Effects of a Tailored Physical Activity Intervention on Cardiovascular Structure and Function in Individuals With Spinal Cord Injury

Abstract

Background Spinal cord injury (SCI) leads to a loss of descending motor and sympathetic control below the level of injury (LOI), which ultimately results in chronically altered cardiovascular function and remodeling. While supervised, laboratory-based exercise training can generate cardiovascular adaptations in people with SCI, it is unknown whether behavioral community-based interventions effectively generate such adaptations for individuals with SCI. Objective Examine the effects of a tailored behavioral physical activity (PA) intervention on cardiac and vascular structure and function in individuals with SCI. Methods In this randomized controlled trial, 32 participants with SCI (18-65 years, SCI >1 year) were assigned to PA (8-week behavioral intervention) or control (CON) groups. At baseline and postintervention, measures of resting left ventricular (LV) structure and function, carotid intima-media thickness and pulse-wave velocity were assessed with ultrasound and tonometry. Results Twenty-eight participants completed the study (n = 14/group). Across the full study cohort there were no significant changes in indices of LV or vascular structure and function, despite notable improvements in peak power and oxygen uptake in the PA group. However, in a subanalysis for LOI, individuals in the PA group with LOIs below T6 had evidence of altered LV geometry (ie, increased LV internal diameter, reduced sphericity index and relative wall thickness; group × time P < 0.05 for all), which was not seen in individuals with higher LOIs at or above T6. Conclusion An 8-week behavioral PA intervention appears to promote adaptations in cardiac geometry more readily in individuals with lower level SCI than those with higher-level SCI.

Métodos de avaliação da aptidão cardiorrespiratória e composição corporal de adultos com lesão medular: uma revisão sistemática

“…As medidas de desfecho incluíram CC [peso corporal, índice de massa corporal, massa corporal gorda, percentual de gordura corporal, gordura visceral, circunferência da Para a ACR, todos os estudos incluídos utilizaram a ergoespirometria em cicloergômetro de membros superiores como ferramenta de avaliação (AKKURT et al, 2017;MA et al, 2019;NIGHTINGALE et al, 2018;NIGHTINGALE et al, 2017;NOOIJEN et al, 2017;WILLIAMS et al, 2021).…”

“…A maioria dos estudos (83,3%), incluídos nessa revisão, que avaliaram a CC utilizaram as medidas antropométricas como indicador de gordura corporal (NIGHTINGALE et al, 2018;NOOIJEN et al, 2017) A randomização ocorreu em 100% dos estudos (AKKURT et al, 2017;MA et al, 2019;NIGHTINGALE et al, 2018;NIGHTINGALE et al, 2017;NOOIJEN et al, 2017;WILLIAMS et al, 2021), sendo que em 33,3% dos estudos (AKKURT et al, 2017;WILLIAMS et al, 2021) houve alocação secreta dos participantes. Para geração da sequência de randomização, relato seletivo de desfechos e outras fontes de vieses, houve resultado de 100% para baixo risco de viés em todos os seis artigos incluídos nesta revisão sistemática (AKKURT et al, 2017;MA et al, 2019;NIGHTINGALE et al, 2018;NIGHTINGALE et al, 2017;NOOIJEN et al, 2017;WILLIAMS et al, 2021).…”

“…Adicionalmente, 83,3% dos estudos (AKKURT et al, 2017;MA et al, 2019;NIGHTINGALE et al, 2018;NIGHTINGALE et al, 2017;WILLIAMS et al, 2021) apresentaram baixo risco de viés para dados incompletos de desfechos. No entanto, em 66,6% dos estudos (AKKURT et al, 2017;MA et al, 2019;NOOIJEN et al, 2017;WILLIAMS et al, 2021) não houve cegamento de participantes e equipe ou este cegamento foi incompleto e em dois estudos (NIGHTINGALE et al, 2018;NIGHTINGALE et al, 2017) não havia informação suficiente para julgar como alto risco e baixo risco de viés. Em 83,3% dos estudos (AKKURT et al, 2017;MA et al, 2019;NIGHTINGALE et al, 2017;NOOIJEN et al, 2017;WILLIAMS et al, 2021)…”

“…Nesse contexto, o exercício físico apresenta-se como uma ferramenta essencial para a reabilitação física de adultos com LME (HOEKSTRA et al, 2020;MARTIN GINIS et al, 2018). De fato, vários estudos mostraram que a intervenção com o exercício físico promove adaptações positivas na aptidão cardiorrespiratória (ACR), força muscular, flexibilidade, composição corporal (CC) e qualidade de vida dessa população (AKKURT et al, 2017;DE CASTRO AMORIM et al, 2021;MA;WEST;MARTIN GINIS, 2019;NIGHTINGALE et al, 2018;NIGHTINGALE et al, 2017;NOOIJEN et al, 2017;WILLIAMS et al, 2021).…”

The effect of exercise on aerobic capacity in individuals with spinal cord injury: A systematic review with meta-analysis and meta-regression

“…Williams et al [99] demonstrated that individuals with a lower level of injury (<T6) significantly improved PPO compared to individuals with a higher level of injury (≥T6), suggesting a potential role of disrupted cardiovascular control in mediating changes in PPO. Whilst methods for ameliorating the reduction in sympathetic cardiovascular control typically associated with injuries ≥T6 have been investigated (e.g., abdominal binding [100], lower-body positive pressure [101], and midodrine [102]), the evidence for an improved CRF is still mixed.…”