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Guideline Approaches for Cardioendocrine Disease Surveillance and Treatment Following Spinal Cord Injury

Abstract

Purpose of Review

Persons with spinal cord injuries (SCI) commonly experience individual risks and coalesced health hazards of the cardiometabolic syndrome (CMS). This review will examinethe role of exercise and nutritional intervention as countermeasures to these disease risks.

Recent Findings

The CMS hazards of overweight/obesity, insulin resistance, hypertension, and dyslipidemia are strongly associated with physical deconditioning and are common after SCI. Both the CMS diagnosis and physical deconditioning worsen the prognosis for all-cause cardiovascular disease occurring early after SCI. Evidence supports a therapeutic role for physical activity after SCI as an effective countermeasure to these risks and often represents the first-line approach to CMS abatement. This evidence is supported by authoritative systematic reviews and associated guidelines that recommend specific activities, frequencies, and activities of work. In many cases, the most effective exercise programming uses more intense periods of work with limited rest. As SCI is also associated with poor dietary habits, including excessive energy intake and saturated fat consumption, more comprehensive lifestyle management incorporating both exercise and nutrition represents a preferred approach for overall health management.

Summary

Irrespective of the interventional strategy, improved surveillance of the population for CMS risks and encouraged incorporation of exercise and nutritional management according to recent population-specific guidelines will most likely play an important role in the preservation of activity, optimal health, and independence throughout the lifespan.

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References

  1. 1.

    Despres JP, Lemieux I, Bergeron J, Pibarot P, Mathieu P, Larose E, et al. Abdominal obesity and the metabolic syndrome: contribution to global cardiometabolic risk. Arterioscler Thromb Vasc Biol. 2008;28(6):1039–49.

  2. 2.

    Castro JP, El-Atat FA, McFarlane SI, Aneja A, Sowers JR. Cardiometabolic syndrome: pathophysiology and treatment. Curr Hypertens Rep. 2003;5(5):393–401.

  3. 3.

    Mancia G, Bombelli M, Facchetti R, Casati A, Ronchi I, Quarti-Trevano F, et al. Impact of different definitions of the metabolic syndrome on the prevalence of organ damage, cardiometabolic risk and cardiovascular events. J Hypertens. 2010;28(5):999–1006.

  4. 4.

    Beltrán-Sánchez H, Harhay MO, Harhay MM, McElligott S. Prevalence and trends of metabolic syndrome in the adult US population, 1999–2010. J Am Coll Cardiol. 2013;62(8):697–703.

  5. 5.

    Bremer AA, Mietus-Snyder M, Lustig RH. Toward a unifying hypothesis of metabolic syndrome. Pediatrics. 2012;129(3):557–70.

  6. 6.

    Nash MS, Tractenberg RE, Mendez AJ, David M, Ljungberg IH, Tinsley EA, et al. Cardiometabolic syndrome in people with spinal cord injury/disease: guideline-derived and non-guideline risk components in a pooled sample. Arch Phys Med Rehabil. 2016;97:1696–705.

  7. 7.

    Weaver FM, Collins EG, Kurichi J, Miskevics S, Smith B, Rajan S, et al. Prevalence of obesity and high blood pressure in veterans with spinal cord injuries and disorders: a retrospective review. Am J Phys Med Rehabil. 2007;86(1):22–9.

  8. 8.

    Groah SL, Nash MS, Ljungberg IH, Libin A, Hamm LF, Ward E, et al. Nutrient intake and body habitus after spinal cord injury: an analysis by sex and level of injury. J Spinal Cord Med. 2009;32(1):25–33.

  9. 9.

    Groah SL, Nash MS, Ward EA, Libin A, Mendez AJ, Burns P, et al. Cardiometabolic risk in community-dwelling persons with chronic spinal cord injury. J Cardiopulm Rehabil Prev. 2011;31(2):73–80.

  10. 10.

    Pelletier CA, Miyatani M, Giangregorio L, Craven BC. Sarcopenic obesity in adults with chronic spinal cord injury: a cross-sectional study. Arch Phys Med Rehabil. 2016;97:1931–7.

  11. 11.

    Gorgey AS, Gater DR Jr. Prevalence of obesity after spinal cord injury.TOP Spinal Cord Inj Rehabil. 2007;12(4):1–7.

  12. 12.

    Buchholz AC, Bugaresti JM. A review of body mass index and waist circumference as markers of obesity and coronary heart disease risk in persons with chronic spinal cord injury. Spinal Cord. 2005;43(9):513–8.

  13. 13.

    Gater DR Jr. Obesity after spinal cord injury. Phys Med Rehabil Clin N Am. 2007;18(2):333–51 vii.

  14. 14.

    Nash MS, Gater DR. Exercise to reduce obesity in SCI. Top Spinal Cord Inj Rehabil. 2007;12(4):76–93.

  15. 15.

    Kressler J, Cowan RE, Bigford GE, Nash MS. Reducing cardiometabolic disease in spinal cord injury. Phys Med Rehabil Clin N Am. 2014;25(3):573–604 viii.

  16. 16.

    Bauman WA, Spungen AM, Raza M, Rothstein J, Zhang RL, Zhong YG, et al. Coronary artery disease: metabolic risk factors and latent disease in individuals with paraplegia. Mt Sinai J Med. 1992;59(2):163–8.

  17. 17.

    Cowan RE, Nash MS. Cardiovascular disease, SCI and exercise: unique risks and focused countermeasures. Disabil Rehabil. 2010;32(26):2228–36.

  18. 18.

    Cowan RE, Nash MS. Cardiovascular disease, SCI and exercise: unique risks and focused countermeasures. 2010;32(26):2228–36.

  19. 19.

    Bauman WA, Spungen AM. Coronary heart disease in individuals with spinal cord injury: assessment of risk factors. Spinal Cord. 2008;46(7):466–76.

  20. 20.

    Banerjea R, Sambamoorthi U, Weaver F, Maney M, Pogach LM, Findley T. Risk of stroke, heart attack, and diabetes complications among veterans with spinal cord injury. Arch Phys Med Rehabil. 2008;89(8):1448–53.

  21. 21.

    Nash MS, Cowan RE. Cardiovascular risk and exercise after spinal cord injuries. In: Spinal cord medicine, vol. 2010. New York: Demos Publications; 2010. p. 848–58.

  22. 22.

    Bauman WA, Spungen AM, Zhong YG, Rothstein JL, Petry C, Gordon SK. Depressed serum high density lipoprotein cholesterol levels in veterans with spinal cord injury. Paraplegia. 1992;30(10):697–703.

  23. 23.

    Brenes G, Dearwater S, Shapera R, LaPorte RE, Collins E. High density lipoprotein cholesterol concentrations in physically active and sedentary spinal cord injured patients. Arch Phys Med Rehabil. 1986;67(7):445–50.

  24. 24.

    Nash MS, Mendez AJ. A guideline-driven assessment of need for cardiovascular disease risk intervention in persons with chronic paraplegia. Arch Phys Med Rehabil. 2007;88(6):751–7.

  25. 25.

    Bauman WA, Adkins RH, Spungen AM, Herbert R, Schechter C, Smith D, et al. Is immobilization associated with an abnormal lipoprotein profile? Observations from a diverse cohort. Spinal Cord. 1999;37(7):485–93.

  26. 26.

    Bauman WA, Adkins RH, Spungen AM, Kemp BJ, Waters RL. The effect of residual neurological deficit on serum lipoproteins in individuals with chronic spinal cord injury. Spinal Cord. 1998;36(1):13–7.

  27. 27.

    Bauman WA, Spungen AM. Disorders of carbohydrate and lipid metabolism in veterans with paraplegia or quadriplegia: a model of premature aging. Metabolism. 1994;43(6):749–56.

  28. 28.

    Dallmeijer AJ, van der Woude LH, van Kamp GJ, Hollander AP. Changes in lipid, lipoprotein and apolipoprotein profiles in persons with spinal cord injuries during the first 2 years post-injury. Spinal Cord. 1999;37(2):96–102.

  29. 29.

    Spungen AM, Wang J, Pierson RN, Bauman WA. Soft tissue body composition differences in monozygotic twins discordant for spinal cord injury. J Appl Physiol. 2000;88(4):1310–5.

  30. 30.

    Buchholz AC, Pencharz PB. Energy expenditure in chronic spinal cord injury. Curr Opin Clin Nutr Metab Care. 2004;7(6):635–9.

  31. 31.

    Monroe MB, Tataranni PA, Pratley R, Manore MM, Skinner JS, Ravussin E. Lower daily energy expenditure as measured by a respiratory chamber in subjects with spinal cord injury compared with control subjects. Am J Clin Nutr. 1998;68(6):1223–7.

  32. 32.

    Emmons RR, Garber CE, Cirnigliaro CM, Kirshblum SC, Spungen AM, Bauman WA. Assessment of measures for abdominal adiposity in persons with spinal cord injury. Ultrasound Med Biol. 2011;37(5):734–41.

  33. 33.

    Inskip J, Plunet W, Ramer L, Ramsey JB, Yung A, Kozlowski P, et al. Cardiometabolic risk factors in experimental spinal cord injury. J Neurotrauma. 2010;27(1):275–85.

  34. 34.

    Nash MS, Cowan RE, Kressler J. Evidence-based and heuristic approaches for customization of care in cardiometabolic syndrome after spinal cord injury. J Spinal Cord Med. 2012;35(5):278–92.

  35. 35.

    Levine AM, Nash MS, Green BA, Shea JD, Aronica MJ. An examination of dietary intakes and nutritional status of chronic healthy spinal cord injured individuals. Paraplegia. 1992;30(12):880–9.

  36. 36.

    Dearwater SR, LaPorte RE, Robertson RJ, Brenes G, Adams LL, Becker D. Activity in the spinal cord-injured patient: an epidemiologic analysis of metabolic parameters. Med Sci Sports Exerc. 1986;18(5):541–4.

  37. 37.

    LaPorte RE, Adams LL, Savage DD, Brenes G, Dearwater S, Cook T. The spectrum of physical activity, cardiovascular disease and health: an epidemiologic perspective. Am J Epidemiol. 1984;120(4):507–17.

  38. 38.

    LaPorte RE, Brenes G, Dearwater S, Murphy MA, Cauley JA, Dietrick R, et al. HDL cholesterol across a spectrum of physical activity from quadriplegia to marathon running. Lancet. 1983;1(8335):1212–3.

  39. 39.

    Zlotolow SP, Levy E, Bauman WA. The serum lipoprotein profile in veterans with paraplegia: the relationship to nutritional factors and body mass index. J Am Paraplegia Soc. 1992;15(3):158–62.

  40. 40.

    Halle M, Berg A, Baumstark M, Keul J. Association of physical fitness with LDL and HDL subfractions in young healthy men. Int J Sports Med. 1999;20(7):464–9.

  41. 41.

    Franks PW, Ekelund U, Brage S, Wong M-Y, Wareham NJ. Does the association of habitual physical activity with the metabolic syndrome differ by level of cardiorespiratory fitness? Diabetes Care. 2004;27(5):1187–93.

  42. 42.

    Carnethon MR, Gulati M, Greenland P. Prevalence and cardiovascular disease correlates of low cardiorespiratory fitness in adolescents and adults. Jama. 2005;294(23):2981–8.

  43. 43.

    Cowan RE, Nash MS, Anderson KD. Exercise participation barrier prevalence and association with exercise participation status in individuals with spinal cord injury. Spinal Cord. 2013;51(1):27–32.

  44. 44.

    Ginis KA, Latimer AE, Arbour-Nicitopoulos KP, Buchholz AC, Bray SR, Craven BC, et al. Leisure time physical activity in a population-based sample of people with spinal cord injury part I: demographic and injury-related correlates. Arch Phys Med Rehabil. 2010;91(5):722–8.

  45. 45.

    Scelza WM, Kalpakjian CZ, Zemper ED, Tate DG. Perceived barriers to exercise in people with spinal cord injury. Am J Phys Med Rehabil. 2005;84(8):576–83.

  46. 46.

    Vissers M, van den Berg-Emons R, Sluis T, Bergen M, Stam H, Bussmann H. Barriers to and facilitators of everyday physical activity in persons with a spinal cord injury after discharge from the rehabilitation centre. J Rehabil Med. 2008;40(6):461–7.

  47. 47.

    Cowan RE, Nash MS, Anderson KD. Exercise participation barrier prevalence and association with exercise participation status in individuals with spinal cord injury. Spinal Cord. 2013;51(1):27–32.

  48. 48.

    Liu L, Nunez AE. Cardiometabolic syndrome and its association with education, smoking, diet, physical activity, and social support: findings from the Pennsylvania 2007 BRFSS Survey. J Clin Hypertens. 2010;12(7):556–64.

  49. 49.

    Feasel SGS. The impact of diet on cardiovascular disease risk in individuals with spinal cord injury. Top Spinal Cord Inj Rehabil. 2009;14(3):56–68.

  50. 50.

    U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary guidelines for Americans. 7th ed. Washington, DC: Government Printing Office; 2010. p. 112.

  51. 51.

    Walters JL, Buchholz AC, Martin Ginis KA. Evidence of dietary inadequacy in adults with chronic spinal cord injury. Spinal Cord. 2009;47(4):318–22.

  52. 52.

    Perret C, Stoffel-Kurt N. Comparison of nutritional intake between individuals with acute and chronic spinal cord injury. J Spinal Cord Med. 2011;34(6):569–75.

  53. 53.

    Aquilani R, Boschi F, Contardi A, Pistarini C, Achilli MP, Fizzotti G, et al. Energy expenditure and nutritional adequacy of rehabilitation paraplegics with asymptomatic bacteriuria and pressure sores. Spinal Cord. 2001;39(8):437–41.

  54. 54.

    Lee BY, Agarwal N, Corcoran L, Thoden WR, Del Guercio LR. Assessment of nutritional and metabolic status of paraplegics. J Rehabil Res Dev. 1985;22(3):11–7.

  55. 55.

    Bigford GE, Brooks L, Burns-Drecq P, Kappy C, Kreger K, Munoz R, et al. A populationrelevant lifestyle-intensive intervention for diabetes prevention after SCI. Top Spinal Cord Inj Rehabil. 2013:1.

  56. 56.

    Bigford GE, Brooks L, Burns-Drecq P, Kappy C, Kreger K, Munoz R, et al. Therapeutic lifestyle intervention after paraplegia significantly reduces component markers of cardiometabolic risk. Top Spinal Cord Inj Rehabil. 2014;20(S1):43.

  57. 57.

    Tomey KM, Chen DM, Wang X, Braunschweig CL. Dietary intake and nutritional status of urban community-dwelling men with paraplegia. Arch Phys Med Rehabil. 2005;86(4):664–71.

  58. 58.

    Sabour H, Javidan AN, Vafa MR, Shidfar F, Nazari M, Saberi H, et al. Calorie and macronutrients intake in people with spinal cord injuries: an analysis by sex and injury-related variables. Nutrition. 2012;28(2):143–7.

  59. 59.

    Moussavi RM, Ribas-Cardus F, Rintala DH, Rodriguez GP. Dietary and serum lipids in individuals with spinal cord injury living in the community. J Rehabil Res Dev. 2001;38(2):225–33.

  60. 60.

    Hooper L, Summerbell CD, Thompson R, Sills D, Roberts FG, Moore HJ, et al. Reduced or modified dietary fat for preventing cardiovascular disease. Cochrane Database Syst Rev. 2012;5:CD002137.

  61. 61.

    Schrauwen P, Westerterp KR. The role of high-fat diets and physical activity in the regulation of body weight. Br J Nutr. 2000;84(4):417–27.

  62. 62.

    Nash MS, DeGroot J, Martinez-Arizala A, Mendez AJ. Evidence for an exaggerated postprandial lipemia in chronic paraplegia. J Spinal Cord Med. 2005;28(4):320–5.

  63. 63.

    Emmons RR, Garber CE, Cirnigliaro CM, Moyer JM, Kirshblum SC, Galea MD, et al. The influence of visceral fat on the postprandial lipemic response in men with paraplegia. J Am Coll Nutr. 2010;29(5):476–81.

  64. 64.

    Ellenbroek D, Kressler J, Cowan RE, Burns PA, Mendez AJ, Nash MS. Effects of prandial challenge on triglyceridemia, glycemia, and pro-inflammatory activity in persons with chronic paraplegia. J Spinal Cord Med. 2015;38(4):468–75.

  65. 65.

    Identification and management of cardiometabolic risk after spinal cord injury—clinical practice guideline for health care providers, 2018. 201. Available from: https://www.pva.org/CMSPages/GetFile.aspx?guid=f3c29b7e-e201-4392-b241-9933dc620e40.

  66. 66.

    Noreau L, Shephard RJ, Simard C, Pare G, Pomerleau P. Relationship of impairment and functional ability to habitual activity and fitness following spinal cord injury. Int J Rehabil Res. 1993;16(4):265–75.

  67. 67.

    Boninger ML, Dicianno BE, Cooper RA, Towers JD, Koontz AM, Souza AL. Shoulder magnetic resonance imaging abnormalities, wheelchair propulsion, and gender. Arch Phys Med Rehabil. 2003;84(11):1615–20.

  68. 68.

    Ballinger DA, Rintala DH, Hart KA. The relation of shoulder pain and range-of-motion problems to functional limitations, disability, and perceived health of men with spinal cord injury: a multifaceted longitudinal study. Arch Phys Med Rehabil. 2000;81(12):1575–81.

  69. 69.

    Cowan RE, Nash MS, Anderson-Erisman K. Perceived exercise barriers and odds of exercise participation among persons with SCI living in high-income households. Top Spinal Cord Inj Rehabil. 2012;18(2):126–7.

  70. 70.

    Kroll T, Kratz A, Kehn M, Jensen MP, Groah S, Ljungberg IH, et al. Perceived exercise self-efficacy as a predictor of exercise behavior in individuals aging with spinal cord injury. Am J Phys Med Rehabil. 2012;91(8):640–51.

  71. 71.

    The Diabetes Prevention Program (DPP). Description of lifestyle intervention. Diabetes Care. 2002;25(12):2165–71.

  72. 72.

    Rubin RR, Fujimoto WY, Marrero DG, Brenneman T, Charleston JB, Edelstein SL, et al. The diabetes prevention program: recruitment methods and results. Control Clin Trials. 2002;23(2):157–71.

  73. 73.

    Moore TJ, Alsabeeh N, Apovian CM, Murphy MC, Coffman GA, Cullum-Dugan D, et al. Weight, blood pressure, and dietary benefits after 12 months of a web-based nutrition education program (DASH for health): longitudinal observational study. J Med Internet Res. 2008;10(4):e52.

  74. 74.

    Steinberg D, Bennett GG, Svetkey L. The DASH diet, 20 years later. Jama. 2017;317(15):1529–30.

  75. 75.

    Bauman WA, Zhong YG, Schwartz E. Vitamin D deficiency in veterans with chronic spinal cord injury. Metabolism. 1995;44(12):1612–6.

  76. 76.

    Chen Y, Henson S, Jackson AB, Richards JS. Obesity intervention in persons with spinal cord injury. Spinal Cord. 2006;44(2):82–91.

  77. 77.

    Garshick E, Kelley A, Cohen SA, Garrison A, Tun CG, Gagnon D, et al. A prospective assessment of mortality in chronic spinal cord injury. Spinal Cord. 2005;43(7):408–16.

  78. 78.

    Lai YJ, Lin CL, Chang YJ, Lin MC, Lee ST, Sung FC, et al. Spinal cord injury increases the risk of type 2 diabetes: a population-based cohort study. Spine J. 2014;14(9):1957–64.

  79. 79.

    Booth FW, Gordon SE, Carlson CJ, Hamilton MT. Waging war on modern chronic diseases: primary prevention through exercise biology. J Appl Physiol (1985). 2000;88(2):774–87.

  80. 80.

    Kesaniemi YK, Danforth E Jr, Jensen MD, Kopelman PG, Lefebvre P, Reeder BA. Dose-response issues concerning physical activity and health: an evidence-based symposium. Med Sci Sports Exerc. 2001;33(6 Suppl):S351–8.

  81. 81.

    Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007;39(8):1423–34.

  82. 82.

    Rimmer JH, Schiller W, Chen MD. Effects of disability-associated low energy expenditure deconditioning syndrome. Exerc Sport Sci Rev. 2012;40(1):22–9.

  83. 83.

    Wilmet E, Ismail AA, Heilporn A, Welraeds D, Bergmann P. Longitudinal study of the bone mineral content and of soft tissue composition after spinal cord section. Paraplegia. 1995;33(11):674–7.

  84. 84.

    Liusuwan A, Widman L, Abresch RT, McDonald CM. Altered body composition affects resting energy expenditure and interpretation of body mass index in children with spinal cord injury. J Spinal Cord Med. 2004;27(Suppl 1):24–8.

  85. 85.

    Nightingale TE, Williams S, Thompson D, Bilzon JLJ. Energy balance components in persons with paraplegia: daily variation and appropriate measurement duration. Int J Behav Nutr Phys Act. 2017;14(1):132.

  86. 86.

    Washburn RA, Zhu W, McAuley E, Frogley M, Figoni SF. The physical activity scale for individuals with physical disabilities: development and evaluation. Arch Phys Med Rehabil. 2002;83(2):193–200.

  87. 87.

    Ginis KA, Arbour-Nicitopoulos KP, Latimer AE, Buchholz AC, Bray SR, Craven BC, et al. Leisure time physical activity in a population-based sample of people with spinal cord injury. Part II: activity types, intensities, and durations. Arch Phys Med Rehabil. 2010;91(5):729–33.

  88. 88.

    Tanhoffer RA, Tanhoffer AI, Raymond J, Johnson NA, Hills AP, Davis GM. Energy expenditure in individuals with spinal cord injury quantified by doubly labeled water and a multi-sensor armband. J Phys Act Health. 2015;12(2):163–70.

  89. 89.

    Tanhoffer RA, Tanhoffer AI, Raymond J, Hills AP, Davis GM. Exercise, energy expenditure, and body composition in people with spinal cord injury. J Phys Act Health. 2014;11(7):1393–400.

  90. 90.

    Blair SN. Physical inactivity: the biggest public health problem of the 21st century. Br J Sports Med. 2009;43(1):1–2.

  91. 91.

    Thyfault JP, Krogh-Madsen R. Metabolic disruptions induced by reduced ambulatory activity in free-living humans. J Appl Physiol (1985). 2011;111(4):1218–24.

  92. 92.

    Washburn RA, Figoni SF. High density lipoprotein cholesterol in individuals with spinal cord injury: the potential role of physical activity. Spinal Cord. 1999;37(10):685–95.

  93. 93.

    Simmons OL, Kressler J, Nash MS. Reference fitness values in the untrained spinal cord injury population. Arch Phys Med Rehabil. 2014;95(12):2272–8.

  94. 94.

    World Health Organization. Global recommendations on physical activity for health. World Health Organization, 2010.

  95. 95.

    Warburton DE, Charlesworth S, Ivey A, Nettlefold L, Bredin SS. A systematic review of the evidence for Canada’s physical activity guidelines for adults. Int J Behav Nutr Phys Act. 2010;7(1):39.

  96. 96.

    Requejo PS, Mulroy SJ, Haubert LL, Newsam CJ, Gronley JK, Perry J. Evidence-based strategies to preserve shoulder function in manual wheelchair users with spinal cord injury. Top Spinal Cord Inj Rehabil. 2008;13(4):86–119.

  97. 97.

    Byrne D, Salzberg C. Major risk factors for pressure ulcers in the spinal cord disabled: a literature review. Spinal Cord. 1996;34(5):255–63.

  98. 98.

    Krassioukov A, Biering-Sørensen F, Donovan W, Kennelly M, Kirshblum S, Krogh K, et al. International standards to document remaining autonomic function after spinal cord injury. J Spinal Cord Med. 2012;35(4):201–10.

  99. 99.

    Griggs KE, Price MJ, Goosey-Tolfrey VL. Cooling athletes with a spinal cord injury. Sports Med. 2015;45(1):9–21.

  100. 100.

    Rimmer JH, Riley B, Wang E, Rauworth A, Jurkowski J. Physical activity participation among persons with disabilities: barriers and facilitators. Am J Prev Med. 2004;26(5):419–25.

  101. 101.

    Carlson KF, Wilt TJ, Taylor BC, Goldish GD, Niewoehner CB, Shamliyan TA, et al. Effect of exercise on disorders of carbohydrate and lipid metabolism in adults with traumatic spinal cord injury: systematic review of the evidence. J Spinal Cord Med. 2009;32(4):361–78.

  102. 102.

    Ginis KA, Hicks AL, Latimer AE, Warburton DE, Bourne C, Ditor DS, et al. The development of evidence-informed physical activity guidelines for adults with spinal cord injury. Spinal Cord. 2011;49(11):1088–96.

  103. 103.

    Cowell LL, Squires WG, Raven PB. Benefits of aerobic exercise for the paraplegic: a brief review. Med Sci Sports Exerc. 1986;18(5):501–8.

  104. 104.

    Hooker SP, Wells CL. Effects of low- and moderate-intensity training in spinal cord-injured persons. Med Sci Sports Exerc. 1989;21(1):18–22.

  105. 105.

    Nightingale TE, Walhin J-P, Thompson D, Bilzon JL. Impact of exercise on cardiometabolic component risks in spinal cord-injured humans. Med Sci Sports Exerc. 2017;49(12):2469–77.

  106. 106.

    de Zepetnek JOT, Pelletier CA, Hicks AL, MacDonald MJ. Following the physical activity guidelines for adults with spinal cord injury for 16 weeks does not improve vascular health: a randomized controlled trial. Arch Phys Med Rehabil. 2015;96(9):1566–75.

  107. 107.

    DiCarlo SE. Effect of arm ergometry training on wheelchair propulsion endurance of individuals with quadriplegia. Phys Ther. 1988;68(1):40–4.

  108. 108.

    Drory Y, Ohry A, Brooks ME, Dolphin D, Kellermann JJ. Armcrank ergometry in chronic spinal cord injured patients. Arch Phys Med Rehabil. 1990;71(6):389–92.

  109. 109.

    Nightingale TE, Metcalfe RS, Vollaard NB, Bilzon JL. Exercise guidelines to promote cardiometabolic health in spinal cord injured humans: time to raise the intensity? Arch Phys Med Rehabil. 2017;98(8):1693–704.

  110. 110.

    Moholdt T, Wisløff U, Nilsen TIL, Slørdahl SA. Physical activity and mortality in men and women with coronary heart disease: a prospective population-based cohort study in Norway (the HUNT study). Eur J Cardiovasc Prev Rehabil. 2008;15(6):639–45.

  111. 111.

    Wisløff U, Nilsen TI, Drøyvold WB, Mørkved S, Slørdahl SA, Vatten LJ. A single weekly bout of exercise may reduce cardiovascular mortality: how little pain for cardiac gain? ‘The HUNT study, Norway’. Eur J Cardiovasc Prev Rehabil. 2006;13(5):798–804.

  112. 112.

    Wen CP, Wai JPM, Tsai MK, Yang YC, Cheng TYD, Lee M-C, et al. Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study. Lancet. 2011;378(9798):1244–53.

  113. 113.

    Gebel K, Ding D, Chey T, Stamatakis E, Brown WJ, Bauman AE. Effect of moderate to vigorous physical activity on all-cause mortality in middle-aged and older Australians. JAMA Intern Med. 2015;175(6):970–7.

  114. 114.

    Samitz G, Egger M, Zwahlen M. Domains of physical activity and all-cause mortality: systematic review and dose–response meta-analysis of cohort studies. Int J Epidemiol. 2011;40(5):1382–400.

  115. 115.

    MacInnis MJ, Zacharewicz E, Martin BJ, Haikalis ME, Skelly LE, Tarnopolsky MA, et al. Superior mitochondrial adaptations in human skeletal muscle after interval compared to continuous single-leg cycling matched for total work. J Physiol. 2017;595(9):2955–68.

  116. 116.

    Ramos JS, Dalleck LC, Tjonna AE, Beetham KS, Coombes JS. The impact of high-intensity interval training versus moderate-intensity continuous training on vascular function: a systematic review and meta-analysis. Sports Med. 2015;45(5):679–92.

  117. 117.

    Jelleyman C, Yates T, O'Donovan G, Gray LJ, King JA, Khunti K, et al. The effects of high-intensity interval training on glucose regulation and insulin resistance: a meta-analysis. Obes Rev. 2015;16(11):942–61.

  118. 118.

    Weston KS, Wisløff U, Coombes JS. High-intensity interval training in patients with lifestyle-induced cardiometabolic disease: a systematic review and meta-analysis. Br J Sports Med. 2014;48(16):1227–34.

  119. 119.

    Astorino TA, Thum JS. Within-session responses to high-intensity interval training in spinal cord injury. Disabil Rehabil. 2018;40(4):444–9.

  120. 120.

    McMillan DWMJ, Jacobs KA, Mendez AJ, Nash MS, Bilzon JLJ. Influence of upper-body continuous, resistance or high intensity interval training (CRIT) on postprandial responses in persons with spinal cord injury: Study protocol for a randomised controlled trial. Trials (under review). 2018.

  121. 121.

    Nash MS, van de Ven I, van Elk N, Johnson BM. Effects of circuit resistance training on fitness attributes and upper-extremity pain in middle-aged men with paraplegia. Arch Phys Med Rehabil. 2007;88(1):70–5.

  122. 122.

    Nilsson S, Staff PH, Pruett ED. Physical work capacity and the effect of training on subjects with long- standing paraplegia. Scand J Rehabil Med. 1975;7(2):51–6.

  123. 123.

    Cooney MM, Walker JB. Hydraulic resistance exercise benefits cardiovascular fitness of spinal cord injured. Med Sci Sports Exerc. 1986;18(5):522–5.

  124. 124.

    Olenik LM, Laskin JJ, Burnham R, Wheeler GD, Steadward RD. Efficacy of rowing, backward wheeling and isolated scapular retractor exercise as remedial strength activities for wheelchair users: application of electromyography. Paraplegia. 1995;33(3):148–52.

  125. 125.

    Jacobs PL, Nash MS, Rusinowski JW. Circuit training provides cardiorespiratory and strength benefits in persons with paraplegia. Med Sci Sports Exerc. 2001;33(5):711–7.

  126. 126.

    Jacobs PL, Mahoney ET, Nash MS, Green BA. Circuit resistance training in persons with complete paraplegia. J Rehabil Res Dev. 2002;39(1):21–8.

  127. 127.

    Nash MS, Jacobs PL, Mendez AJ, Goldberg RB. Circuit resistance training improves the atherogenic lipid profiles of persons with chronic paraplegia. J Spinal Cord Med. 2001;24(1):2–9.

  128. 128.

    Kressler J, Burns PA, Betancourt L, Nash MS. Circuit training and protein supplementation in persons with chronic tetraplegia. Med Sci Sports Exerc. 2014;46(7):1277–84.

  129. 129.

    Kerksick CM, Rasmussen CJ, Lancaster SL, Magu B, Smith P, Melton C, et al. The effects of protein and amino acid supplementation on performance and training adaptations during ten weeks of resistance training. J Strength Cond Res. 2006;20(3):643–53.

  130. 130.

    Nash MS, Jacobs PL, Woods JM, Clark JE, Pray TA, Pumarejo AE. A comparison of 2 circuit exercise training techniques for eliciting matched metabolic responses in persons with paraplegia. Arch Phys Med Rehabil. 2002;83(2):201–9.

  131. 131.

    Ginis KAM, van der Scheer JW, Latimer-Cheung AE, Barrow A, Bourne C, Carruthers P, et al. Evidence-based scientific exercise guidelines for adults with spinal cord injury: an update and a new guideline. Spinal Cord. 2018;56(4):308–21.

  132. 132.

    van der Scheer JW, Ginis KAM, Ditor DS, Goosey-Tolfrey VL, Hicks AL, West CR, et al. Effects of exercise on fitness and health of adults with spinal cord injury: a systematic review. Neurology. 2017;89(7):736–45.

  133. 133.

    Chamberlain JJ, Herman WH, Leal S, Rhinehart AS, Shubrook JH, Skolnik N, et al. Pharmacologic therapy for type 2 diabetes: synopsis of the 2017 American Diabetes Association Standards of Medical Care in Diabetes Pharmacologic Therapy for Type 2 Diabetes. Ann Intern Med. 2017;166(8):572–8.

  134. 134.

    James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). Jama. 2014;311(5):507–20.

  135. 135.

    Alaedeen DI, Jasper J. Gastric bypass surgery in a paraplegic morbidly obese patient. Obes Surg. 2006;16(8):1107–8.

  136. 136.

    Williams G, Georgiou P, Cocker D, Bonanomi G, Smellie J, Efthimiou E. The safety and efficacy of bariatric surgery for obese, wheelchair bound patients. Ann R Coll Surg Engl. 2014;96(5):373–6.

  137. 137.

    Wong S, Barnes T, Coggrave M, Forbes A, Pounds-Cornish E, Appleton S, et al. Morbid obesity after spinal cord injury: an ailment not to be treated? Eur J Clin Nutr. 2013;67(9):998–9.

  138. 138.

    Fried M, Yumuk V, Oppert J, Scopinaro N, Torres A, Weiner R, et al. Interdisciplinary European guidelines on metabolic and bariatric surgery. Obes Surg. 2014;24(1):42–55.

  139. 139.

    Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity. 2013;21:S1.

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Correspondence to Mark S. Nash or James L. J. Bilzon.

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This article is part of the Topical Collection on Spinal Cord Injury Rehabilitation

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Nash, M.S., Bilzon, J.L.J. Guideline Approaches for Cardioendocrine Disease Surveillance and Treatment Following Spinal Cord Injury. Curr Phys Med Rehabil Rep 6, 264–276 (2018). https://doi.org/10.1007/s40141-018-0203-z

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Keywords

  • Cardioendocrine disease
  • Spinal cord injury
  • Nutrition
  • Exercise
  • Physical activity
  • Pharmacotherapy
  • Bariatrics