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

Farkas, Gary J.; Gordon, Phillip; Swartz, Ann M.; Berg, Arthur; Gater, David R.

doi:10.1038/s41394-020-00363-5

Cited by 4 publications

(7 citation statements)

References 51 publications

(66 reference statements)

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“…In the current study, measured BMR for the denervated group was 1597 ± 333 kcal/day. Farkas et al reported a mean measured BMR 1693 ± 329 kcal/day in five low paraplegic individuals using T9 as the demarcation point to account for individuals with a LMN (Farkas et al, 2020). In the present study, we showed that both SCI-specific equations developed by Chun et al and Nightingale & Gorgey (Models 1-3) significantly underpredicted BMR for the denervated male group.…”

Section: Denervated Males With Scisupporting

confidence: 50%

Validation of basal metabolic rate equations in persons with innervated and denervated chronic spinal cord injury

Alazzam,

Gorgey

2024

Physiological Reports

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Basal metabolic rate (BMR) measurement is time consuming and requires specialized equipment. Prediction equations allow clinicians and researchers to estimate BMR; however, their accuracy may vary across individuals with chronic spinal cord injury (SCI). The objective of this study was to investigate the validity of SCI‐specific equations as well as able‐bodied (AB) prediction equations in individuals with upper motor neuron (UMN), lower motor neuron (LMN), and females with SCI. Twenty‐six men and women with chronic SCI (n = 12 innervated males, n = 6 innervated females, n = 8 denervated males) participated in this cross‐sectional study. BMR values were measured by indirect calorimetry. Body composition (dual‐energy X‐ray absorptiometry and anthropometrics) assessment was conducted. AB‐prediction equations [Cunningham, Nelson, Owen, Harris and Benedict, Mifflin, Schofield, Henry] and SCI‐specific equations [Chun and Nightingale & Gorgey] were used to estimate and validate BMR. The accuracy of AB‐specific FFM equations in predicting BMR was evaluated using Bland–Altman plots, paired t‐tests, and error metrics. Measured BMR for innervated males, females, and denervated males was 1436 ± 213 kcal/day, 1290 ± 114, and 1597 ± 333 kcal/day, respectively. SCI‐specific equations by Chun et al., Nightingale & Gorgey, and AB‐specific FFM equations accurately predicted BMR for innervated males. For the denervated males, Model 4 equation by Nightingale & Gorgey was not different (p = 0.18), and Bland–Altman analyses showed negative mean bias but similar limits of agreement between measured and predicted BMR for the SCI‐specific equations and AB‐specific FFM equations. We demonstrated that SCI‐specific equations accurately predicted BMR for innervated males but underpredicted it for denervated males. The Model 4 equation by Nightingale & Gorgey accurately estimated BMR in females with SCI. Findings from the current study will help to determine caloric needs in different sub‐groups of SCI.

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Section: Denervated Males With Scisupporting

confidence: 50%

Validation of basal metabolic rate equations in persons with innervated and denervated chronic spinal cord injury

Alazzam,

Gorgey

2024

Physiological Reports

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“…In addition, the age difference between the 2 groups may have affected the group comparison, as, in general, younger subjects are more likely to have higher cardiorespiratory fitness. However, it is generally difficult to establish groups of able-bodied and paraplegic subjects that are comparable in terms of cardiorespiratory fitness, as it has been well investigated ( 35 ) that paraplegic subjects have lower cardiorespiratory fitness in comparison with able-bodied subjects. In any case, only group comparisons may have been influenced by the age difference, the effects of propulsion mode are not affected.…”

Section: Discussionmentioning

confidence: 99%

Metabolic Cost and Mechanical Efficiency of a Novel Handle-Based Device for Wheelchair Propulsion

Puchinger¹,

Kurup²,

Gstaltner³

et al. 2022

JRM

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Objective: To investigate differences in metabolic cost and gross mechanical efficiency of a novel handlebased wheelchair propulsion device and to compare its performance with conventional push-rim propulsion.Design: Double-group comparative study between 2 different propulsion methods.Participants: Eight paraplegic individuals and 10 non-disabled persons.Methods: Participants performed the same exercise using a push-rim device and the novel handle-based device on a wheelchair- based test rig. The exercise consisted of a combined submaximal and maximal test. Power output, oxygen uptake, ventilation, respiratory exchange ratio and heart rate were recorded continuously during the tests. Analysis of variance was performed to determine the effects of group, mode and on power output.Results: Submaximal exercise resulted in a higher efficiency for the novel device and significant main effects of propulsion mode on all investigated parameters, except heart rate. On the respiratory exchange ratio, a significant interaction effect was found for both mode and group. The maximal exercise resulted in a higher peak power output and lower peak heart rate during propulsion using the handle-based device. A significant main effect on mode for mean peak power output, ventilation and heart rate was also observed.Conclusion: Wheelchair propulsion using the handlebased device resulted in lower physical responses and higher mechanical efficiency, suggesting that this novel design may be well suited for indoor use, thereby offering an attractive alternative to pushrim wheelchairs.

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“…After SCI, a MET is 2.7 mL/kg/min (0.189 L/min) [80], approximately 30% lower than persons without SCI. This reduced MET value, first reported by Collins et al [80] in SCI, is based on multiple factors, including decreased energy metabolism [6], limited oxygen utilization in sublesional active skeletal muscle [81], sympathetic nervous system dysfunction [82], an injury level-reduced cardiorespiratory response [83], and circulatory hypokinesis that hampers the hemodynamic response by restricting venous return and subsequently diminishing cardiac output [23]. Higher injury levels, often necessitating hand-securing devices for upper body PA modalities [84], exacerbate these factors [80].…”

Section: Physical Fitnessmentioning

confidence: 99%

“…For persons with and without SCI, authoritative guidelines established by expert panels endorse physical activity (PA) interventions as a practical approach to mitigating CMR [13–15,16 ▪▪ ,17 ▪▪ ,18–20]. However, compared to those without SCI, these PA guidelines may benefit from an additional evaluation of the diminished cardiorespiratory response to physical exertion in individuals with SCI [21–23]. Consequently, the initial prescription of PA may inadvertently lead to an insufficient PA volume by underestimating the duration and intensity required to address CMR effectively.…”

Section: Introductionmentioning

confidence: 99%

Assessing the efficacy of duration and intensity prescription for physical activity in mitigating cardiometabolic risk after spinal cord injury

Farkas,

Caldera,

Nash

2023

Current Opinion in Neurology

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Purpose of review Spinal cord injury (SCI) heightens susceptibility to cardiometabolic risk (CMR), predisposing individuals to cardiovascular disease. This monograph aims to assess the optimal duration and intensity of physical activity (PA) for managing CMR factors, particularly obesity, after SCI and provide modality-specific PA durations for optimal energy expenditure. Recent findings PA guidelines recommend at least 150 min/week of moderate-intensity activity. However, non-SCI literature supports the effectiveness of engaging in vigorous-intensity PA (≥6 METs) and dedicating 250–300 min/week (≈2000 kcal/week) to reduce CMR factors. Engaging in this volume of PA has shown a dose-response relationship, wherein increased activity results in decreased obesity and other CMR factors in persons without SCI. Summary To optimize cardiometabolic health, individuals with SCI require a longer duration and higher intensity of PA to achieve energy expenditures comparable to individuals without SCI. Therefore, individuals with SCI who can engage in or approach vigorous-intensity PA should prioritize doing so for at least 150 min/wk. At the same time, those unable to reach such intensities should engage in at least 250–300 min/week of PA at a challenging yet comfortable intensity, aiming to achieve an optimal intensity level based on their abilities. Given the potential to decrease CMR after SCI, increasing PA duration and intensity merits careful consideration in future SCI PA directives.

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

Cited by 4 publications

References 51 publications

Validation of basal metabolic rate equations in persons with innervated and denervated chronic spinal cord injury

Validation of basal metabolic rate equations in persons with innervated and denervated chronic spinal cord injury

Metabolic Cost and Mechanical Efficiency of a Novel Handle-Based Device for Wheelchair Propulsion

Assessing the efficacy of duration and intensity prescription for physical activity in mitigating cardiometabolic risk after spinal cord injury

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