Effects of exercise on fitness and health of adults with spinal cord injury

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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Exercise Interventions Targeting Obesity in Persons With Spinal Cord Injury

Topics in Spinal Cord Injury Rehabilitation ◽

10.46292/sci20-00058 ◽

2021 ◽

Vol 27 (1) ◽

pp. 109-120 ◽

Cited By ~ 1

Author(s):

David W. McMillan ◽

Jennifer L. Maher ◽

Kevin A. Jacobs ◽

Mark S. Nash ◽

David R. Gater

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Therapeutic Potential ◽

Upper Body ◽

Obesity Management ◽

Common Component ◽

Exercise Interventions ◽

Cord Injury ◽

Muscle Groups ◽

Large Muscle

Spinal cord injury (SCI) results in an array of cardiometabolic complications, with obesity being the most common component risk of cardiometabolic disease (CMD) in this population. Recent Consortium for Spinal Cord Medicine Clinical Practice Guidelines for CMD in SCI recommend physical exercise as a primary treatment strategy for the management of CMD in SCI. However, the high prevalence of obesity in SCI and the pleiotropic nature of this body habitus warrant strategies for tailoring exercise to specifically target obesity. In general, exercise for obesity management should aim primarily to induce a negative energy balance and secondarily to increase the use of fat as a fuel source. In persons with SCI, reductions in the muscle mass that can be recruited during activity limit the capacity for exercise to induce a calorie deficit. Furthermore, the available musculature exhibits a decreased oxidative capacity, limiting the utilization of fat during exercise. These constraints must be considered when designing exercise interventions for obesity management in SCI. Certain forms of exercise have a greater therapeutic potential in this population partly due to impacts on metabolism during recovery from exercise and at rest. In this article, we propose that exercise for obesity in SCI should target large muscle groups and aim to induce hypertrophy to increase total energy expenditure response to training. Furthermore, although carbohydrate reliance will be high during activity, certain forms of exercise might induce meaningful postexercise shifts in the use of fat as a fuel. General activity in this population is important for many components of health, but low energy cost of daily activities and limitations in upper body volitional exercise mean that exercise interventions targeting utilization and hypertrophy of large muscle groups will likely be required for obesity management.

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The use of simple muscle strength tests to reflect body compositions among individuals with spinal cord injury

Spinal Cord ◽

10.1038/s41393-021-00650-4 ◽

2021 ◽

Author(s):

Arpassanan Wiyanad ◽

Pipatana Amatachaya ◽

Thanat Sooknuan ◽

Charoonsak Somboonporn ◽

Thiwabhorn Thaweewannakij ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Muscle Strength ◽

Cord Injury ◽

Strength Tests ◽

Body Compositions

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Pharmacological approaches for bone health in persons with spinal cord injury

Current Opinion in Pharmacology ◽

10.1016/j.coph.2021.07.024 ◽

2021 ◽

Vol 60 ◽

pp. 346-359

Author(s):

William A. Bauman

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Bone Health ◽

Cord Injury

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Scapular Stabilization and Muscle Strength in Manual Wheelchair Users with Spinal Cord Injury and Subacromial Impingement

Topics in Spinal Cord Injury Rehabilitation ◽

10.1310/sci2201-60 ◽

2016 ◽

Vol 22 (1) ◽

pp. 60-70 ◽

Cited By ~ 2

Author(s):

Susan R. Wilbanks ◽

C. Scott Bickel

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Muscle Strength ◽

Subacromial Impingement ◽

Wheelchair Users ◽

Manual Wheelchair ◽

Cord Injury

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Obstacles and Possibilities for Participation in Sport after Spinal Cord Injury

Baltic Journal of Sport and Health Sciences ◽

10.33607/bjshs.v1i88.150 ◽

2018 ◽

Vol 1 (88) ◽

Author(s):

Kęstutis Skučas

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Sport Participation ◽

Athletic Identity ◽

Body Part ◽

Disabled Persons ◽

Upper Body ◽

Motor Disorder ◽

Social Agents ◽

Cord Injury

Research background and hypothesis. Studies have shown that persons after spinal cord injury rarely continue participating in sport (Stryker, Burke, 2000; Hanson, Nabavi, 2001; Stephan, Brewer, 2007). This could be caused by the obstacles that the persons face due to the motor disorder after spinal cord injury (Wu, Williams, 2001; Tasiemski et al., 2004). Hypothesis: persons with spinal cord injury while being involved in disabled sport face the same problems irrespectively of gender. Research aim was to determine the obstacles and possibilities for involvement and participation in sport after spinal cord injury.Research methods. The questionnaire method was used to collect sport participation data (Tasiemski et al., 2004) and determine socialization agents of persons after spinal cord injury (Williams, 1994). The athletic identity assessment scale (Brewer, Cornelius, 2002) was used in the research. Research results. Data showed that the majority of the subjects after spinal cord injury were not involved in sport; 11.9% did sports 1 hour per week, 13.2% – 2–3 hours per week, 10.6% – more than 6 hours per week. The value of athletic identity of paraplegic subjects was equal to 23 points, and that of tetraplegic subjects – 18 points (statistically significant data difference between the two groups when p < 0.05). It was found that athletic identity value of men after spinal cord injury (22 points) was statistically significantly higher compared to that of women (16 points, p < 0.05). Lack of adapted sport facilities – 49.6%, equipment – 53.2%, coaches – 48.4% and financial resources – 42.0% proved to be the major obstacles to participate in sport for persons after spinal cord injury. Discussion and conclusions. According to the research, only a minority of persons after spinal cord injury identified themselves as athletes. It was found that the main social agents involving disabled persons into the mainstream of sport were other disabled persons, rehabilitation and physical therapists, coaches and other sports professionals. Persons after spinal cord injury believed that the main reasons of non-participation in sport was lack of information about disabled sport, also lack of sports equipment, financial problems and lack of sports professionals. Most persons after spinal cord injury participated or would participate in sport with the aim of getting fit, strengthening the upper body part, socializing, feeling the joy of life. The majority of results of the study were similar to the results of other researchers (Tasiemski et al., 2004) who analyzed disabled persons’ problems while involving in sport.Keywords: involvement in disabled sport, athletic identity, social agents.

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Segmental analysis in cervical spinal cord injury reveals the recovery potential of hand muscles with preserved corticospinal tract: Insights beyond impairment scales

10.1101/2021.11.30.21265051 ◽

2021 ◽

Author(s):

Gustavo Balbinot ◽

Guijin Li ◽

Sukhvinder Kalsi-Ryan ◽

Rainer Abel ◽

Doris Maier ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Muscle Strength ◽

Evoked Potentials ◽

Corticospinal Tract ◽

Cervical Spinal Cord ◽

Hand Muscles ◽

Recovery Potential ◽

Strength Recovery ◽

Cord Injury

Cervical spinal cord injury (SCI) severely impacts widespread bodily functions with extensive impairments for individuals, who prioritize regaining hand function. Although prior work has focused on the recovery at the person-level, the factors determining the recovery potential of individual muscles are poorly understood. There is a need for changing this paradigm in the field by moving beyond person-level classification of residual strength and sacral sparing to a muscle-specific analysis with a focus on the role of corticospinal tract (CST) sparing. The most striking part of human evolution involved the development of dextrous hand use with a respective expansion of the sensorimotor cortex controlling hand movements, which, because of the extensive CST projections, may constitute a drawback after SCI. Here, we investigated the muscle-specific natural recovery after cervical SCI in 748 patients from the European Multicenter Study about SCI (EMSCI), one of the largest datasets analysed to date. All participants were assessed within the first 4 weeks after SCI and re-assessed at 12, 24, and 48 weeks. Subsets of individuals underwent electrophysiological multimodal evaluations to discern CST and lower motor neuron (LMN) integrity [motor evoked potentials (MEP): N = 203; somatosensory evoked potentials (SSEP): N = 313; nerve conduction studies (NCS): N = 280]. We show the first evidence of the importance of CST sparing for proportional recovery in SCI, which is known in stroke survivors to represent the biological limits of structural and functional plasticity. In AIS D, baseline strength is a good predictor of segmental muscle strength recovery, while the proportionality in relation to baseline strength is lower for AIS B/C and breaks for AIS A. More severely impaired individuals showed non-linear and more variable recovery profiles, especially for hand muscles, while measures of CST sparing (by means of MEP) improved the prediction of hand muscle strength recovery. Therefore, assessment strategies for muscle-specific motor recovery in acute SCI improve by accounting for CST sparing and complement gross person-level predictions. The latter is of paramount importance for clinical trial outcomes and to target neurorehabilitation of upper limb function, where any single muscle function impacts the outcome of independence in cervical SCI.

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Effects of exercise interventions on cardiovascular health in individuals with chronic, motor complete spinal cord injury: protocol for a randomised controlled trial [Cardiovascular Health/Outcomes: Improvements Created by Exercise and education in SCI (CHOICES) Study]

BMJ Open ◽

10.1136/bmjopen-2018-023540 ◽

2019 ◽

Vol 9 (1) ◽

pp. e023540 ◽

Cited By ~ 7

Author(s):

Andrei V Krassioukov ◽

Katharine D Currie ◽

Michèle Hubli ◽

Tom E Nightingale ◽

Abdullah A Alrashidi ◽

...

Keyword(s):

Physical Activity ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Arterial Stiffness ◽

Outcome Measures ◽

Cardiovascular Health ◽

Secondary Outcome ◽

Exercise Interventions ◽

Cord Injury ◽

Randomised Controlled

IntroductionRecent studies demonstrate that cardiovascular diseases and associated complications are the leading cause of morbidity and mortality in individuals with spinal cord injury (SCI). Abnormal arterial stiffness, defined by a carotid–to-femoral pulse wave velocity (cfPWV) ≥10 m/s, is a recognised risk factor for heart disease in individuals with SCI. There is a paucity of studies assessing the efficacy of conventional training modalities on arterial stiffness and other cardiovascular outcomes in this population. Therefore, this study aims to compare the efficacy of arm cycle ergometry training (ACET) and body weight-supported treadmill training (BWSTT) on reducing arterial stiffness in individuals with chronic motor complete, high-level (above the sixth thoracic segment) SCI.Methods and analysisThis is a multicentre, randomised, controlled, clinical trial. Eligible participants will be randomly assigned (1:1) into either ACET or BWSTT groups. Sixty participants with chronic (>1 year) SCI will be recruited from three sites in Canada (Vancouver, Toronto and Hamilton). Participants in each group will exercise three times per week up to 30 min and 60 min for ACET and BWSTT, respectively, over the period of 6 months. The primary outcome measure will be change in arterial stiffness (cfPWV) from baseline. Secondary outcome measures will include comprehensive assessments of: (1) cardiovascular parameters, (2) autonomic function, (3) body composition, (4) blood haematological and metabolic profiles, (5) cardiorespiratory fitness and (6) quality of life (QOL) and physical activity outcomes. Outcome measures will be assessed at baseline, 3 months, 6 months and 12 months (only QOL and physical activity outcomes). Statistical analyses will apply linear-mixed modelling to determine the training (time), group (ACET vs BWSTT) and interaction (time × group) effects on all outcomes.Ethics and disseminationEthical approval was obtained from all three participating sites. Primary and secondary outcome data will be submitted for publication in peer-reviewed journals and widely disseminated.Trial registration numberNCT01718977; Pre-results.Trial statusRecruitment for this study began on January 2013 and the first participant was randomized on April 2013. Recruitment stopped on October 2018.

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