Obesity Clinical Trial
Official title:
Finding the Optimal Voluntary Exercise Parameters for Generating a Health Benefit in Those Living With Quadriplegia
There are over 44,000 persons living with spinal cord injury (SCI) in Canada, who face substantial challenges in maintaining a healthy body composition after injury. As a result, obesity, diabetes and cardiovascular disease are prevalent in this population. Guidelines indicating that twice weekly 20-minute sessions of exercise (plus resistance training) will increase physical fitness in those with SCI have been recently published. However, no SCI-specific guidelines indicating the volume of exercise to reduce the risk of developing obesity-related diseases exist. Longitudinal studies indicate that a weekly exercise-related energy expenditure of 2000 - 2500 Calories is correlated with the least likelihood of cardiovascular disease in the able-bodied population. There is little information regarding energy expenditure (EE) for activities carried out by persons with SCI, with less available for persons with tetraplegia. Once known, this EE data can be used to develop exercise interventions to determine the volume of voluntary exercise required to reduce obesity and risk factors for diabetes and cardiovascular disease in those living with tetraplegia.
In the absence of successful regeneration treatments to recover normal neurological function
after spinal cord injury, there has been a needed focus on research aimed at preventing or
minimizing the secondary complications of living with a spinal cord injury (SCI).
Approximately 44,000 persons live with traumatic spinal cord injury in Canada, half of which
have tetraplegia, with 35 new spinal cord injuries (SCI) per million each year. Persons with
spinal cord injury SCI are among the most sedentary on the planet, with a much higher
incidence of related diseases, such as obesity, glucose intolerance, diabetes and
cardiovascular disease than the able-bodied population. At the same time, information needed
to minimize the risk of developing these diseases for those living with spinal cord injury
is lacking. For example, specific information regarding resting energy requirements, energy
expenditure during exercise, and the volume of exercise required to maintain a healthy body
composition and prevent the development of sedentary-related disease in this population is
scarce.
In order to maintain weight, and not gain excess body fat, energy intake in food Calories
needs to match energy use. In addition to understanding energy use in order to maintain
weight balance, exercise is also important for muscular and cardiovascular health. Research
to date indicates that the resting energy expenditure of persons with SCI is considerably
less than able-bodied persons with the same weight or body mass index. A considerable
portion of this reduced resting energy expense is due to the reduced muscle mass after SCI.
There are mixed research results regarding whether there are additional reductions in
resting energy expenditure, after adjusting for fat free mass, in persons with SCI. Training
has been shown to be effective in reducing shoulder pain, improving function, improving
physical capacity, reducing hyperinsulinemia, and reducing dyslipidemia in persons with
chronic paraplegia.
However, it is less clear if voluntary exercise can have the same beneficial effects for
those living with tetraplegia, in part because their peak power output is only one-third to
one-half that achieved during arm exercise in those with paraplegia. In addition, it may be
very difficult for those with tetraplegia to be able to exercise for a sufficient duration
to achieve a sufficient training effect to either maintain a healthy body composition or
reduce the risk of developing the sedentary diseases common to this population. This study
will provide the exercise-related energy expenditure data to address this question.
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