Effects of Exercise in People With Tetraplegia
Condition: Spinal Cord Injury; Tetraplegia
MeSH terms: Spinal Cord Injuries; Quadriplegia
Study type: Interventional

Summary: 
      This study is designed to assess the impact of exercise and supplementation on measures of
      fitness, function, and cardiovascular disease risk factors/modifiers in individuals with
      spinal cord injury (SCI). The primary purpose of this study is to improve fitness and
      function, reduce cardiovascular disease risks, and enhance oxidation of dietary and body fats
      in persons with chronic tetraplegia through acute exercise, exercise conditioning, and
      dietary supplementation. This study will test the hypothesis that timing of supplementation
      with regards to exercise bout ('intervention/placebo') affects fitness, function, lipid
      profiles, lipid oxidation, and inflammatory markers after acute exercise and chronic
      conditioning.
    

Detailed description: 
      Much as in the general population, cardiovascular disease (CVD) is a leading cause of death
      in persons with spinal cord injury. However, CVD occurs earlier in life for those with SCI,
      progresses silently, and manifests atypical symptoms which fail to warn of impending ischemic
      damage. This accelerated development of CVD is multimodal in cause, including, but not
      limited to: a sedentary lifestyle, decreased muscle mass, increased fat mass, and physiologic
      alterations in lipid metabolism, all attributable in part to SCI. Traditional methods of
      dietary modification and exercise intervention are likely insufficient to elicit adequate
      modification of post-SCI physiology to prevent CVD. Secondary to our purposes, but of
      immediate importance to an individual with SCI is the impact of a sedentary lifestyle and
      increased obesity on their ability to remain independent. A quarter of young persons with SCI
      possess levels of fitness which are inadequate to complete essential activities of daily
      living. Thus, a sedentary lifestyle, as measured by fitness, is a correlate if not perceptive
      of morbidity and mortality in persons with SCI.

      Atherosclerosis has recently been defined as an inflammatory disease. C-reactive protein has
      emerged as a general marker of inflammation and is elevated in persons with SCI. We have
      demonstrated persons with SCI have a pathophysiologic lipid uptake response to a high fat
      meal, the endpoint of which is increased vascular oxidative stress, a precursor to CVD,
      indexed by endothelial microparticles. We have also demonstrated circuit resistance training
      favorably alters lipid profiles of persons with paraplegia. Research in able-bodied
      individuals suggests acute bouts of exercise accelerate postprandial lipid metabolism (PPL).
      Post-exercise supplementation has been demonstrated to improve gains in both lean muscle mass
      and performance over exercise alone in both the able-bodied and individuals with spinal cord
      injury.

      Targeting inflammation, post-prandial lipidemia, and altering lipid profiles through dietary
      and exercise interventions may be a method to reverse or pre-empt the development of CVD in
      persons with SCI. Increasing muscle mass and physical performance through the same
      interventions may improve physical performance and thus independence in activities of daily
      living in persons with SCI. In addition, exercise may serve to decrease depression and
      anxiety in persons with SCI, much as in non-disabled persons. Targeted exercise plus timed
      supplementation may decrease the accelerated morbidity and mortality of persons with SCI.
    

Intervention name(s): Circuit Resistance Training (CRT)
Intervention type(s): Other
Intervention description(s): CRT will occur 3 times per week for 26 weeks. Each session will last approximately 40-45 minutes and employ resistance training (weight lifting) and endurance activities (reciprocal arm exercise, Vita-Glide®, RehaMed International) with interposed periods of incomplete recovery (i.e., heart rate not falling to baseline).
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: cardiovascular risk; exercise; post-exercise diet supplementation