Skeletal muscle hypertrophy and attenuation of cardio-metabolic risk factors (SHARC) using functional electrical stimulation-lower extremity cycling in persons with spinal cord injury: study protocol for a randomized clinical trial

Abstract

Background: Persons with spinal cord injury (SCI) are at heightened risks of developing unfavorable cardiometabolic consequences due to physical inactivity. Functional electrical stimulation (FES) and surface neuromuscular electrical stimulation (NMES)-resistance training (RT) have emerged as effective rehabilitation methods that can exercise muscles below the level of injury and attenuate cardio-metabolic risk factors. Our aims are to determine the impact of 12 weeks of NMES + 12 weeks of FES-lower extremity cycling (LEC) compared to 12 weeks of passive movement + 12 weeks of FES-LEC on: (1) oxygen uptake (VO 2), insulin sensitivity, and glucose disposal in adults with SCI; (2) skeletal muscle size, intramuscular fat (IMF), and visceral adipose tissue (VAT); and (3) protein expression of energy metabolism, protein molecules involved in insulin signaling, muscle hypertrophy, and oxygen uptake and electron transport chain (ETC) activities. Methods/Design: Forty-eight persons aged 18-65 years with chronic (> 1 year) SCI/D (AIS A-C) at the C5-L2 levels, equally sub-grouped by cervical or sub-cervical injury levels and time since injury, will be randomized into either the NMES + FES group or Passive + FES (control group). The NMES + FES group will undergo 12 weeks of evoked RT using twice-weekly NMES and ankle weights followed by twice-weekly progressive FES-LEC for an additional 12 weeks. The control group will undergo 12 weeks of passive movement followed by 12 weeks of progressive FES-LEC. Measurements will be performed at baseline (B; week 0), post-intervention 1 (P1; week 13), and post-intervention 2 (P2; week 25), and will include: VO 2 measurements, insulin sensitivity, and glucose effectiveness using intravenous glucose tolerance test; magnetic resonance imaging to measure muscle, IMF, and VAT areas; muscle biopsy to measure protein expression and intracellular signaling; and mitochondrial ETC function.

Long-Term Spinal Cord Stimulation After Chronic Complete Spinal Cord Injury Enables Volitional Movement in the Absence of Stimulation

“…Despite heterogeneity in daily time and effort dedicated to physical therapy among all participants, more than half of the participants (SVM group) demonstrated progressive statistically significant improvements in volitional movement in the off stimulation state during the study period. As a result, there were statistically significant improvements in the ability to cycle without assistance, providing the basis for cost-effective home-based therapies to provide incremental improvements in muscle mass, cardio-metabolic risk factors and activities of daily living as well as a platform for activity-dependent plasticity ( Shen et al, 2018 ; Gorgey et al, 2019 ).…”

Long-term effect of intrathecal baclofen treatment on bone health and body composition after spinal cord injury: A case matched report

“…Persons with SCI suffer dramatic changes in the parameters of body composition as characterized by decreasing lean mass and increasing fat mass[ 7 ]. In fact, the long-term consequences of altered body composition on metabolic profile is well recognized[ 17 ]. In the current study, long-term use of IBT may have negatively influenced body composition parameters in the case compared to the matched participants.…”

“…Table 1 shows demographics, neurological characteristics, and treatment for the three participants (case and matches). The three participants were recruited from a convenience pool as a part of a parent clinical trial registered at clinicaltrials.gov (NCT01652040)[ 17 ].…”

Visceral Adiposity, Inflammation, and Testosterone Predict Skeletal Muscle Mitochondrial Mass and Activity in Chronic Spinal Cord Injury

“…Participants provided written, informed consent before the study commenced. Participants with the following pre-existing medical conditions were excluded: active urinary tract infection, those using insulin, hematocrit > 50%, stage 3 pressure sore or above, uncontrolled hypertension, cardiovascular disease or uncontrolled type 2 diabetes mellitus, and individuals with neck of femur or total body osteoporosis (T-score ≤ −2.5 according to the World health organization guidelines) ( Reginster and Burlet, 2006 ; Gorgey et al, 2019a ). All participants were instructed to abstain from exercise, alcohol, and caffeine consumption 24 h before the examination.…”