Abstract
ABSTRACTPurposeSpinal cord injury (SCI) creates a complex pathology, characterized by low levels of habitual physical activity and an increased risk of cardiometabolic disease. This study aimed to assess the effect of a moderate-intensity upper-body exercise training intervention on biomarkers of cardiometabolic component risks, adipose tissue metabolism, and cardiorespiratory fitness in persons with SCI.MethodsTwenty-one inactive men and women with chronic (>1 yr) SCI (all paraplegic injuries) 47 ± 8 yr of age (mean ± SD) were randomly allocated to either a 6-wk prescribed home-based exercise intervention (INT; n = 13) or control group (CON; n = 8). Participants assigned to the exercise group completed 4 × 45-min moderate-intensity (60%–65% peak oxygen uptake (V˙O2peak)) arm-crank exercise sessions per week. At baseline and follow-up, fasted and postload blood samples (collected during oral glucose tolerance tests) were obtained to measure metabolic regulation and biomarkers of cardiovascular disease. Abdominal subcutaneous adipose tissue biopsies were also obtained, and cardiorespiratory fitness was assessed.ResultsCompared with CON, INT significantly decreased (P = 0.04) serum fasting insulin (Δ, 3.1 ± 10.7 pmol·L−1 for CON and −12.7 ± 18.7 pmol·L−1 for INT) and homeostasis model assessment of insulin resistance (HOMA2-IR; Δ, 0.06 ± 0.20 for CON and −0.23 ± 0.36 for INT). The exercise group also increased V˙O2peak (Δ, 3.4 mL·kg−1·min−1; P ≤ 0.001). Adipose tissue metabolism, composite insulin sensitivity index (C-ISIMatsuda), and other cardiovascular disease risk biomarkers were not different between groups.ConclusionsModerate-intensity upper-body exercise improved aspects of metabolic regulation and cardiorespiratory fitness. Changes in fasting insulin and HOMA2-IR, but not C-ISIMatsuda, suggest improved hepatic but not peripheral insulin sensitivity after 6 wk of exercise training in persons with chronic paraplegia.
Highlights
Epidemiological studies suggest that mortality and morbidity rates associated with cardiovascular disease and Type 2 diabetes are elevated in individuals with spinal cord injury (SCI) relative to adults without physical disabilities [11,19]
Body mass changes were predominantly explained by reductions in fat mass (j0.6; 95% confidence intervals (CI), j1.4 to 0.2 kg) and lean mass (j0.5 kg; 95% CI, j1.4 to 0.5 kg) in the intensity upper-body home-based exercise (INT) and CON groups, respectively
Our study shows that 6 wk of home-based moderate-intensity arm-crank ergometry in inactive adults with chronic paraplegia induced positive changes in functional capacity and fasting insulin concentrations, as well as improvements in hepatic insulin sensitivity
Summary
Epidemiological studies suggest that mortality and morbidity rates associated with cardiovascular disease and Type 2 diabetes are elevated in individuals with spinal cord injury (SCI) relative to adults without physical disabilities [11,19]. Upper-body aerobic exercise in this population improves strength and cardiorespiratory fitness, its effect on cardiometabolic component risks in adults with SCI remains unclear [4]. The aim of this study was to determine the effect of moderate-intensity exercise on cardiometabolic component risks, the expression of key genes within adipose tissue, and cardiorespiratory fitness in persons with chronic paraplegia. In comparison to a control group, 6 wk of home-based moderate-intensity exercise would improve (i) metabolic regulation, (ii) biomarkers of cardiovascular disease, (iii) adipose tissue metabolism, and (iv) cardiorespiratory fitness in persons with SCI
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