The comparison of total energy and protein intake relative to estimated requirements in chronic spinal cord injury.

In chronic spinal cord injury (SCI), individuals experience dietary inadequacies complicated by an understudied research area. Our objectives were to assess (1) the agreement between methods of estimating energy requirement (EER) and estimated energy intake (EEI) and (2) whether dietary protein intake met SCI-specific protein guidelines. Persons with chronic SCI (n = 43) completed 3-day food records to assess EEI and dietary protein intake. EER was determined with the Long and Institute of Medicine (IOM) methods and the SCI-specific Farkas method. Protein requirements were calculated as 0·8-1·0 g/kg of body weight (BW)/d. Reporting accuracy and bias were calculated and correlated to body composition. Compared with IOM and Long methods (P < 0·05), the SCI-specific method did not overestimate the EEI (P = 0·200). Reporting accuracy and bias were best for SCI-specific (98·9 %, -1·12 %) compared with Long (94·8 %, -5·24 %) and IOM (64·1 %, -35·4 %) methods. BW (r = -0·403), BMI (r = -0·323) and total fat mass (r = -0·346) correlated with the IOM reporting bias (all, P < 0·05). BW correlated with the SCI-specific and Long reporting bias (r = -0·313, P = 0·041). Seven (16 %) participants met BW-specific protein guidelines. The regression of dietary protein intake on BW demonstrated no association between the variables (ß = 0·067, P = 0·730). In contrast, for every 1 kg increase in BW, the delta between total and required protein intake decreased by 0·833 g (P = 0·0001). The SCI-specific method for EER had the best agreement with the EEI. Protein intake decreased with increasing BW, contrary to protein requirements for chronic SCI.

Electrical stimulation and blood flow restriction increase wrist extensor cross-sectional area and flow meditated dilatation following spinal cord injury.

PURPOSE: To examine the effects of neuromuscular electrical stimulation (NMES) and blood flow restricted (BFR) exercise on wrist extensors cross-sectional area (CSA), torque and hand functions compared NMES only in individuals with incomplete tetraplegia. The acute effect of an acute bout of NMES with BFR on flow mediated dilation (FMD) was compared with BFR only. METHOD: Nine men completed 6 weeks twice weekly of bilateral NMES training of the wrist extensor muscles. The right forearm received NMES + BFR (30 % above the resting systolic blood pressure), while the left forearm received NMES only. The CSA of the extensor carpi radialis longus (ECRL) and extensor digitorum communis (EDC) muscles was measured on ultrasound images. Torque was measured isometrically and hand function with grasp and release test. Another eight men with SCI received NMES+BFR to the right forearm, while the left forearm received BFR only. Immediately, the FMD of the brachial artery was measured. RESULT: Following training, the ECRL CSA was 17 % greater in the NMES+BFR forearm (mean difference = 0.6 cm(2), p = 0.003) compared with the NMES only. The NMES+BFR had a 15 % increase in ECRL CSA (mean increase = 0.58 cm(2), p = 0.048). FMD increased (p = 0.05) in the exercise arm (12 ± 3 %) compared with the control arm (6.5 ± 6 %). CONCLUSION: NMES training with BFR is a strategy that can increase skeletal muscle size. NMES with and without BFR can improve wrist strength and hand function. The acute effects of NMES+BFR may suggest that an increase in FMD may partially contribute to skeletal muscle hypertrophy.

Effects of spinal cord injury on body composition and metabolic profile - part I.

Several body composition and metabolic-associated disorders such as glucose intolerance, insulin resistance, and lipid abnormalities occur prematurely after spinal cord injury (SCI) and at a higher prevalence compared to able-bodied populations. Within a few weeks to months of the injury, there is a significant decrease in total lean mass, particularly lower extremity muscle mass and an accompanying increase in fat mass. The infiltration of fat in intramuscular and visceral sites is associated with abnormal metabolic profiles. The current review will summarize the major changes in body composition and metabolic profiles that can lead to comorbidities such as type 2 diabetes mellitus and cardiovascular diseases after SCI. It is crucial for healthcare specialists to be aware of the magnitude of these changes. Such awareness may lead to earlier recognition and treatment of metabolic abnormalities that may reduce the co-morbidities seen over the lifetime of persons living with SCI.

The Clinical Management of Electrical Stimulation Therapies in the Rehabilitation of Individuals with Spinal Cord Injuries.

Background: People with spinal cord injuries (SCIs) often have trouble remaining active because of paralysis. In the past, exercise recommendations focused on the non-paralyzed muscles in the arms, which provides limited benefits. However, recent studies show that electrical stimulation can help engage the paralyzed extremities, expanding the available muscle mass for exercise. Methods: The authors provide an evidence-based approach using expertise from diverse fields, supplemented by evidence from key studies toward the management of electrical stimulation therapies in individuals with SCIs. Literature searches were performed separately using the PubMed, Medline, and Google Scholar search engines. The keywords used for the searches included functional electrical stimulation cycling, hybrid cycling, neuromuscular electrical stimulation exercise, spinal cord injury, cardiovascular health, metabolic health, muscle strength, muscle mass, bone mass, upper limb treatment, diagnostic and prognostic use of functional electrical stimulation, tetraplegic hands, and hand deformities after SCI. The authors recently presented this information in a workshop at a major rehabilitation conference. Additional information beyond what was presented at the workshop was added for the writing of this paper. Results: Functional electrical stimulation (FES) cycling can improve aerobic fitness and reduce the risk of cardiovascular and metabolic diseases. The evidence indicates that while both FES leg cycling and neuromuscular electrical stimulation (NMES) resistance training can increase muscle strength and mass, NMES resistance training has been shown to be more effective for producing muscle hypertrophy in individual muscle groups. The response to the electrical stimulation of muscles can also help in the diagnosis and prognosis of hand dysfunction after tetraplegia. Conclusions: Electrical stimulation activities are safe and effective methods for exercise and testing for motor neuron lesions in individuals with SCIs and other paralytic or paretic conditions. They should be considered part of a comprehensive rehabilitation program in diagnosing, prognosing, and treating individuals with SCIs to improve function, physical activity, and overall health.

Seat pressure changes after eight weeks of functional electrical stimulation cycling: a pilot study.

BACKGROUND: Pressure ulcers (PUs) are a common secondary condition associated with spinal cord injury (SCI). PUs can potentially interfere with activities of daily living, occupational duties, and rehabilitation programs, and in severe cases they may threaten life. Functional electrical stimulation (FES) cycling has been proposed as an activity that may decrease the risk of PUs through the promotion of increased blood flow and thickening of the gluteus maximus. The purpose of this pilot study was to measure the effects of home-based FES cycling on the average and maximal seat pressure of wheelchair-reliant individuals with SCI. METHOD: Eight male veterans with C5-T6 SCI participated in FES cycling 3 times per week. Cycling parameters were individualized depending on the comfort of the participants and the amount of current needed to perform the cycling activity. Pressure mapping was completed immediately before and after the 8 weeks of FES cycling with the measurement performed by a force sensitive application (FSA) 4 pressure mapping system. RESULTS: The mean average seat pressure decreased by 3.69 ± 4.46 mm Hg (35.57 ± 11.99 to 31.88 ± 13.02), while the mean maximum seat pressure decreased by 14.56 ±18.45 mm Hg (112 ± 34.73 to 98.36 ± 25.89). Although neither measurement was statistically significant, there was a strong trend toward a reduction in average and maximal seat pressure (P = .052 and P = .061, respectively). CONCLUSION: The positive trend of decreased seat pressure in our study creates incentive for further investigation of the effects of electrical stimulation activities on seat pressure and the prevention of PUs.

Home-based functional electrical stimulation cycling enhances quality of life in individuals with spinal cord injury.

BACKGROUND: With advances in medicine and increased survival rates, the focus of health care after spinal cord injury (SCI) has evolved from extending life to increasing independence and quality of life (QOL). Because enhancing QOL is an ultimate goal of the rehabilitation process, research involving the improvement of QOL is of great importance. OBJECTIVE: The purpose of this study was to determine the effects of a home-based functional electrical stimulation lower extremity cycling (FES-LEC) program on the QOL of persons with SCI. DESIGN: Eleven veterans with posttraumatic C4-T11 AIS A-C SCI participated in 8 weeks of 3 times weekly home-based FES-LEC. QOL was assessed using the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire. Tests were completed by all participants prior to and after the 8-week FES-LEC program. RESULTS: There were significant increases in the physical and environmental domain QOL scores. There were nominal nonsignificant increases in the psychological and social domain QOL scores. CONCLUSIONS: The results of this study provide evidence that home-based FES-LEC 3 times per week for 8 weeks has the potential to result in QOL improvements.

Electrical Stimulation Exercise for People with Spinal Cord Injury: A Healthcare Provider Perspective.

Electrical stimulation exercise has become an important modality to help improve the mobility and health of individuals with spinal cord injury (SCI). Electrical stimulation is used to stimulate peripheral nerves in the extremities to assist with muscle strengthening or functional activities such as cycling, rowing, and walking. Electrical stimulation of the peripheral nerves in the upper extremities has become a valuable tool for predicting the risk of hand deformities and rehabilitating functional grasping activities. The purpose of this paper is to provide healthcare providers perspective regarding the many rehabilitation uses of electrical stimulation in diagnosing and treating individuals with SCI. Electrical stimulation has been shown to improve functional mobility and overall health, decrease spasticity, decrease the risk of cardiometabolic conditions associated with inactivity, and assist in the diagnosis/prognosis of hand deformities in those with tetraplegia. Studies involving non-invasive stimulation of the spinal nerves via external electrodes aligned with the spinal cord and more invasive stimulation of electrodes implanted in the epidural lining of the spinal cord have demonstrated improvements in the ability to stand and enhanced the stepping pattern during ambulation. Evidence is also available to educate healthcare professionals in using functional electrical stimulation to reduce muscle spasticity and to recognize limitations and barriers to exercise compliance in those with SCI. Further investigation is required to optimize the dose-response relationship between electrical stimulation activities and the mobility and healthcare goals of those with SCI and their healthcare providers.

A model of prediction and cross-validation of fat-free mass in men with motor complete spinal cord injury.

OBJECTIVES: To establish and validate prediction equations by using body weight to predict legs, trunk, and whole-body fat-free mass (FFM) in men with chronic complete spinal cord injury (SCI). DESIGN: Cross-sectional design. SETTING: Research setting in a large medical center. PARTICIPANTS: Individuals with SCI (N=63) divided into prediction (n=42) and cross-validation (n=21) groups. INTERVENTION: Not applicable. MAIN OUTCOME MEASURE: Whole-body FFM and regional FFM were determined by using dual-energy x-ray absorptiometry. Body weight was measured by using a wheelchair weighing scale after subtracting the weight of the chair. RESULTS: Body weight predicted legs FFM (legs FFM=.09×body weight+6.1; R(2)=.25, standard error of the estimate [SEE]=3.1kg, P<.01), trunk FFM (trunk FFM=.21×body weight+8.6; R(2)=.56, SEE=3.6kg, P<.0001), and whole-body FFM (whole-body FFM=.288×body weight+26.3; R(2)=.53, SEE=5.3kg, P<.0001). The whole-body FFM(predicted) (FFM predicted from the derived equations) shared 86% of the variance in whole-body FFM(measured) (FFM measured using dual-energy x-ray absorptiometry scan) (R(2)=.86, SEE=1.8kg, P<.0001), 69% of trunk FFM(measured), and 66% of legs FFM(measured). The trunk FFM(predicted) shared 69% of the variance in trunk FFM(measured) (R(2)=.69, SEE=2.7kg, P<.0001), and legs FFM(predicted) shared 67% of the variance in legs FFM(measured) (R(2)=.67, SEE=2.8kg, P<.0001). Values of FFM did not differ between the prediction and validation groups. CONCLUSIONS: Body weight can be used to predict whole-body FFM and regional FFM. The predicted whole-body FFM improved the prediction of trunk FFM and legs FFM.

Report of practicability of a 6-month home-based functional electrical stimulation cycling program in an individual with tetraplegia.

BACKGROUND: Sedentarism is common among people with spinal cord injury (SCI). However, new technologies such as functional electrical stimulation cycles with internet connectivity may provide incentive by removing some of the limitations and external barriers. OBJECTIVE: To determine the effectiveness of a long-term home-based functional electrical stimulation lower extremities cycling (FES-LEC) program on exercise adherence, body composition, energy expenditure, and quality of life (QOL) in an adult with chronic tetraplegia. PARTICIPANT: A 53-year-old man, 33 years post-motor complete C4 SCI participated in FES-LEC in his home, three sessions per week for 24 weeks. METHODS: Exercise adherence was calculated as the percentage of performed cycling sessions relative to the recommended number of cycling sessions. Body composition was measured by dual-energy X-ray absorptiometry. Energy expenditure was measured using a COSMED K4b2 and QOL via the World Health Organization Quality of Life (WHO-QOL) Brief Questionnaire. Testing was performed before and after the 24-week exercise program. RESULTS: The participant cycled 59 out of a recommended 72 sessions which is an exercise adherence rate of 82%. Body composition displayed increases in total body lean mass (LM) with an increase of 3.3% and an increase in leg LM of 7.1%. Energy expenditure increased by 1.26 kcal/minute or greater than 200%. The physical and psychological domain scores of QOL increased by 25 and 4.5%, respectively. CONCLUSION: This case study provides encouragement concerning the practicality of a home-based FES-LEC program for those with SCI.

A report of anticipated benefits of functional electrical stimulation after spinal cord injury.

BACKGROUND: Functional electrical stimulation (FES) has been regularly used to offset several negative body composition and metabolic adaptations following spinal cord injury (SCI). However, the outcomes of many FES trials appear to be controversial and incoherent. OBJECTIVE: To document the potential consequences of several factors (e.g. pain, spasms, stress and lack of dietary control) that may have attenuated the effects on body composition and metabolic profile despite participation in 21 weeks of FES training. PARTICIPANT: A 29-year-old man with T6 complete SCI participated in 21 weeks of FES, 4 days per week. METHODS: Prior to and following training, the participant performed arm-crank-graded exercise testing to measure peak VO(2). Tests conducted included anthropometrics and dual energy X-ray absorptiometry body composition assessments, resting energy expenditure, plasma lipid profiles and intravenous glucose tolerance tests. RESULTS: The participant frequently reported increasing pain, stress and poor eating habits. VO(2) peak decreased by 2.4 ml/kg/minute, body mass increased by 8.5 kg, and body mass index increased from 25 to 28 kg/m(2). Waist and abdominal circumferences increased by 2-4 cm, while %fat mass increased by 5.5%. Absolute increases in fat mass and fat-free mass of 8.4 and 1 kg, respectively, were reported. Fasting and peak plasma glucose increased by 12 and 14.5%, while lipid panel profiles were negatively impacted. CONCLUSION: Failure to control for the listed negative emerging factors may obscure the expected body composition and metabolic profile adaptations anticipated from FES training.

Benefits and interval training in individuals with spinal cord injury: A thematic review.

BACKGROUND: Arm crank ergometry (ACE), functional electrical stimulation leg cycling exercise (FES-LCE), and the combination of the two (FES hybrid exercise) have all been used as activities to help improve the fitness-related health of individuals with spinal cord injury (SCI). More recently, high-intensity interval training (HIIT) has become popular in the non-disabled community due to its ability to produce greater aerobic fitness benefits or equivalent benefits with reduced time commitment. OBJECTIVE: This thematic review of the literature sought to determine the potential benefits and practicality of using ACE, FES-LCE, and FES hybrid exercise in an interval training format for individuals with SCI. METHODS: Systematic literature searches were conducted in May 2020 and March 2021 focusing on interval training in individuals with SCI. Pre-defined nested search terms were used to narrow the available literature from 4273 citations to 1362 articles. The titles and abstracts were then reviewed to determine the appropriateness of the articles ending with fifteen articles. RESULTS: The literature was limited to fifteen articles with low participant numbers (n = 1-20). However, in each article, HIIT protocols either demonstrated a greater improvement in cardiovascular, metabolic, or practicality scores compared to moderate intensity continuous training (MICT) protocols, or improvement during relatively brief time commitments. CONCLUSION: The available literature lacked sufficient numbers of randomized control trials. However, the available evidence is encouraging concerning the potential benefits and practicality of using HIIT (ACE, FES-LCE, or FES hybrid exercise) to improve aerobic and anaerobic capacity and decrease cardiometabolic risk after SCI.

Fat to lean mass ratio in spinal cord injury: Possible interplay of components of body composition that may instigate systemic inflammation and metabolic syndrome.

OBJECTIVE: To investigate the relationships between percentage fat mass (%FM), percentage lean mass (%LM), and the ratio of %FM to %LM with pro-inflammatory adipokines and metabolic syndrome in individuals with chronic spinal cord injury (SCI). DESIGN: Observational, cross-sectional. Linear and logistic regression were used to examine the associations between the %FM, %LM, and the %FM to %LM ratio with inflammatory markers and metabolic syndrome, respectively. PARTICIPANTS: Seventy chronic SCI men and women. MAIN OUTCOME MEASURES: %FM, %LM, %FM to %LM ratio; fasting lipids, glucose, and tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), and high-sensitivity c-reactive protein (hs-CRP); metabolic syndrome as determined by The International Diabetes Federation criteria. RESULTS: There were significant correlations between %FM, %LM and the %FM to %LM ratio with hs-CRP. The %LM beta coefficient value was negative and greater than the beta coefficient value for %FM. The %FM to %LM ratio had the strongest correlation with hs-CRP and showed the only significant relationship with IL-6. There were strong significant correlations between %FM, %LM and the %FM to %LM ratio with metabolic syndrome. However, the %FM to %LM ratio, again, showed the strongest relationship indicating that it may be the best predictor of metabolic syndrome. CONCLUSION: Both higher %FM and lower %LM affect cardiometabolic health and can be used as predictors for metabolic syndrome. However, the %FM to %LM ratio was the best predictor of systemic inflammation and cardiometabolic disorders in this group of SCI participants, suggesting that they both contribute to the statistical model.

Invasive and Non-Invasive Approaches of Electrical Stimulation to Improve Physical Functioning after Spinal Cord Injury.

This review of literature provides the latest evidence involving invasive and non-invasive uses of electrical stimulation therapies that assist in restoring functional abilities and the enhancement of quality of life in those with spinal cord injuries. The review includes neuromuscular electrical stimulation and functional electrical stimulation activities that promote improved body composition changes and increased muscular strength, which have been shown to improve abilities in activities of daily living. Recommendations for optimizing electrical stimulation parameters are also reported. Electrical stimulation is also used to enhance the skills of reaching, grasping, standing, and walking, among other activities of daily living. Additionally, we report on the use of invasive and non-invasive neuromodulation techniques targeting improved mobility, including standing, postural control, and assisted walking. We attempt to summarize the effects of epidural stimulation on cardiovascular performance and provide a mechanistic explanation to the current research findings. Future trends such as the combination of epidural stimulation and exoskeletal-assisted walking are also discussed.

Does aerobic exercise benefit persons with tetraplegia from spinal cord injury? A systematic review.

CONTEXT: This review synthesizes the findings of previous research studies on the cardiovascular and metabolic benefits of aerobic exercise for individuals with tetraplegia secondary to spinal cord injury. They are often less active due to muscular paralysis, sensory loss, and sympathetic nervous system dysfunction that result from injury. Consequently, these persons are at higher risk for exercise intolerance and secondary health conditions. OBJECTIVE: To evaluate the evidence concerning efficacy of aerobic exercise training for improving health and exercise performance in persons with tetraplegia from cervical injury. METHODS: The search engines PubMed and Google Scholar were used to locate published research. The final 75 papers were selected on the basis of inclusion criteria. The studies were then rank-ordered using Physiotherapy Evidence Database. RESULTS: Studies combining individuals with tetraplegia and paraplegia show that voluntary arm-crank training can increase mean peak power output by 33%. Functional electrical stimulation leg cycling was shown to induce higher peak cardiac output and stroke volume than arm-crank exercise. A range of peak oxygen uptake (VO2peak) values have been reported (0.57-1.32 L/min). Both VO2peak and cardiac output may be enhanced via increased muscle pump in the legs and venous return to the heart. Hybrid exercise (arm-crank and functional electrical stimulation leg cycling) can result in greater peak oxygen uptake and cardiovascular responses. CONCLUSION: Evidence gathered from this systematic review of literature is inconclusive due to the lack of research focusing on those with tetraplegia. Higher power studies (level 1-3) are needed with the focus on those with tetraplegia.

Safety and preliminary efficacy of functional electrical stimulation cycling in an individual with cervical cord injury, autonomic dysreflexia, and a pacemaker: Case report.

Context: Functional electric stimulation (FES) cycling is a commonly used therapeutic exercise modality after spinal cord injury (SCI); however, additional precautions must be taken in certain situations. The purpose of this study was to develop and apply a safety monitoring protocol for autonomic dysreflexia (AD) during FES cycling and to determine if an interval-FES cycling program can be safe and beneficial to an individual with cervical SCI, a history of AD, and a non-dependent cardiac pacemaker.The participant was a 36-year-old male with C6 AIS-C SCI sustained 9 years earlier, intermittent AD, and implanted cardiac pacemaker. Ten sessions of interval-FES cycling were performed twice weekly for 5 weeks. Rating of perceived exertion (RPE), blood pressure (BP), oxygen saturation (O2sat), and heart rate (HR) were monitored before, after, and every 5 min during cycling. ECG and cardiac pacemaker were evaluated by a cardiologist after ending the program.Findings: The participant reported self-limited chills 27 times over 10 sessions (19 "light", 3 "moderate", 5 "sharp"). Chills coincided with BP increases 59% of the time and their magnitudes moderately correlated (r = 0.32). The ECG was determined to be normal and the pacemaker fully functional at the end of the study, while blood glucose decreased (111-105 mg/dl), HbA1c levels increased (5.5-5.9%), and resting BP decreased (118/84-108/66 mmHg).Conclusion/Clinical Relevance: A person with cervical SCI, symptomatic AD, and a non-dependent pacemaker can safely participate and benefit from the interval-FES cycling program provided adequate monitoring of symptoms and vital signs.

Body Composition and Metabolic Assessment After Motor Complete Spinal Cord Injury: Development of a Clinically Relevant Equation to Estimate Body Fat.

Background: Obesity is at epidemic proportions in the population with spinal cord injury (SCI), and adipose tissue (AT) is the mediator of the metabolic syndrome. Obesity, however, has been poorly appreciated in SCI because of the lack of sensitivity that body mass index (BMI) conveys for obesity risk in SCI without measuring AT. Objectives: The specific objectives were to compare measures of body composition assessment for body fat with the criterion standard 4-compartment (4C) model in persons with SCI, to develop a regression equation that can be utilized in the clinical setting to estimate fat mass (FM), and to determine cardiometabolic risk using surrogates of obesity in a current model of metabolic syndrome. Methods: Seventy-two individuals with chronic (>1 year) motor complete (AIS A and B) C5-L2 SCI were recruited over 3 years. Subjects underwent assessment with 4C using hydrostatic (underwater) weighing (UWW), dual-energy x-ray absorptiometry (DXA), and total body water (TBW) assessment to determine percent body fat (%BF); fasting glucose and lipid profiles, and resting blood pressure were also obtained. BMI, DXA, bioelectrical impedance analyses (BIA), BodPod, circumferences, diameters, lengths, and nine-site skinfold (SF) were assessed and validated against 4C. A multiple linear regression model was used to fit %BF (dependent variable) using anthropometric and demographic data that had the greatest correlations with variables, followed by a combined forward/backward stepwise regression with Akaike information criterion (AIC) to identify the variables most predictive of the 4C %BF. To allow for a more practical model for use in the clinical setting, we further reduced the AIC model with minimal loss of predictability. Surrogate markers of obesity were employed with metabolic biomarkers of metabolic syndrome to determine prevalence in persons with SCI. Results: Subject characteristics included age 44.4 ± 11.3 years, time since injury (TSI) 14.4 ± 11.0 years, BMI 27.3 ± 5.9 kg/m2; 59 were men and 13 were women. Sitting waist circumference (WCSit ) was 95.5 ± 13.1 cm, supine waist circumference (WCSup) was 93.4 ± 12.7 cm, and abdominal skinfold (ABDSF) was 53.1 ± 19.6 mm. Findings showed 4C %BF 42.4 ± 8.6%, UWW %BF 37.3 ± 9.7%, DXA %BF 39.1 ± 9.4%, BodPod %BF 33.7 ± 11.4%, nine-site SF %BF 37.8 ± 9.3%, and BIA %BF 27.6 ± 8.6%. A regression equation using age, sex, weight, and ABDSF provided R2 correlation of 0.57 with 4C %BF (p < .0001). Metabolic syndrome was identified in 59.4% of the sample. Conclusion: Body composition techniques to determine body fat are labor intensive and expensive for persons with SCI, and the regression equation developed against the criterion standard 4C model may allow clinicians to quickly estimate %BF and more accurately demonstrate obesity-induced cardiometabolic syndrome in this population.

Energy Expenditure, Cardiorespiratory Fitness, and Body Composition Following Arm Cycling or Functional Electrical Stimulation Exercises in Spinal Cord Injury: A 16-Week Randomized Controlled Trial.

Background: Physical deconditioning and inactivity following spinal cord injury (SCI) are associated with multiple cardiometabolic risks. To mitigate cardiometabolic risk, exercise is recommended, but it is poorly established whether arm cycling exercise (ACE) or functional electrical stimulation (FES) leg cycling yields superior benefits. Objectives: To determine the adaptations of 16 weeks of FES cycling and ACE on exercise energy expenditure (EEE), cardiorespiratory fitness (CRF), and obesity after SCI. Methods: Thirteen physically untrained individuals were randomly assigned to FES (n = 6) or ACE (n = 7) exercise 5 days/week for 16 weeks. Pre- and post-intervention EEE, peak oxygen consumption (absolute and relative VO2Peak), and work were assessed using indirect calorimetry, while body composition was measured by dual-energy x-ray absorptiometry. Results: Main effects were found for peak power (p < .001), absolute (p = .046) and relative (p = .042) VO2Peak, and peak work (p = .013). Compared to baseline, the ACE group increased in EEE (+85%, p = .002), peak power (+307%, p < .001), VO2Peak (absolute +21%, relative +22%, p ≤ .024), peak work (19% increase, p = .003), and total body fat decreased (-6%, p = .05). The FES group showed a decrease in percentage body fat mass (-5%, p = .008). The ACE group had higher EEE (p = .008), peak power (p < .001), and relative VO2Peak (p = .025) compared to postintervention values in the FES group. Conclusion: In the current study, ACE induced greater increases in EEE and CRF, whereas ACE and FES showed similar results on body fat. Exercise promotional efforts targeting persons with SCI should use both FES and ACE to reduce sedentary behavior and to optimize different health parameters after SCI.

Comparison of Various Indices in Identifying Insulin Resistance and Diabetes in Chronic Spinal Cord Injury.

The purpose of this screening and diagnostic study was to examine the accord among indices of glucose metabolism, including the Homeostatic Model Assessment for Insulin Resistance (HOMA), HOMA2, Matsuda Index, Quantitative Insulin-sensitivity Check Index (QUICKI), hemoglobin A1C (HbA1C), and fasting plasma glucose (FPG) against intravenous glucose tolerance test-measured insulin sensitivity (Si) in individuals with chronic motor complete SCI. Persons with chronic (≥12-months post-injury) SCI (n = 29; 79% men; age 42.2 ± 11.4; body mass index 28.6 ± 6.4 kg/m2; C4-T10) were included. Measures were compared using adjusted R2 from linear regression models with Akaike information criterion (AIC, a measure of error). QUICKI had the greatest agreement with Si (adjusted R2 = 0.463, AIC = 91.1, p = 0.0001), followed by HOMA (adjusted R2 = 0.378, AIC = 95.4, p = 0.0008), HOMA2 (adjusted R2 = 0.256, AIC = 99.7, p = 0.0030), and the Matsuda Index (adjusted R2 = 0.356, AIC = 95.5, p = 0.0004). FPG (adjusted R2 = 0.056, AIC = 107.5, p = 0.1799) and HbA1C (adjusted R2 = 0.1, AIC = 106.1, p = 0.0975) had poor agreement with Si. While HbA1C and FPG are commonly used for evaluating disorders of glucose metabolism, QUICKI demonstrates the best accord with Si compared to the other measures.