Energetic Response to Feeding and Exercise in SCI

Study Overview
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Brief Summary
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This study investigates the effect of various forms of upper extremity exercise on postprandial glycemia and lipemia in persons with spinal cord injury (SCI). Participants are measured at rest and fed a standardized meal following seated rest (CON), moderate intensity continuous arm cycling (MICT), high intensity interval arm cycling (HIIT), and circuit resistance exercise (CRT) matched for exercise energy expenditure.

Official Title
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Effect of Various Forms of Upper Body Exercise on the Energetic Response to a Meal in Persons With Spinal Cord Injury

Conditions
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Spinal Cord Injuries

Intervention / Treatment
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* Behavioral: Seated control (CON)
* Behavioral: Moderate intensity continuous (MICT)
* Behavioral: High intensity interval training (HIIT)
* Behavioral: Circuit resistance training (CRT)
* Other: Liquid Meal


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult (>/=18 years of age) Neurologically stable chronic (>/= 1year) spinal cord injury (SCI) American Spinal Injury Association Impairment Scale (AIS) grade A, B, or C SCI at level </= the first thoracic vertebrae (T1) Exclusion Criteria: Being of ≤ 18 years of age. Contraindication to exercise (ACSM Guideline, 10th edition) Lower extremity fracture or dislocation within 6 months of participation, History head injury or seizures. Inability to consent. Restrictions in upper extremity range of motion that would prevent an individual from achieving an unhindered arm cycling motion or moving throughout a range needed to perform resistance maneuvers. A pressure ulcer at ischial/gluteus, trochanteric, sacral, or heel sites within the last 3 months. Pregnancy determined by urine testing in sexually active females. Imprisonment in state or federal jail or prison.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Factorial Assignment
Interventional Model Description: Static first arm with randomized remaining three arms.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Seated control (CON)<br>Participants remain seated in their habitual wheel chair for  45 min (duration of exercise performed in other arms). Following the intervention they are fed. | Behavioral: Seated control (CON)<br>* Seated rest<br>Other: Liquid Meal<br>* A liquid meal consisting of 600 kcal comprised of 50% carbohydrate, 35% fat, and 15% protein (by kcal).<br>|
| Experimental: Circuit resistance training (CRT)<br>Participants complete upper extremity resistance maneuvers (lifts) interspersed with low-load/high-speed arm cycling for a combined 30 repetitions of 6 lifts and  20 min of arm cycling. During this time energy expenditure is measured via open-circuit indirect calorimetry. Following the intervention they are fed. | Behavioral: Circuit resistance training (CRT)<br>* Alternating between six upper extremity resistance maneuvers interspersed with low-resistance/high-speed arm cycling.<br>Other: Liquid Meal<br>* A liquid meal consisting of 600 kcal comprised of 50% carbohydrate, 35% fat, and 15% protein (by kcal).<br>|
| Experimental: Moderate intensity continuous (MICT)<br>Participants complete continous arm cycling at a steady-state power output (intensity) matched to the energy expenditure (kcal/min) and duration of exercise (min) response during CRT. Following the intervention they are fed. | Behavioral: Moderate intensity continuous (MICT)<br>* Arm cycling at a continuous power output<br>Other: Liquid Meal<br>* A liquid meal consisting of 600 kcal comprised of 50% carbohydrate, 35% fat, and 15% protein (by kcal).<br>|
| Experimental: High intensity interval training (HIIT)<br>Participants complete interval arm cycling at power output that varies between 2 min active and two min recovery periods. This interval exercise is matched to the total energy expenditure (accumulated kcals) response during CRT. Following the intervention they are fed. | Behavioral: High intensity interval training (HIIT)<br>* Arm cycling at power outputs that vary between high and low intensity intervals<br>Other: Liquid Meal<br>* A liquid meal consisting of 600 kcal comprised of 50% carbohydrate, 35% fat, and 15% protein (by kcal).<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Postprandial insulin sensitivity | Measured by insulin incremental area under the curve (iAUC). | 2.5 hr | 
| Postprandial insulin sensitivity | Measured by ISIMatsuada insulin sensitivity index. This index is calculated based on the ratio of blood glucose and insulin. | 2.5 hr | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Lipemia | Measured by blood concentrations of triglycerides. | 2.5 hr | 
| Carbohydrate use | Whole-body rates of carbohydrate oxidation, as determined by open-circuit indirect calorimetry. | 2.5 hr | 
| Fat use | Whole-body rates of fat oxidation, as determined by open-circuit indirect calorimetry. | 2.5 hr | 
| Fasted insulin sensitivity | Measured by HOMA-2 model. This model is calculated based on the ratio of blood glucose and insulin. | Baseline | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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glycemia, postprandial, lipemia, macronutrient metabolism, physical activity