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

项目摘要 在美国，每年有11，000人遭受脊髓损伤（SCI）。 生理功能的深刻下降，形成未来心血管疾病的潜在基质， 疾病事实上，获得性心血管疾病是SCI的一个日益被认可的后果 是脊髓损伤患者死亡的主要原因。虽然不完全理解，但几乎10倍的 心血管疾病的流行部分是由于严重的生理性“停止训练”， 运动障碍和不动。目前，有效的干预措施，防止急性下降， 导致心血管损害和SCI风险增加的运动疗法缺乏， 与SCI是具有挑战性的，并且当使用时，通常限于上身。最近，我们改进了 这是一种针对SCI患者的独特运动形式， 没有SCI。功能性电刺激（FES）划船训练（RT）将意志性手臂和 电动控制的腿部锻炼，导致血液动力学特征， 大肌肉群运动的心脏负荷条件。因此，FES-RT可能是一种安全且 减轻SCI后心血管功能下降的有效方法。我们的目标是测试 假设FES-RT将：1）减轻内脏肥胖增加和胰岛素减少 敏感性，2）防止脂质分布恶化和压力反射功能受损，以及3）对抗 急性SCI时发生心室壁增厚和心室功能下降， 其效果将大于仅用手臂锻炼组观察到的效果。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。在过去3-6年内发生SCI的个体 6个月后，将随机分配至立即FES-RT组，6个月后开始FES-RT， 等待，或6个月的仅组-RT，然后是FES-RT。将在基线和每3个月进行测量 个月我们的工作将提供明确描述FES-RT潜在健康益处的结果， FES-RT在大多数SCI患者中有效，其应用，实施和整合 很容易复制。

Project Summary 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.