User:Kahlabell

What is the background to this research?
Spinal Cord Injury (SCI) patients are two to five times more likely to die prematurely than people without a SCI. There is a greater risk prevalence of obesity, lipid disorders, metabolic syndrome, and diabetes is in SCI subjects compared with ambulatory subjects. In addition, an increased risk of cardiovascular disease may present carotid artery intima-media thickness(IMT) and reduced left ventricular diastolic function in SCI subject. Cardiovascular structure and function in SCI patients has been associated with regular participation in adapted sports. Physical inactivity in SCI subjects can cause a decrease in lean muscle mass, changes in body composition and an increase in fat mass storage due to extreme lack of movement. The study compares the function of physically active SCI patients (PA-SCI) and sedentary SCI (S-SCI) subjects by evaluating the changes in the expression of adipocytokines as well as leptin, adiponectin and plasminogen activating inhibitor-1 (PAL-1).

Where is the research from?
The research was conducted through the University of Campinas and University of Sa~o Paulo, Sa~o Carlos, SP and Brazil by various different departments including Medicine, Physical Education, Orthopaedics and Electrical Engineering.The primary authors who contributed to this study are Roberto Schreiber and Cristiane M. Souza. Roberto Schreiber has been involved in many studies investigating pathologies, similarity Christiane M. Souza has contributed to many studies although minimal known in the field of SCI and adiponectin responses to exercise.

The article was published through American Congress of Rehabilitation Medicine and can be found in the archives of Physical Medicine and Rehabilitation 2018;99:15617.

What kind of research was this?
The type of research design is a Cross-sectional observational study which is often utilised in medical research. It allows the collection of data from a particular population that represents a specific point in time. A Cross-sectional study allows an analysis to be expressed in a comparative table displaying quantitative data. Subjects in this study self-reported or coach based reported exercise which can be a limitation due to over or under reporting.

What did the research involve?
41 men with at least 1 year of a SCI were enrolled to undertake this study. The American Spinal Cord Injury Association Impairment scale was utilised to grade PA SCI subjects.
 * 16 Sedentary SCI from the hospital at the University of Campinas
 * 25 Physically Active SCI participants from the School of Physical Education.

The methodology standardised those who were PA training on average 11.05.9h/wk for 4.82.5 years. Accuracy of results are facilitated by the exclusion criteria, based on if the SCI patient listed:
 * An active infection
 * Smoking
 * Hypertension, diabetes mellitus, cancer, pulmonary and/or cardiac disease
 * Any lipid lowering medication like statins/aspirin.

Clinical data collection of BMI, blood pressure and heart rate as well as laboratory methods, blood samples, lipid, glucose and C-reactive protein measures were taken from the subjects. Echocardiography and carotid studies were evaluated with the SCI subjects in a sitting position, along with an assay on adipocytokines, plasma leptin and PAI-1 levels assessment undertaken.

The results can only be applied to male subjects because women were not evaluated during the study. In addition, the observation between body composition and adipocytokines are assumed to be casual due to metabolic variables. The physical activity was not systematically measured and subjects could be bias towards over or under reporting.

What were the basic results?
The findings suggest PA-SCI subjects had a lower BMI and there is a trend toward lower LDL-C, heart rate, glucose and C- reactive protein levels compared to the S-SCI subjects. The results suggest similar plasma levels of leptin and adiponectin and leptin adiponectin ratio and PAI-1 observed between the two groups. The analysis showed S-SCI have worse LV diastolic function and higher carotid IMT than PA-SCI.

The researchers interpreted the results by evaluating t-tests and chi-square tests, respectively. Pearson correlation coefficients were utilised to assess correlations between SCI subgroups. Multivariable linear regression analysis was used to evaluate variables in the echocardiographic and carotid characteristics between the two groups: S-SCI and PA-SCI. The researchers results are interpreted table formats, linear regression graphs and written discussion of their findings.

What conclusions can we take from this research?
The aim of the article was to evaluate the level of adiponectin ratio in PA-SCI and S-SCI to assess the beneficial cardiovascular effects from physical activity in this population. The results indicate PA-SCI participants had similar levels of adipocytokines, although lower carotid IMT and better left ventricular diastolic function than S-SCI subjects. Leptin-adiponectin ratio showed a direct correlation to triglycerides and low lipoprotein cholesterol in S-SCI individuals but not PA-SCI subjects. Overall the study showed that adipocytokines did not correlate with cardiac function in PA-SCI and S-SCI participants.

The results align with many published reviews, stating the need for SCI subjects to adopt a healthy lifestyle by incorporating physical exercise remains important to reduce cardiovascular disease and other negative health implications. The overall benefits of physical activity for a SCI subject include:
 * Lower levels of adiposity
 * Improved quality of life
 * Reduced risk of CV disease, diabetes, hypertension and other health related diseases
 * Lower Lipoprotein cholesterol

It has been investigated in a supplementary cross-sectional study that men with SCI had a tendency toward higher serum adiponectin level than able-bodied controls.

Practical advice
The implication of this research indicates that SCI subjects who adopt and PA lifestyle considering there limitation from injury has health benefits at a cellular level.

Exercise and Sport Science Australia (ESSA) exercise recommendations for people with SCI are: ≥30 min of moderate aerobic exercise on ≥5 d/week or ≥20 min of vigorous aerobic ≥3 d/week; strength training on ≥2 d/week, including scapula stabilisers and posterior shoulder girdle; and ≥2 d/week flexibility training, including shoulder internal and external rotators.

Further readings and additional fact sheets and information can be found below:

Archives of Physical Medicine and Rehabilitation

American Spinal Injury Association

Fact Sheet WHO and SCI