Energy Expenditure as a Function of Activity Level After Spinal Cord Injury: The Need for Tetraplegia-Specific Energy Balance Guidelines

Abstract

The World Health Organization recognizes obesity as a global and increasing problem for the general population. Because of their reduced physical functioning, people with spinal cord injury (SCI) face additional challenges for maintaining an appropriate whole body energy balance, and the majority with SCI are overweight or obese. SCI also reduces exercise capacity, particularly in those with higher-level injury (tetraplegia). Tetraplegia-specific caloric energy expenditure (EE) data is scarce. Therefore, we measured resting and exercise-based energy expenditure in participants with tetraplegia and explored the accuracy of general population-based energy use predictors. Body composition and resting energy expenditure (REE) were measured in 25 adults with tetraplegia (C4/5 to C8) and in a sex-age-height matched group. Oxygen uptake, carbon dioxide production, heart rate, perceived exertion, and exercise intensity were also measured in 125 steady state exercise trials. Those with motor-complete tetraplegia, but not controls, had measured REE lower than predicted (mean = 22% less, p < 0.0001). REE was also lower than controls when expressed per kilogram of lean mass. Nine had REE below 1200 kcal/day. We developed a graphic compendium of steady state EE during arm ergometry, wheeling, and hand-cycling. This compendium is in a format that can be used by persons with tetraplegia for exercise prescription (calories, at known absolute intensities). EE was low (55–450 kcal/h) at the intensities participants with tetraplegia were capable of maintaining. If people with tetraplegia followed SCI-specific activity guidelines (220 min/week) at the median intensities we measured, they would expend 563–1031 kcal/week. Participants with tetraplegia would therefore require significant time (4 to over 20 h) to meet a weekly 2000 kcal exercise target. We estimated total daily EE for a range of activity levels in tetraplegia and compared them to predicted values for the general population. Our analysis indicated that the EE values for sedentary through moderate levels of activity in tetraplegia fall well below predicted sedentary levels of activity for the general population. These findings help explain sub-optimal responses to exercise interventions after tetraplegia, and support the need to develop tetraplegia-specific energy-balance guidelines that reflects their unique EE situation.

Efficacy of early rehabilitation in a patient with spinal cord ischemia and hypoxic-ischemic encephalopathy: a case report

“…Although the cardiovascular outcome was excellent in this patient, rare and significant neurological morbidity has occurred. The researchers reported that patients with tetraplegia after spinal ischemia might have a loss of balance and loss of strength in the lower limb muscles (14). These results supports our study.…”

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

“…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 ). Consequently, Shea and colleagues ( Shea et al, 2018 ) suggested that individuals with higher level injuries may require a greater exercise volume (>220 min per week) to overcome the unique low energy expenditure achieved in this population and observe a health benefit from upper-body exercise. Thus, future research is required to determine optimal ACE prescriptions to effectively and consistently modify body composition and CVD risk factors for adults with chronic SCI.…”

Health provider identified barriers and facilitators to weight management for individuals with spinal cord injury

“…It is not surprising that healthcare providers commonly mentioned physical limitations and altered body composition as barriers to weight management, particularly as these have been previously identified as barriers to exercise in SCI [ 10 , 11 ]. Following SCI, individuals experience changes in their level of function based on the level of injury, and as a result, reductions in muscle mass [ 17 ] and decreased resting energy expenditure [ 18 ]. Participants also highlighted that as a result of the injury and subsequent bodily changes, these individuals have fewer opportunities to participate in leisure physical activities or exercise and more challenges in shopping and preparing meals.…”