Evidence-based and heuristic approaches for customization of care in cardiometabolic syndrome after spinal cord injury

Abstract

Component and coalesced health risks of the cardiometabolic syndrome (CMS) are commonly reported in persons with spinal cord injuries (SCIs). These CMS hazards are also co-morbid with physical deconditioning and elevated pro-atherogenic inflammatory cytokines, both of which are common after SCI and worsen the prognosis for all-cause cardiovascular disease. This article describes a systematic procedure for individualized CMS risk assessment after SCI, and emphasizes evidence-based and intuitioncentered countermeasures to disease. A unified approach will propose therapeutic lifestyle intervention as a routine plan for aggressive primary prevention in this risk-susceptible population. Customization of dietary and exercise plans then follow, identifying shortfalls in diet and activity patterns, and ways in which these healthy lifestyles can be more substantially embraced by both stakeholders with SCI and their health care providers. In cases where lifestyle intervention utilizing diet and exercise is unsuccessful in countering risks, available pharmacotherapies and a preferred therapeutic agent are proposed according to authoritative standards. The over-arching purpose of the monograph is to create an operational framework in which existing evidence-based approaches or heuristic modeling becomes best practice. In this way persons with SCI can lead more active and healthy lives.

Respiratory, cardiovascular and metabolic responses during different modes of overground bionic ambulation in persons with motor-incomplete spinal cord injury: A case series

“…Lower intensities are associated with higher proportions of fat oxidation (12). Low levels of fat oxidation are associated with increased obesity and disease and are a particularly pertinent issue for people with SCI (13)(14)(15)(16)(17)(18). Targeting maximal levels of fat oxidation is therefore a potential target for healthfocused exercise interventions, and for Subject 1 this would be achieved in Adaptive mode.…”

Assessing kinematics and kinetics of functional electrical stimulation rowing

“…Regular physical activity has important multi-system health benefits, and more vigorous exercise is associated with greater benefits (Nelson et al, 2007). SCI does not alter this effect, and in fact may make exercise of critical importance to health (Groah et al, 2012; Hooker and Wells, 1989; Nash et al, 2012; West et al, 2014a). However, this population is typically restricted to only upper body exercise, which involves a smaller amount of muscle mass and limits cardiovascular adaptations compared to lower extremity or combined activities (Figoni, 1993; Gates et al, 2002; Pitetti et al, 1994; Rimaud et al, 2012; West et al, 2014b).…”

Acute Cardiorespiratory and Metabolic Responses During Exoskeleton-Assisted Walking Overground Among Persons with Chronic Spinal Cord Injury

“…19,20 Fortunately, a growing body of evidence suggests that increased participation in physical activity and exercise may mitigate the effects of SCI on long-term secondary health complications. 17,18,[21][22][23][24][25][26][27] Thus, clinicians, researchers, and device manufacturers continue to investigate new and innovative strategies for improving mobility, physical conditioning, and health after SCI.…”