Original article
Fitness, Inflammation, and the Metabolic Syndrome in Men With Paraplegia

https://doi.org/10.1016/j.apmr.2004.11.020Get rights and content

Abstract

Manns PJ, McCubbin JA, Williams DP. Fitness, inflammation, and the metabolic syndrome in men with paraplegia. Arch Phys Med Rehabil 2005;86:1176–81.

Objective

To determine the relations among peak aerobic capacity, physical activity, functional ability, components of the metabolic syndrome (high-density lipoprotein cholesterol [HDL-C], triglycerides [TG], glucose, insulin, abdominal obesity, high blood pressure), and inflammatory factors (interleukin-6 [IL-6], C-reactive protein [CRP]) in men with paraplegia.

Design

Cross-sectional exploratory design.

Setting

University research laboratory.

Participants

Twenty-two men (age, 39±9y; duration of injury, 17±9y; level of injury, T2-L2) with functionally complete paraplegia volunteered to participate.

Interventions

Not applicable.

Main Outcome Measures

Peak aerobic capacity was measured using a graded peak exercise test with an arm ergometer, and physical activity was assessed by the Physical Activity and Disability Scale. Functional ability was assessed by the Self-Report Functional Measure. Circulating glucose, insulin, HDL-C, TG, total cholesterol, IL-6, and CRP levels were determined by specific enzyme or immunologic assays. Body fat was determined by dual-energy x-ray absorptiometry, and central obesity was estimated from abdominal sagittal diameters.

Results

Lower peak aerobic capacities were associated with lower HDL-C and lower physical activity levels (P<.014). Lower physical activity levels were associated with higher fasting glucose, lower HDL-C level, and larger abdominal sagittal diameters (P<.036). Larger abdominal sagittal diameters were associated with higher fasting glucose, higher fasting and postload insulin, lower HDL-C, higher TG, and higher CRP levels (P<.05).

Conclusions

Diet and exercise trials are needed to determine the efficacy and effectiveness of lifestyle interventions aimed at slowing the progression of the metabolic syndrome in people with spinal cord injury.

Section snippets

Participants

Twenty-two male volunteers with functionally complete paraplegia (ie, they use a wheelchair as their only mode of locomotion) of at least 3 years in duration participated. Participants with diabetes and coronary heart disease were excluded. All participants stated that they had no acute infections. The level of SCI ranged from T2 to L2, and 5 participants had injuries at or above T6. Participants were asked to maintain a consistent medication schedule during the course of the study.

Testing

A 75-g oral

Results

Twenty-two men with paraplegia participated in the study. Subject characteristics are presented in table 1. All participants were completely independent with horizontal transfers and mobility, and all participants used a manual wheelchair. On average, participants were overweight, had low HDL-C levels, and had subclinical inflammation, as indicated by elevated levels of IL-6 and CRP. Older age was associated with lower peak aerobic capacity (P=.031) and higher 2-hour postload insulin levels (P

Discussion

We found that lower physical activity levels were associated with higher fasting glucose levels, lower HDL-C levels, and larger ASDs in men with a paraplegic SCI (see table 2). We also found that larger ASDs were associated with higher fasting glucose, higher fasting and postload insulin, higher HOMA-derived estimates of insulin resistance, lower HDL-C, higher TG, and higher CRP levels in men with a paraplegic SCI (see table 3). Other studies have reported associations between aerobic capacity

Conclusions

We found that lower physical activity levels were associated with higher fasting glucose, lower HDL-C, and larger ASDs. Larger ASDs, in turn, were associated with higher fasting glucose, higher fasting and postload insulin, lower HDL-C, higher TG, and higher CRP levels. These findings suggest that the metabolic syndrome is prevalent in people with SCI and that diet and exercise trials are needed to determine the efficacy and effectiveness of lifestyle interventions aimed at slowing the

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    Supported by the Christopher Reeve Paralysis Foundation.

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the author(s) or on any organization with which the author(s) is/are associated.

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