HYBRID-FES EXERCISE TO PREVENT CARDIOVASCULAR DECLINES IN ACUTE SPINAL CORD INJUR

描述（由申请人提供）：在美国，每年有11000人遭受脊髓损伤（SCI）。在第一年，患者的生理功能会严重下降，形成未来心血管疾病的潜在基础。事实上，获得性心血管疾病越来越被认为是脊髓损伤的后果，也是脊髓损伤死亡的主要原因。尽管尚未完全了解，但心血管疾病的患病率几乎是10倍，部分原因是由于运动损伤和不动导致的深刻的生理“去训练”。目前，缺乏有效的干预措施来预防导致心血管损害和脊髓损伤风险增加的急性衰退——运动疗法对脊髓损伤患者具有挑战性，而且通常仅限于上半身。最近，我们为那些患有脊髓损伤的人改进了一种独特的运动形式，它特别反映了那些没有脊髓损伤的人所做的运动。功能性电刺激（FES）行训练（RT）结合了意志手臂和电控腿部运动，从而产生血流动力学特征，产生有益的大肌肉量运动的心脏负荷条件。因此，FES-RT可能是一种安全有效的减轻脊髓损伤后心血管功能下降的方法。我们的目的是验证FES-RT的总体假设：1)减轻内脏脂肪增加和胰岛素敏感性降低，2)防止脂质谱恶化和压力反射功能受损，以及3)急性脊髓损伤时发生的反心室壁增厚和心室功能下降，这些效果将比仅臂运动组观察到的效果更大。FES-RT的变化将与时间（等候名单）控制和仅限武器的rt进行比较。在最近3-6个月内发生过脊髓损伤的个人将会

DESCRIPTION (provided by applicant): Each year, 11,000 people suffer a spinal cord injury (SCI) in the U.S. Within the first year, there are profound declines in physiologic function, forming the underlying substrate for future cardiovascular disease. In fact, acquired cardiovascular disease is an increasingly recognized consequence of SCI and is the leading cause of death in SCI. Though incompletely understood, the almost 10-fold prevalence of cardiovascular disease results in part from profound physiologic 'detraining' resulting from motor impairment and immobility. Currently, effective interventions preventing acute declines that lead to cardiovascular compromise and increased risk in SCI are lacking - exercise therapy for those with SCI is challenging and when employed, is typically limited to the upper body. Recently, we refined a unique form of exercise for those with SCI that specifically mirrors exercise performed by those without SCI. Functional Electrical Stimulation (FES) Row Training (RT) couples volitional arm and electrically controlled leg exercise, resulting in a hemodynamic profile that produces the beneficial cardiac loading conditions of large muscle mass exercise. As such, FES-RT may be a safe and effective way to attenuate cardiovascular declines following SCI. Our aims are to test the overall hypotheses that FES-RT will: 1) mitigate against increased visceral adiposity and reduced insulin sensitivity, 2) prevent worsening lipid profile and compromised baroreflex function, and 3) counter ventricular wall thickening and declining ventricular function occurring with acute SCI, and that these effects will be greater than that observed with an arms-only exercise group. Changes with FES-RT will be compared to a time (wait-list) control and to arms-only-RT. Individuals with an SCI within the last 3-6 months will be randomized to immediate FES-RT, to a time control beginning FES-RT after a 6 month wait, or 6 months of arms-only-RT followed by FES-RT. Measures will be made at baseline and every 3 months. Our work will provide results that clearly delineate potential health benefits of FES-RT, and if FES-RT is effective in a majority of those with SCI, its application, implementation, and integration could be easily replicated.