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|Title:||Exercise Rehabilitation after Spinal Cord Injury|
|Keywords:||kinesiology;rehabilitation;spinal cord;spinal cord injury;exercise rehab|
|Abstract:||Spinal cord injury (SCI) is a debilitating event that leads to either complete or partial paralysis, sensory loss and loss of autonomic control below the level of neurological interruption. Consequent to the physiological changes that accompany the sustenance of a SCI, many affected individuals experience increased risk of developing cardiovascular disease. In addition, although not experienced by all individuals with SCI, decreased quality of life and depression are more common in these individuals than in the able-bodied population. Participation in regular exercise has been investigated as a way to decrease both cardiovascular risk and depressive symptoms in able-bodied individuals, however a relatively small number of similar investigations have been performed in individuals with SCI. The current study examined the effects of a training protocol that incorporated arm ergomety and resistance training, two relatively inexpensive and accessible exercise modalities, on blood lipid variables (high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), total cholesterol (TC), triglycerides (TG) and HDLITC ratio), fasting blood glucose (FBG) and psychological well being (PWB). Baseline blood measures were obtained via fingerstick, and were subjected to automated analysis (Cholestech L.D.X, Cholestech, Hayward, CA). Resting systolic (SBP) and diastolic (DBP) were obtained via auscultation, while resting heart rate (HR) was obtained using either chest electrodes or an ear clip HR monitor. Three successively more difficult, 6-minute bouts of arm ergometry were performed, during which were monitored HR, arm rating of perceived exertion (ARPE) and total body rating of perceived exertion (TRPE). Systolic blood pressure and DBP were measured via auscultation immediately following each exercise session. Two minutes of rest were allowed between arm ergometry bouts. Psychological measures including the Center for Epidemiologic Studies depression scale (CES-D) (Radloff, 1977), an adaptation of Cantril's ladder of life satisfaction (Cantril, 1965), the Perceived Stress Scale (PSS) (Cohen et al., 1983), a bodily pain question from the Short-Form 36-Item Health Survey (SF-36) (Ware and Sherbourne, 1992), the modified Exercise-Induced Feeling Inventory (EFI-C) (Rejeski et al., 1999) and perceived control questions from the Beliefs Scale (BS) (Shnek et al., 1997) were administered in interview format. One repetition maximum (1 RM) lifts were determined for chest press, shoulder flexion and elbow flexion. Participants were matched on the basis of Coli ratings (Coli et al., 1998) and years post injury (+/-10 years post) and then randomized to either exercise (EX) or control (C) groups. Subsequently EX participants took part in an exercise protocol that entailed the twice-weekly training of cardiovascular endurance and strength. During each exercise session, participants performed two bouts of arm ergometry and two resistance training exercises for shoulder musculature, elbow flexors, elbow extensors, chest musculature, wrist flexors, wrist extensors and back musculature, respectively. Duration of arm ergometry was adjusted according to individual participant tolerance, while work load was manipulated in order to attempt to elicit TRPE scores of approximately 3. Two sets of 15 repetitions of the resistance training exercises were performed during each of the first 6-8 sessions, in order to facilitate injury-free adjustment to resistance training. Subsequently, 3 sets of 10 repetitions were performed, with relatively heavier weights, in order to maximize improvements in strength. Control participants were asked to refrain from initiating a regular exercise program during the course of the study. Post-testing occurred 3 months following the acquisition of baseline measures for the C group, and following the completion of between 22 to 24 exercise sessions for the EX group. No significant changes in blood lipid variables, FBG or indices of PWB occurred during the course of the study. However, favourable baseline values for absolute blood data, FBG and PWB may have made improvements difficult. Improved arm ergometry tolerance was indicated in EX participants by significant differences in percentage improvement of ARPE at the conclusion of the study. Statistically significant improvements in strength were not observed for the EX group, except in the case of left elbow flexion; however, trends were observed that suggested increased strength in the EX group in comparison with the C group following the completion of the experimental protocol. Several recommendations are provided regarding the performance of future research examining the effects of arm ergometry and resistance training exercise on cardiovascular risk and PWB in individuals with SCI.|
|Appears in Collections:||Digitized Open Access Dissertations and Theses|
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