Ryan Solinsky1,2,3, Hannah Mercier1,2, Glen Picard1, J Andrew Taylor1,2,3. 1. Spaulding Rehabilitation Hospital, Boston, MA. 2. Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA. 3. Spaulding Research Institute, Boston, MA.
Abstract
INTRODUCTION: The prevalence of cardiometabolic disease following spinal cord injury is known to be high. However, it is unknown whether engaging in high-intensity exercise, which is advocated by recent guidelines, is beneficial or feasible for these individuals. OBJECTIVE: To assess the effects of high-intensity, whole-body exercise on the prevalence of cardiometabolic disease in individuals with spinal cord injury. DESIGN: Combination of a randomized controlled trial and an open label intervention study of functional electrical stimulation legs plus arms rowing. SETTING: Outpatient academic rehabilitation hospital. PARTICIPANTS: Forty individuals with spinal cord injury, with American Spinal Injury Association (ASIA) impairments scales A-D and neurological levels of injury C1-T12. INTERVENTION: Six months of high-intensity, hybrid-functional electrical stimulation rowing. MAIN OUTCOME MEASURES: Change in VO2max , serum lipids, and insulin resistance, prevalence of cardiometabolic disease. RESULTS: Individuals averaged 42.1 ± 22.0 minutes of hybrid-functional electrical stimulation rowing a week over an average of 1.69 sessions per week over the 6 months of intervention. This amounted to an average of 170.9 ± 100 km rowed, at a mean heart rate of 82.7% of individualized maximum. Only one of 40 individuals met current exercise guidelines for the full 6 months. VO2max increased significantly (P < .001), yet prevalence of cardiometabolic disease did not change significantly (decrease from 22.5% to 20%, P = .70). Hemoglobin A1c did decrease significantly over this time (P = .01), although serum lipids and fasting glucose/insulin levels were unchanged. In exploratory subanalyses assessing individuals injured ≤12 months, those with more chronic injuries decreased their triglyceride-to-high-density lipoprotein (HDL) ratio (P = .04), a marker of cardiac mortality. Stratifying by neurological level of injury, individuals with paraplegia had worsened low-density lipoprotein (LDL) level (P = .02) and total cholesterol-to-HDL ratio (P = .04) over the 6-month intervention. CONCLUSIONS: Sustained high-intensity exercise with hybrid functional electrical stimulation rowing does not decrease the prevalence of cardiometabolic disease after spinal cord injury.
INTRODUCTION: The prevalence of cardiometabolic disease following spinal cord injury is known to be high. However, it is unknown whether engaging in high-intensity exercise, which is advocated by recent guidelines, is beneficial or feasible for these individuals. OBJECTIVE: To assess the effects of high-intensity, whole-body exercise on the prevalence of cardiometabolic disease in individuals with spinal cord injury. DESIGN: Combination of a randomized controlled trial and an open label intervention study of functional electrical stimulation legs plus arms rowing. SETTING: Outpatient academic rehabilitation hospital. PARTICIPANTS: Forty individuals with spinal cord injury, with American Spinal Injury Association (ASIA) impairments scales A-D and neurological levels of injury C1-T12. INTERVENTION: Six months of high-intensity, hybrid-functional electrical stimulation rowing. MAIN OUTCOME MEASURES: Change in VO2max , serum lipids, and insulin resistance, prevalence of cardiometabolic disease. RESULTS: Individuals averaged 42.1 ± 22.0 minutes of hybrid-functional electrical stimulation rowing a week over an average of 1.69 sessions per week over the 6 months of intervention. This amounted to an average of 170.9 ± 100 km rowed, at a mean heart rate of 82.7% of individualized maximum. Only one of 40 individuals met current exercise guidelines for the full 6 months. VO2max increased significantly (P < .001), yet prevalence of cardiometabolic disease did not change significantly (decrease from 22.5% to 20%, P = .70). Hemoglobin A1c did decrease significantly over this time (P = .01), although serum lipids and fasting glucose/insulin levels were unchanged. In exploratory subanalyses assessing individuals injured ≤12 months, those with more chronic injuries decreased their triglyceride-to-high-density lipoprotein (HDL) ratio (P = .04), a marker of cardiac mortality. Stratifying by neurological level of injury, individuals with paraplegia had worsened low-density lipoprotein (LDL) level (P = .02) and total cholesterol-to-HDL ratio (P = .04) over the 6-month intervention. CONCLUSIONS: Sustained high-intensity exercise with hybrid functional electrical stimulation rowing does not decrease the prevalence of cardiometabolic disease after spinal cord injury.
Authors: Harald Edvard Molmen-Hansen; Tomas Stolen; Arnt Erik Tjonna; Inger Lise Aamot; Inga Schjerve Ekeberg; Gjertrud Aunet Tyldum; Ulrik Wisloff; Charlotte Bjork Ingul; Asbjorn Stoylen Journal: Eur J Prev Cardiol Date: 2011-03-04 Impact factor: 7.804
Authors: Inga E Schjerve; Gjertrud A Tyldum; Arnt E Tjønna; Tomas Stølen; Jan P Loennechen; Harald E M Hansen; Per M Haram; Garreth Heinrich; Anja Bye; Sonia M Najjar; Godfrey L Smith; Stig A Slørdahl; Ole J Kemi; Ulrik Wisløff Journal: Clin Sci (Lond) Date: 2008-11 Impact factor: 6.124