Jennifer L. Caputo

Physical Activity and Quality of Life in Adults With Spinal Cord Injury

Abstract Background/Objective: To document the relationship between level of physical activity and quality of life in persons with spinal cord injury. Design: Cross-sectional investigation. Participants/Methods: Men (n = 32) and women (n = 30) with complete and incomplete spinal cord lesions below C6 volunteered to participate in this study. The average length of time since the onset of disability was 9 years (range, 1.5-40 years). Using an interview-formatted survey (Quality of Well-Being Scale), a measure of quality of life was obtained for each participant. Physical activity levels were determined using the Physical Activity Scale for Individuals with Physical Disabilities. Results: A strong positive association (r= 0.75; P < 0.05) was observed between level of physical activity and quality of life. Multiple regression analysis also showed that when level of physical activity, anatomical location of the injury, completeness of injury, and time since injury were used as explanatory variables, level of physical activity was the only significant predictor of quality of life, accounting for 56% of the total variation in quality of life. Conclusions: Results from this study show that a significant and moderately strong positive relationship exists between level of physical activity and quality of life in adults with spinal cord injury. From a clinical perspective, these findings suggest that interventions aimed at promoting physical activity may be effective in improving quality of life in this population.

Comparison of direct and indirect measures of walking energy expenditure in children with hemiplegic cerebral palsy

The purpose of this study was to investigate the use of the heart‐rate (HR) version of the energy expenditure index (EEIHR) as a proxy for measurement of walking oxygen consumption (VO2) in children with cerebral palsy (CP). Thirteen children (eight males, five females; mean age 11 years 2 months [SD 3 years], age range 6 to 15 years) with hemiplegic CP, participated in this study. The study was conducted over three sessions. During session 1, participants were familiarized with testing procedures and given 5 minutes of treadmill walking practice. In session 2, participants completed three 5‐minute walking bouts on the treadmill at 0.67m˙s‐1 to familiarize themselves with treadmill locomotion. During the final session participants walked at 0.67, 0.89, and 1.12m˙s‐1 for 5 minutes while gross oxygen consumption (gross VO2; walking VO2/speed), net VO2 ([walking VO2‐resting VO2]/speed), and EEIHR ([walking HR‐resting HR]/speed) were measured during the last 2 minutes of each bout. Correlational analyses indicated no relationship (p>0.05) between measures of gross VO2 and EEIHR at each speed. Although no association was evident between net VO2 and EEIHR at 0.67 and 0.89m˙s‐1, a moderate relationship (r=0.64;p < 0.05) was present between these variables at 1.12m˙s‐1. Examination of individual data revealed that most participants displayed an unmatched pattern of response between net VO2 and EEIHR. Our results suggest that caution should be applied when using EEIHR to estimate walking energy expenditure in children with CP.

Resistance exercise training improves heart function and physical fitness in stable patients with heart failure

PURPOSE This study determined the effect of a structured isotonic strength training (ST) program on left ventricular (LV) function (ejection fraction, stroke volume, and end-diastolic and end-systolic volumes) and physical fitness (6-minute walk test, upper body strength, lower body strength, and body composition) in patients with New York Heart Association class II and III heart failure. METHODS Sixteen patients were randomized into 2 groups, ST and usual care. The ST group (10 patients) performed 24 ST exercise sessions (3 per week, 8 weeks), while the usual care (6 patients) group followed routine medical care. The structured isotonic ST program involved 12 different exercises on circuit weight machines. LV function (3D echocardiography) and physical fitness were assessed at baseline and 8 weeks. RESULTS Modest improvements (P < .05) in resting ejection fraction (0.32–0.37) and stroke volume (46 to 53 mL/beat), as well as in muscular strength and 6-minute walk distance, were found after training. CONCLUSIONS A short-term structured isotonic ST program appears to improve selected measures of resting LV function and fitness in patients with mild congestive heart failure. Additional studies utilizing larger numbers of subjects, including women, are needed.

Longitudinal profiles of oxygen uptake during treadmill walking in able-bodied children: the locomotion energy and growth study

The purpose of this study was to document age-related changes in walking V(O(2)) in able-bodied boys and girls. Beginning at age 6 and ending at age 10, 23 children (14 girls, 9 boys) performed six 5-min bouts of level treadmill walking at 0.67, 0.89, 1.12, 1.34, 1.56, and 1.79 m s(-1) on an annual basis. Prior to data collection, subjects received 60 min of treadmill walking practice. During the last 2 min of each walking bout, a 2-min sample of expired air was collected in a meteorological balloon and analyzed to determine V(O(2)). Averaged across age, interindividual variation in V(O(2)) ranged from 32 to 41%. Repeated-measures analysis of variance demonstrated a speed by age interaction for V(O(2)), such that mean V(O(2)) rose (P< or = 0.05) across the five fastest speeds for 6-, 7-, 8-, and 10-year olds and increased over the entire speed range for 9-year olds. For all speeds, V(O(2)) decreased yearly from the ages of 6 to 8. When averaged across speeds, V(O(2)) was 27% higher for 6-year olds compared with 10-year olds. From a clinical perspective, access to longitudinal measurements of walking V(O(2)) in able-bodied children should be helpful in interpreting gait energy use in children with movement disorders and evaluating treatment strategies designed to reduce the aerobic demand of locomotion in youth with impaired mobility.

Waist‐to‐Height Ratio and Body Mass Index as Indicators of Cardiovascular Risk in Youth

BACKGROUND The purpose of this investigation was to determine if waist-to-height ratio (WHTR) or body mass index (BMI) is the better indicator of cardiovascular disease risk in children and adolescents of varying ages. METHODS Data from children and adolescents (N = 2300) who were part of the 2003-2004 National Health and Nutrition Examination Survey (NHANES) were analyzed. Chi-square analyses (2 × 2) were used to compare risk levels of WHTR (>0.50) and BMI (>85th percentile) to systolic blood pressure (SBP) (>90th percentile) as well as total cholesterol (TC) (>200 mg(.) dL(-1) ) for the entire cohort and specified age groups. RESULTS Significant relationships were detected between SBP and WHTR and BMI, respectively, for the entire cohort as well as the 2 oldest subsamples. A significant association was also noted for both WHTR and BMI to TC for the entire sample and the eldest age group. CONCLUSIONS A significant association was observed between indicators of cardiovascular health risk and both WHTR and BMI in the entire NHANES cohort of boys and girls as well as in the older age groups. The younger groups of participants did not display a notable link between these cardiovascular indicators and WHTR or BMI.

Strength and Step Activity After Eccentric Resistance Training in Those With Incomplete Spinal Cord Injuries

Background: Individuals with spinal cord injuries (SCIs) often experience general weakness in the lower extremities that undermines daily step activity. Objective: To investigate the efficacy of eccentrically biased resistance training on lower extremity strength and physical activity of individuals with spinal injuries. Methods: Individuals with long-standing incomplete SCIs (N = 11) capable of completing a 10-meter walk assessment were included. All participants who completed the familiarization period finished the training. Individuals trained two times per week for 12 weeks on a lower body eccentric resistance training machine. It was hypothesized that the outcome variables (eccentric strength, isometric strength, and daily step physical activity) would improve as a result of the training intervention. Results: Eccentric strength [F(1.27, 12.71) = 8.42, MSE = 1738.35, H-F p = .009] and isometric strength [F(1.97, 19.77) = 7.10, MSE = 11.29, H-F p = .005] improved as a result of the training while daily step activity remained unchanged [F(2.00, 18.00) = 2.73, MSE = 216,836.78, H-F p = .092]. Conclusions: Eccentric resistance training improves eccentric and isometric strength. These physiological adaptations may translate to improved gait mechanics, but further study is required to identify this potential crossover effect.

The Joint Association of Fitness and Fatness on Cardiovascular Disease Mortality: A Meta-Analysis

The joint association of cardiorespiratory fitness (CRF) and body mass index (BMI) on cardiovascular disease (CVD) mortality was determined. PubMed and CINAHL were searched following PRISMA guidelines. Included studies were prospective, had objective assessments of maximal CRF and BMI, and compared the joint impact of CRF and BMI on CVD mortality risk to normal weight, fit referents. Pooled hazard ratios and 95% confidence intervals were calculated from eight articles with nine independent groups using a random effects model. Unfit individuals had two to three times the risk of mortality across all levels of BMI. Overweight and obese-fit individuals had 25% and 42% increased mortality risk, respectively, compared to normal weight-fit individuals. However, for the obese-fit group, a one study removed analysis for five studies resulted in non-significant changes in mortality risk. Researchers, clinicians, and public health officials are encouraged to employ CRF interventions to reduce CDV mortality risk.

Ambulation and physical function after eccentric resistance training in adults with incomplete spinal cord injury: A feasibility study

Background: Strengthening the lower extremities has shown to positively influence walking mechanics in those with neurological deficiencies. Eccentric resistance training (ERT) is a potent stimulus for the development of muscular strength with low metabolic demand. Thereby, ERT may benefit those with incomplete spinal cord injuries (iSCI) seeking to improve ambulatory capacity. Design: This study was aimed to determine the effect of ERT on walking speed, mobility, independence, and at home function following iSCI. Methods: Individuals with longstanding iSCI trained twice a week for 12 weeks on an eccentrically biased recumbent stepper. Outcome measures: Walking speed (10 meter walk test; 10MWT), mobility (timed up and go), independence (Walking Index for Spinal Cord Injury; WISCI), and at home function (Spinal Cord Independence Measure; SCIM) were assessed at baseline, after 6 weeks, and after 12 weeks of ERT. Results: There were improvements in walking mobility (158.36 + 165.84 seconds to 56.31 + 42.42 seconds, P = .034, d = 0.62), speed (0.34 + 0.42  m/s to 0.43 + 0.50  m/s, P = .005, d = .23), and independence (8 + 7 to 13 + 7, P = .004, d = .73) after 12 weeks of ERT. At home function remained unchanged (22 + 10 to 24 + 10, P = .10, d = .12). Conclusions: Improving lower extremity strength translated to walking performance and independence in those with iSCI. Additionally, ERT may diminish therapist burden in programs designed to improve ambulatory capacity or strength in those with iSCI.

Impact of EPOC adjustment on estimation of energy expenditure using activity monitors

Abstract Purpose: To examine the accuracy of activity monitors in estimating energy expenditure (EE) during activities of varying mode and intensity and to evaluate the impact of including energy expended during recovery from activity (EPOC) on the EE estimate. EE estimates obtained from the Fitbit Surge (FBS), Garmin Vívofit (GV) and SenseWear Armband Mini (SWA) were compared to criterion EE with and without EPOC adjustments during moderate- and vigorous-intensity treadmill and cycling activities. Methods: Participants (N = 34; 23 males) completed counterbalanced treadmill or cycling conditions, comprised of a resting metabolic rate measurement, 10-min bouts of moderate- and vigorous-intensity activity and an EPOC measurement. Participants simultaneously wore the three activity monitors and a portable metabolic analyser. Results: The FBS provided lowest percent error (PE) during treadmill walking (4.4%) and the GV during moderate (6.4%) and vigorous (−0.1%) cycling bouts. EPOC-adjusted PE was higher than non-EPOC PE across all monitors and activities. Mean absolute error rate (MAPE), indicating overall measurement error, was the smallest for the FBS (14.1%) during moderate treadmill walking and the largest for the SWA (53.5%) for vigorous intensity cycling. Only the FBS had comparable non-EPOC (14.6%) and EPOC-adjusted (17.6%) MAPE during treadmill walking. Conclusion: The activity monitors tended to underestimate EE during moderate and vigorous treadmill and cycling activities. The EE estimates from the activity monitors did not account for the energy cost met by anaerobic means during activity, as suggested by the higher EPOC-adjusted EE error rates.

Impact of Underwater Treadmill Training on Glycemic Control, Blood Lipids, and Health-Related Fitness in Adults With Type 2 Diabetes

IN BRIEF A large number of adults with type 2 diabetes experience comorbidities that discourage physical activity and hinder regular participation in land-based exercise programs. An aquatic exercise program is an innovative exercise modality that incorporates combined aerobic and resistance exercise. The purpose of this study was to determine if an underwater treadmill walking program featuring gradual and progressive increases in walking speed and duration has a positive effect on glycemic control, metabolic health, cardiovascular function, body composition, and leg strength in middle-aged adults with type 2 diabetes.