Publications by authors named "Gary J Farkas"

36 Publications

The Diagnosis and Management of Cardiometabolic Risk and Cardiometabolic Syndrome after Spinal Cord Injury.

J Pers Med 2022 Jun 30;12(7). Epub 2022 Jun 30.

Department of Physical Medicine and Rehabilitation, School of Medicine, University of Miami Miller, Miami, FL 33136, USA.

Individuals with spinal cord injuries (SCI) commonly present with component risk factors for cardiometabolic risk and combined risk factors for cardiometabolic syndrome (CMS). These primary risk factors include obesity, dyslipidemia, dysglycemia/insulin resistance, and hypertension. Commonly referred to as "silent killers", cardiometabolic risk and CMS increase the threat of cardiovascular disease, a leading cause of death after SCI. This narrative review will examine current data and the etiopathogenesis of cardiometabolic risk, CMS, and cardiovascular disease associated with SCI, focusing on pivotal research on cardiometabolic sequelae from the last five years. The review will also provide current diagnosis and surveillance criteria for cardiometabolic disorders after SCI, a novel obesity classification system based on percent total body fat, and lifestyle management strategies to improve cardiometabolic health.
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http://dx.doi.org/10.3390/jpm12071088DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9320035PMC
June 2022

Predictive factors of academic success in neuromusculoskeletal anatomy among doctor of physical therapy students.

Anat Sci Educ 2022 Jun 2. Epub 2022 Jun 2.

Department of Physical Medicine and Rehabilitation, Miller School of Medicine, University of Miami, Miami, Florida, USA.

Predictors of academic success in anatomy have been studied, but not in Doctor of Physical Therapy (DPT) students. The objectives of this study were to (1) explore predictors of academic success in a DPT anatomy course, (2) evaluate sex-based differences in the predictors of academic success and their influence on anatomy course grade, and (3) investigate the influence of the DPT anatomy course on visual-spatial ability. Forty-nine DPT students completed a demographic questionnaire, Learning and Study Strategies Inventory (LASSI), and Mental Rotations Test (MRT) before the ten-week anatomy course (MRT-1) and repeated the MRT at the end of the course (MRT-2). Anatomy course grade was determined based on quizzes and written and practical examinations. Multiple regression analysis showed significant associations between the predictor variables age (p = 0.010) and the LASSI anxiety subscale (p = 0.017), which measures anxiety coping, with the anatomy course grade. On the MRT-1, male DPT students attempted and correctly answered more questions than females (both, p < 0.0001). Female students had higher LASSI self-regulation and use of academic resources subscale scores (both, p < 0.05). In the 44 DPT students that completed the MRT-2, the number of correct and attempted responses increased following the anatomy course (p < 0.0001). Age and anxiety coping, but not sex, are predictors of anatomy course grades in DPT students. Mental rotations test scores improved following the anatomy course. The LASSI should be used in other cohorts to identify students with low anxiety subscale scores in order to provide targeted support.
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http://dx.doi.org/10.1002/ase.2202DOI Listing
June 2022

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

J Clin Med 2021 Nov 28;10(23). Epub 2021 Nov 28.

Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL 33136, USA.

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 ( = 29; 79% men; age 42.2 ± 11.4; body mass index 28.6 ± 6.4 kg/m; C4-T10) were included. Measures were compared using adjusted R from linear regression models with Akaike information criterion (AIC, a measure of error). QUICKI had the greatest agreement with Si (adjusted R = 0.463, AIC = 91.1, = 0.0001), followed by HOMA (adjusted R = 0.378, AIC = 95.4, = 0.0008), HOMA2 (adjusted R = 0.256, AIC = 99.7, = 0.0030), and the Matsuda Index (adjusted R = 0.356, AIC = 95.5, = 0.0004). FPG (adjusted R = 0.056, AIC = 107.5, = 0.1799) and HbA1C (adjusted R = 0.1, AIC = 106.1, = 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.
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http://dx.doi.org/10.3390/jcm10235591DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8658352PMC
November 2021

Exercise to mitigate cardiometabolic disorders after spinal cord injury.

Curr Opin Pharmacol 2022 02 2;62:4-11. Epub 2021 Dec 2.

Department of Neurological Surgery, The University of Miami Miller School of Medicine, Miami, FL 33136, USA; Department of Physical Medicine & Rehabilitation, The University of Miami Miller School of Medicine, Miami, FL 33136, USA; The Miami Project to Cure Paralysis, The University of Miami Miller School of Medicine, Miami, FL 33136, USA.

The cardiometabolic disorder (CMD) is a syndrome caused by coalescing of cardiovascular, endocrine, pro-thrombotic, and inflammatory health risks. Together, these risks confer a hazard as health-threatening as coronary artery disease or type2 diabetes, whether an individual has a diagnosis of coronary disease or diabetes, or not. CMD is most often defined by three or more of five clinically assessed risk components, notably obesity, insulin resistance, hypertension, hypertriglyceridemia, and depressed high-density lipoprotein cholesterol. Evidence currently suggests that worldwide CMD is expanding at a pandemic rate, and it is known that people living with spinal cord injuries (SCI) qualify for the diagnosis at more than 50% of the prevalence of a non-disabled cohort. A recent evidence-based guideline warned of the current state of CMD following SCI and recommended early lifestyle intervention incorporating exercise and prudent nutrition as a first-line disease countermeasure. This monograph will define the CMD following SCI, explore its underlying pathophysiology, and provide evidence that recommends exercise for CMD health hazards after SCI.
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http://dx.doi.org/10.1016/j.coph.2021.10.004DOI Listing
February 2022

An analysis of anatomy education before and during Covid-19: August-December 2020.

Anat Sci Educ 2022 Jan;15(1):5-26

Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida, USA.

Coronavirus disease-2019 (Covid-19) disrupted the in-person teaching format of anatomy. To study changes in gross anatomy education that occurred during August-December, 2020 compared to before the pandemic, an online survey was distributed to anatomy educators. The 191 responses received were analyzed in total and by academic program, geographic region, and institution type. Cadaver use decreased overall (before: 74.1 ± 34.1%, during: 50.3 ± 43.0%, P < 0.0001), as well as across allopathic and osteopathic medicine, therapy, undergraduate, and veterinary programs (P < 0.05), but remained unchanged for other programs (P > 0.05). Cadaver use decreased internationally and in the US (P < 0.0001), at public and private (P < 0.0001) institutions, and among allopathic medical programs in Northeastern, Central, and Southern (P < 0.05), but not Western, US geographical regions. Laboratories during Covid-19 were delivered through synchronous (59%), asynchronous (4%), or mixed (37%) formats (P < 0.0001) and utilized digital resources (47%), dissection (32%), and/or prosection (21%) (P < 0.0001). The practical laboratory examination persisted during Covid-19 (P = 0.419); however, the setting and materials shifted to computer-based (P < 0.0001) and image-based (P < 0.0001), respectively. In-person lecture decreased during Covid-19 (before: 88%, during: 24%, P = 0.003). When anatomy digital resources were categorized, dissection media, interactive software, and open-access content increased (P ≤ 0.008), with specific increases in BlueLink, Acland's Videos, and Complete Anatomy (P < 0.05). This study provided evidence of how gross anatomy educators continued to adapt their courses past the early stages of the pandemic.
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http://dx.doi.org/10.1002/ase.2152DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8653345PMC
January 2022

Energy expenditure and nutrient intake after spinal cord injury: a comprehensive review and practical recommendations.

Br J Nutr 2021 Sep 23:1-25. Epub 2021 Sep 23.

Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA.

Many persons with spinal cord injury (SCI) have one or more preventable chronic diseases related to excessive energetic intake and poor eating patterns. Appropriate nutrient consumption relative to need becomes a concern despite authoritative dietary recommendations from around the world. These recommendations were developed for the non-disabled population and do not account for the injury-induced changes in body composition, hypometabolic rate, hormonal dysregulation and nutrition status after SCI. Because evidence-based dietary reference intake values for SCI do not exist, ensuring appropriate consumption of macronutrient and micronutrients for their energy requirements becomes a challenge. In this compressive review, we briefly evaluate aspects of energy balance and appetite control relative to SCI. We report on the evidence regarding energy expenditure, nutrient intake and their relationship after SCI. We compare these data with several established nutritional guidelines from American Heart Association, Australian Dietary Guidelines, Dietary Guidelines for Americans, Institute of Medicine Dietary Reference Intake, Public Health England Government Dietary Recommendations, WHO Healthy Diet and the Paralyzed Veterans of America (PVA) Clinical Practice Guidelines. We also provide practical assessment and nutritional recommendations to facilitate a healthy dietary pattern after SCI. Because of a lack of strong SCI research, there are currently limited dietary recommendations outside of the PVA guidelines that capture the unique nutrient needs after SCI. Future multicentre clinical trials are needed to develop comprehensive, evidence-based dietary reference values specific for persons with SCI across the care continuum that rely on accurate, individual assessment of energy need.
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http://dx.doi.org/10.1017/S0007114521003822DOI Listing
September 2021

The Relationship between HIV Duration, Insulin Resistance and Diabetes Risk.

Int J Environ Res Public Health 2021 04 8;18(8). Epub 2021 Apr 8.

Department of Psychiatry & Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL 33136, USA.

The risk of developing Type 2 Diabetes Mellitus in people living with HIV (PLWH) can be four times greater and can occur at an earlier age and even without the presence of obesity compared to those without HIV. Therefore, the purpose of this analytical cross-sectional study was to determine the relationship between HIV duration and glucose metabolism among PLWH. Eighty-two PLWH were categorized into shorter (≤15 years) or longer HIV duration (≥16 years) and then compared for differences in demographics, physical and clinical characteristics, biomarkers, and dietary intake. Compared to those with shorter HIV duration ( = 34), those with longer HIV duration ( = 48) were on average older ( = 0.02), reported lower consumption of alcohol ( = 0.05), had higher levels of homeostasis model assessment of insulin resistance (HOMA-IR, = 0.02), were also more likely to be a woman ( = 0.06), and have higher levels of fasting insulin ( = 0.06). When adjusted for age and body weight, the levels of HOMA-IR and fasting insulin were higher ( = 0.02 and = 0.04) with longer compared to shorter HIV duration, respectively. Longer exposure to HIV infection is associated with impaired insulin sensitivity. Continuing research aimed at the long-term effects of HIV infection and (antiretroviral therapy) is required.
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http://dx.doi.org/10.3390/ijerph18083926DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8068399PMC
April 2021

Acute exercise improves glucose effectiveness but not insulin sensitivity in paraplegia.

Disabil Rehabil 2021 Apr 27:1-7. Epub 2021 Apr 27.

Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA.

Purpose: To determine the effect of a single session of arm crank ergometry (ACE) exercise on carbohydrate metabolism immediately and 24 h after the exercise bout in paraplegia and able-bodied controls (ABC).

Methods: Paraplegia ( = 11; 91% male; age 34.8 ± 11.4 years) and ABC ( = 6; 67% male; age 28.7 ± 11.9 years) underwent 45 min of ACE exercise at 75% VO. Glucose effectiveness (Sg) and insulin sensitivity (Si) were assessed. Data were analyzed with two-way mixed analysis of variance and Wilcoxon rank-sum or signed-rank test.

Results: VO was lower in paraplegia versus ABC (22.3 ± 3.99 vs. 30.8 ± 2.9 ml/kg/min,  = 0.003). Si was lower paraplegia vs. ABC immediately following exercise (3.28 ± 1.6 vs. 5.30 ± 1.2 min/[µU/mL]x10,  = 0.023). In paraplegia, Sg was higher immediately after exercise than baseline (B: 0.021 ± 0.01 vs. I: 0.026 ± 0.01 min,  = 0.037). Twenty-four hours after exercise, Sg was lower than immediately following exercise (I: 0.026 ± 0.01 vs. 24: 0.017 ± 0.01 min,  = 0.001), but not different than baseline in paraplegia (B: 0.021 ± 0.01 vs. 24: 0.017 ± 0.01 min,  = 0.216). In the ABC group, Sg was not different at all timepoints ( > 0.05). Si did not differ at all timepoints ( > 0.05).

Conclusion: A single bout of ACE at 75% VO helped to acutely control glucose metabolism in those with paraplegia by increasing Sg by nearly 27%; however, this was not sustained past 24-hours. These data provide support for regular exercise engagement.Implications for RehabilitationDisorders of glucose metabolism have been reported at a greater prevalence in persons with spinal cord injury.A single bout of arm crank ergometry exercise at 75% VO helped to acutely control glucose metabolism persons with paraplegia; however, this was not sustained past 24 h.These data provide support for regular exercise engagement in persons with paraplegia.
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http://dx.doi.org/10.1080/09638288.2021.1913517DOI Listing
April 2021

Role of exercise on visceral adiposity after spinal cord injury: a cardiometabolic risk factor.

Eur J Appl Physiol 2021 Aug 23;121(8):2143-2163. Epub 2021 Apr 23.

Spinal Cord Injury and Disorders Center, Central Virginia VA Health Care System, 1201 Broad Rock Boulevard, Richmond, VA, 23249, USA.

Purpose: Visceral adipose tissue (VAT) is associated with cardiometabolic disease risk in able-bodied (AB) populations. However, the underlying mechanisms of VAT-induced disease risk are unknown in persons with spinal cord injury (SCI). Potential mechanisms of VAT-induced cardiometabolic dysfunction in persons with SCI include systemic inflammation, liver adiposity, mitochondrial dysfunction, and anabolic deficiency. Moreover, how exercise interventions impact these mechanisms associated with VAT-induced cardiometabolic dysfunction are still being explored.

Methods: A search for relevant scientific literature about the effects of exercise on VAT and cardiometabolic health was conducted on the PubMed database. Literature from reference lists was also included when appropriate.

Results: Both aerobic and resistance exercise training beneficially impact health and VAT mass via improving mitochondrial function, glucose effectiveness, and inflammatory signaling in SCI and AB populations. Specifically, aerobic exercise appears to also modulate cellular senescence in AB populations and animal models, while resistance exercise seems to augment anabolic signaling in persons with SCI.

Conclusions: The current evidence supports regular engagement in exercise to reduce VAT mass and the adverse effects on cardiometabolic health in persons with SCI. Future research is needed to further elucidate the precise mechanisms by which VAT negatively impacts health following SCI. This will likely facilitate the development of rehabilitation protocols that target VAT reduction in persons with SCI.
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http://dx.doi.org/10.1007/s00421-021-04688-3DOI Listing
August 2021

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.

Top Spinal Cord Inj Rehabil 2021 ;27(1):121-134

Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida.

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. To determine the adaptations of 16 weeks of FES cycling and ACE on exercise energy expenditure (EEE), cardiorespiratory fitness (CRF), and obesity after SCI. Thirteen physically untrained individuals were randomly assigned to FES ( = 6) or ACE ( = 7) exercise 5 days/week for 16 weeks. Pre- and post-intervention EEE, peak oxygen consumption (absolute and relative VO), and work were assessed using indirect calorimetry, while body composition was measured by dual-energy x-ray absorptiometry. Main effects were found for peak power ( < .001), absolute ( = .046) and relative ( = .042) VO, and peak work ( = .013). Compared to baseline, the ACE group increased in EEE (+85%, = .002), peak power (+307%, < .001), VO (absolute +21%, relative +22%, ≤ .024), peak work (19% increase, = .003), and total body fat decreased (-6%, = .05). The FES group showed a decrease in percentage body fat mass (-5%, = .008). The ACE group had higher EEE ( = .008), peak power ( < .001), and relative VO ( = .025) compared to postintervention values in the FES group. 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.
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http://dx.doi.org/10.46292/sci20-00065DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7983642PMC
April 2021

Dietetics After Spinal Cord Injury: Current Evidence and Future Perspectives.

Top Spinal Cord Inj Rehabil 2021 ;27(1):100-108

Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida.

Following spinal cord injury (SCI), individuals are at high risk for obesity and several chronic cardiometabolic disorders due to a deterioration in body composition, hypometabolic rate, and endometabolic dysregulation. Countermeasures to the consequences of an SCI include adopting a healthy diet that provides adequate nutrition to maintain good body habitus and cardiometabolic health. A proper diet for individuals with SCI should distribute carbohydrates, protein, and fat to optimize a lower energy intake requirement and should stress foods with low caloric yet high nutrient density. The purpose of this article is to present available evidence on how nutritional status after SCI should advance future research to further develop SCI-specific guidelines for total energy intake, as it relates to percent carbohydrates, protein, fat, and all vitamins and minerals, that take into consideration the adaptations after SCI.
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http://dx.doi.org/10.46292/sci20-00031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7983636PMC
April 2021

Energy Expenditure Following Spinal Cord Injury: A Delicate Balance.

Top Spinal Cord Inj Rehabil 2021 ;27(1):92-99

Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida.

Following a spinal cord injury (SCI), neurogenic obesity results from changes in body composition, physical impairment, and endometabolic physiology and when dietary intake exceeds energy expenditure. Given the postinjury reductions in lean body mass, sympathetic nervous system dysfunction, and anabolic deficiencies, energy balance is no longer in balance, and thereby an obesogenic environment is created that instigates cardiometabolic dysfunction. Accurate determination of metabolic rate can prevent excess caloric intake while promoting positive body habitus and mitigating obesity-related comorbidities. Metabolic rate as determined by indirect calorimetry (IC) has not been adopted in routine clinical care for persons with SCI despite several studies indicating its importance. This article reviews current literature on measured and predicted metabolic rate and energy expenditure after SCI and stresses the importance of IC as standard of care for persons with SCI.
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http://dx.doi.org/10.46292/sci20-00030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7983637PMC
April 2021

Neurogenic Obesity-Induced Insulin Resistance and Type 2 Diabetes Mellitus in Chronic Spinal Cord Injury.

Top Spinal Cord Inj Rehabil 2021 ;27(1):36-56

Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida.

The population with SCI is at a significant risk for both insulin resistance and type 2 diabetes mellitus (T2DM) secondary to neurogenic obesity. The prevalence of insulin resistance and T2DM in persons with SCI suggests that disorders of carbohydrate metabolism are at epidemic proportions within the population. However, the true frequency of such disorders may be underestimated because biomarkers of insulin resistance and T2DM used from the population without SCI remain nonspecific and may in fact fail to identify true cases that would benefit from intervention. Furthermore, diet and exercise have been used to help mitigate neurogenic obesity, but results on disorders of carbohydrate metabolism remain inconsistent, likely because of the various ways carbohydrate metabolism is assessed. The objective of this article is to review current literature on the prevalence and likely mechanisms driving insulin resistance and T2DM in persons with SCI. This article also explores the various assessments and diagnostic criteria used for insulin resistance and T2DM and briefly discusses the effects of exercise and/or diet to mitigate disorders of carbohydrate metabolism brought on by neurogenic obesity.
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http://dx.doi.org/10.46292/sci20-00063DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7983643PMC
April 2021

Anthropometric Prediction of Visceral Adiposity in Persons With Spinal Cord Injury.

Top Spinal Cord Inj Rehabil 2021 ;27(1):23-35

Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida.

Over two-thirds of persons with spinal cord injury (SCI) experience neurogenic obesity-induced cardiometabolic syndrome (CMS) and other chronic comorbidities. Obesity is likely to impede social and recreational activities, impact quality of life, and impose additional socioeconomic burdens on persons with SCI. Advances in imaging technology facilitate the mapping of adiposity and its association with the cardiometabolic profile after SCI. Central adiposity or central obesity is characterized by increased waist (WC) and abdominal circumferences (AC) as well as visceral adipose tissue (VAT). A number of studies, while relying on expensive imaging techniques, have reported direct associations of both central obesity and VAT in imposing significant health risks after SCI. The mechanistic role of central obesity on cardiometabolic heath in persons with SCI has yet to be identified, despite the knowledge that it has been designated as an independent risk factor for cardiometabolic dysfunction and premature mortality in other clinical populations. In persons with SCI, the distribution of adipose tissue has been suggested to be a function of sex, level of injury, and age. To date, there is no SCI-specific WC or AC cutoff value to provide anthropometric prediction of VAT and diagnostic capability of persons at risk for central obesity, CMS, and cardiovascular disease after SCI. The purpose of the current review is to summarize the factors contributing to visceral adiposity in persons with SCI and to develop an SCI-specific anthropometric prediction equation for this population. Furthermore, a proposed WC cutoff will be discussed as a surrogate index for central obesity, CMS, and cardiovascular disorders after SCI.
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http://dx.doi.org/10.46292/sci20-00055DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7983634PMC
April 2021

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

Top Spinal Cord Inj Rehabil 2021 ;27(1):11-22

Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia.

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. 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. 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. Subject characteristics included age 44.4 ± 11.3 years, time since injury (TSI) 14.4 ± 11.0 years, BMI 27.3 ± 5.9 kg/m; 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 correlation of 0.57 with 4C %BF ( < .0001). Metabolic syndrome was identified in 59.4% of the sample. 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.
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http://dx.doi.org/10.46292/sci20-00079DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7983632PMC
April 2021

Pathophysiology of Neurogenic Obesity After Spinal Cord Injury.

Top Spinal Cord Inj Rehabil 2021 ;27(1):1-10

Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida.

Individuals with a spinal cord injury (SCI) have a unique physiology characterized by sarcopenia, neurogenic osteoporosis, neurogenic anabolic deficiency, sympathetic dysfunction, and blunted satiety associated with their SCI, all of which alter energy balance and subsequently body composition. The distinct properties of "neurogenic obesity" place this population at great risk for metabolic dysfunction, including systemic inflammation, hyperglycemia, dyslipidemia, and hypertension. The purpose of this article is to demonstrate the relationship between neurogenic obesity and the metabolic syndrome after SCI, highlighting the mechanisms associated with adipose tissue pathology and those respective comorbidities. Additionally, representative studies of persons with SCI will be provided to elucidate the severity of the problem and to prompt greater vigilance among SCI specialists as well as primary care providers in order to better manage the epidemic from a public health perspective.
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http://dx.doi.org/10.46292/sci20-00067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7983633PMC
April 2021

An Analysis of Anatomy Education Before and During Covid-19: May-August 2020.

Anat Sci Educ 2021 Mar 12;14(2):132-147. Epub 2021 Feb 12.

Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida.

Coronavirus disease 2019 (Covid-19) created unparalleled challenges to anatomy education. Gross anatomy education has been particularly impacted given the traditional in-person format of didactic instruction and/or laboratory component(s). To assess the changes in gross anatomy lecture and laboratory instruction, assessment, and teaching resources utilized as a result of Covid-19, a survey was distributed to gross anatomy educators through professional associations and listservs. Of the 67 survey responses received for the May-August 2020 academic period, 84% were from United States (US) institutions, while 16% were internationally based. Respondents indicated that in-person lecture decreased during Covid-19 (before: 76%, during: 8%, P < 0.001) and use of cadaver materials declined (before: 76 ± 33%, during: 34 ± 43%, P < 0.001). The use of cadaver materials in laboratories decreased during Covid-19 across academic programs, stand-alone and integrated anatomy courses, and private and public institutions (P ≤ 0.004). Before Covid-19, cadaveric materials used in laboratories were greater among professional health programs relative to medical and undergraduate programs (P ≤ 0.03) and among stand-alone relative to integrated anatomy courses (P ≤ 0.03). Furthermore, computer-based assessment increased (P < 0.001) and assessment materials changed from cadaveric material to images (P < 0.03) during Covid-19, even though assessment structure was not different (P > 0.05). The use of digital teaching resources increased during Covid-19 (P < 0.001), with reports of increased use of in-house created content, BlueLink, and Complete Anatomy software (P < 0.05). While primarily representing US institutions, this study provided evidence of how anatomy educators adapted their courses, largely through virtual mediums, and modified laboratory protocols during the initial emergence of the Covid-19 pandemic.
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http://dx.doi.org/10.1002/ase.2051DOI Listing
March 2021

Influence of mid and low paraplegia on cardiorespiratory fitness and energy expenditure.

Spinal Cord Ser Cases 2020 12 16;6(1):110. Epub 2020 Dec 16.

Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA.

Study Design: Observational, Cross-sectional.

Objective: Examine the influence of mid (MP) and low (LP) paraplegia on cardiorespiratory fitness (CRF), energy expenditure (EE), and physical activity levels (PAL), and compare these data to able-bodied (AB) individuals.

Setting: Academic medical center.

Methods: Persons with MP (n = 6, T6-T8, 83% male, age: 31 ± 11 y, BMI: 24 ± 7 kg/m) and LP (n = 5; T10-L1, 100% male, age: 39 ± 11 y, BMI: 26 ± 5 kg/m) and AB controls (n = 6; 67% male, age: 29 ± 12 y, BMI: 26 ± 5 kg/m) participated. All participants underwent 45-min of arm-crank exercise where CRF and exercise EE were measured. Basal metabolic rate (BMR) was measured, and total daily EE (TDEE) and PAL were estimated.

Results: Absolute VO (MP: 1.6 ± 0.2, LP: 1.9 ± 0.1, AB: 2.5 ± 0.7 l/min), peak metabolic equivalents (MP: 6.8 ± 1.3, LP: 5.7 ± 0.7, AB: 8.8 ± 0.8 METs), peak power output (MP: 72.9 ± 11.5, LP: 86.8 ± 6.1, AB: 121.0 ± 34.8 Watts), and maximal heart rate (MP: 177.7 ± 9.8, LP: 157 ± 13.6, AB: 185.2 ± 8.5 bpm) were significantly different between the three groups (p < 0.05). BMR and TDEE did not significantly differ between the three groups (p > 0.05), whereas exercise EE (MP: 7.8 ± 1.2, LP: 9.5 ± 0.7, AB: 12.4 ± 3.5 kcal/min) and PAL (MP: 1.30 ± 0.04, LP: 1.32 ± 0.04, AB: 1.43 ± 0.06) significantly differed (p < 0.05). In the AB group, 33.3% and 66.7% were classified as sedentary or having low activity levels, respectively, while all persons with paraplegia were classified as sedentary according to PAL classifications.

Conclusion: Individuals with MP and LP have lower CRF, exercise EE, and PALs compared to AB individuals.
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http://dx.doi.org/10.1038/s41394-020-00363-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7744794PMC
December 2020

Squat and gait biomechanics 6 months following hip arthroscopy for femoroacetabular impingement syndrome.

J Hip Preserv Surg 2020 Jan 18;7(1):27-37. Epub 2020 Feb 18.

Department of Orthopedic Surgery, Rush University Medical Center, 1611 West Harrison St, Suite 300, Chicago, IL 60612, USA.

The purpose of this study was to (i) assess whether squat and gait biomechanical measures improve in patients with femoroacetabular impingement syndrome (FAIS) 6 months after surgery compared to pre-operative measures and (ii) compare biomechanical properties to controls without FAIS. In this prospective study, biomechanical data during a double leg squat task and gait for 15 FAIS patients and 9 controls were collected using three-dimensional motion analysis. Data were collected in the FAIS group at two-time points, pre-operatively and 6-month post-operatively following arthroscopic hip surgery, and at a single time point for the healthy controls. Independent sample's -test were used to compare the FAIS group to the controls, and paired samples -test were used to determine within-group differences before and after hip arthroscopy in the FAIS group. The results indicated that there were significant within-group increases for sagittal plane moment rate during the double leg squat task ( = 0.009) between the pre-operative and post-operative time points for the FAIS group. Between-group differences showed that FAIS patients pre-operatively exhibit slower squat velocities during the descent ( = 0.005) and ascent phase ( = 0.012) of a double leg squat when compared healthy controls. Reduced hip external rotation moments during gait ( = 0.02) were also found between FAIS patients pre-operatively and controls. In conclusion, alterations in hip biomechanics are present before surgery for FAIS when compared to healthy controls, and joint mechanics change 6 months after surgery. However, the biomechanical differences during a double leg squat and gait were minimal.
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http://dx.doi.org/10.1093/jhps/hnaa004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7195932PMC
January 2020

Energy Expenditure and Nutrition in Neurogenic Obesity following Spinal Cord Injury.

J Phys Med Rehabil 2020 ;2(1):11-13

Department of Physical Medicine and Rehabilitation, Miami, FL 33136, USA.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7100891PMC
January 2020

A Systematic Review of the Accuracy of Estimated and Measured Resting Metabolic Rate in Chronic Spinal Cord Injury.

Int J Sport Nutr Exerc Metab 2019 09;29(5):548-558

Penn State College of Medicine.

The objective of this systematic review was to examine resting metabolic rate (RMR) measured through indirect calorimetry in adults with chronic spinal cord injury (SCI) and to evaluate the predication equations used for the estimation of RMR in this population. The authors additionally aimed to review the impact of sex and level of injury on RMR. A MEDLINE/PubMed, Google Scholar, Scopus, and Web of Science search was performed for studies published from the database inception to January 2018, identifying 326 articles. On the basis of the inclusion criteria, 22 studies remained for review. All articles that were identified were full-text, English language articles examining adults with chronic SCI who were fasted for a minimum of 8 hr before undergoing RMR through indirect calorimetry for at least 20 min. The measured RMR ranged from 1,256.0 to 1,854.0 kcal/day, whereas the estimated RMR ranged from 1,276.8 to 1,808.0 kcal/day in the chronic SCI population. Seven studies overestimated RMR from 4% to 15%, whereas two studies underestimated RMR from 2% to 17% using prediction equations established for the able-bodied population. Two studies produced SCI-specific equations to estimate RMR. With regard to sex and level of injury, RMR does not differ between individuals with tetraplegia and paraplegia, whereas sex-based differences remain inconclusive, given limited results. These data provide evidence for the use of indirect calorimetry to assess RMR and the need to validate SCI-specific prediction equations in the estimation of RMR.
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http://dx.doi.org/10.1123/ijsnem.2018-0242DOI Listing
September 2019

Caloric Intake Relative to Total Daily Energy Expenditure Using a Spinal Cord Injury-Specific Correction Factor: An Analysis by Level of Injury.

Am J Phys Med Rehabil 2019 11;98(11):947-952

From the Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, San Francisco, California (GJF); Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia (ASG); Department of Physical Therapy, William Carey University, Hattiesburg, Mississippi (DRD); Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania (ASB); and Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, Hershey, Pennsylvania (DRG).

Objective: The aims of the study were to evaluate the influence of level of spinal cord injury (SCI) on caloric intake relative to total daily energy expenditure (TDEE) and body composition, and to develop a SCI-specific correction factor for the TDEE estimation.

Design: Individuals with paraplegia (PARA, n = 28) and tetraplegia (TETRA, n = 13) were analyzed. Daily caloric intake, basal metabolic rate, and TDEE were obtained using dietary recall, indirect calorimetry, and prediction equations, respectively. Caloric intake and TDEE were adjusted to bodyweight. Body composition was assessed using dual-energy x-ray absorptiometry.

Results: Total caloric (PARA 1516.4 ± 548.4, TETRA 1619.1 ± 564.3 kcal/d), fat (PARA 58.6 ± 27.4, TETRA 65.8 ± 29.7 g), and protein (PARA 62.7 ± 23.2, TETRA 71.5 ± 30.9 g) intake were significantly higher in TETRA versus PARA (P < 0.05) when adjusted for bodyweight. Adjusted and unadjusted TDEE (unadjusted: PARA 1851.0 ± 405.3, TETRA 1530.4 ± 640.4 kcal/d) and basal metabolic rate (unadjusted: PARA 1516.6 ± 398.0, TETRA 1223.6 ± 390.2 kcal/d) were significantly higher in PARA versus TETRA (P < 0.05). Bone mineral content (PARA 3.17 ± 0.6, TETRA 2.71 ± 0.5 g), lean body mass (PARA 50.0 ± 8.6, TETRA 40.96 ± 8.8 kg), and regional percent body fat (PARA 36.45 ± 8.0, TETRA 41.82 ± 9.1) were different between groups (P < 0.05). The SCI-specific correction factor was 1.15.

Conclusions: A dichotomy exists in caloric intake, TDEE, and body composition among TETRA and PARA. The SCI-specific correction factor of 1.15 is a promising tool to estimate TDEE in SCI.

To Claim Cme Credits: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Understand the influence of spinal cord level of injury on energy expenditure and body composition; (2) Appreciate that equations used to estimate total daily energy expenditure overestimate energy expenditure in individuals with spinal cord injury; and (3) Understand the importance of normalizing caloric intake to bodyweight after spinal cord injury.

Level: Advanced.

Accreditation: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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http://dx.doi.org/10.1097/PHM.0000000000001166DOI Listing
November 2019

Correction: Nutritional status in chronic spinal cord injury: a systematic review and meta-analysis.

Spinal Cord 2019 03;57(3):256

Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, 500 University Drive, P.O. Box 850, Mail Code R120, Hershey, PA, 17033-0850, USA.

The authors noted that there were two typographical errors in Table 2. Under the 'Tetraplegia' group of 'Gorgey et al. [55]' the 'RMR' value was originally given as '14,101 ± 10'. This has now been corrected to '1411 ± 10'. Under the 'Tetra' group of 'Sabour et al. [22]' the 'Energy intake' was originally given as '20,123 ± 681'. This has now been corrected to '2013 ± 681'. This has been corrected in both the PDF and HTML versions of the Article.
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http://dx.doi.org/10.1038/s41393-019-0252-xDOI Listing
March 2019

Nutritional status in chronic spinal cord injury: a systematic review and meta-analysis.

Spinal Cord 2019 Jan 12;57(1):3-17. Epub 2018 Nov 12.

Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, 500 University Drive, P.O. Box 850, Mail Code R120, Hershey, PA, 17033-0850, USA.

Study Design: Systematic review and meta-analysis.

Objectives: The objective was to investigate nutritional status in chronic spinal cord injury (SCI), and compare macronutrient and micronutrient intake to the recommended values by the United States Department of Agriculture (USDA) 2015-2020 Dietary Guidelines for Americans.

Setting: United States of America.

Methods: A MEDLINE/PubMed, Google Scholar, Scopus, and Web of Science search was performed, identifying 268 papers. All papers included were English-language papers examining adults with chronic SCI. A meta-analysis was performed to produce weighted averages and 95% confidence intervals (CI) when summary statistics were provided.

Results: The systematic review included 15 articles, while the meta-analysis included 12. Resting metabolic rate (1492 kcal/day; CI: 1414-1569) fell below the able-bodied average, and total energy (1876 kcal/day; CI: 1694-2059) and fiber (17 g/day; CI: 14-20) intake were below USDA guidelines. Protein (319 kcal/day; CI: 294-345) and carbohydrate (969 kcal/day; CI: 851-1087) intake were above guidelines. Fat intake (663 kcal/day; CI: 590-736) was within USDA guidelines. Vitamins A, B5, B7, B9, D, E, potassium, and calcium were deficient, while vitamins B1, B2, B3, B12, C, K, sodium, phosphorus, copper, and zinc were in excess according to USDA guidelines. Vitamin B6, iron, and magnesium were within USDA guidelines.

Conclusion: Findings indicate greater energy intake relative to energy needs in those with chronic SCI, and an imbalance in fiber intake and micronutrients compared to the USDA guidelines. Future research examining nutritional health status is needed in order to establish evidence-based, SCI-specific dietary guidelines.
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http://dx.doi.org/10.1038/s41393-018-0218-4DOI Listing
January 2019

Transient anisocoria after a traumatic cervical spinal cord injury: A case report.

J Spinal Cord Med 2020 05 20;43(3):398-401. Epub 2018 Aug 20.

Department of Physical Medicine and Rehabilitation, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.

Autonomic dysreflexia and dysautonomia can be a common complication following spinal cord injury, especially at levels of T6 and above and can lead to complications associated with the pupil. In this case report, we review autonomic dysreflexia, the anatomy and physiology of the sympathetic nervous system of the eye, as well as review the clinical relevance in understanding autonomic and pupillary changes in response to autonomic dysfunction. We present a patient with an incomplete C4 level injury who was found to have isolated anisocoria on two separate occasions during his acute inpatient rehabilitation stay. Anisocoria associated with abnormal sympathetic activation may be a clinical sign of dysautonomia.
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http://dx.doi.org/10.1080/10790268.2018.1509532DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7241474PMC
May 2020

Gait asymmetries in unilateral symptomatic hip osteoarthritis and their association with radiographic severity and pain.

Hip Int 2019 Mar 7;29(2):209-214. Epub 2018 May 7.

6 Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA.

Introduction:: Little is known about the loading patterns in unilateral hip osteoarthritis (OA) and their relationship to radiographic severity and pain. We aimed to examine the loading patterns at the hips of those with unilateral symptomatic hip OA and identify associations between radiographic severity and pain with loading alterations.

Methods:: 61 subjects with symptomatic unilateral hip OA underwent gait analyses and evaluation for radiographic severity (Kellgren-Lawrence [KL]-grade) and pain (visual analogue scale) at bilateral hips.

Results:: Hip OA subjects had greater range of motion and higher hip flexion, adduction, internal and external rotation moments at the contralateral, asymptomatic hip compared to the ipsilateral hip ( p < 0.05). Correlations were noted between increasing KL-grade and increasing asymmetry of contralateral to ipsilateral hip loading ( p < 0.05). There were no relationships with pain and loading asymmetry.

Discussion:: Unilateral symptomatic hip OA subjects demonstrate asymmetry in loading between the hips, with relatively greater loads at the contralateral hip. These loading asymmetries were directly related to the radiographic severity of symptomatic hip OA and not with pain.

Conclusion:: Additional research is needed to determine the role of gait asymmetries in disease progression.
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http://dx.doi.org/10.1177/1120700018773433DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7333443PMC
March 2019

Sex dimorphism in the distribution of adipose tissue and its influence on proinflammatory adipokines and cardiometabolic profiles in motor complete spinal cord injury.

J Spinal Cord Med 2019 07 21;42(4):430-436. Epub 2018 Feb 21.

a Department of Physical Medicine and Rehabilitation , Penn State College of Medicine , Hershey , Pennsylvania , USA.

We aimed to examine the influence of sex on the distribution of adipose tissue, as well as proinflammatory adipokine and cardiometabolic profiles, in chronic motor complete spinal cord injury (SCI). Cross-sectional and correlational study. Academic rehabilitation hospital. Forty-seven individuals with chronic motor complete SCI classified according to sex (males: age 44.0 ± 10.9 y, body mass index (BMI) 27.2 ± 5.8, level of injury (LOI) C4 - L1; females: 42.0 ± 13.5 y, BMI 27.8 ± 6.6, LOI C4 - T11). Not applicable. Visceral (VAT), subcutaneous (SAT), and total trunk (TTAT) adipose tissue volumes were assessed utilizing magnetic resonance imaging and a VAT:SAT ratio was calculated. Proinflammatory adipokines (tumor neurosis factor-α, interleukin-6, plasminogen activator inhibitor-1, thrombin-activatable fibrinolysis inhibitor, and high sensitivity c-reactive protein) and cardiovascular, carbohydrate, and lipid profiles were evaluated according to standard techniques. VAT and VAT:SAT ratio were significantly greater in male participates with SCI (P ≤ 0.002), while SAT volume was significantly greater in female participants with SCI (P = 0.001). No difference was noted in TTAT between groups (P = 0.341). Male participants with SCI demonstrated lower high-density lipoprotein-cholesterol (HDLC) profiles and an elevated total cholesterol to HDLC ratio (P ≤ 0.003) compared with females. No other significant differences were found between groups concerning cardiometabolic profiles or proinflammatory adipokines; however, males exhibited poorer profiles overall. Proinflammatory adipokines significantly correlated with adipose tissue depots by sex (P < 0.05). The results show that sex influences the distribution of adipose tissue, and may influence proinflammatory and cardiometabolic profiles following SCI. The findings of this study highlight the need for further research with dietary modification and exercise to decrease health risks.
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http://dx.doi.org/10.1080/10790268.2018.1436125DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6718133PMC
July 2019

Arm crank ergometry improves cardiovascular disease risk factors and community mobility independent of body composition in high motor complete spinal cord injury.

J Spinal Cord Med 2019 05 15;42(3):272-280. Epub 2018 Jan 15.

b Department of Physical Medicine and Rehabilitation , Pennsylvania State University College of Medicine , Hershey , Pennsylvania.

Objective: Evaluate the effect of aerobic exercise using arm crank ergometry (ACE) in high motor complete (ISNCSCI A/B) spinal cord injury (SCI) as primarily related to cardiovascular disease (CVD) risk factors and functional mobility and secondarily to body composition and metabolic profiles.

Design: Longitudinal interventional study at an academic medical center.

Methods: Ten previously untrained participants (M8/F2, Age 36.7 y ± 10.1, BMI 24.5 ± 6.0) with high motor complete SCI (C7-T5) underwent ACE exercise training 30 minutes/day × 3 days/week for 10 weeks at 70% VO.

Outcome Measures: Primary outcome measures were pre- and post-intervention changes in markers of cardiovascular fitness (graded exercise testing (GXT): VO, VO, respiratory quotient [RQ], GXT time, peak power, and energy expenditure [EE]) and community mobility (time to traverse a 100ft-5° ramp, and 12-minute WC propulsion test). Secondary outcome measures were changes in body composition and metabolic profiles (fasting and area under the curve for glucose and insulin, homeostasis model assessment [HOMA] for %β-cell activity [%β], %insulin sensitivity [%S], and insulin resistance [IR], and Matsuda Index [ISI]).

Results: Resting VO, relative VO, absolute VO, peak power, RQ, 12-minute WC propulsion, fasting insulin, fasting G:I ratio, HOMA-%S, and HOMA-IR all significantly improved following intervention (P < 0.05). There were no changes in body composition (P>0.05).

Conclusions: Ten weeks of ACE at 70% VO in high motor complete SCI improves aerobic capacity, community mobility, and metabolic profiles independent of changes in body composition.
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http://dx.doi.org/10.1080/10790268.2017.1412562DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6522950PMC
May 2019

Prevalence of metabolic syndrome in veterans with spinal cord injury.

J Spinal Cord Med 2019 01 11;42(1):86-93. Epub 2018 Jan 11.

c Division of Physical Medicine and Rehabilitation, Department of Neurosurgical Surgery , University of Louisville School of Medicine , Louisville , Kentucky.

Context/objective: Recent literature would suggest the prevalence of metabolic syndrome in persons with spinal cord injury (SCI) is higher than that of the general population, although no large cohorts have yet been reported. Part of the controversy relates to the differing definitions provided for metabolic syndrome and the characterization of obesity in persons with SCI.

Design/participants: The current retrospective investigation represents a cross-sectional cohort of 473 veterans with SCI from a single center in the mid-Atlantic region of the United States for whom modified International Diabetes Federation (IDF) criterion variables for the metabolic syndrome were available in the computerized personal record system (CPRS).

Outcome Measures: These variables included a surrogate marker of obesity appropriate to SCI (Body Mass Index (BMI) ≥ 22 kg/m), as well as indicators of diabetes, dyslipidemia and hypertension.

Results: Over 57% of the veterans assessed were determined to have metabolic syndrome by modified IDF criteria, including 76.7% with BMI ≥ 22 kg/m, 55.1% with or under treatment for hypertension, 49.7% with or previously diagnosed with diabetes mellitus, and 69.7% with or under treatment for high density lipoprotein (HDL) cholesterol under 40 mg/dl.

Conclusion: Metabolic syndrome and its constituent components appear to be more prevalent in veterans with SCI than in the general population, suggesting a greater need for identification and treatment interventions in this specialty population.
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http://dx.doi.org/10.1080/10790268.2017.1423266DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6340269PMC
January 2019

Gender Dimorphism in Central Adiposity May Explain Metabolic Dysfunction After Spinal Cord Injury.

PM R 2018 04 18;10(4):338-348. Epub 2017 Aug 18.

Spinal Cord Injury and Disorders Service, Hunter Holmes McGuire VAMC, 1201 Broad Rock Blvd, Richmond, VA 23249; Virginia Commonwealth University, Department of Physical Medicine & Rehabilitation, Richmond, VA.

Background: Increase in visceral adipose tissue (VAT) is an independent risk for mortality and other health-related comorbidities.

Objective: To examine the gender differences in VAT and subcutaneous adipose tissue (SAT) cross-sectional areas (CSA) between men and women with chronic spinal cord injury (SCI). The differences in the distribution of central adiposity were used to determine the association of VAT and SAT to metabolic dysfunction after SCI.

Design: Cross-sectional design.

Setting: Hospital-based study.

Participants: Sixteen individuals (8 men and 8 women) with motor complete SCI were matched based on age, time since injury, and level of injury.

Methods: Anthropometrics, dual x-ray absorptiometry (DXA), and magnetic resonance imaging were captured to measure lean mass, fat mass (FM), percentage FM, VAT, and SAT CSAs. Basal metabolic rate was measured, and intravenous glucose tolerance test and lipid panel were performed.

Main Outcome Measurements: VAT, SAT, and metabolic profile.

Results: SAT CSA was 1.6 -1.75 times greater in the upper and lower trunks in women compared to men with SCI (P < .05). VAT CSA was 1.8-2.6 times greater in the upper and lower trunks in men compared to women with SCI (P < .05). VAT adjusted to body weight was greater in men compared to women with SCI. High-density lipoprotein cholesterol (HDL-C) was positively related to SAT and negatively related to VAT. Glucose effectiveness was negatively related to lower trunk SAT (r = -0.60, P = .02). HDL-C ratio and triglycerides were positively related to upper VAT, lower VAT, and VAT:SAT ratio.

Conclusion: Magnetic resonance imaging demonstrated that there is a gender dimorphism in central adiposity in persons with chronic SCI. This gender dimorphism in central adipose tissue distribution may explain the higher prevalence of metabolic dysfunction in men with SCI, especially, the decrease in the HDL-C profile.

Level Of Evidence: IV.
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http://dx.doi.org/10.1016/j.pmrj.2017.08.436DOI Listing
April 2018
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