Abstract
BackgroundDespite obesity being highly prevalent in persons with spinal cord injury (SCI), our current understanding of the interactions between energy balance components, which may contribute to this, is limited. The primary aim of this study is to identify the intra-individual variability of physical activity dimensions across days and suggest an appropriate monitoring time frame for these constructs in adults with SCI. The secondary aim is to examine these parameters with regard to energy intake and dietary macronutrient composition.MethodsParticipants [33 men and women with chronic (> 1 year post injury) paraplegia; age = 44 ± 9 years (mean ± S.D.] wore an Actiheart™ PA monitor and completed a weighed food diary for 7 consecutive days. Spearman-Brown Prophecy Formulae, based on Intraclass Correlations of .80 (acceptable reliability), were used to predict the number of days required to measure energy balance components. Linear mixed-effects analyses and magnitude-based inferences were performed for all energy intake, expenditure and physical activity dimensions. Adjustments were made for age, injury level, wear time, sex, day of the week and measurement order as fixed effects.ResultsTo reliably measure energy expenditure components; 1 day [total energy expenditure (TEE)], 2 days [physical activity energy expenditure (PAEE), light-intensity activity, moderate-to-vigorous PA (MVPA)], 3 days [physical activity level (PAL)] and 4 days (sedentary behaviour) are necessary. Device wear time (P < 0.02), injury level (P < 0.04) and sex (P < 0.001) were covariates for energy expenditure components. Four and ≤24 days are required to reliably measure total energy intake (kcal) and diet macronutrient composition (%), respectively. Measurement order (from day 1–7) was a covariate for total energy intake (P = 0.01).ConclusionsThis is the first study to demonstrate the variability of energy intake and expenditure components in free-living persons with chronic (> 1 year) paraplegia and propose suitable measurement durations to achieve acceptable reliability in outcome measures. Device wear time and measurement order play a role in the quality of energy expenditure and intake data, respectively, and should be considered when designing and analysing studies of energy balance components in persons with SCI.Trial registrationN/A
Highlights
Despite obesity being highly prevalent in persons with spinal cord injury (SCI), our current understanding of the interactions between energy balance components, which may contribute to this, is limited
Paraplegia is a condition characterised by impaired motor or sensory function of the lower extremities, with paralysis commonly caused by spinal cord injury (SCI)
If energy intake increases slightly or remains constant for a prolonged period, concurrent reductions in total energy expenditure (TEE) can lead to a sustained energy surplus, which drives the notable trajectory of weight gain following SCI [12]
Summary
Despite obesity being highly prevalent in persons with spinal cord injury (SCI), our current understanding of the interactions between energy balance components, which may contribute to this, is limited. Paraplegia is a condition characterised by impaired motor or sensory function of the lower extremities, with paralysis commonly caused by spinal cord injury (SCI). Total energy expenditure (TEE) can be partitioned into resting metabolic rate (RMR), diet-induced thermogenesis (DIT) and, physical activity energy expenditure (PAEE). PAEE is lower due to mobility impairments and the use of a smaller available muscle mass (upper-body), while hormonal and body composition changes post SCI likely impact upon DIT [11]. PAEE is the most important component of TEE due to its high variability amongst free-living individuals and is potentially more malleable [13]. Sedentary behaviour [any behaviour ≤1.5 metabolic equivalents (METS), i.e. sitting or lying down] is viewed as an important lifestyle behaviour, distinct from physical activity, due to its independent effects on cardiometabolic health [16]
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