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11，000人遭受脊髓损伤（SCI）。在第一年内，生理功能严重下降，形成未来心血管疾病的潜在基质。事实上，获得性心血管疾病是SCI的一个日益被认可的后果，并且是SCI死亡的主要原因。虽然不完全了解，心血管疾病的发病率几乎是10倍，部分原因是由于运动障碍和不动造成的深刻的生理性“停止训练”。目前，缺乏有效的干预措施来预防急性下降，导致心血管损害和SCI风险增加-SCI患者的运动疗法具有挑战性，并且在使用时通常仅限于上身。最近，我们为SCI患者改进了一种独特的运动形式，专门反映了那些没有SCI的人所进行的运动。功能性电刺激（FES）划船训练（RT）结合了自主手臂和电控腿部运动，从而产生血液动力学特征，产生大肌肉质量运动的有益心脏负荷条件。因此，FES-RT可能是一种安全有效的减轻SCI后心血管功能下降的方法。我们的目的是检验FES-RT将：1）减轻内脏肥胖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，3）对抗急性SCI发生的心室壁增厚和心室功能下降，并且这些作用将大于仅用手臂运动组观察到的作用。FES-RT的变化将与时间（等待列表）对照和仅限手臂的RT进行比较。 随机分配至立即FES-RT、等待6个月后开始FES-RT的时间控制、或6个月的仅组RT随后FES-RT。将在基线和每3个月进行测量。我们的工作将提供明确描述FES-RT潜在健康益处的结果，如果FES-RT在大多数SCI患者中有效，则其应用，实施和整合可以很容易地复制。

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.