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

描述(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，形成了未来心血管疾病的潜在基础。事实上，获得性心血管疾病是脊髓损伤的一种日益公认的后果，也是脊髓损伤死亡的主要原因。虽然还不完全了解，但心血管疾病的患病率几乎是10倍，部分原因是运动障碍和行动不便导致的严重的生理‘缺乏训练’。目前，缺乏有效的干预措施来防止导致心血管损害和脊髓损伤风险增加的急剧下降-运动疗法对脊髓损伤患者来说是具有挑战性的，当使用运动疗法时，通常仅限于上半身。最近，我们为有脊髓损伤的人改进了一种独特的运动形式，专门反映了没有脊髓损伤的人进行的运动。功能性电刺激(FES)排训练(RT)结合了意志性手臂运动和电控腿部运动，产生了血液动力学特征，从而产生了大肌肉群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方法来减轻脊髓损伤后心血管功能的下降。我们的目标是测试FES-RT将：1)缓解内脏脂肪增加和胰岛素敏感性降低，2)防止血脂状况恶化和压力感受性反射功能受损，以及3)对抗急性脊髓损伤时发生的室壁增厚和心功能下降的总体假设，并且这些影响将比仅使用手臂的运动组观察到的效果更大。FES-RT的变化将与时间(等待列表)控制和仅限武器-RT进行比较。在最近3-6个月内有脊髓损伤的个人将被 随机分为即刻FES-RT组，等待6个月后开始FES-RT的时间对照组，或在等待6个月后开始FES-RT的6个月单纯手臂RT组。措施将在基线和每3个月进行一次。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在大多数脊髓损伤患者中有效，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.