Abstract
Study design: Pre–post training intervention.
Objectives: To evaluate the effect of training intensity on physical capacity, lipid profile and insulin sensitivity in early rehabilitation of spinal cord injured (SCI) patients, and to assess the correlation between peak aerobic capacity (VO2Peak) and insulin sensitivity.
Setting: Spinal Cord Rehabilitation Unit, Sunnaas Hospital, Nesoddtangen, Norway.
Method: Six recently injured SCI individuals participated in the arm training intervention and were randomly admitted to a high-intensity (HI; 70–80% heart rate reserve (HRR)) and low-intensity (LI; 40–50% HRR) group. The 1 h interval training consisted of 3 min exercise bouts interspersed with 2 min of rest, three times a week for 8 weeks. In addition, a correlation coefficient was obtained between VO2Peak and insulin sensitivity in 11 SCI patients.
Results: The 8-week training program resulted in a significant increase in VO2Peak and maximal power output (POMax) for the group as a whole (P<0.05). VO2Peak increased significantly more and total cholesterol/high-density lipoprotein cholesterol (TC/HDL-C) ratio and triglycerids decreased significantly more in the HI group than in the LI group (P=0.05). Training-induced changes in insulin sensitivity were significantly different between the groups (P=0.05), which was due to a nonsignificant decline in insulin sensitivity in the HI group and a nonsignificant improvement in the LI group. A significant positive correlation was found between VO2peak and insulin sensitivity (r=0.68, P=0.02).
Conclusion: The interval arm training protocol as used in the present study enables recently injured SCI patients to do substantial work at a relatively high intensity. Results indicate that improvements in physical capacity and lipid profile were more pronounced in response to high-intensity training. The significant correlation between maximal oxygen consumption and insulin sensitivity indicates that, as in the able-bodied population, peak aerobic capacity is a predictive value with regard to insulin sensitivity in SCI. Future studies with larger groups assessing the role of exercise intensity on insulin sensitivity in SCI are suggested.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Bauman WA et al. Depressed serum high density lipoprotein cholesterol levels in veterans with spinal cord injury. Paraplegia 1992; 30: 697–703.
Bauman WA et al. Coronary artery disease: metabolic risk factors and latent disease in individuals with paraplegia. Mt Sinai J Med 1992; 59: 163–168.
Bauman WA et al. The effect of residual neurological deficit on serum lipoproteins in individuals with chronic spinal cord injury. Spinal Cord 1998; 36: 13–17.
Dallmeijer AJ, Hopman MT, van der Woude LH . Lipid, lipoprotein, and apolipoprotein profiles in active and sedentary men with tetraplegia. Arch Phys Med Rehabil 1997; 78: 1173–1176.
Hjeltnes N et al. Improved body composition after 8 wk of electrically stimulated leg cycling in tetraplegic patients. Am J Physiol 1997; 273: R1072–R1079.
LaPorte RE et al. HDL cholesterol across a spectrum of physical activity from quadriplegia to marathon running. Lancet 1983; 1: 1212–1213.
Dearwater SR et al. Activity in the spinal cord-injured patient: an epidemiologic analysis of metabolic parameters. Med Sci Sports Exerc 1986; 18: 541–544.
Dela F et al. Effect of training on insulin-mediated glucose uptake in human muscle. Am J Physiol 1992; 263 (6 Part 1): E1134–E1143.
Tran ZV, Weltman A, Glass GV, Mood DP . The effects of exercise on blood lipids and lipoproteins: a meta-analysis of studies. Med Sci Sports Exerc 1983; 15: 393–402.
Mikines KJ et al. Effect of physical exercise on sensitivity and responsiveness to insulin in humans. Am J Physiol 1988; 254 (3 Part 1): E248–E259.
Tremblay A, Simoneau JA, Bouchard C . Impact of exercise intensity on body fatness and skeletal muscle metabolism. Metabolism 1994; 43: 814–818.
Borghouts LB, Backx K, Mensink MF, Keizer HA . Effect of training intensity on insulin sensitivity as evaluated by insulin tolerance test. Eur J Appl Physiol Occup Physiol 1999; 80: 461–466.
Hopman MT et al. Blood redistribution and circulatory responses to submaximal arm exercise in persons with spinal cord injury. Scand J Rehabil Med 1998; 30: 167–174.
Hopman MT et al. Limits to maximal performance in individuals with spinal cord injury. Int J Sports Med 1998; 19: 98–103.
Horton ES . Exercise and physical training: effects on insulin sensitivity and glucose metabolism. Diabetes Metab Rev 1986; 2: 1–17.
Koivisto VA, Yki-Jarvinen H, DeFronzo RA . Physical training and insulin sensitivity. Diabetes Metab Rev 1986; 1: 445–481.
Matthews DR et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28: 412–419.
Hosker JP et al. Continuous infusion of glucose with model assessment: measurement of insulin resistance and beta-cell function in man. Diabetologia 1985; 28: 401–411.
Friedewald WT, Levy RI, Fredrickson DS . Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972; 18: 499–502.
Wilmore JHC . Physiology of Sports and Exercise: Human Kinetics: Champaign, 1994.
van der Woude LH et al. Physical work capacity after 7 wk of wheelchair training: effect of intensity in able-bodied subjects. Med Sci Sports Exerc 1999; 31: 331–341.
Hooker SP, Wells CL . Effects of low- and moderate-intensity training in spinal cord-injured persons. Med Sci Sports Exerc 1989; 21: 18–22.
Whiteneck GG et al. Mortality, morbidity, and psychosocial outcomes of persons spinal cord injured more than 20 years ago. Paraplegia 1992; 30: 617–630.
Stampfer MJ et al. A prospective study of cholesterol, apolipoproteins, and the risk of myocardial infarction. N Engl J Med 1991; 325: 373–381.
Duckworth WC et al. Glucose intolerance due to insulin resistance in patients with spinal cord injuries. Diabetes 1980; 29: 906–910.
Aksnes AK et al. Intact glucose transport in morphologically altered denervated skeletal muscle from quadriplegic patients. Am J Physiol 1996; 271 (3 Part 1): E593–E600.
Hjeltnes N et al. Exercise-induced overexpression of key regulatory proteins involved in glucose uptake and metabolism in tetraplegic persons: molecular mechanism for improved glucose homeostasis. FASEB J 1998; 12: 1701–1712.
Mohr T et al. Insulin action and long term-electrically induced training in individuals with spinal cord injuries. Med Sci Spo Exer 2001; 33: 1247–1252.
Jeon J et al. Improved glucose tolerance and insulin sensitivity after electrical stimulation-assisted cycling in people with spinal cord injury. Spinal Cord 2002; 40: 110–117.
Hermans MP, Levy JC, Morris RJ, Turner RC . Comparison of insulin sensitivity tests across a range of glucose tolerance from normal to diabetes. Diabetologia 1999; 42: 678–687.
Ebeling P et al. Mechanism of enhanced insulin sensitivity in athletes. Increased blood flow, muscle glucose transport protein (GLUT-4) concentration, and glycogen synthase activity. J Clin Invest 1993; 92: 1623–1631.
Acknowledgements
The enthusiastic participation of all subjects in the study is greatly appreciated. We acknowledge Wenche Ronning and other employees of the Clinical Chemical Laboratory at Sunnaas Hospital for their assistance with the measurements and analyses of blood samples.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
de Groot, P., Hjeltnes, N., Heijboer, A. et al. Effect of training intensity on physical capacity, lipid profile and insulin sensitivity in early rehabilitation of spinal cord injured individuals. Spinal Cord 41, 673–679 (2003). https://doi.org/10.1038/sj.sc.3101534
Published:
Issue date:
DOI: https://doi.org/10.1038/sj.sc.3101534
Keywords
This article is cited by
-
Hybrid high-intensity interval training using functional electrical stimulation leg cycling and arm ski ergometer for people with spinal cord injuries: a feasibility study
Pilot and Feasibility Studies (2022)
-
Physiological responses to moderate intensity continuous and high-intensity interval exercise in persons with paraplegia
Spinal Cord (2021)
-
The effectiveness of vigorous training on cardiorespiratory fitness in persons with spinal cord injury: a systematic review and meta-analysis
Spinal Cord (2021)
-
Viability of high intensity interval training in persons with spinal cord injury—a perspective review
Spinal Cord (2021)
-
A tele-health intervention to increase physical fitness in people with spinal cord injury and cardiometabolic disease or risk factors: a pilot randomized controlled trial
Spinal Cord (2021)
