Exercise Interventions Targeting Obesity in Persons With Spinal Cord Injury

Abstract

Spinal cord injury (SCI) results in an array of cardiometabolic complications, with obesity being the most common component risk of cardiometabolic disease (CMD) in this population. Recent Consortium for Spinal Cord Medicine Clinical Practice Guidelines for CMD in SCI recommend physical exercise as a primary treatment strategy for the management of CMD in SCI. However, the high prevalence of obesity in SCI and the pleiotropic nature of this body habitus warrant strategies for tailoring exercise to specifically target obesity. In general, exercise for obesity management should aim primarily to induce a negative energy balance and secondarily to increase the use of fat as a fuel source. In persons with SCI, reductions in the muscle mass that can be recruited during activity limit the capacity for exercise to induce a calorie deficit. Furthermore, the available musculature exhibits a decreased oxidative capacity, limiting the utilization of fat during exercise. These constraints must be considered when designing exercise interventions for obesity management in SCI. Certain forms of exercise have a greater therapeutic potential in this population partly due to impacts on metabolism during recovery from exercise and at rest. In this article, we propose that exercise for obesity in SCI should target large muscle groups and aim to induce hypertrophy to increase total energy expenditure response to training. Furthermore, although carbohydrate reliance will be high during activity, certain forms of exercise might induce meaningful postexercise shifts in the use of fat as a fuel. General activity in this population is important for many components of health, but low energy cost of daily activities and limitations in upper body volitional exercise mean that exercise interventions targeting utilization and hypertrophy of large muscle groups will likely be required for obesity management.

Neither Postabsorptive Resting Nor Postprandial Fat Oxidation Are Related to Peak Fat Oxidation in Men With Chronic Paraplegia

“…Hereditary factors play a larger role in determining FO at rest than physical activity level (33) and body composition appears to have little influence (32). Despite the known reductions in the proportion of type 1 muscle fibers (34)(35)(36)(37)(38) and capacity to increase exercise energy expenditure (39) with SCI, the rates of FO of our participants in the postabsorptive resting (0.08 ± 0.02 g/min) and postprandial states (0.10 ± 0.03 g/min) are very similar to those of non-injured participants (0.06-0.08 and 0.08-0.12 g/min, respectively) (14,33,40,41). The participants of the current study were able to achieve normal rates of FO in the face of the moderate metabolic challenges of fasting and consumption of an acute mixed meal.…”

Effects of Arm-Crank Exercise on Fitness and Health in Adults With Chronic Spinal Cord Injury: A Systematic Review

“…Compared to lower-body exercise or whole-body exercise, there are fewer muscles activated during ACE and the muscles involved have a relatively smaller muscle mass, hence a reduced oxygen consumption and lower energy expenditure ( Nightingale et al, 2017a ). Consequently, ACE results in a smaller metabolic disturbance and generates less of an energy deficit to modulate body composition, compared with lower-body or whole-body exercise ( McMillan et al, 2021 ). Furthermore, it has been reported that individuals with motor-complete tetraplegia utilize ∼50% less VO 2 during exercise than individuals with motor-complete paraplegia ( Holmlund et al, 2018 ).…”

Rates, Variability, and Predictors of Screening for Obesity: Are Individuals with Spinal Cord Injury Being Overlooked?

“…Tailored interventions for the targeted management of obesity have been shown to be important in persons with SCI [31]. However, this often depends on an adequate recognition of disease.…”