Finding the Optimal Voluntary Exercise Parameters for Those Living With Quadriplegia
Condition: Metabolism; Obesity; Spinal Cord Injury
MeSH terms: Spinal Cord Injuries; Quadriplegia
Study type: Observational

Summary: 
      There are over 44,000 persons living with spinal cord injury (SCI) in Canada, who face
      substantial challenges in maintaining a healthy body composition after injury. As a result,
      obesity, diabetes and cardiovascular disease are prevalent in this population. Guidelines
      indicating that twice weekly 20-minute sessions of exercise (plus resistance training) will
      increase physical fitness in those with SCI have been recently published. However, no
      SCI-specific guidelines indicating the volume of exercise to reduce the risk of developing
      obesity-related diseases exist. Longitudinal studies indicate that a weekly exercise-related
      energy expenditure of 2000 - 2500 Calories is correlated with the least likelihood of
      cardiovascular disease in the able-bodied population. There is little information regarding
      energy expenditure (EE) for activities carried out by persons with SCI, with less available
      for persons with tetraplegia. Once known, this EE data can be used to develop exercise
      interventions to determine the volume of voluntary exercise required to reduce obesity and
      risk factors for diabetes and cardiovascular disease in those living with tetraplegia.
    

Detailed description: 
      In the absence of successful regeneration treatments to recover normal neurological function
      after spinal cord injury, there has been a needed focus on research aimed at preventing or
      minimizing the secondary complications of living with a spinal cord injury (SCI).
      Approximately 44,000 persons live with traumatic spinal cord injury in Canada, half of which
      have tetraplegia, with 35 new spinal cord injuries (SCI) per million each year. Persons with
      spinal cord injury SCI are among the most sedentary on the planet, with a much higher
      incidence of related diseases, such as obesity, glucose intolerance, diabetes and
      cardiovascular disease than the able-bodied population. At the same time, information needed
      to minimize the risk of developing these diseases for those living with spinal cord injury is
      lacking. For example, specific information regarding resting energy requirements, energy
      expenditure during exercise, and the volume of exercise required to maintain a healthy body
      composition and prevent the development of sedentary-related disease in this population is
      scarce.

      In order to maintain weight, and not gain excess body fat, energy intake in food Calories
      needs to match energy use. In addition to understanding energy use in order to maintain
      weight balance, exercise is also important for muscular and cardiovascular health. Research
      to date indicates that the resting energy expenditure of persons with SCI is considerably
      less than able-bodied persons with the same weight or body mass index. A considerable portion
      of this reduced resting energy expense is due to the reduced muscle mass after SCI. There are
      mixed research results regarding whether there are additional reductions in resting energy
      expenditure, after adjusting for fat free mass, in persons with SCI. Training has been shown
      to be effective in reducing shoulder pain, improving function, improving physical capacity,
      reducing hyperinsulinemia, and reducing dyslipidemia in persons with chronic paraplegia.

      However, it is less clear if voluntary exercise can have the same beneficial effects for
      those living with tetraplegia, in part because their peak power output is only one-third to
      one-half that achieved during arm exercise in those with paraplegia. In addition, it may be
      very difficult for those with tetraplegia to be able to exercise for a sufficient duration to
      achieve a sufficient training effect to either maintain a healthy body composition or reduce
      the risk of developing the sedentary diseases common to this population. This study will
      provide the exercise-related energy expenditure data to address this question.
    

Intervention name(s): exercise
Intervention type(s): Other
Intervention description(s): energy expenditure will be measured for each of the participants during different conditions, rest, during exercise with the arm crank height high or low. Energy expenditure will also be measured during exercise using different modes (arm ergometer, wheelchair and arm-bike). Results will be compared between rest and exercise and between individuals with SCI and able-bodied.
Observational model: Case-Control
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        Participants will consist of 7 persons living with tetraplegia in addition to 7 persons
        living with paraplegia to act as controls for study 1. Participants will have sustained a
        motor-complete spinal cord injury at least 6 months previous. Able-bodied participants are
        matched for age, height and weight.