Abstract
Haematological indexes of both inflammation and platelet activation have been suggested as predictive markers of cardiovascular disease (CVD), which has high prevalence in Paralympic athletes (PA). Different mechanisms could play a role in increasing CVD risk in PA with spinal cord injury (PA-SCI), lower limb amputation (PA-LLA), or upper limb impairment (PA-ULI). We compared, in 4 groups of PA competing in power, intermittent (mixed metabolism), and endurance sports, Framingham Risk Score (FRS), metabolic syndrome criteria (MetS-C), inflammation (INFLA) Score, 5 haematological indexes of platelet activation (mean platelet volume (MPV), platelet distribution width (PDW), and the ratios between MPV and platelet (MPVPR), between MPV and lymphocyte (MPVLR), and between PDW and lymphocyte (PDWLR)) and the endogenous antioxidants uric acid (UA) and bilirubin (BR). A retrospective chart review of PA from preparticipation examinations' records (London 2012 and Sochi 2014 Paralympics) was performed. We included 25 PA-SCI (13 with high and 12 with low lesion, PA-SCI-H and PA-SCI-L), 15 PA-LLA, and 10 PA-ULI. FRS and INFLA Score did not differ among groups, but PA-SCI-H had lower HDL, compared to PA-SCI-L and PA-ULI. PA-LLA had more MetS diagnostic criteria with significant higher glucose levels than other groups. PA-SCI-H had significantly lower lymphocytes' count compared to PA-LLA and higher MPV, PDW, MPVPR, MPVLR, and PDWLR. SCI-H had lower BR, haemoglobin, haematocrit, proteins, and creatinine. No interaction was found between the 3 kinds of sitting sports and the 2 groups of health conditions (PA-SCI and PA-LLA). In conclusion, PA-LLA had a higher cardiometabolic risk, whereas PA-SCI-H had a higher platelet-derived cardiovascular risk. Further larger studies are needed to investigate the relationship between indexes of inflammation/oxidation and dietary habit, body composition, and physical fitness/performance in PA with motor impairments.
Highlights
The common activities of daily life, carried out by individuals with spinal cord injury (SCI) or lower limb amputation (LLA), forced by their impairment to be sedentary, determine a vicious circle that perpetuates and increases sarcopenia, fat mass and osteoporosis [1], oxidative stress [2], chronic systemic inflammation [3], reduction of cardiovascular efficiency [4], dyslipidemia, insulin resistance, and atherosclerotic cardiovascular disease (CVD) risk [5]
Framingham Risk Score (FRS) did not differ among groups, whereas Paralympic athletes (PA)-LLA had more criteria needed for metabolic syndrome (MetS) diagnosis and higher GLU levels compared to both Paralympic athletes with SCI (PA-SCI) and PA with upper limb impairment (PA-ULI)
Despite PA-LLA had more cardiometabolic risk factors, assessed by MetS ATP III criteria, and higher GLU levels, no differences were found in FRS, INFLA Score, and C reactive protein (CRP)
Summary
The common activities of daily life, carried out by individuals with spinal cord injury (SCI) or lower limb amputation (LLA), forced by their impairment to be sedentary, determine a vicious circle that perpetuates and increases sarcopenia, fat mass and osteoporosis [1], oxidative stress [2], chronic systemic inflammation [3], reduction of cardiovascular efficiency [4], dyslipidemia, insulin resistance, and atherosclerotic cardiovascular disease (CVD) risk [5]. Cardiovascular autonomic nervous system dysfunction, typical in individuals with SCI, is commonly observed in RA, and it has been suggested that lowering the inflammation may represent the most effective intervention to reduce arrhythmic risk in these patients [9]. Regarding the antioxidant defence system, it was found that both total antioxidant status and erythrocyte glutathione peroxidase activity were significantly increased at the end of the training program, whereas plasmatic levels of lipid (malondialdehyde) and protein (carbonyl groups) oxidation markers were significantly reduced [2]
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