The purpose of this proposal was to evaluate and compare the health benefits of using upper extremity exercise versus functional electrical stimulation for lower extremity exercise. It was our hypothesis that both Functional Electrical Stimulation Leg Cycle Ergometry (FES LCE) exercise and voluntary Arm Crank Ergometry (ACE) upper extremity exercise would increase whole body energy expenditure, thereby increasing muscle mass, insulin sensitivity, glucose effectiveness and improving lipid profiles in adults with paraplegia.
Objective: Spinal cord injuries (SCI) predispose individuals to impaired fitness, obesity, glucose intolerance and insulin resistance, placing them at greater risk for diabetes, coronary artery disease, and upper extremity overuse syndrome as body weight increases. The specific objectives for the current proposal were to compare the impact of FES (functional electrical stimulation) lower extremity exercise versus upper extremity arm crank ergometry on energy metabolism, body composition and fat deposition, insulin sensitivity, glucose effectiveness, lower extremity bone mineral density and lipid profiles, in adults with complete paraplegia. Research Plan: A randomized, baseline-controlled, prospective, 16-week interventional trial was employed to assess the impact of FES LCE versus volitional arm crank ergometry exercise on energy metabolism, body composition and fat deposition, insulin sensitivity, glucose effectiveness, lower extremity bone mineral density and lipid profiles in adults with complete paraplegia. Methods: Twenty-four 18-65 y.o. individuals with motor complete T4-L2 SCI were assigned to either FES lower extremity exercise or upper extremity arm crank ergometry to compare impact on energy expenditure, obesity, and insulin sensitivity. Both groups were provided similar nutritional assessments and intervention. Exercise training consisted of five, 40-minute sessions at 70% maximal heart rate (HRmax) each week for a total of 16 weeks. Resting metabolic rate, exercise energy expenditure, body composition by DXA, insulin sensitivity, glucose effectiveness, lipid profiles, and lower extremity bone mineral density (BMD) were determined before and after 16-week exercise interventions.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
29
Use of an upper body cycle to perform exercise. 10-minute warm up, 40 minutes @ 70%HRMax (50RPM), 10 minute cool down 5x/week x 16 weeks
Use of an FES cycle ergometer to perform exercise. 10-minute warm up, 40 minutes @ 70%HRMax (50RPM), 10 minute cool down 5x/week x 16 weeks
Hunter Holmes McGuire VA Medical Center
Richmond, Virginia, United States
Change in % Body Fat
Change in % Body Fat after 16 week intervention. Change score was calculated as final value (i.e., post intervention variable) minus baseline value.
Time frame: baseline, 16 weeks
Change in Fat Mass
Change in Fat Mass (Kg) after 16 week intervention. Change score was calculated as final value (i.e., post intervention variable) minus baseline value.
Time frame: Baseline, 16 Weeks
Change in Fat-Free Mass
Fat-Free Mass (kg). Change score was calculated as final value (i.e., post intervention variable) minus baseline value.
Time frame: baseline, 16 weeks
Change in Glucose Effectiveness (Sg)
Change in Glucose Effectiveness (min\^-1). Change score was calculated as final value (i.e., post intervention variable) minus baseline value.
Time frame: Baseline, 16-weeks
Change in Insulin Sensitivity (Si)
Change in insulin sensitivity (min\^-1). Change score was calculated as final value (i.e., post intervention variable) minus baseline value.
Time frame: Baseline, 16-weeks
%Body Fat Between Groups
Comparison of %body fat between the ACE and FESLCE groups following the 16 week intervention.
Time frame: 16 weeks
Fat Mass Between Groups
Comparison of fat mass between the ACE and FESLCE groups following the 16 week intervention.
Time frame: 16 weeks
Fat Free Mass Between Groups
Comparison of fat free mass between the ACE and FESLCE groups following the 16 week intervention.
Time frame: 16 weeks
Insulin Sensitivity (Si) Between Groups
Comparison of Si between the ACE and FESLCE groups following the 16 week intervention.
Time frame: 16 weeks
Glucose Effectiveness (Sg) Between Groups
Comparison of Sg between the ACE and FESLCE groups following the 16 week intervention.
Time frame: 16 weeks
Change in Lower Limb Bone Mineral Density
Change in lower limb bone mineral density after 16 week intervention. Change score was calculated as final value (i.e., post intervention variable) minus baseline value.
Time frame: baseline, 16 weeks
Change in Lower Limb Bone Mineral Content
Change in lower limb bone mineral content after 16 week intervention. Change score was calculated as final value (i.e., post intervention variable) minus baseline value.
Time frame: baseline, 16 weeks
Change in Triglycerides
Change in triglycerides after 16 week intervention. Change score was calculated as final value (i.e., post intervention variable) minus baseline value.
Time frame: baseline, 16 weeks
Change in High Density Lipoprotein Cholesterol (HDL)
Change in HDL after 16 week intervention. Change score was calculated as final value (i.e., post intervention variable) minus baseline value.
Time frame: baseline, 16 weeks
Change in Low Density Lipoprotein Cholesterol (LDL)
Change in LDL after 16 week intervention. Change score was calculated as final value (i.e., post intervention variable) minus baseline value.
Time frame: baseline, 16 weeks
Change in Total Cholesterol (TC)
Change in TC after 16 week intervention. Change score was calculated as final value (i.e., post intervention variable) minus baseline value.
Time frame: baseline, 16 weeks
Change in the Ratio of Total Cholesterol to High Density Lipoprotein Cholesterol (TC:HDL)
Change in TC:HDL after 16 week intervention. Change score was calculated as final value (i.e., post intervention variable) minus baseline value.
Time frame: Baseline, 16 weeks
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Lower Limb Bone Mineral Density Between Groups
Comparison of Lower limb bone mineral density between the ACE and FESLCE groups following the 16 week intervention
Time frame: 16 weeks
Lower Limb Bone Mineral Content Between Groups
Comparison of Lower limb bone mineral content between the ACE and FESLCE groups following the 16 week intervention
Time frame: 16 weeks
Triglycerides Between Groups
Comparison of Triglycerides between the ACE and FESLCE groups following the 16 week intervention
Time frame: 16 weeks
High Density Lipoprotein Cholesterol (HDL) Between Groups
Comparison of HDL between the ACE and FESLCE groups following the 16 week intervention
Time frame: 16 weeks
Low Density Lipoprotein Cholesterol (LDL) Between Groups
Comparison of LDL between the ACE and FESLCE groups following the 16 week intervention
Time frame: 16 weeks
Total Cholesterol (TC) Between Groups
Comparison of TC between the ACE and FESLCE groups following the 16 week intervention
Time frame: 16 weeks
Ratio of Total Cholesterol to High Density Lipoprotein Cholesterol (TC:HDL) Between Groups
Comparison of Ratio of Total Cholesterol to High Density Lipoprotein Cholesterol (TC:HDL) between the ACE and FESLCE groups following the 16 week intervention
Time frame: 16 weeks