Decreased total and central adiposity after 100 exoskeletal-assisted walking sessions in persons with chronic spinal cord injury

Abstract

Introduction In persons with spinal cord injury (SCI), paralysis results in extreme physical inactivity and a higher percent of body fat. The accumulation of excess fat in the visceral cavity is a primary contributor to metabolic abnormalities and an increased risk of cardiovascular disease (CVD), one of the leading causes of death in the SCI population. Powered exoskeleton-assisted walking (EAW) are robotic devises that promote exercise through rehabilitation and overground walking that may have positive effects on body composition and cardiometabolic health. Objective The purpose of this prospective observational study was to determine changes in total body fat mass (TBFmass), total body fat percent (TBF%), android adipose tissue percent (AAT%), visceral adipose tissue percent (VAT%), and subcutaneous adipose tissue percent (SAT%) after 100 sessions of powered EAW in persons with chronic SCI. Design/Method This prospective single arm intervention study was performed in 8 participants with chronic SCI (>12 months). Participants trained in a robotic exoskeleton (Ekso, Ekso Bionics, Richmond, CA, USA) with each loading session lasting 1-hour, 3-4 times a week, for a total of 100 1-hour sessions. Measures of TBF, TBF%, AAT%, VAT%, and SAT% were obtained prior to training (PRE) and immediately after 100 sessions of EAW (POST) using dual energy x-ray absorptiometry (DXA, GE Lunar iDXA, enCore and CoreScan, platform version 14.0, Madison, WI). Paired t-tests were performed to determine significant differences in the absolute pre-post values and the a priori level of significance was set at p Results Compared to the PRE training values, adiposity POST training was significantly decreased in TBF (pre vs. post: 28.7 ± 7.3 vs. 26.5 ± 7.5 kg, p Conclusions EAW training provided sufficient energy expenditure to reduce total body adiposity and most of the measures of central adiposity. Decreased adiposity would be expected to be associated with reduced risk of metabolic syndrome and CVD.