Brock University, Brock-Niagara Centre for Health and Well-Being
| | - Kimberley L Gammage
- Department of Kinesiology, Brock University and Brock-Niagara Centre for Health and Well-Being
| | | | - David S Ditor
- Department of Kinesiology, Brock University and Brock-Niagara Centre for Health and Well-Being
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25
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Allison DJ, Chapman B, Wolfe D, Sequeira K, Hayes K, Ditor DS. Effects of a Functional Electrical Stimulation-Assisted Cycling Program on Immune and Cardiovascular Health in Persons with Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2016; 22:71-78. [PMID: 29398895 DOI: 10.1310/sci2201-71] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 01/10/2023]
Abstract
Background: Spinal cord injury (SCI) is associated with both a state of chronic inflammation and an increased prevalence of cardiovascular disease (CVD). These disorders are closely linked and have been shown to negatively influence one another. Participation in regular exercise has been shown to be an effective intervention strategy in the treatment of each of these disorders. For individuals with SCI who may lack the lower limb motor capabilities to perform certain traditional exercise modalities, functional electrical stimulation (FES) cycling may provide an effective alternative. Objective: The purpose of this study was to examine the effects of 12 weeks of FES training performed 3 times per week on physiological indices of cardiovascular function as well as molecular indices of inflammation and cardiovascular health. Methods: Ten individuals with chronic SCI were included. Measures of central and peripheral cardiovascular function as well as hematological and immunological markers were assessed before and after the 12-week exercise program. Results: Enhancements in exercise performance as well as a corresponding increase in peripheral cardiovascular function were achieved, as shown by a significant 34% increase in pulse volume (P = .04) and trends toward increases in cross-sectional area (P = .09) and arterial inflow volume (P = .11) of the common femoral artery. Despite this, no change in any hematological or immunological markers was evident. Conclusion: Although the efficacy of FES exercise in enhancing exercise performance (time and distance to fatigue) and peripheral cardiovascular function has been reaffirmed, no alterations in any molecular indices of cardiovascular risk were achieved.
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Affiliation(s)
- David J Allison
- Department of Kinesiology, Brock University, St. Catharines, Ontario, Canada.,Brock-Niagara Centre for Health and Well-being, St Catharines, Ontario, Canada
| | - Bonnie Chapman
- Aging, Rehabilitation & Geriatric Care, Lawson Health Research Institute, London, Ontario, Canada
| | - Dalton Wolfe
- Aging, Rehabilitation & Geriatric Care, Lawson Health Research Institute, London, Ontario, Canada
| | - Keith Sequeira
- Aging, Rehabilitation & Geriatric Care, Lawson Health Research Institute, London, Ontario, Canada
| | - Keith Hayes
- Aging, Rehabilitation & Geriatric Care, Lawson Health Research Institute, London, Ontario, Canada
| | - David S Ditor
- Department of Kinesiology, Brock University, St. Catharines, Ontario, Canada.,Brock-Niagara Centre for Health and Well-being, St Catharines, Ontario, Canada
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26
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Sharif H, Millar PJ, Incognito AV, Ditor DS. Non-invasive electrocardiographic assessments of cardiac autonomic modulation in individuals with spinal cord injury. Spinal Cord 2015; 54:166-71. [DOI: 10.1038/sc.2015.207] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 10/09/2015] [Accepted: 10/16/2015] [Indexed: 12/11/2022]
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Allison DJ, Ditor DS. Targeting inflammation to influence mood following spinal cord injury: a randomized clinical trial. J Neuroinflammation 2015; 12:204. [PMID: 26545369 PMCID: PMC4636770 DOI: 10.1186/s12974-015-0425-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 10/31/2015] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The purpose of the present study was to examine the efficacy of targeting inflammation as a means of improving mood following spinal cord injury (SCI) and explore the potential mechanisms of action. METHODS The study was a randomized, parallel-group, controlled, clinical trial (NCT02099890) whereby 20 participants with varying levels and severities of SCI were randomized (3:2) to either the treatment group, consisting of a 12-week anti-inflammatory diet, or control group. Outcome measures were assessed at baseline, 1 and 3 months, and consisted of CES-D scores of depression, markers of inflammation as assessed by various pro- and anti-inflammatory cytokines and several amino acids related to depression. RESULTS A significant group × time interaction was found for CES-D (Center for Epidemiologic studies Depression Scale) score (p = 0.01), the TRP/LNAA (tryptophan/large neutral amino acid) ratio (p = 0.04), the composite score of pro-inflammatory cytokines (p = 0.04), IL-1β (interleukin-1 beta) (p = 0.04), and IFN-γ (interferon gamma) (p = 0.03). Pearson's r correlation showed significance between the ∆IL-1β and both the ∆CES-D score (r = 0.740, p < 0.01) and the ∆KYN/TRP (kynurenine/tryptophan) ratio (r = 0.536, p = 0.02). The ∆KYN/TRP ratio was also significantly correlated with the ∆CES-D score (r = 0.586, p = 0.01). Mediation analysis showed that the relationship between the ∆KYN/TRP ratio and the ∆CES-D score was mediated by the ∆IL-1β. Subgroup analysis showed that participants with high CES-D scores had significantly higher concentrations of IL-1β, and all correlations were maintained or strengthened within this subgroup. CONCLUSIONS Overall, the results demonstrated the effectiveness of targeting inflammation as a means of improving mood in SCI, with potential mechanisms relating to the reduction in IL-1β and improvements in levels of neuroactive compounds related to the kynurenine pathway. Due to the limited sample size, results should be interpreted with caution; however, they are worthy of further examination due to the potential impact of inflammation on depression. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT02099890 .
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Affiliation(s)
- David J Allison
- Department of Kinesiology, Faculty of Applied Health Science, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON, L2S 3A1, Canada. .,Brock-Niagara Centre for Health and Well-Being, St. Catharines, ON, L2T 1W4, Canada.
| | - David S Ditor
- Department of Kinesiology, Faculty of Applied Health Science, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON, L2S 3A1, Canada. .,Brock-Niagara Centre for Health and Well-Being, St. Catharines, ON, L2T 1W4, Canada.
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Bailey KA, Gammage KL, van Ingen C, Ditor DS. "It's all about acceptance": A qualitative study exploring a model of positive body image for people with spinal cord injury. Body Image 2015; 15:24-34. [PMID: 26002149 DOI: 10.1016/j.bodyim.2015.04.010] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 04/20/2015] [Accepted: 04/28/2015] [Indexed: 11/28/2022]
Abstract
Using modified constructivist grounded theory, the purpose of the present study was to explore positive body image experiences in people with spinal cord injury. Nine participants (five women, four men) varying in age (21-63 years), type of injury (C3-T7; complete and incomplete), and years post-injury (4-36 years) were recruited. The following main categories were found: body acceptance, body appreciation and gratitude, social support, functional gains, independence, media literacy, broadly conceptualizing beauty, inner positivity influencing outer demeanour, finding others who have a positive body image, unconditional acceptance from others, religion/spirituality, listening to and taking care of the body, managing secondary complications, minimizing pain, and respect. Interestingly, there was consistency in positive body image characteristics reported in this study with those found in previous research, demonstrating universality of positive body image. However, unique characteristics (e.g., resilience, functional gains, independence) were also reported demonstrating the importance of exploring positive body image in diverse groups.
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Wecht JM, La Fountaine MF, Handrakis JP, West CR, Phillips A, Ditor DS, Sharif H, Bauman WA, Krassioukov AV. Autonomic Nervous System Dysfunction Following Spinal Cord Injury: Cardiovascular, Cerebrovascular, and Thermoregulatory Effects. Curr Phys Med Rehabil Rep 2015. [DOI: 10.1007/s40141-015-0093-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Sharif H, Cotie LM, La Fountaine MF, Ditor DS. The influence of cardiac autonomic activity on the QT-variability index in able-bodied and incomplete spinal cord injured individuals. Auton Neurosci 2015; 190:46-52. [DOI: 10.1016/j.autneu.2015.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 03/03/2015] [Accepted: 04/11/2015] [Indexed: 11/26/2022]
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Totosy de Zepetnek JO, Au JS, Ditor DS, MacDonald MJ. Lower limb conduit artery endothelial responses to acute upper limb exercise in spinal cord injured and able-bodied men. Physiol Rep 2015; 3:3/4/e12367. [PMID: 25847920 PMCID: PMC4425972 DOI: 10.14814/phy2.12367] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Vascular improvements in the nonactive regions during exercise are likely primarily mediated by increased shear rate (SR). Individuals with spinal cord injury (SCI) experience sublesional vascular deconditioning and could potentially benefit from upper body exercise-induced increases in lower body SR. The present study utilized a single bout of incremental arm-crank exercise to generate exercise-induced SR changes in the superficial femoral artery in an effort to evaluate the acute postexercise impact on superficial femoral artery endothelial function via flow-mediated dilation (FMD), and determine regulatory factors in the nonactive legs of individuals with and without SCI. Eight individuals with SCI and eight age, sex, and waist-circumference-matched able-bodied (AB) controls participated. Nine minutes of incremental arm-crank exercise increased superficial femoral artery anterograde SR (P = 0.02 and P < 0.01), retrograde SR (P < 0.01 and P < 0.01), and oscillatory shear index (OSI) (P < 0.001 and P < 0.001) in both SCI and AB, respectively. However, these SR alterations resulted in acute postexercise increases in FMD in the AB group only (SCI 6.0 ± 1.2% to 6.3 ± 2.7%, P = 0.74; AB 7.5 ± 1.4% to 11.2 ± 1.4%, P = 0.03). While arm exercise has many cardiovascular benefits and results in changes in SR patterns in the nonactive legs, these changes are not sufficient to induce acute changes in FMD among individuals with SCI, and therefore are less likely to stimulate exercise training-associated improvements in nonactive limb endothelial function. Understanding the role of SR patterns on FMD brings us closer to designing effective strategies to combat impaired vascular function in both healthy and clinical populations.
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Affiliation(s)
| | - Jason S Au
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - David S Ditor
- Department of Kinesiology, Brock University, St. Catharines, Ontario, Canada
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Allison DJ, Ditor DS. Immune dysfunction and chronic inflammation following spinal cord injury. Spinal Cord 2014; 53:14-8. [PMID: 25366531 DOI: 10.1038/sc.2014.184] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 09/24/2014] [Accepted: 09/28/2014] [Indexed: 01/07/2023]
Abstract
STUDY DESIGN Review article. OBJECTIVES The objective of this study is to provide an overview of the many factors that contribute to the chronic inflammatory state typically observed following spinal cord injury (SCI). METHODS Literature review. RESULTS Not applicable. CONCLUSION SCI is typically characterized by a low-grade inflammatory state due to a number of factors. As bidirectional communication exists between the nervous, endocrine and immune systems, damage to the spinal cord may translate into both endocrinal and immune impairment. Damage to the autonomic nervous system may induce immune dysfunction directly, through the loss of neural innervation of lymphoid organs, or indirectly by inducing endocrinal impairment. In addition, damage to the somatic nervous system and the corresponding loss of motor and sensory function increases the likelihood of developing a number of secondary health complications and metabolic disorders associated with a state of inflammation. Lastly, numerous related disorders associated with a state of chronic inflammation have been found to be at a substantially higher prevalence following SCI. Together, such factors help explain the chronic inflammatory state and immune impairment typically observed following SCI. An understanding of the interactions between systems, both in health and disease, and the many causes of chronic inflammation may aid in the effective future treatment of immune dysfunction and related disorders following SCI.
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Affiliation(s)
- D J Allison
- Department of Kinesiology, Faculty of Applied Health Science, Brock University, St. Catharines, ON, Canada
| | - D S Ditor
- Department of Kinesiology, Faculty of Applied Health Science, Brock University, St. Catharines, ON, Canada
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Allison DJ, Green LA, Gabriel DA, Roy BD, Inglis JG, Ditor DS. Elevated concentrations of circulating cytokines and correlations with nerve conduction velocity in human peripheral nerves. J Neuroimmunol 2014; 277:134-9. [PMID: 25266142 DOI: 10.1016/j.jneuroim.2014.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 07/02/2014] [Accepted: 09/13/2014] [Indexed: 12/21/2022]
Abstract
The purpose of the current study was to quantify the potential relationship between various cytokines and peripheral nerve function in humans, in-vivo. Measures of nerve conduction velocity (NCV) were examined prior to and following the induction of a cytokine spike. A significant negative correlation was found between the change in IL-1ra and the change in NCV at 24h post-exercise (r=-0.65, p=0.02) while a significant positive correlation was found between the change in IL-6 and the change in NCV at 2h post-exercise (r=0.61, p=0.048). It may be possible that different cytokines induce a unique neural influence at elevated concentrations.
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Affiliation(s)
- David J Allison
- Department of Kinesiology, Brock University, St. Catharines, Ontario L2S 3A1, Canada.
| | - Lara A Green
- Department of Kinesiology, Brock University, St. Catharines, Ontario L2S 3A1, Canada.
| | - David A Gabriel
- Department of Kinesiology, Brock University, St. Catharines, Ontario L2S 3A1, Canada.
| | - Brian D Roy
- Department of Kinesiology, Brock University, St. Catharines, Ontario L2S 3A1, Canada.
| | - J Greig Inglis
- Department of Kinesiology, Brock University, St. Catharines, Ontario L2S 3A1, Canada.
| | - David S Ditor
- Department of Kinesiology, Brock University, St. Catharines, Ontario L2S 3A1, Canada.
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Allison DJ, Ditor DS. The common inflammatory etiology of depression and cognitive impairment: a therapeutic target. J Neuroinflammation 2014; 11:151. [PMID: 25178630 PMCID: PMC4156619 DOI: 10.1186/s12974-014-0151-1] [Citation(s) in RCA: 140] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 08/13/2014] [Indexed: 12/27/2022] Open
Abstract
Chronic inflammation has been shown to contribute to the development of a wide variety of disorders by means of a number of proposed mechanisms. Depression and cognitive impairment are two such disorders which may share a closely linked inflammatory etiology. The ability of inflammatory mediators to alter the activity of enzymes, from key metabolic pathways, may help explain the connection between these disorders. The chronic up-regulation of the kynurenine pathway results in an imbalance in critical neuroactive compounds involving the reduction of tryptophan and elevation of tryptophan metabolites. Such imbalances have established implications in both depression and cognitive impairment. This may implicate the immune system as a potential therapeutic target in the treatment of these disorders. The most common treatment modalities currently utilized, involve drug interventions which act on downstream targets. Such treatments help to reestablish protein balances, but fail to treat the inflammatory basis of the disorder. The use of anti-inflammatory interventions, such as regular exercise, may therefore, contribute to the effectiveness of current drug interventions in the treatment of both depression and cognitive impairment.
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Affiliation(s)
- David J Allison
- Department of Kinesiology, Faculty of Applied Health Science, Brock University, 500 Glenridge Ave, St, Catharines L2S 3A1, ON, Canada.
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Pelletier CA, Ditor DS, Latimer-Cheung AE, Warburton DE, Hicks AL. Exercise equipment preferences among adults with spinal cord injury. Spinal Cord 2014; 52:874-9. [DOI: 10.1038/sc.2014.146] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 07/21/2014] [Accepted: 07/30/2014] [Indexed: 11/09/2022]
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Abstract
The authors conducted a review of the literature on women's sexuality after spinal cord injury, including studies from 1990 to 2011 retrieved from PubMed. Several facets of a woman's sexuality are negatively affected by after spinal cord injury, and consequently, sexual satisfaction has been shown to decrease, which also negatively affects quality of life. Neurogenic bladder is common after spinal cord injury, and the resulting urinary incontinence is a top therapeutic priority of this population. To improve sexual satisfaction and quality of life for women with spinal cord injury, future research needs to explore the effects of urinary incontinence on various aspects of sexuality.
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Affiliation(s)
- Jackie D Cramp
- a Department of Kinesiology , Brock University , St. Catharines , Ontario , Canada
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Millar PJ, Cotie LM, St. Amand T, McCartney N, Ditor DS. Effects of autonomic blockade on nonlinear heart rate dynamics. Clin Auton Res 2010; 20:241-7. [DOI: 10.1007/s10286-010-0058-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Accepted: 02/10/2010] [Indexed: 11/30/2022]
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Abstract
Individuals with spinal cord injury (SCI) are susceptible to an array of secondary health complications. Some of these health concerns are attributable to the SCI per se, but many are secondary to the resulting immobility. For example, the incidence of pressure ulcers, type 2 diabetes, and cardiovascular disease are greatly increased in this population. Despite the need for exercise training as a means to reverse these health risks, individuals with SCI have traditionally been one of the most inactive segments of society. Physical activity programs and information about how activity can promote health are two of the services most desired but least available to people with SCI. Recently, efforts have been made to increase exercise options for individuals with SCI and to study the health benefits of exercise in this population. Accessible resistance and aerobic exercise training, functional electrically stimulated exercise, and body weight-supported treadmill training have all shown promise as ways to reverse some of the physiological consequences of SCI. Future research will determine whether these physiological adaptations actually translate to a long-term reduction in disease and mortality.
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Affiliation(s)
- David S Ditor
- Department of Physical Education and Kinesiology, Brock University, Canada.
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Ditor DS, John S, Cakiroglu J, Kittmer C, Foster PJ, Weaver LC. Magnetic resonance imaging versus histological assessment for estimation of lesion volume after experimental spinal cord injury. J Neurosurg Spine 2008; 9:301-6. [DOI: 10.3171/spi/2008/9/9/301] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The purpose of this study was to compare measures of lesion volume obtained by means of 1.5-T MR imaging to those obtained by the Cavalieri method, 6 weeks after experimental spinal cord injury.
Methods
Nine male Wistar rats were subjected to spinal cord injury by clip compression (50 g) at the T-4 level. Six weeks postinjury, the rats were sacrificed, and spinal cords were analyzed ex vivo for lesion volume by means of 1.5-T MR imaging and subsequently, by the Cavalieri method. In the latter method, cords were cut longitudinally in 25-μm sections and stained with solochrome cyanin for myelin. The area of the lesion was determined for each serial section, and the distance-weighted sum of all area measures was then calculated to estimate the total lesion volume.
Results
Bland–Altman analysis showed that the 2 methods had an acceptable level of agreement for lesion volume estimation, but the Cavalieri method was prone to an overestimation bias. The MR imaging estimates of lesion volume were greater than the Cavalieri method estimates in 3 spinal cords, but the difference between measures was within 1 standard deviation of perfect agreement in these 3 lesions, and the mean difference between measures was 18.3%. In contrast, in those lesions in which the Cavalieri method yielded larger lesion volumes (5 lesions), the difference between measures was 2 standard deviations away from perfect agreement for 2 animals and the mean difference between measures was 72.4%.
Conclusions
The results illustrate that the overestimation bias of the Cavalieri method is due, in part, to artifacts produced during processing of the spinal cord tissue.
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Affiliation(s)
- David S. Ditor
- 1Department of Physical Education and Kinesiology, Brock University, St. Catharines; and
| | - Sunil John
- 2Spinal Cord Injury Team, BioTherapeutics Research Group, Imaging Research Group, Robarts Research Institute, London, Ontario, Canada
| | - Jason Cakiroglu
- 2Spinal Cord Injury Team, BioTherapeutics Research Group, Imaging Research Group, Robarts Research Institute, London, Ontario, Canada
| | - Colin Kittmer
- 2Spinal Cord Injury Team, BioTherapeutics Research Group, Imaging Research Group, Robarts Research Institute, London, Ontario, Canada
| | - Paula J. Foster
- 2Spinal Cord Injury Team, BioTherapeutics Research Group, Imaging Research Group, Robarts Research Institute, London, Ontario, Canada
| | - Lynne C. Weaver
- 2Spinal Cord Injury Team, BioTherapeutics Research Group, Imaging Research Group, Robarts Research Institute, London, Ontario, Canada
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Ditor DS, John SM, Roy J, Marx JC, Kittmer C, Weaver LC. Effects of polyethylene glycol and magnesium sulfate administration on clinically relevant neurological outcomes after spinal cord injury in the rat. J Neurosci Res 2007; 85:1458-67. [PMID: 17410603 DOI: 10.1002/jnr.21283] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The purpose of this study was to determine the long-term effects of polyethylene glycol (PEG) and magnesium sulfate (MgSO(4)) on clinically relevant motor, sensory, and autonomic outcomes after spinal cord injury (SCI). Rats were injured by clip compression (50 g; T4) and treated 15 min and 6 hr postinjury intravenously (tail vein) with PEG (1 g/kg, 30% w/w in saline; n = 11), MgSO(4) (300 mg/kg; n = 5), PEG + MgSO(4) (n = 6), or saline (n = 10). Behavioral testing lasted for 6 weeks, followed by histological analysis of the spinal cord. Both PEG and MgSO(4) resulted in enhanced locomotor recovery and lower susceptibility to neuropathic pain (mechanical allodynia) compared with saline. At 6 weeks, BBB scores were 7.3 +/- 0.2, 7.7 +/- 0.4, and 6.4 +/- 0.6 in PEG-treated, MgSO(4)-treated, and saline-treated control groups, respectively. Likewise, at 6 weeks PEG-, MgSO(4)-, and saline-treated control animals showed 3.5 +/- 0.4, 2.8 +/- 0.9, and 5.0 +/- 0.5 avoidance responses to at-level touch, respectively. PEG + MgSO(4) improved locomotor recovery and reduced pain but did not provide additional benefit compared with either treatment alone. Neither treatment, nor their combination, attenuated mean arterial pressure (MAP) increases during autonomic dysreflexia. However, saline-treated controls had significantly lower resting MAP than PEG-treated rats and tended to have lower resting MAP than MgSO(4)-treated rats 6 weeks postinjury. MgSO(4) treatment and PEG + MgSO(4) treatment resulted in significant increases in dorsal myelin sparing, and the latter resulted in significant reductions in lesion volume, compared with saline-treated controls. Furthermore, mean lesion volumes correlated negatively with the corresponding mean BBB scores and positively with the corresponding mean pain scores. In conclusion, both PEG and MgSO(4) enhanced long-term clinical outcomes after SCI.
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Affiliation(s)
- David S Ditor
- Spinal Cord Injury Team, BioTherapeutics Research Group, Robarts Research Institute, London, Ontario, Canada.
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Ditor DS, Bao F, Chen Y, Dekaban GA, Weaver LC. A therapeutic time window for anti-CD 11d monoclonal antibody treatment yielding reduced secondary tissue damage and enhanced behavioral recovery following severe spinal cord injury. J Neurosurg Spine 2006; 5:343-52. [PMID: 17048772 DOI: 10.3171/spi.2006.5.4.343] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The purpose of this study was to investigate the therapeutic time window for antiinflammatory treatment within the first 24 hours of spinal cord injury (SCI). The authors have shown that an anti-CD11d antibody treatment attenuates leukocyte infiltration and improves neurological function when administered beginning 2 hours after SCI. A more clinically relevant time for the initiation of treatment after SCI, however, is 6 or more hours postinjury. METHODS In Study 1, the T-4 vertebrae in four groups of rats were injured by a 50-g clip-induced compression method, and the anti-CD11d antibody (1 mg/kg) was intravenously administered starting 2, 6, 12, or 24 hours postinjury. All groups received subsequent doses at 24 and 48 hours, and animals were killed at 72 hours. The anti-CD11d antibody treatment starting at 6 hours postinjury caused significant attenuation of leukocyte infiltration, reactive oxygen species-associated enzymes, and secondary tissue damage. Based on these findings, Study 2 included two groups of rats receiving the aforementioned injury and treatment beginning at 6 hours postinjury (with subsequent treatments at 24 and 48 hours) with the anti-CD11d or a control antibody (1B7); these rats were then observed for 5 weeks. Basso-Beattie-Bresnahan (BBB) scores were significantly higher in anti-CD11d-treated rats (mean BBB score 8.9 +/- 0.1) than controls (mean BBB score 7.7 +/- 0.1) 5 weeks postinjury. Increases in mean arterial pressure during colon distension were smaller in anti-CD11d-treated rats (19.5 +/- 3.7 mm Hg) than in controls (37.4 +/- 4.7 mm Hg). CONCLUSIONS These findings suggest that antiinflammatory treatments that reduce secondary tissue damage after SCI may be delayed until 6 hours postinjury and still be effective.
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Affiliation(s)
- David S Ditor
- Spinal Cord Injury Team, BioTherapeutics Research Group, Robarts Research Institute, London, Ontario, Canada.
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Adams MM, Ditor DS, Tarnopolsky MA, Phillips SM, McCartney N, Hicks AL. The effect of body weight-supported treadmill training on muscle morphology in an individual with chronic, motor-complete spinal cord injury: A case study. J Spinal Cord Med 2006; 29:167-71. [PMID: 16739562 PMCID: PMC1864805 DOI: 10.1080/10790268.2006.11753860] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE The purpose of this pilot study was to examine the effects of 4 months of thrice-weekly body weight-supported treadmill training (BWSTT) on skeletal muscle morphology in a woman (age 27 y) with chronic, motor-complete (ASIA B) spinal cord injury (SCI). METHODS The participant performed passive thrice-weekly BWSTT for 4 months (48 total sessions) with manual assistance from therapists. Muscle biopsies of the vastus lateralis were taken prior to the beginning of the training program as well as following the completion of 4 months of training. Histochemical analysis was utilized to evaluate changes in muscle fiber size and type following training. RESULTS At baseline, vastus lateralis muscle biopsies showed evidence of fiber atrophy and fiber type redistribution typical of persons with SCI, with mean fiber areas (and % distributions) of type I, type IIa and type IIx fibers being 3474 microm2 (1.3%), 3146 microm2 (30.8%) and 1284 microm2 (68.0%), respectively. Following training, there were increases in treadmill walking speed (pre: 1.0km/h; post: 2.5km/h) and distance walked/session (pre: 500m; post: 1875m). Vastus lateralis mean fiber area increased by 27.1% and type I fiber % distribution increased to 24.6%, whereas type IIa and type IIx fiber % distributions both decreased following training. CONCLUSION These data indicate that 4 months of thrice-weekly BWSTT improved muscle morphology in an individual with chronic, motor-complete SCI.
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Affiliation(s)
- Melanie M Adams
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada.
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Ditor DS, Kamath MV, Macdonald MJ, Bugaresti J, McCartney N, Hicks AL. Reproducibility of heart rate variability and blood pressure variability in individuals with spinal cord injury. Clin Auton Res 2005; 15:387-93. [PMID: 16362541 DOI: 10.1007/s10286-005-0293-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2004] [Accepted: 05/03/2005] [Indexed: 10/25/2022]
Abstract
Individuals with spinal cord injury (SCI) are prone to orthostatic intolerance and an increased risk of cardiovascular disease. The use of heart rate variability (HRV) and blood pressure variability (BPV) as indices of cardiovascular regulation would be valuable in this population; however, their reproducibility has yet to be tested in those with SCI. The purpose of this study was to examine the day-to-day reproducibility of resting HRV and BPV in individuals with SCI. Ten individuals (age 35.9 +/- 13.2 yrs) with chronic (5.4 +/- 7.7 years post injury) SCI (C4-T12; ASIA A-C) participated. On two occasions within a two-week period, 10-minute supine electrocardiogram and Finapres blood pressure recordings were obtained during spontaneous breathing. Computer software calculated frequency domain measures of HRV and BPV (Low frequency (LF) power, High frequency (HF) power, and LF:HF ratio). Intraclass correlations coefficients (R) were used as an index of day-to-day reproducibility, and analyses were conducted on all participants and only those with tetraplegia. For HRV, measures of heart rate, LF, and LF:HF were found to be highly reproducible (R = 0.82-0.88); however, the reproducibility of HF was found to be poor (all participants: R = 0.53, tetraplegia: R = 0.66). Measures of blood pressure as well as systolic BPV also showed high reproducibility (R = 0.72-0.93). Measures of diastolic BPV were less reproducible but still acceptable (R = 0.71-0.89) with the exception of LF:HF(DBP) (R = 0.51). In conclusion, despite the autonomic dysfunction associated with SCI, measures of HRV and BPV may still be used as reproducible indices of autonomic cardiovascular regulation in this population.
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Affiliation(s)
- David S Ditor
- Dept. of Kinesiology, McMaster University, Hamilton (OT), Canada.
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Ditor DS, Macdonald MJ, Kamath MV, Bugaresti J, Adams M, McCartney N, Hicks AL. The effects of body-weight supported treadmill training on cardiovascular regulation in individuals with motor-complete SCI. Spinal Cord 2005; 43:664-73. [PMID: 15968298 DOI: 10.1038/sj.sc.3101785] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Four-month longitudinal within-subject exercise training study. OBJECTIVE Although body-weight supported treadmill training (BWSTT) has not shown promise as a means of improving ambulation in individuals with motor-complete spinal cord injury (SCI), it may still improve cardiovascular health and function in this population. The purpose of this study was to (i) investigate the effects of BWSTT on peripheral muscular and elastic artery dimension and function and measures of heart rate variability (HRV) and blood pressure variability (BPV) in individuals with motor-complete SCI, and (ii) to make a preliminary examination of what factors may predict favourable cardiovascular outcomes following BWSTT in this population. SETTING Centre for Health Promotion and Rehabilitation, McMaster University, Hamilton, Ontario, Canada. METHODS Six individuals (four male, two female; age 37.7+/-15.4 years) with chronic SCI (C4-T12; ASIA A-B; 7.6+/-9.4 years post-injury) were included in the present investigation. Doppler ultrasound was used to determine femoral (exercising; muscular), carotid (elastic) and brachial (non-exercising control; muscular) artery dimension and function before and after 4 months of BWSTT. Continuous heart rate and blood pressure were also recorded before and after 4-months of BWSTT to determine frequency domain measures of HRV and BPV; clinically valuable indices of neurocardiac and neurovascular control, respectively. RESULTS Two-way ANOVA (vessel x time) revealed no exercise-induced change in femoral or carotid artery cross-sectional area, blood flow or resistance and no change in carotid artery compliance following the 4 months of BWSTT compared to the non-exercising control brachial artery. However, there was a significant exercise-induced increase in femoral artery compliance. There were no exercise-induced changes in HRV or BPV when all participants were considered together. However, the results suggest that the subgroup of individuals who had a substantial heart rate response to BWSTT (n=3), experienced exercise-training induced changes in HRV reflective of a relative shift toward cardiac vagal predominance and reductions in BPV. CONCLUSIONS BWSTT may cause an increase in femoral artery compliance in individuals with motor-complete SCI and therefore, should be encouraged as a means of improving cardiovascular health in this population. BWSTT may also cause modest improvements in measures of HRV and BPV in a select subgroup of individuals who respond to ambulation with moderate to large increases in HR. In the present study, factors associated with a substantial HR response to BWSTT were a propensity to orthostatic intolerance and muscular spasticity.
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Affiliation(s)
- D S Ditor
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
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Ditor DS, Kamath MV, MacDonald MJ, Bugaresti J, McCartney N, Hicks AL. Effects of body weight-supported treadmill training on heart rate variability and blood pressure variability in individuals with spinal cord injury. J Appl Physiol (1985) 2005; 98:1519-25. [PMID: 15563629 DOI: 10.1152/japplphysiol.01004.2004] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Individuals with spinal cord injury are prone to cardiovascular dysfunction and an increased risk of cardiovascular disease. Body weight-supported treadmill training (BWSTT) may enhance ambulation in individuals with incomplete spinal cord injury; however, its effects on cardiovascular regulation have not been investigated. The purpose of this study was to examine the effects of 6-mo of BWSTT on the autonomic regulation of heart rate (HR) and blood pressure (BP) in individuals with incomplete tetraplegia. Eight individuals [age 27.6 yr (SD 5.2)] with spinal cord injury [C4–C5; American Spinal Injury Association B-C; 9.6 yr (SD 7.5) postinjury] participated. Ten-minute HR and finger arterial pressure (Finapres) recordings were collected during 1) supine rest and 2) an orthostatic stress (60° head-up tilt) before and after 6 mo of BWSTT. Frequency domain measures of HR variability [low-frequency (LF) power, high-frequency (HF) power, and LF-to-HF ratio] and BP variability (systolic and diastolic LF power) were used as clinically valuable indexes of neurocardiac and neurovascular control, respectively. There was a significant reduction in HR [61.9 (SD 6.9) vs. 55.7 beats/min (SD 7.7); P = 0.05] and LF-to-HF ratio [1.23 (SD 0.47) vs. 0.99 (SD 0.40); P < 0.05] after BWSTT. There was a significant reduction in LF systolic BP [183.1 (SD 46.8) vs. 158.4 mmHg2 (SD 45.2); P < 0.01] but no change in BP. There were no significant effects of training on HR variability or BP variability during 60° head-up tilt. In conclusion, individuals with incomplete tetraplegia retain the ability to make positive changes in cardiovascular autonomic regulation with BWSTT without worsening orthostatic intolerance.
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Affiliation(s)
- David S Ditor
- Dept. of Kinesiology, McMaster Univ., 1280 Main St. West, Hamilton, Ontario, Canada L8S 4K1.
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Abstract
Sex differences in fatigue resistance of the adductor pollicis (AP) muscle were studied in 24 older adults who were divided into three groups: 12 older men (69.8 +/- 4.60 years), 6 older women not on hormone replacement therapy (HRT) (70.2 +/- 4.02 years), and 6 older women on HRT (68.7 +/- 6.47 years). Fatigue in the AP muscle was induced using an intermittent (5 s contraction, 5 s rest) submaximal voluntary contraction (50% of maximal voluntary contraction (MVC)) protocol, which was continued until exhaustion (i.e., when subjects could either no longer maintain a 5-s contraction at 50% MVC or when the MVC was deemed to be lower than the target force). There was no effect of HRT on MVC or time to fatigue (TTF); therefore, the older women were pooled as one subject group. At baseline, men were stronger than women for MVC (75.9 +/- 18.8 N in men vs. 56.8 +/- 10.0 N in women; P < 0.05) and evoked twitch force (7.3 +/- 1.7 N in men vs. 5.2 +/- 0.8 N in women; P < 0.05). There was no difference in TTF between men and women (14.77 +/- 7.06 min in men vs. 11.53 +/- 4.91 min in women; P > 0.20), nor was there a significant relationship between baseline muscle force and TTF (r = 0.14). There was also no difference in the pattern of fatigue and recovery between the men and women. These results suggest that there is no difference in endurance or fatigue characteristics of the AP muscle in men and women over the age of 65 years, and that baseline muscle force does not predict fatigue resistance in this muscle.
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Affiliation(s)
- Arthur Cheng
- Department of Kinesiology, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
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Ditor DS, Latimer AE, Ginis KAM, Arbour KP, McCartney N, Hicks AL. Maintenance of exercise participation in individuals with spinal cord injury: effects on quality of life, stress and pain. Spinal Cord 2003; 41:446-50. [PMID: 12883542 DOI: 10.1038/sj.sc.3101487] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Follow-up study of seven individuals with spinal cord injury (SCI) who completed a 9-month randomized control trial (RCT) of exercise training. OBJECTIVE In a 9-month RCT conducted in our lab, individuals with SCI who participated in a twice-weekly supervised exercise training reported greater perceived quality of life (PQOL), and less stress and pain than a nonexercising control cohort. The present follow-up study examined the voluntary continuation of exercise training after the study ended and the persistence of the accrued psychosocial benefits. SETTING Centre for Health Promotion and Rehabilitation, McMaster University, Hamilton, Ontario, Canada. METHODS Five men and two women (age 42.3+/-3.6 years) with SCI (C5-T12; ASIA A-D 12.7+/-8.2 years postinjury) were invited to continue supervised exercise training twice weekly at the completion of the 9-month RCT. Exercise adherence, PQOL, stress and bodily pain were measured at a 3-month follow-up and were compared to values obtained at baseline, and at 3, 6 and 9 months during the intervention. RESULTS There was a significant decrease in adherence at the 3-month follow-up compared to the overall 9-month adherence rate (42.7 versus 80.6%, respectively; P<0.01). There was also a significant decrease in PQOL (P<0.05) and a trend for increased pain (P=0.07) and stress (P=0.12), at follow-up compared to the end of the 9-month trial. Finally, there was a significant negative correlation between pain at the conclusion of the RCT and exercise adherence over the 3-month follow-up period (r=-0.91; P<0.01). CONCLUSIONS These findings emphasize the importance of continued exercise adherence to the maintenance of exercise-related increases in psychological well-being among individuals with SCI.
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Affiliation(s)
- D S Ditor
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
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Ginis KAM, Latimer AE, McKechnie K, Ditor DS, McCartney N, Hicks AL, Bugaresti J, Craven BC. Using exercise to enhance subjective well-being among people with spinal cord injury: The mediating influences of stress and pain. Rehabil Psychol 2003. [DOI: 10.1037/0090-5550.48.3.157] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ditor DS, Hamilton S, Tarnopolsky MA, Green HJ, Craven BC, Parise G, Hicks AL. Na+,K+-ATPase concentration and fiber type distribution after spinal cord injury. Muscle Nerve 2003; 29:38-45. [PMID: 14694496 DOI: 10.1002/mus.10534] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Complete spinal cord injury (SCI) is characterized, in part, by reduced fatigue-resistance of the paralyzed skeletal muscle during stimulated contractions, but the underlying mechanisms are not fully understood. The effects of complete SCI on skeletal muscle Na(+),K(+)-adenosine triphosphatase (ATPase) concentration, and fiber type distribution were therefore investigated. Six individuals (aged 32.0 +/- 5.3 years) with complete paraplegia (T4-T10; 1-19 years since injury) participated. There was a significantly lower Na(+),K(+)-ATPase concentration in the paralyzed vastus lateralis (VL) when compared to either the subjects' own unaffected deltoid or literature values (from our laboratory, utilizing the same methodology) of VL Na(+),K(+)-ATPase concentration for the healthy able-bodied (141.6 +/- 50.0, 213.4 +/- 23.9, 339 +/- 16 pmol/g wet wt., respectively; P < 0.05). There was also a significant negative correlation between the Na(+),K(+)-ATPase concentration in the paralyzed VL and years since injury (r = -0.75, P < 0.05). These findings are clinically relevant as they suggest that reductions in Na(+),K(+)-ATPase contribute to the fatigability of paralyzed muscle after SCI. Unexpectedly, the VL muscles of our subjects had a higher proportion of their area represented by type I fibers compared to literature values for the VL of the healthy able-bodied (52.6 +/- 25.3% vs. 36 +/- 11.3%, respectively; P < 0.05). As all our subjects had upper motor neuron injuries and, therefore, experienced muscle spasticity, our findings warrant further investigation into the relationship between muscle spasticity and fiber type expression after SCI.
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Affiliation(s)
- D S Ditor
- Department of Kinesiology, McMaster University, 1280 Main St. West, Hamilton, Ontario L8S 4K1, Canada
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Hicks AL, Martin KA, Ditor DS, Latimer AE, Craven C, Bugaresti J, McCartney N. Long-term exercise training in persons with spinal cord injury: effects on strength, arm ergometry performance and psychological well-being. Spinal Cord 2003; 41:34-43. [PMID: 12494319 DOI: 10.1038/sj.sc.3101389] [Citation(s) in RCA: 312] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Randomized controlled trial of exercise training in persons with spinal cord injury. OBJECTIVE The purpose of this study was to examine the effects of 9 months of twice-weekly exercise training on strength, arm ergometry performance, and indices of psychological well-being and quality of life. SETTING Centre for Health Promotion and Rehabilitation, McMaster University, Hamilton, Ontario, Canada. METHODS Thirty-four men and women (aged 19-65 years) with traumatic spinal cord injury (C4-L1; ASIA A-D) of 1-24 years duration volunteered to participate, and were randomized into exercise (EX; n=21) and control (CON; n=13) groups. Twenty-three subjects (11 EX; 12 CON) successfully completed the 9-month study. Subjects were assessed for one repetition maximum (1RM) strength, arm ergometry performance, and several indices of quality of life and psychological well-being at baseline, 3, 6, and 9 months. RESULTS At baseline, there were no significant differences between groups in age, submaximal arm ergometry performance, muscle strength, or psychological well-being. Following training, the EX group had significant increases in submaximal arm ergometry power output (81%; P<0.05), and significant increases in upper body muscle strength (19-34%; P<0.05); no significant changes occurred in CON. Participants in EX reported significantly less pain, stress and depression after training, and scored higher than CON in indices of satisfaction with physical function, level of perceived health and overall quality of life (P<0.05). Exercise adherence (per cent of prescribed sessions attended) in those subjects who completed the 9 months of training was 82.5%. CONCLUSIONS These results demonstrate that long-term twice-weekly exercise training in this population is feasible, and results in significant gains in both physical and psychological well-being.
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Affiliation(s)
- A L Hicks
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
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