Physical activity is associated with improved subclinical atherosclerosis in spinal cord injury subjects independent of variation in traditional risk factors

Introduction: Physical activity is presumed to improve cardiovascular disease (CVD), of which carotid artery intima-media thickness (CIMT) is a common indicator. Individuals with spinal cord injury (SCI) have limited mobility and therefore an expected increased risk for CVD. The purpose of this study was to determine which CVD risk factors predict CIMT among women with SCI, with the ultimate goal of targeting therapy to improve CVD in this population. Methods: One hundred twenty-two women with SCI who attended an outpatient SCI clinic and met inclusion and exclusion criteria participated in this study. SCI was categorized into 1 of 4 categories: complete tetraplegia, incomplete tetraplegia, complete paraplegia, and incomplete paraplegia. Maximum heart rate and VO2 max were obtained using bicycle ergometry with ventilatory gas exchange and continuous electrocardiogram. Hierarchical regression was used to predict CIMT, with the first block including demographic variables (age, race, smoking status) and the second block including physiologic variables (total cholesterol, heart rate, VO2 max, BMI, fasting serum glucose, hemoglobin A1c, and blood pressure). Results: Similar findings were observed for left and right CIMT, therefore only results from right CIMT are reported. The overall model was significant, F(16,46)=8.53, p=.000. Adjusted R square was .54 for the first block of variables and increased significantly (p=.006) to .66 when the second block of variables was added. Significant predictors at alpha=.05 included age (beta=.51, t=4.79, p=.000) and max/peak heart rate (beta=−.336, t=−2.39, p=.02). At alpha=.10, A1c was significant (beta=.187, t=1.99, p=.053). Conclusions: Although low aerobic conditioning is a purported CVD risk factor, quantitative measurements of such lack a demonstrable relationship with subclinical atherosclerosis (CIMT), perhaps because of its reduced importance relative to other CVD risk factors in a mobile population. We found expected relationships with CIMT in our SCI population (i.e., age), however we also found a quantitative measure of aerobic conditioning (max/peak heart rate) to be associated with CIMT. Our data indicate that SCI individuals may bear a greater CVD burden from cardiac de-conditioning than the general population and that investigation of a cohort with mobility limitation may provide a unique opportunity to study the impact of physical conditioning on CVD risk.

Download Full-text

Greater daily leisure time physical activity is associated with lower chronic disease risk in adults with spinal cord injury

Applied Physiology Nutrition and Metabolism ◽

10.1139/h09-050 ◽

2009 ◽

Vol 34 (4) ◽

pp. 640-647 ◽

Cited By ~ 88

Author(s):

Andrea C. Buchholz ◽

Kathleen A. Martin Ginis ◽

Steven R. Bray ◽

B. Catharine Craven ◽

Audrey L. Hicks ◽

...

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Blood Pressure ◽

Type 2 Diabetes ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Leisure Time ◽

Leisure Time Physical Activity ◽

Cord Injury

The objective of this study was to examine the relationship between leisure time physical activity (LTPA) and common risk factors for cardiovascular disease (CVD) and type 2 diabetes in community-dwelling adults with chronic spinal cord injury (SCI). LTPA was measured using the Physical Activity Recall Assessment for People with SCI in 76 men and women with chronic (≥1 year) paraplegia or tetraplegia, living in or near Hamilton, Ontario. Body mass index (BMI), waist circumference, body composition (fat mass (FM) and fat-free mass (FFM)), blood pressure, and biochemical data were collected. Thirty-seven percent (n = 28 participants) were inactive, reporting no LTPA whatsoever, and were compared with an equal-sized group consisting of the most active study participants (≥25 min of LTPA per day). After adjusting for significant covariates, BMI (18.7%), %FM (19.4%), and C-reactive protein (143%) were all lower, and %FFM was higher (7.2%), in active participants (all p ≤ 0.05). Ten percent of active participants vs. 33% of inactive participants were insulin resistant (p = 0.03). Waist circumference (17.6%) and systolic blood pressure (15.3%) were lower in active vs. inactive participants with paraplegia (both p ≤ 0.05), but not tetraplegia. In conclusion, greater daily LTPA is associated with lower levels of selected CVD and type 2 diabetes risk factors in individuals living with SCI. Whether this relationship translates into a lower incidence of these chronic diseases has yet to be determined.

Download Full-text

Health promotion and cardiovascular risk reduction in people with spinal cord injury: physical activity, healthy diet and maintenance after discharge— protocol for a prospective national cohort study and a preintervention- postintervention study

BMJ Open ◽

10.1136/bmjopen-2019-030310 ◽

2019 ◽

Vol 9 (12) ◽

pp. e030310 ◽

Cited By ~ 2

Author(s):

Nicolaj Jersild Holm ◽

Tom Møller ◽

Lis Adamsen ◽

Line Trine Dalsgaard ◽

Fin Biering-Sorensen ◽

...

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Cohort Study ◽

Cardiovascular Risk ◽

Primary Study ◽

Cord Injury ◽

National Cohort ◽

Test Retest Reliability

IntroductionSpinal cord injury (SCI) predisposes those who suffer from it to physical inactivity and weight gain; consequently, death due to cardiovascular diseases is more frequent among people with SCI than in the general population. The literature documents a consensus about an interdisciplinary multimodal approach for the prevention and treatment of cardiovascular risk factors including overweight and obesity in people with SCI, focusing on diet, physical activity (PA) and behavioural interventions. This study will investigate implementation of recommendations from a recent clinical practice guideline for identification and management of cardiometabolic risk after SCI through multimodal patient education in a subacute clinical setting.Methods and analysisAll patients who are aged 18 years or older with an SCI within the previous 12 months and admitted to highly specialised rehabilitation are included, regardless of SCI aetiology or neurological level. A primary study designed as a controlled, pragmatic, preintervention- postintervention study with 6-month follow-up evaluates the effect of the clinical intervention; a prospective national cohort study on body mass index (BMI) serves as a historical control. The intervention consists of a standardised approach to patient education about cardiovascular risk factors, PA and a healthy diet that begins at the outset of primary SCI rehabilitation and is integrated into existing settings and workflows. Outcome measures are collected at admission, discharge and 6 months after discharge and include peak oxygen uptake (VO2peak) (primary outcome), BMI, body composition, metabolic profile, neurological status, level of functioning, depression, quality of life, objective PA (accelerometry), self-reported PA, self-assessed PA ability, shared decision making, and dietary habits. Test–retest reliability of four VO2peak test protocols are investigated, as is test–retest reliability of a multisensor accelerometer in a rehabilitation setting.Ethics and disseminationThe project is approved by the Committees on Health Research Ethics in the Capital Region of Denmark on 10 July 2018 (Journal-nr.: H-18018325). The principal investigator obtains informed consent from all participants. The interventions in the project are closely related to existing rehabilitation care, and the risk of pain and discomfort is considered modest. Any unintended events related to the elements of the intervention are reported, according to existing regional procedures. Data are stored in a secure web-based database (Redcap). The primary study and prospective cohort study are registered at Clinicaltrials.gov. Positive and negative results will be submitted to relevant scientific journals related to SCI for publication. Important protocol modifications are reported to the Committees on Health Research Ethics in the Capital Region of Denmark.Trial registration numbersNCT03689023 and NCT03369080.

Download Full-text

Associations between leisure time physical activity and cardiovascular risk factors among older adults with long-term spinal cord injury

Spinal Cord ◽

10.1038/s41393-018-0233-5 ◽

2019 ◽

Vol 57 (5) ◽

pp. 427-433 ◽

Cited By ~ 1

Author(s):

Sophie Jörgensen ◽

Stina Svedevall ◽

Linnea Magnusson ◽

Kathleen A. Martin Ginis ◽

Jan Lexell

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Older Adults ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Cardiovascular Risk ◽

Leisure Time ◽

Leisure Time Physical Activity ◽

Cord Injury

Download Full-text

Supplemental Material for Examining Physical Activity Trajectories for People With Spinal Cord Injury

Health Psychology ◽

10.1037/a0027795.supp ◽

2012 ◽

Keyword(s):

Physical Activity ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Cord Injury

Download Full-text

Development of Predictive Informatics Tool Using Electronic Health Records to Inform Personalized Evidence-Based Pressure Injury Management for Veterans with Spinal Cord Injury

Military Medicine ◽

10.1093/milmed/usaa469 ◽

2021 ◽

Vol 186 (Supplement_1) ◽

pp. 651-658

Author(s):

Kath M Bogie ◽

Steven K Roggenkamp ◽

Ningzhou Zeng ◽

Jacinta M Seton ◽

Katelyn R Schwartz ◽

...

Keyword(s):

Risk Factors ◽

Health Care ◽

Spinal Cord ◽

Spinal Cord Injury ◽

User Interface ◽

Veterans Health Administration ◽

Study Cohort ◽

Veterans Health ◽

Health Administration ◽

Cord Injury

ABSTRACT Background Pressure injuries (PrI) are serious complications for many with spinal cord injury (SCI), significantly burdening health care systems, in particular the Veterans Health Administration. Clinical practice guidelines (CPG) provide recommendations. However, many risk factors span multiple domains. Effective prioritization of CPG recommendations has been identified as a need. Bioinformatics facilitates clinical decision support for complex challenges. The Veteran’s Administration Informatics and Computing Infrastructure provides access to electronic health record (EHR) data for all Veterans Health Administration health care encounters. The overall study objective was to expand our prototype structural model of environmental, social, and clinical factors and develop the foundation for resource which will provide weighted systemic insight into PrI risk in veterans with SCI. Methods The SCI PrI Resource (SCI-PIR) includes three integrated modules: (1) the SCIPUDSphere multidomain database of veterans’ EHR data extracted from October 2010 to September 2015 for ICD-9-CM coding consistency together with tissue health profiles, (2) the Spinal Cord Injury Pressure Ulcer and Deep Tissue Injury Ontology (SCIPUDO) developed from the cohort’s free text clinical note (Text Integration Utility) notes, and (3) the clinical user interface for direct SCI-PIR query. Results The SCI-PIR contains relevant EHR data for a study cohort of 36,626 veterans with SCI, representing 10% to 14% of the U.S. population with SCI. Extracted datasets include SCI diagnostics, demographics, comorbidities, rurality, medications, and laboratory tests. Many terminology variations for non-coded input data were found. SCIPUDO facilitates robust information extraction from over six million Text Integration Utility notes annually for the study cohort. Visual widgets in the clinical user interface can be directly populated with SCIPUDO terms, allowing patient-specific query construction. Conclusion The SCI-PIR contains valuable clinical data based on CPG-identified risk factors, providing a basis for personalized PrI risk management following SCI. Understanding the relative impact of risk factors supports PrI management for veterans with SCI. Personalized interactive programs can enhance best practices by decreasing both initial PrI formation and readmission rates due to PrI recurrence for veterans with SCI.

Download Full-text