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Published in:

01-08-2010 | Review Article

Energy Expenditure and Metabolism during Exercise in Persons with a Spinal Cord Injury

Author: Dr Michael Price

Published in: Sports Medicine | Issue 8/2010

Abstract

Resting energy expenditure of persons with a spinal cord injury (SCI) is generally lower than that seen in able-bodied (AB) individuals due to the reduced amounts of muscle mass and sympathetic nervous system available. However, outside of clinical studies, much less data is available regarding athletes with an SCI. In order to predict the energy expenditure of persons with SCI, the generation and validation of prediction equations in relation to specific levels of SCI and training status are required. Specific prediction equations for the SCI would enable a quick and accurate estimate of energy requirements. When compared with the equivalent AB individuals, sports energy expenditure is generally reduced in SCI with values representing 30–75% of AB values. The lowest energy expenditure values are observed for sports involving athletes with tetraplegia and where the sport is a static version of that undertaken by the AB, such as fencing. As with AB sports there is a lack of SCI data for true competition situations due to methodological constraints. However, where energy expenditure during field tests are predicted from laboratory-based protocols, wheelchair ergometry is likely to be the most appropriate exercise mode. The physiological and metabolic responses of persons with SCI are similar to those for AB athletes, but at lower absolute levels. However, the underlying mechanisms pertaining to substrate utilization appear to differ between the AB and SCI. Carbohydrate feeding has been shown to improve endurance performance in athletes with generally low levels of SCI, but no data have been reported for mid to high levels of SCI or for sport-specific tests of an intermittent nature. Further research within the areas reviewed may help to bridge the gap between what is known regarding AB athletes and athletes with SCI (and other disabilities) during exercise and also the gap between clinical practice and performance.

Schmid A, Huonker M, Barturen JM, et al. Catecholamines, heart rate, and oxygen uptake during exercise in personswith spinal cord injury. J Appl Physiol 1998; 85 (2): 635–41PubMed

Schmid A, Huonker M, Stahl F, et al. Free plasma catecholamines in spinal cord injured persons with differentinjury levels at rest and during exercise. J Auton Nerv Syst 1998; 19: 68 (1-2): 96–100PubMedCrossRef

Price MJ, Campbell IG. Thermoregulatory responses of able-bodied and paraplegic athletes to prolonged upperbody exercise. Eur J Appl Physiol 1997; 76: 552–60CrossRef

Price MJ, Campbell IG. Effects of spinal cord lesion level upon thermoregulation during exercise in the heat. Med Sci Sports Exerc 2003; 35 (7): 1100–7PubMedCrossRef

Price MJ. The effects of absolute exercise intensity on core temperature responses of athletes with a spinal cord injury. In: Cisneros AB, Goins BL, editors. Body temperature regulation. New York: Nova Biomedical Books Inc., 2009: 227–41

Hollinshead WH, Jenkins DB. Functional anatomy of the limb and back. 5th rev. ed. Philadelphia (PA): WB Saunders, 1981

Hopman MT. Circulatory responses during arm exercise in individualswith paraplegia. Int J Sports Med 1994; 15 (3): 126–31PubMedCrossRef

Tortora GJ. Principles of human anatomy. 8th rev ed. San Francisco (CA): Benjamin/Cummings Scientific Publishers, 1998

Guyton AC, Hall JE. Textbook of medical physiology. 9th rev. ed. Philadelphia (PA): WB Saunders, 1996: 770

10.

Stallknecht B, Lorentsen J, Enevoldsen LH, et al. Role of the sympathoadrenergic system in adipose tissue metabolismduring exercise in humans. J Physiol 2001; 536 (Pt1): 283–94PubMedCrossRef

11.

Steinberg LL, Lauro FA, Sposito MM, et al. Catecholamine response to exercise in individuals with different levels ofparaplegia. Braz J Med Biol Res 2000; 33 (8): 913–8PubMedCrossRef

12.

Frey GC, McCubbin JA, Dunn JM, et al. Plasma catecholamine and lactate relationship during graded exercise in men withspinal cord injury. Med Sci Sports Exerc 1997; 29 (4): 451–6PubMedCrossRef

13.

McArdle WD, Katch FI, Katch VL, et al. Exercise physiology: energy, nutition and human performance. 2nd ed. Philadelphia (PA): Lea and Febiger, 1986: 642–9

14.

Ainsworth BE, Haskell WL, Whitt MC, et al. Compendiumof physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 2000; 32 (9 Suppl.): S498–504PubMed

15.

Ainsworth BE, Haskell WL, Leon AS, et al. Compendium of physical activities: classification of energy costs of humanphysical activities. Med Sci Sports Exerc 1993; 25 (1): 71–80PubMedCrossRef

16.

Buchholz AC, Pencharz PB. Energy expenditure in chronic spinal cord injury. Curr Opin Clin Nutr Metab Care 2004; 7 (6): 635–9PubMedCrossRef

17.

Alexander LR, Spungen AM, Liu MH, et al. Resting metabolic rate in subjects with paraplegia: the effect of pressuresores. Arch Phys Med Rehabil 1995; 76 (9): 819–22PubMedCrossRef

18.

Monroe MB, Tataranni PA, Pratley R, et al. Lower daily energy expenditure as measured by a respiratory chamberin subjects with spinal cord injury compared with controlsubjects. Am J Clin Nutr 1998; 68 (6): 1223–7PubMed

19.

Liusuwan RA, Widman LM, Abresch RT, et al. Body composition and resting energy expenditure in patientsaged 11 to 21 years with spinal cord dysfunction comparedto controls: comparisons and relationships among thegroups. J Spinal Cord Med 2007; 30 Suppl.1: S105–11PubMed

20.

Liusuwan A, Widman L, Abresch RT, et al. Altered body composition affects resting energy expenditure and interpretationof body mass index in children with spinal cordinjury. J Spinal Cord Med 2004; 27 Suppl.1: S24–8PubMed

21.

Barco KT, Smith RA, Peerless JR, et al. Energy expenditure assessment and validation after acute spinal cord injury. Nutr Clin Pract 2002; 17 (5): 309–13PubMedCrossRef

22.

Spungen AM, Bauman WA, Wang J, et al. The relationship between total body potassium and resting energy expenditurein individuals with paraplegia. Arch Phys Med Rehabil 1993; 74 (9): 965–8PubMed

23.

Mollinger LA, Spurr GB, el Ghatit AZ, et al. Daily energy expenditure and basalmetabolic rates of patients with spinalcord injury. Arch Phys Med Rehabil 1985; 66 (7): 420–6PubMed

24.

Kearns PJ, Thompson JD, Werner PC, et al. Nutritional and metabolic response to acute spinal-cord injury. J Parenter Enteral Nutr 1992; 16 (1): 11–5CrossRef

25.

Patt PL, Agena SM, Vogel LC, et al. Estimation of resting energy expenditure in children with spinal cord injuries. J Spinal Cord Med 2007; 30 Suppl.1: S83–7

26.

Chermesino C, Edelstein S. Energy expenditure after spinal cord injury: a case study. SCI Nurs 2003; 20 (4): 258–60PubMed

27.

Sedlock DA, Laventure SJ. Body composition and resting energy expenditure in long term spinal cord injury. Paraplegia 1990; 28 (7): 448–54PubMedCrossRef

28.

Schneider DA, Sedlock DA, Gass E, et al. VO2peak and the gas-exchange anaerobic threshold during incremental armcranking in able-bodied and paraplegic men. Eur J Appl Physiol Occup Physiol 1999; 80 (4): 292–7PubMedCrossRef

29.

Price MJ, Campbell IG. Determination of peak oxygen uptake during upper body exercise. Ergonomics 1997; 40 (4): 491–9PubMedCrossRef

30.

Smith PM, Price MJ, Doherty M. The influence of crank rate on peak oxygen uptake during arm crank ergometry. J Sports Sci 2001; 19: 955–60PubMedCrossRef

31.

Abel T, Kröner M, Rojas Vega S, et al. Energy expenditure in wheelchair racing and handbiking: a basis for preventionof cardiovascular diseases in those with disabilities. EurJ Cardiovasc Prev Rehabil 2003; 10 (5): 371–6CrossRef

32.

Abel T, Platen P, RojasVega S, et al. Energy expenditure in ball games for wheelchair users. Spinal Cord 2008; 46 (12): 785–90PubMedCrossRef

33.

Yamasaki M, Irizawa M, Komura T, et al. Daily energy expenditure in active and inactive persons with spinal cordinjury. J Hum Ergol (Tokyo) 1992; 21 (2): 125–33

34.

Hayes AM, Myers JN, Myers JN, et al. Heart rate as a predictor of energy expenditure in people with spinal cord injury. J Rehabil Res Dev 2005; 42 (5): 617–24PubMedCrossRef

35.

Lakomy HK, Campbell I, Williams C. Treadmill performance and selected physiological characteristics of wheelchairathletes. Br J Sports Med 1987; 21 (3): 130–3PubMedCrossRef

36.

Ramsbottom R, Nute MG, Williams C. Determinants of five kilometre running performance in active men andwomen. Br J Sports Med 1987; 21 (2): 9–13PubMedCrossRef

37.

Knechtle B, Müller G, Willmann F, et al. Comparison of fat oxidation in arm cranking in spinal cord-injured peopleversus ergometry in cyclists. Eur J Appl Physiol 2003; 90 (5-6): 614–9PubMedCrossRef

38.

Martin L, Doggart AL, Whyte GP. Comparison of physiological responses to morning and evening submaximalrunning. J Sports Sci 2001; 19 (12): 969–76PubMedCrossRef

39.

Abel T, Schneider S, Platen P, et al. Performance diagnostics in handbiking during competition. Spinal Cord 2006; 44 (4): 211–6PubMedCrossRef

40.

Loftin M, Sothern M, Koss C, et al. Energy expenditure and influence of physiologic factors during marathon running. J Strength Cond Res 2007; 21 (4): 1188–91PubMed

41.

Gass GC, Camp EM. Effects of prolonged exercise in highly trained traumatic paraplegic men. J Appl Physiol 1987; 63 (5): 1846–52PubMed

42.

Gass GC, Camp EM, Davis HA, et al. The effects of prolonged exercise on spinally injured subjects. Med Sci Sports Exerc 1981; 13 (5): 277–83PubMed

43.

Gass GC, Camp EM. Physiological characteristics of trained Australian paraplegic and tetraplegic subjects. Med Sci Sports 1979; 11 (3): 256–9PubMed

44.

Burke EJ, Auchinachie JA, Hayden R, et al. Energy cost of wheelchair basketball. Phys Sports Med 1985; 13 (3): 99–102

45.

Bernardi M, Canale I, Felici F, et al. Field evaluation of the energy cost of different wheelchair sports. Int J Sports Cardiol 1988; 5: 58–61

46.

Roy JL, Menear KS, Schmid MM, et al. Physiological responses of skilled players during a competitive wheelchairtennis match. J Strength Cond Res 2006; 20 (3): 665–71PubMed

47.

Smekal G, von Duvillard SP, Rihacek C, et al. A physiological profile of tennis match play. Med Sci Sports Exerc 2001; 33 (6): 999–1005PubMedCrossRef

48.

Fernandez-Fernandez J, Mendez-Villanueva A, Fernandez-Garcia B, et al. Match activity and physiological responsesduring a junior female singles tennis tournament. Br JSports Med 2007; 41 (11): 711–6CrossRef

49.

Ferrauti A, Bergeron MF, Pluim BM, et al. Physiological responses in tennis and running with similar oxygen uptake. Eur J Appl Physiol 2001; 85 (1-2): 27–33PubMedCrossRef

50.

Coutts A, Reaburn P, Abt G. Heart rate, blood lactate concentration and estimated energy expenditure in a semiprofessionalrugby league team during a match: a casestudy. J Sports Sci 2003; 21 (2): 97–103PubMedCrossRef

51.

Novas AM, Rowbottom DG, Jenkins DG. A practical method of estimating energy expenditure during tennisplay. J Sci Med Sport 2003; 6 (1): 40–50PubMedCrossRef

52.

Ballor DL, Burke LM, Knudson DV, et al. Comparison of threemethods of estimating energy expenditure: caltrac, heartrate, and video analysis. ResQ Exerc Sport 1989; 60 (4): 362–8

53.

Spendiff O, Campbell IG. The effect of glucose ingestion on endurance upper-body exercise and performance. Int JSports Med 2002; 23 (2): 142–7CrossRef

54.

Spendiff O, Campbell IG. Influence of glucose ingestion prior to prolonged exercise on selected responses ofwheelchair athletes. Adapt Phys Act Q 2003; 20: 80–90

55.

McInnes SE, Carlson JS, Jones CJ, et al. The physiological load imposed on basketball players during competition. J Sports Sci 1995; 13 (5): 387–97PubMedCrossRef

56.

Christmass MA, Richmond SE, Cable NT, et al. Exercise intensity and metabolic response in singles tennis. J Sports Sci 1998; 16 (8): 739–47PubMedCrossRef

57.

Coutts KD. Heart rates of participants in wheelchair sports. Paraplegia 1988; 26: 43–9PubMedCrossRef

58.

Hoch F, Werle E, Weicker H. Sympathoadrenergic regulation in elite fencers in training and competition. Int J Sports Med 1988; 9 Suppl.2: S141–5PubMedCrossRef

59.

Christmass MA, Dawson B, Passeretto P, et al. A comparison of skeletal muscle oxygenation and fuel use in sustainedcontinuous and intermittent exercise. Eur J Appl Physiol Occup Physiol 1999; 80 (5): 423–35PubMedCrossRef

60.

Price MJ, Campbell IG. Thermoregulatory and physiological responses of wheelchair athletes to prolonged arm crank andwheelchair exercise. Int J Sports Med 1999; 20 (7): 457–63PubMedCrossRef

61.

McConnell TJ, Horvat MA, Beutel-Horvat TA, et al. Arm crank versus wheelchair treadmill ergometry to evaluate theperformance of paraplegics. Paraplegia 1989; 27 (4): 307–13PubMedCrossRef

62.

Pitetti KH, Snell PG, Stray-Gundersen J. Maximal response of wheelchair-confined subjects to four types of arm exercise. Arch Phys Med Rehabil 1987; 68 (1): 10–3PubMed

63.

Glaser RM, Sawka MN, Brune MF, et al. Physiological responses to maximal effort wheelchair and arm crank ergometry. J Appl Physiol 1980; 48 (6): 1060–4PubMed

64.

Knechtle B, Müller G, Willmann F, et al. Fat oxidation at different intensities in wheelchair racing. Spinal Cord 2004; 42 (1): 24–8PubMedCrossRef

65.

Price MJ, Campbell IG. Thermoregulatory responses of paraplegic and able-bodied athletes at rest and duringprolonged upper body exercise and passive recovery. EurJ Appl Physiol Occup Physiol 1997; 76 (6): 552–60CrossRef

66.

Price MJ, Campbell IG. Thermoregulatory responses of spinal cord injured and able-bodied athletes to prolongedupper body exercise and recovery. Spinal Cord 1999; 37 (11): 772–9PubMedCrossRef

67.

Spendiff O, Campbell IG. Influence of pre-exercise glucose ingestion of two concentrations on paraplegic athletes. J Sports Sci 2005; 23 (1): 21–30PubMedCrossRef

68.

Skrinar GS, Evans WJ, Ornstein LJ, et al. Glycogen utilization in wheelchair-dependent athletes. Int J Sports Med 1982; 3 (4): 215–9PubMedCrossRef

69.

Price MJ. Thermoregulatory responses of spinal cord injured and able-bodied athletes to prolonged exercise and thermal stress [PhD Thesis]. Manchester: Manchester MetropolitanUniversity, 1997

70.

Campbell IG, Williams C, Lakomy HK. Physiological responses of wheelchair athletes at percentages of top speed. Br J Sports Med 1997; 31 (1): 36–40PubMedCrossRef

71.

Bhambhani YN, Holland LJ, Eriksson P, et al. Physiological responses during wheelchair racing in quadriplegics andparaplegics. Paraplegia 1994; 32 (4): 253–60PubMedCrossRef

72.

Bhambhani YN, Burnham RS, Wheeler GD, et al. Physiological correlates of simulated wheelchair racing in trainedquadriplegics. Can J Appl Physiol 1995; 20 (1): 65–77PubMedCrossRef

73.

Asayama K, Nakamura Y, Ogata H, et al. Physical fitness of paraplegics in full wheelchair marathon racing. Paraplegia 1985; 23 (5): 277–87PubMedCrossRef

74.

Knoepfli B, Riddell MC, Ganzoni E, et al. Off seasonal and pre-seasonal assessment of circulating energy sourcesduring prolonged running at the anaerobic threshold incompetitive triathletes. Br J Sports Med 2004; 38 (4): 402–7PubMedCrossRef

75.

Howlett KF, Spriet LL, Hargreaves M. Carbohydrate metabolism during exercise in females: effect of reduced fatavailability. Metabolism 2001; 50 (4): 481–7PubMedCrossRef

76.

Thomas TR, Feiock CW, Araujo J. Metabolic responses associated with four modes of prolonged exercise. J Sports Med Phys Fitness 1989; 29 (1): 77–82PubMed

77.

Carey AL, Staudacher HM, Cummings NK, et al. Effects of fat adaptation and carbohydrate restoration on prolongedendurance exercise. J Appl Physiol 2001; 91 (1): 115–22PubMed

78.

Bangsbo J, Jacobsen K, Nordberg N, et al. Acute and habitual caffeine ingestion and metabolic responses tosteady-state exercise. J Appl Physiol 1992; 72 (4): 1297–303PubMedCrossRef

79.

Pillard F, Moro C, Harant I, et al. Lipid oxidation according to intensity and exercise duration in overweight men andwomen. Obesity 2007; 15 (9): 2256–62PubMedCrossRef

80.

Bauman WA, Spungen AM. Carbohydrate and lipid metabolism in chronic spinal cord injury. J Spinal Cord Med 2001; 24 (4): 266–77PubMed

Title: Energy Expenditure and Metabolism during Exercise in Persons with a Spinal Cord Injury
Author: Dr Michael Price
Publication date: 01-08-2010
Publisher: Springer International Publishing
Published in: Sports Medicine / Issue 8/2010
Print ISSN: 0112-1642
Electronic ISSN: 1179-2035
DOI: https://doi.org/10.2165/11531960-000000000-00000

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Energy Expenditure and Metabolism during Exercise in Persons with a Spinal Cord Injury

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