Sarcopenic Obesity in Adults With Spinal Cord Injury: A Cross-Sectional Study.

OBJECTIVES: To describe (1) the frequency and utility of clinically relevant spinal cord injury (SCI)-specific and general population thresholds for obesity and sarcopenic obesity; and (2) the fat and lean soft tissue distributions based on the neurologic level of injury and the American Spinal Injury Association Impairment Scale. DESIGN: Cross-sectional. SETTING: Tertiary SCI rehabilitation hospital. PARTICIPANTS: Persons (N=136; men, n=100; women, n=36) with chronic (mean ± SD: 15.6±11.3y postinjury) tetraplegia (n=66) or paraplegia (n=70). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Body composition was assessed with anthropometrics and whole-body dual-energy x-ray absorptiometry. Muscle atrophy was quantified using a sarcopenia threshold of appendicular lean mass index (ALMI) (men, ≤7.26kg/m2; women, ≤5.5kg/m2). Obesity was defined by percentage body fat (men, ≥25%; women, ≥35%), visceral adipose tissue (≥130cm2), and SCI-specific obesity thresholds (body mass index [BMI] ≥22kg/m2; waist circumference ≥94cm). Sarcopenic obesity was defined as the presence of both sarcopenia and obesity. Groups were compared based on impairment characteristics using an analysis of covariance. RESULTS: Sarcopenic obesity was prevalent in 41.9% of the sample. ALMI was lower among participants with motor-complete (6.2±1.3kg/m2) versus motor-incomplete (7.5±1.6kg/m2) injuries (P<.01). Whole-body fat was greater among participants with tetraplegia (28.8±11.2kg) versus paraplegia (24.1±8.7kg; P<.05). Compared with general population guidelines (20.6%), SCI-specific BMI thresholds identified all the participants with obesity (77.9%) based on percentage body fat (72.1%). CONCLUSIONS: The observed frequency of sarcopenic obesity in this sample of individuals with chronic SCI is very high, and identification of obesity is dissimilar when using SCI-specific versus general population criteria.

Using Risk Scores to Estimate Lower Extremity Fragility Fracture Risk among Individuals with Chronic Spinal Cord Injury: A Preliminary Model.

Objectives: To develop SCI-FX, a risk score to estimate 5-year lower extremity fragility fracture risk among patients living with chronic spinal cord injury (cSCI). Methods: Adults with traumatic cSCI (n = 90) participated in a 2-year prospective longitudinal cohort study describing bone mineral density (BMD) change and fracture incidence conducted at the Lyndhurst Centre (University Health Network), University of Waterloo, and Physical Disability Rehabilitation Institute of Québec City. Prior publication and clinical intuition were used to identify fragility fracture risk factors including prior fragility fracture, years post-injury, motor complete injury (AIS A/B), benzodiazepine use, opioid use, and parental osteoporosis. We conducted bivariate analyses to identify variables associated with fracture. Multiple logistic regressions were performed using fragility fracture incidence as the dependent variable and all variables from the univariate analyses with a highly liberal p value at 0.2. Using the odds ratios (ORs) from the multiple logistic regression model, a point system for fragility fracture risk score was developed, and the odds of fracture for each point was estimated. Results: All initial variables, with the exception of benzodiazepine exposure, were included in the final model. Conclusion: We identified a simple preliminary model for clinicians to estimate 5-year fracture risk among patients with cSCI based on their total score.

Test-retest reliability of pulse wave velocity in individuals with chronic spinal cord injury.

BACKGROUND: Pulse wave velocity (PWV), which reflects arterial stiffness, is an important predictor of future coronary artery disease. The test-retest reliability of PWV has not been investigated in people with spinal cord injury (SCI). PURPOSE: To report the test-retest (day-to-day) reliability of PWV measurements among people with SCI, and to determine the smallest real difference (SRD) of PWV values. PARTICIPANTS: Twenty men (n = 19) and a woman (n = 1) with SCI (C4-T10; AIS A-D; ≥ 1-year post-injury; 10 with paraplegia and 10 with tetraplegia; time post-injury: 11.8 ± 8.7 years; age: 43.0 ± 12.6 years). METHODS: On two occasions within a 2-week period, aortic PWV (between the common carotid and femoral artery), arm PWV (between the brachial and radial artery), and leg PWV (between femoral and posterior tibial artery) were assessed at the same time of day using Doppler flowmeters. RESULTS: No statistically significant differences were found between days 1 and 2 in aortic PWV (day 1: 941 ± 185 cm/seconds, day 2: 917 ± 160 cm/seconds, P = 0.257), leg PWV (day 1: 1088 ± 141 cm/seconds, day 2: 1122 ± 165 cm/seconds, P = 0.099) and arm PWV (day 1: 1283 ± 185 cm/seconds, day 2: 1358 ± 256 cm/seconds, P = 0.180). The aortic and leg PWVs had high test-retest reliability (intraclass correlation coefficient: ICC = 0.920 and 0.913, respectively; P < 0.001 for both) and arm PWV had moderate test-retest reliability (ICC = 0.598, P = 0.03). SRDs for each PWV were 104 cm/seconds (aortic PWV), 97 cm/seconds (leg PWV) and 143 cm/seconds (arm PWV). CONCLUSION: The test-retest reliability of PWV assessment is high among patients with chronic SCI. Changes in aortic PWV values above 104 cm/seconds with repeated testing like represent true changes in health status.

Variability of limb muscle size in young men.

The purpose of this study was to determine the interindividual variability of the upper and lower limb muscle size in young men. Subjects were 655 Japanese men aged 18-39 years. They were sedentary and mildly to highly active individuals, including college athletes of various sports. Muscle thicknesses at each of the anterior and posterior portions of the upper arm, thigh, and lower leg were measured using B-mode ultrasonography. Interindividual variability of muscle thickness was evaluated by coefficients of variation (CVs). The CVs of muscle thicknesses were found to be in the order of upper arm posterior (17.7%), thigh anterior (14.8%), thigh posterior (12.6%), upper arm anterior (12.2%), lower leg anterior (9.8%), and lower leg posterior (9.4%). The CVs were significantly different between each pair of measurement sites except for those of upper arm anterior-thigh posterior and lower leg anterior-posterior. These differences remain significant even when the muscle thicknesses were normalized to the segment length. The observed differences in the size variability can be interpreted as muscle-related differences in hypertrophic responsiveness to resistance training. The muscle-dependent size variability may be related to the differences in the fiber-type composition and/or muscle usage in daily life among examined muscle groups.

Pulse wave velocity for assessment of arterial stiffness among people with spinal cord injury: a pilot study.

BACKGROUND/OBJECTIVE: The most significant complication and leading cause of death for people with spinal cord injury (SCI) is coronary artery disease (CAD). It has been confirmed that aortic pulse wave velocity (PWV) is an emerging CAD predictor among able-bodied individuals. No prior study has described PWV values among people with SCI. The objective of this study was to compare aortic (the common carotid to femoral artery) PWV, arm (the brachial to radial artery) PWV, and leg (the femoral to posterior tibial artery) PWV in people with SCI (SCI group) to able-bodied controls (non-SCI group). METHODS: Participants included 12 men with SCI and 9 non-SCI controls matched for age, sex, height, and weight. Participants with a history of CAD or current metabolic syndrome were excluded. Aortic, arm, and leg PWV was measured using the echo Doppler method. RESULTS: Aortic PWV (mean +/- SD) in the SCI group (1,274 +/- 369 cm/s) was significantly higher (P < 0.05) than in the non-SCI group (948 +/- 110 cm/s). There were no significant between-group differences in mean arm PWV (SCI: 1,152 +/- 193 cm/s, non-SCI: 1,237 +/- 193 cm/s) or mean leg PWV (SCI: 1,096 +/- 173 cm/s, non-SCI: 994 +/- 178 cm/s) values. CONCLUSIONS: Aortic PWV was higher among the SCI group compared with the non-SCI group. The higher mean aortic PWV values among the SCI group compared with the non-SCI group indicated a higher risk of CAD among people with SCI in the absence of metabolic syndrome.

Lessons learned from the pilot study of an orthostatic hypotension intervention in the subacute phase following spinal cord injury.

Context: Following spinal cord injury (SCI) at the cervical or upper-thoracic level, orthostatic hypotension (OH) is observed in 13-100% of patients. This study aimed to test the feasibility of conducting a randomized controlled trial combining a dynamic tilt-table (Erigo®) and functional electrical stimulation (FES) to mitigate OH symptoms in the subacute phase after SCI. Design: Pilot study. Setting: A tertiary rehabilitation hospital. Participants: Inpatients who had a C4-T6 SCI (AIS A-D) less than 12 weeks before recruitment, and reported symptoms of OH in their medical chart. Interventions: Screening sit-up test to determine eligibility, then 1 assessment session and 3 intervention sessions with Erigo® and FES for eligible participants. Outcome measures: Recruitment rate, duration of assessment and interventions, resources used, blood pressure, and Calgary Presyncope Form (OH symptoms). Results: Amongst the 232 admissions, 148 inpatient charts were reviewed, 11 inpatients met all inclusion criteria, 7 participated in a screening sit-up test, and 2 exhibited OH. Neither of the two participants recruited in the pilot study was able to fully complete the assessment and intervention sessions due to scheduling issues (i.e. limited available time). Conclusion: This pilot study evidenced the non-feasibility of the clinical trial as originally designed, due to the low recruitment rate and the lack of available time for research in participant's weekday schedule. OH in the subacute phase after SCI was less prevalent and less incapacitating than expected. Conventional management and spontaneous resolution of symptoms appeared sufficient to mitigate OH in most patients with subacute SCI.

Development of Cardiometabolic Health indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project.

Context: Spinal cord injury or disease (SCI/D) leads to unchanged low-density lipoprotein and cholesterol, very low high-density lipoprotein a form of dyslipidemia and physical inactivity which combine to increase risk of morbidity and mortality from cardiometabolic disease. Herein, we describe the selection of structure, process and outcome indicators for adults in the first 18 months post-SCI/D rehabilitation admission. Methods: A Pan-Canadian Cardiometabolic Health Working Group was formed to develop a construct definition. Cardiometabolic risk factors were summarized in a Driver diagram. Release of the Paralyzed Veterans of America "Identification and Management of Cardiometabolic Risk after Spinal Cord Injury" and the International Scientific Exercise Guidelines: "Evidence-based scientific exercise guidelines for adults with spinal cord injury", informed the group's focus on prevention strategies to advance this Domain of rehabilitation admission. Results: The structure indicator identifies during rehabilitation the presence of appropriate time and resources for physical exercise prescription. Process indicators are lipid profile assessment at rehabilitation admission and documented exercise prescriptions prior to discharge. The outcome indicators track patient's knowledge retention regarding exercise prescription at discharge, current exercise adherence and lipid status 18 months after rehabilitation discharge. Conclusion: Routine national implementation of these indicators at the specified time points will enhance efforts to detect dyslipidemia and assure routine participation in endurance exercise. These indicators align with international initiatives to improve cardiometabolic health through interventions targeting modifiable risk factors specifically endurance exercising and optimal lipid profiles, crucial to augmenting cardiometabolic health after SCI/D.

Cardiovascular response to functional electrical stimulation and dynamic tilt table therapy to improve orthostatic tolerance.

Orthostatic hypotension is a common condition for individuals with stroke or spinal cord injury. The inability to regulate the central nervous system will result in pooling of blood in the lower extremities leading to orthostatic intolerance. This study compared the use of functional electrical stimulation (FES) and passive leg movements to improve orthostatic tolerance during head-up tilt. Four trial conditions were assessed during head-up tilt: (1) rest, (2) isometric FES of the hamstring, gastrocnemius and quadriceps muscle group, (3) passive mobilization using the Erigo dynamic tilt table; and (4) dynamic FES (combined 2 and 3). Ten healthy male subjects experienced 70 degrees head-up tilt for 15 min under each trial condition. Heart rate, blood pressure and abdominal echograms of the inferior vena cava were recorded for each trial. Passive mobilization and dynamic FES resulted in an increase in intravascular blood volume, while isometric FES only resulted in elevating heart rate. No significant differences in blood pressure were observed under each condition. We conclude that FES combined with passive stepping movements may be an effective modality to increase circulating blood volume and thereby tolerance to postural hypotension in healthy subjects.

Required muscle mass for preventing lifestyle-related diseases in Japanese women.

BACKGROUND: Since it is essential to maintain a high level of cardiorespiratory fitness to prevent life-style related disease, the Ministry of Health, Labour and Welfare of Japan in 2006 proposed to determine the maximal oxygen uptake (Vo2max: mL.kg-1.min-1) reference values to prevent life-style related diseases (LSRD). Since muscle mass is one of the determinant factors of Vo2max, it could be used as the reference parameter for preventing LSRD. The aim of this study was to determine and quantify the muscle mass required to maintain the Vo2max reference values in Japanese women. METHODS: A total of 403 Japanese women aged 20-69 years were randomly allocated to either a validation or a cross-validation group. In the validation group, a multiple regression equation, which used a set of age and the percentage of muscle mass (%MM, percentage of appendicular lean soft tissue mass to body weight), as independent variables, was derived to estimate the Vo2max. After the equation was cross-validated, data from the two groups were pooled together to establish the final equation. The required %MM for each subject was recalculated by substituting the Vo2max reference values and her age in the final equation. RESULTS: The mean value of required %MM was identified as (28.5 +/- 0.35%). Thus, the present study proposed the required muscle mass (28.5% per body weight) in Japanese women to maintain the Vo2max reference values determined by the Japanese Ministry of Health Labour and Welfare. CONCLUSION: The estimated required %MM (28.5% per body weight) can be used as one of the reference parameters of fitness level in Japanese women.

Quality reporting of carotid intima-media thickness methodology; Current state of the science in the field of spinal cord injury.

OBJECTIVES: Carotid intima-media thickness (cIMT) may be used increasingly as a cardiovascular disease (CVD) screening tool in individuals with spinal cord injury (SCI) as other routine invasive diagnostic tests are often unfeasible. However, variation in cIMT acquisition and analysis methods is an issue in the current published literature. The growth of the field is dependent on cIMT quality acquisition and analysis to ensure accurate reporting of CVD risk. The purpose of this study is to evaluate the quality of the reported methodology used to collect cIMT values in SCI. METHODS: Data from 12 studies, which measured cIMT in individuals with SCI, were identified from the Medline, Embase and CINAHL databases. The quality of the reported methodologies was scored based on adherence to cIMT methodological guidelines abstracted from two consensus papers. RESULTS: Five studies were scored as 'moderate quality' in methodological reporting, having specified 9 to 11 of 15 quality reporting criterion. The remaining seven studies were scored as 'low quality', having reported less than 9 of 15 quality reporting criterion. No study had methodological reporting that was scored as 'high quality'. The overall reporting of quality methodology was poor in the published SCI literature. CONCLUSIONS: A greater adherence to current methodological guidelines is needed to advance the field of cIMT in SCI. Further research is necessary to refine cIMT acquisition and analysis guidelines to aid authors designing research and journals in screening manuscripts for publication.

Cardiovascular disease risk in individuals with chronic spinal cord injury: Prevalence of untreated risk factors and poor adherence to treatment guidelines.

BACKGROUND/OBJECTIVE: Cardiovascular disease (CVD) is currently the leading cause of mortality among individuals living with chronic spinal cord injury (SCI). The purpose of this study is to: 1) Describe the prevalence of CVD risk factors including dyslipidemia (DYS), hypertension (HTN) and type II diabetes mellitus (DM) in patients with chronic SCI; 2) Report the frequency of individuals recommended for diagnostic testing, as per current Canadian CVD diagnostic guidelines; and 3) Report the frequency of individuals receiving guideline-derived appropriate therapy for these risk factors. METHODS: Adults with a chronic, stable SCI (n = 91) were included in this study. Medical histories, current medications, blood serum analyses and blood pressures were collected and compared to current Canadian CVD diagnostic guidelines to assess for DYS, HTN and DM. RESULTS: Of the 81 participants with blood serum analyses, 10 (14.7%) of 23 (28.4%) individuals meeting diagnostic criteria for DYS were not taking appropriate statin medication and 2 (2.5%) of 7 (8.6%) individuals meeting diagnostic criteria for DM were not taking appropriate DM medication. Of the 91 participants having BP measurements, 13 (14.3%) of 26 (28.6%) individuals meeting diagnostic criteria for HTN were not taking appropriate BP medication. CONCLUSIONS: In addition to a high prevalence of CVD risk factors among individuals with chronic SCI, there is also evidence of poor adherence to diagnostic and treatment guidelines for DYS, HTN and DM. The study results highlight an important gap between the observed prevalence of disease and the low rates of screening and guideline adherence in the SCI population.

Participation in moderate-to-vigorous leisure time physical activity is related to decreased visceral adipose tissue in adults with spinal cord injury.

Increased visceral adiposity places individuals with chronic spinal cord injury (SCI) at increased risk of cardiometabolic disease. The purpose of this study was to identify if people with chronic SCI who participate in any moderate- to vigorous-intensity leisure time physical activity (LTPA) have lower visceral adipose tissue (VAT) area compared with those who report none. Participants included 136 adult men (n = 100) and women (n = 36) with chronic (mean (±SD) 15.6 ± 11.3 years post-injury) tetraplegia (n = 66) or paraplegia (n = 70) recruited from a tertiary rehabilitation hospital. VAT area was assessed via whole-body dual-energy X-ray absorptiometry using a Hologic densitometer and the manufacturer's body composition software. Moderate-to-vigorous LTPA was assessed using the Leisure Time Physical Activity Questionnaire for People with SCI (LTPAQ-SCI) or the Physical Activity Recall Assessment for People with SCI (PARA-SCI). Summary scores were dichotomized into any or no participation in moderate-to-vigorous LTPA to best represent the intensity described in current population-specific physical-activity guidelines. Data were analyzed using univariate and multiple regression analyses to identify the determinants of VAT. Overall, the model explained 67% of the variance in VAT area and included time post-injury, age-at-injury, android/gynoid ratio, waist circumference, and moderate-to-vigorous LTPA. Participation in any moderate-to-vigorous LTPA was significantly (95% confidence interval: -34.71 to -2.61, p = 0.02) associated with VAT after controlling for injury-related and body-composition correlates. Moderate-to-vigorous LTPA appears to be related to lower VAT area, suggesting potential for LTPA to reduce cardiometabolic disease risk among individuals with chronic SCI.

Assessing Heart Rate Variability As a Surrogate Measure of Cardiac Autonomic Function in Chronic Traumatic Spinal Cord Injury.

Background: Although cardiac autonomic dysfunction is a contributing factor for cardiovascular disease development in individuals with a spinal cord injury (SCI), it remains poorly understood. Heart rate variability (HRV) analysis has the potential to non-invasively assess the cardiac autonomic nervous system. The study objectives are (a) to determine if there are differences in HRV measures across neurological level of impairment (NLI) and American Spinal Cord Injury Association Impairment Scale (AIS) subgroups, and (b) to determine if there is a relationship between HRV frequency measures (low frequency [LF] and high frequency [HF]) at rest. Methods: We conducted a secondary data analysis of a primary data set from a published cross-sectional study of electrocardiogram recordings of 56 subjects (44 men and 12 women, mean age ± SD = 46.75 ± 12.44 years) with a chronic traumatic SCI (C1-T12, AIS A-D, ≥2 years post injury). HRV was analyzed using time and frequency domain measures. Results: There were no significant HRV differences across NLI and AIS subgroups. The LF and HF indices were positively correlated in the entire sample (r = 0.708, p < .0001) and among impairment subgroups. Conclusion: No differences were observed in the HRV time and frequency measures when compared across NLI and AIS subgroups. The results were considered inconclusive, since possible explanations include inadequate sample size as well as other physiological considerations. A positive correlation was found between LF and HF when assessed at rest. The relationship between LF and HF may not necessarily represent a rebalanced autonomic nervous system, but it does question the utility of solely measuring LF:HF at rest in persons with chronic SCI.

Applicability of a segmental bioelectrical impedance analysis for predicting the whole body skeletal muscle volume.

This study aimed to test the hypothesis that a segmental bioelectrical impedance (BI) analysis can predict whole body skeletal muscle (SM) volume more accurately than a whole body BI analysis. Thirty males (19-34 yr) participated in this study. They were divided into validation (n = 20) and cross-validation groups (n = 10). The BI values were obtained using two methods: whole body BI analysis, which determines impedance between the wrist and ankle; and segmental BI analysis, which determines the impedance of every body segment in both sides of the upper arm, lower arm, upper leg and lower leg, and five parts of the trunk. Using a magnetic resonance imaging method, whole body SM volume was determined as a reference (SMV(MRI)). Simple and multiple regression analyses were applied to (length)(2)/Z (BI index) for the whole body and for every body segment, respectively, to develop the prediction equations of SMV(MRI). In the validation group, there were no significant differences between the measured and estimated SMV and no systematic errors in either BI analysis. In the cross-validation group, the whole body BI analysis produced systematic errors and resulted in the overestimation of SMV(MRI), but the segmental BI analysis was cross-validated. In the pooled data, the segmental BI analysis produced a prediction equation, which involves the BI indexes of the trunk and upper thigh as independent variables, with a SE of estimation of 1,693.8 cm(3) (6.1%). Thus the findings obtained here indicated that the segmental BI analysis is superior to the whole body BI analysis for estimating SMV(MRI).

Association between abnormal arterial stiffness and cardiovascular risk factors in people with chronic spinal cord injury.

Aims To describe the association between cardiovascular risk factors and abnormal arterial stiffness, defined by a carotid-femoral pulse wave velocity ≥ 10 m/s, in patients with chronic spinal cord injury (SCI). Methods Ninety consenting adults with chronic SCI (C1-T10 ASIA Impairment Scale A-D) participated in this cross-sectional study. The cardiovascular risk factors considered included age, sex, duration of injury, neurological level of injury (C1-T1, tetraplegia; T2-T12, paraplegia), age at injury, impairment scale category, supine resting systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, leisure time physical activity, treated hypertension, treated hyperlipidemia, diabetes, lipid profiles, fasting blood glucose, glycated hemoglobin, and C reactive protein. Logistic regression analysis was used to determine the association between abnormal arterial stiffness and dichotomized cardiovascular risk factors. Results Dichotomized variables significantly associated with increased arterial stiffness were: age ≥ 52 years (OR 22.1, CI 4.28-113.99); systolic blood pressure ≥ 130 mmHg (OR 11.76, CI 2.89-47.88); heart rate ≥ 62 bpm (OR 6.62, CI 1.33-33.03); and paraplegia (OR 4.26, CI 1.00-18.33). The area under the receiver operating characteristic curve for probability of arterial stiffness was 0.920 (95% CI 0.861-0.978, p < 0.001). Conclusions Age, resting systolic blood pressure, resting heart rate, and neurological level of injury can identify patients at high risk of elevated arterial stiffness in the population with chronic SCI.

The effects of whole body vibration on pulse wave velocity in men with chronic spinal cord injury.

OBJECTIVE: A pilot study to evaluate the therapeutic potential of 40 weeks of passive standing with whole body vibration (PS-WBV) on central and peripheral arterial stiffness among men with chronic spinal cord injury (SCI). METHODS: Consenting participants were pre-screened to ensure safe participation. Fifteen individuals with chronic SCI were enrolled to participate in PS-WBV sessions three times per week for 40 weeks on a modified WAVE platform custom-fitted with an EASYStand 5000. Knee angle was set at 160°, and vibration parameters were 45Hz frequency and 0.7mm displacement. Each 45-minute session of PS-WBV training was intermittent (60 seconds on and 120 seconds off). Aortic and leg pulse wave velocity (PWV) was measured at baseline, mid-point (20 weeks) and exit (40 weeks). RESULTS: Nine males (age 41±11 years, American Spinal Injury Association Impairment Scale A-D, neurological level of injury T4-T10, years post-injury 12±8 years) completed the intervention. Aortic PWV was collected on n=7 at exit, and leg PWV was collected on n=6 at exit. No changes over time were found for either aortic PWV (P = 0.46) or leg PWV (P = 0.54). One possible study-related serious adverse event occurred during study intervention: the development of a grade III pressure sore on the right proximal anterior shin (n=1). CONCLUSION: Forty weeks of PS-WBV in adults with SCI did not result in an observable change in arterial stiffness.

Applicability of segmental bioelectrical impedance analysis for predicting trunk skeletal muscle volume.

This study aimed to investigate the validity of using segmental bioelectrical impedance (BI) analysis for estimating skeletal muscle volume (MV) in the trunk, defined as the body segment from the acromion process to the greater trochanter. Using a magnetic resonance imaging (MRI) method, the trunk MV was determined in 28 men (19 approximately 34 yr), divided into validation (n = 20) and cross-validation (n = 8) groups, and used as a reference (MV(MRI)). For BI measurements of the trunk, the source electrodes were placed at the dorsal surface of the third metacarpal bone of both hands and the dorsal surface of the third metatarsal bone of both feet, and the detector electrodes were placed at the acromion process of both shoulders and the greater trochanter of both femurs. Using this arrangement, the BI values of five parts of the trunk, both sides of the upper region, the middle region, and both sides of the lower region, were obtained and then used to calculate the whole trunk BI value and BI index (BI index(TR)). In the validation group, a simple regression analysis of the relationship between BI index(TR) and MV(MRI) showed a significant correlation between the two variables (r = 0.884, P < 0.05) and produced a prediction equation with a SE of estimation of 1,020.3 cm3 (8.5%). In the validation and cross-validation groups, there were no significant differences between the measured and estimated MV without systematic errors. These findings indicate that the segmental BI analysis employed in the present study can be used to estimate trunk MV.

Exploring the associations between arterial stiffness and spinal cord impairment: A cross-sectional study.

BACKGROUND/OBJECTIVE: Elevated aortic arterial stiffness (aortic pulse wave velocity: aPWV) is an independent coronary artery disease predictor among the general population. The purpose of this study was to: (1) report aPWV values in a representative cohort of patients with spinal cord injury (SCI); (2) to compare aPWV values in people with SCI based on neurological level of injury; and (3) to contrast the reported aPWV values with available normal values for the general population. METHODS: Adults with chronic SCI (n = 87) were divided into two groups (TETRA group, n = 37 and PARA group, n = 50). aPWV and potential confounders of aPWV were assessed. Analysis of covariance was used for comparisons between groups and adjusted for the confounders. Subjects' aPWV values were contrasted with reference values for general population determined by "The Reference value for arterial stiffness' collaboration" and prevalence of abnormal aPWV defined as greater than or equal to the age-specific 90th percentile was reported. RESULTS: Prevalence of abnormal aPWV in the cohort was 25.3%. After adjusting for covariates, the mean aPWV values were significantly different between two groups (TETRA: 8.0 (95% confidence interval (CI): 7.5-8.6) m/second, PARA: 9.0 (95% CI: 8.5-9.4) m/second, P = 0.010). The prevalence of abnormal aPWV was significantly higher in the PARA group (36%) compared to the TETRA group (11%) (P = 0.012). CONCLUSIONS: One-quarter of the total cohort had an abnormal aPWV. Subjects with paraplegia had higher aPWV values and a higher frequency of abnormal aPWV than subjects with tetraplegia. Elevated aPWV in people with SCI, particularly those with paraplegia, may impart significant adverse cardiovascular consequences.

Cardiovascular response of individuals with spinal cord injury to dynamic functional electrical stimulation under orthostatic stress.

In this pilot study, we examined how effectively functional electrical stimulation (FES) and passive stepping mitigated orthostatic hypotension in participants with chronic spinal cord injury (SCI). While being tilted head-up to 70 (°) from the supine position, the participants underwent four 10-min conditions in a random sequence: 1) no intervention, 2) passive stepping, 3) isometric FES of leg muscles, and 4) FES of leg muscles combined with passive stepping. We found that FES and passive stepping independently mitigated a decrease in stroke volume and helped to maintain the mean blood pressure. The effects of FES on stroke volume and mean blood pressure were greater than those of passive stepping. When combined, FES and passive stepping did not interfere with each other, but they also did not synergistically increase stroke volume or mean blood pressure. Thus, the present study suggests that FES delivered to lower limbs can be used in individuals with SCI to help them withstand orthostatic stress. Additional studies are needed to confirm whether this use of FES is applicable to a larger population of individuals with SCI.

Bioelectrical impedance and dual-energy x-ray absorptiometry assessments of changes in body composition following exercise in patients with type 2 diabetes mellitus.

We aimed to compare the level of agreement between leg-to-leg bioelectrical impedance analysis (LBIA) and dual-energy X-ray absorptiometry (DXA) for assessing changes in body composition following exercise intervention among individuals with Type 2 diabetes mellitus (T2DM). Forty-four adults with T2DM, age 53.2 ± 9.1 years; BMI 30.8 ± 5.9 kg/m(2) participated in a 6-month exercise program with pre and post intervention assessments of body composition. Fat free mass (FFM), % body fat (%FM) and fat mass (FM) were measured by LBIA (TBF-300A) and DXA. LBIA assessments of changes in %FM and FM post intervention showed good relative agreements with DXA variables (P < 0.001). However, Bland-Altman plot(s) indicated that there were systematic errors in the assessment of the changes in body composition using LBIA compared to DXA such that, the greater the changes in participant body composition, the greater the disparity in body composition data obtained via LBIA versus DXA data (FFM, P = 0.013; %FM, P < 0.001; FM, P < 0.001). In conclusion, assessment of pre and post intervention body composition implies that LBIA is a good tool for assessment qualitative change in body composition (gain or loss) among people with T2DM but is not sufficiently sensitive to track quantitative changes in an individual's body composition.