Aerobic Fitness and Protection on Atherosclerotic Cardiovascular Risk in Paralympic Athletes with a Locomotor Impairment

Abstract

Atherosclerotic cardiovascular disease (ACVD) is a leading cause of morbidity and mortality in individuals with a locomotor impairment (I-LI). ACVD occurs at earlier ages in I-LI than in ambulatory subjects because they, in particular those with a spinal cord injury (SCI), have a higher prevalence of risk factors (RF) mainly due to their increased sedentary habit. While reduced daily energy expenditure has been established as further RF, at our knowledge, the possible role of aerobic fitness as ACVD protective factor has not been fully evaluated in I-LI. PURPOSE: The present study, carried out on Paralympic athletes (PA) with a LI, was aimed at both assessing the prevalence of ACVD RF in PA with either a SCI (PA-SCI) or other (different from SCI) LI (PA-OLI) and evaluating the hypothesis that aerobic fitness (oxygen uptake peak - VO2peak) was inversely related to ACVD RF. METHODS: A total of 135 male PA (72 PA-SCI -, 28 PA with lower limb amputation, 12 PA with a cerebral palsy/brain Injury, 7 PA with poliomyelitis, 9 PA with other neurological disorders and 7 PA with other orthopedic disorders) were screened through anthropometric and blood pressure (BP) measurements, laboratory blood tests and graded maximal exercise test, to estimate both an ACVD-RF score and VO2peak. The ACVD risk score was assessed summing 1 point for each of the following RF: obesity - OB - (BMI≥30 or waist circumference ≥102 cm), hypertension - HT - (systolic BP ≥ 140 mm Hg and diastolic BP ≥ 90 mm Hg), dyslipidemia - DL -(total Cholesterol - C - ≥200 mg•dl-1 or LDL-C ≥130 mg•dl-1 or HDL-C < 40mg•dl-1), impaired fasting glucose - IG -(fasting plasma glucose ≥100 mg•dl-1) and subtracting 1 point when serum HDL-C was higher than 60 mg•dl-1. RESULTS: Prevalence of OB, HT, DL, IG and high HDL-C were equal to 5.9% and 3.2%, 13.9% and 14.3%, 58.3% and 49%, 29.2% and 34.9%, 27.8% and 17.4%, in PA-SCI and PA-OLI, respectively. Based on the ACVD RF, 3 groups were formed: group 1 (RF≤0, N=54), group 2 (RF=1, N=41), group 3 (RF≥2, N=40). VO2peak was equal to 37.9±14.71 ml•kg-1•min-1, 30.9±9.13 ml•kg-1•min-1 and 24.1±5.50 ml•kg-1•min-1 in the PA of groups 1, 2 and 3, respectively. CONCLUSIONS: ACVD RF prevalence resulted similar in PA-SCI and PA-OLI. VO2peak is inversely related to groups of ACDR RF. High aerobic fitness seems to provide a protective effect on the risk of ACVD morbidity in PA.