Physical Activity and Improved Diastolic Function in Spinal Cord–Injured Subjects

Rossi, Gianpaolo; Matos‐Souza, José R.; Silva, Anselmo de Athayde Costa e; Campos, Luis Felipe Castelli Correia de; Santos, Luiz Gustavo Teixeira Fabrício dos; Azevedo, Eliza Regina Ferreira Braga Machado de; Alonso, Karina Cristina; Paim, Layde R.; Schreiber, Roberto; Gorla, José Irineu; Cliquet, Alberto; Nadruz, Wilson

doi:10.1249/mss.0000000000000187

Cited by 34 publications

(34 citation statements)

References 24 publications

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“…Diastolic function, in contrast, is less clear. Some studies have reported preserved diastolic function post-SCI , whereas others report impaired diastolic function (Kessler et al 1986;De Rossi et al 2014). There has been recent interest in developing animal models of cardiac dysfunction post-SCI to try to gain mechanistic insight into the underlying causes of said dysfunction.…”

Section: Introductionmentioning

confidence: 99%

Effects of early and delayed initiation of exercise training on cardiac and haemodynamic function after spinal cord injury

Popok

West

McCracken

et al. 2017

Experimental Physiology

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What is the central question of this study? How does early versus delayed initiation of passive hindlimb cycling, as well as detraining, affect cardiac function and blood pressure control in a rodent model of spinal cord injury? What is the main finding and its importance? Early or delayed initiation of hindlimb cycling improves cardiac and haemodynamic function in spinal cord injury, although the benefits of early administration are more pronounced. We also demonstrate the need for exercise to be maintained, because detraining rapidly reverses the cardiac and haemodynamic benefits. Spinal cord injury (SCI) reduces physical activity and alters descending supraspinal cardiovascular control, predisposing this population to early onset of cardiovascular disease. We used a T3 SCI rodent model to investigate the effect of early versus delayed passive hindlimb cycling (PHLC), as well as the effect of detraining on cardiac dysfunction and blood pressure control, including autonomic dysreflexia (AD). Twenty male Wistar rats were divided into an early PHLC initiation group followed by a period of detraining (PHLC starting day 6 post-SCI, for 4 weeks, followed by 4 weeks of detraining; 'early PHLC/detraining' group) and a delayed PHLC intervention group (no PHLC for first 5 weeks post-SCI, followed by PHLC for 4 weeks; 'no PHLC/delayed PHLC' group). At 5 weeks post-SCI, the no PHLC/delayed PHLC group exhibited a decline in almost all cardiac indices (all P < 0.029), which was maintained in the early PHLC/detraining group. Also, the severity of induced AD was reduced in the early PHLC/detraining versus no PHLC/delayed PHLC group (all P < 0.0279). At 9 weeks post-SCI, no PHLC/delayed PHLC animals exhibited a reversal of cardiac dysfunction such that all indices were not different from pre-SCI, whereas early PHLC/detraining rats exhibited a reduction in all cardiac indices relative to pre-SCI (all P < 0.049), except ejection fraction. Between weeks 7 and 9 post-SCI, the no PHLC/delayed PHLC rats exhibited fewer spontaneous AD events than the early PHLC/detraining rats (P < 0.01). We show, for the first time, that delayed exercise promotes similar improvements in cardiac and haemodynamic function to those observed with early initiation. Furthermore, exercise needs to be maintained, because detraining reduces these cardiohaemodynamic benefits.

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Section: Introductionmentioning

confidence: 99%

Effects of early and delayed initiation of exercise training on cardiac and haemodynamic function after spinal cord injury

Popok

West

McCracken

et al. 2017

Experimental Physiology

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“…There is evidence that physical activity in people with SCI can result in health benefits, improving subclinical atherosclerosis regardless of variation in traditional risk factors. Besides, regular physical activity can be related to improved left ventricle diastolic function maybe exerting particular cardiac structural effects in SCI subjects .…”

Section: Functional Diagnoses and Therapymentioning

confidence: 99%

“…improved left ventricle diastolic function maybe exerting particular cardiac structural effects in SCI subjects (60)(61)(62). FES protocols yield possible solutions such as hybrid systems exercise that involves both the nonparalyzed upper body and the electrically stimulated paralyzed lower body muscles, with much greater oxygen consumption by the patient (15,46,63).…”

Section: Experiencing Fes Roots E195mentioning

confidence: 99%

Experiencing Functional Electrical Stimulation Roots on Education, and Clinical Developments in Paraplegia and Tetraplegia With Technological Innovation

Varoto

Cliquet

2015

Artificial Organs

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Cybernetics-based concepts can allow for complete independence for paralyzed individuals, including sensory motor recovery. Spinal cord injuries are responsible for a huge stress on health and a financial burden to society. This article focuses on novel procedures such as functional diagnosis for paraplegics and tetraplegics, cybertherapies toward lessening comorbidities such as cardiovascular diseases, osteoporosis, etc., and the production of new technology for upper and lower limb control. Functional electrical stimulation reflects a unique opportunity for bipedal gait to be achieved by paraplegics and tetraplegics. Education and training of undergraduates and postgraduates in engineering and life sciences have also been a major aim of this work.

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“…Cardiac adaptations following a spinal cord injury (SCI) have been well documented by echocardiography studies over the past few decades. While changes in both left ventricular (LV) structure and global LV systolic and diastolic function have been observed in individuals with tetraplegia and paraplegia, [1][2][3][4][5][6][7][8][9][10][11][12] there appears to be a lesion level-dependent effect of SCI on cardiac function with the most severe changes occurring in individuals with tetraplegia. In particular, reductions in global LV systolic function including stroke volume (SV), cardiac output ( ) and ejection fraction (EF) have been documented in both untrained individuals with tetraplegia (UT) and trained individuals with tetraplegia (TT) relative to either individuals with paraplegia or able-bodied (AB) controls.…”

Section: Introductionmentioning

confidence: 99%

“…In particular, reductions in global LV systolic function including stroke volume (SV), cardiac output ( ) and ejection fraction (EF) have been documented in both untrained individuals with tetraplegia (UT) and trained individuals with tetraplegia (TT) relative to either individuals with paraplegia or able-bodied (AB) controls. 1,5,8,11,12 Conversely, global LV diastolic function appears to be influence by exercise-training status whereby global LV diastolic dysfunction in present in UT while Paralympic athletes with tetraplegia (TT) have global LV diastolic values comparable to AB individuals. 11 While it has long been speculated that the differences in global function are attributed to reductions in loading, it still remains to be determined whether inherent dysfunction in the myocardium itself is a contributing factor.…”

Section: Introductionmentioning

confidence: 99%

Left Ventricular Mechanics in Untrained and Trained Males with Tetraplegia

Currie

West

Stöhr

et al. 2017

Journal of Neurotrauma

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Reduced left ventricular (LV) function is common in tetraplegia, yet it is unknown whether intrinsic myocardial function is attenuated. This study examined the effect of SCI and exercise-training status on LV mechanics (intrinsic function) and LV systolic/diastolic function by comparing untrained (UT) and trained (TT) individuals with tetraplegia and able-bodied (AB) individuals. Individuals with tetraplegia had a traumatic, chronic, motor-complete cervical spinal cord injury. Nine UT males (40 ± 10 years), 8 TT males (30 ± 5 years), and nine AB males (37 ± 9 years) participated in the study. LV indices were assessed using two-dimensional transthoracic echocardiography, with speckle-tracking analysis for the determination of LV mechanics. For systolic function, stroke volumes were lower in both UT (59 ± 9 mL; p < 0.001) and TT (63 ± 9 mL; p < 0.001) relative to AB (82 ± 11 mL), whereas systolic mechanics were similar across groups. Diastolic function was only reduced in UT, including a lower ratio of early-to-late transmitral filling velocity (1.55 ± 0.28) relative to TT (2.07 ± 0.42; p < 0.05) and AB (2.44 ± 0.61; p < 0.01) and longer isovolumetric relaxation times in UT (101 ± 7 ms) relative to TT (88 ± 11 ms; p < 0.05) and AB (85 ± 6 ms; p < 0.01). Diastolic mechanics (apical circumferential strain rate) were significantly enhanced in TT (3.03 ± 0.83 s) compared to AB (1.85 ± 0.65 s; p < 0.05). There was a trend (p = 0.062) for a between-group difference in apical radial diastolic strain rate (UT: -2.51 ± 0.83 s; TT: -3.92 ± 1.96 s; AB: -1.84 ± 0.46 s). In tetraplegia, attenuated LV systolic function is not attributed to intrinsic dysfunction, whereas exercise-training status appears to improve both global LV diastolic function and LV mechanics.

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Physical Activity and Improved Diastolic Function in Spinal Cord–Injured Subjects

Abstract: Regular physical activity is associated with improved LV diastolic function in SCI subjects and might exert distinct cardiac structural effects in tetraplegic and paraplegic subjects.

Cited by 34 publications

References 24 publications

Effects of early and delayed initiation of exercise training on cardiac and haemodynamic function after spinal cord injury

Effects of early and delayed initiation of exercise training on cardiac and haemodynamic function after spinal cord injury

Experiencing Functional Electrical Stimulation Roots on Education, and Clinical Developments in Paraplegia and Tetraplegia With Technological Innovation

Left Ventricular Mechanics in Untrained and Trained Males with Tetraplegia

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