Spinal Cord Injuries
Conditions
Keywords
lipemia, feeding, paraplegia, tetraplegia, physical activity, macronutrient metabolism
Brief summary
This study investigates the effect of upper extremity exercise on postprandial lipemia (PPL) in persons with spinal cord injury (SCI). Participants are measured at rest and fed a standardized meal following seated rest (CON) or arm cycling exercise (ACE). The meal is infused with stable isotope lipid tracers that allow for determination of the end fates of the fat in the meal.
Detailed description
Spinal cord injury (SCI) results in dysregulation of fat metabolism that increases the risk of morbidity and mortality from cardioendocrine disease. Excessive accumulation of visceral fat after SCI is a serious risk component for cardioendocrine disease and results in part from pronounced hypertriglyceridemia following ingestion of fat-containing meals (i.e., exaggerated postprandial lipemia; PPL). Although exaggerated PPL is well documented in persons with SCI, its etiology is unknown. Specifically, it remains to be determined to what extent exaggerated PPL in those with SCI results from impairments in the use of exogenous (dietary) and/or endogenous (stored) fats. Additionally, it is not known if exercise improves postprandial fat use in a manner that alleviates the exaggerated PPL in this population and reduces the risk of cardioendocrine disease. The objective of the this study is to examine the mechanisms of exaggerated PPL in those with SCI and the effects of an acute pre-meal exercise bout by employing novel stable isotope tracer techniques. In persons without SCI, it is well established that pre-meal exercise lowers PPL in part by improving the use of exogenous and endogenous fats. While muscle atrophy and blunted sublesional sympathetic activity following SCI may hinder fat use, preliminary data indicate that fat use is increased during recovery from exercise in the postabsorptive (fasted) state in this population. Thus, the investigators hypothesize that decreased use of exogenous and endogenous fats contributes to exaggerated PPL in SCI, and that pre-meal exercise will reduce PPL due to increased use of both fat sources.
Interventions
BEHAVIORALSeated control (CON)
Seated rest
BEHAVIORALArm cycle exercise (ACE)
Arm cycling at a continuous power output
BEHAVIORALLiquid meal
Liquid meal of 0.5 L volume containing 20 kcal/kg fat free mass (FFM) and 5 mg/kg FFM of uniformly 13-carbon labeled palmitate (\[U-13C\]palmitate) at a macronutrient distribution of 50% carbohydrate, 35% fat, and 15% protein (by kcal).
Sponsors
The Craig H. Neilsen Foundation
University of Miami
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
PREVENTION
Masking
NONE
Intervention model description
Mixed-crossover: three separate groups (paraplegia, tetraplegia, and neurologically intact) undergo two conditions (seated control and exercise) in a randomized order.
Eligibility
Sex/Gender
MALE
Age
18 Years to 60 Years
Healthy volunteers
Yes
Inclusion criteria
* Males aged 18-60 years. * For the spinal cord injury subgroups, the participant's injury will be: * neurologically stable, * American Spinal Injury Association (ASIA) Impairment Scale A-C, * and will have occurred \> 1 year from the testing date.
Exclusion criteria
* Existing diagnosis of cardiovascular disease or diabetes. * Contraindication to exercise (ACSM Guideline, 10th edition). * Lower extremity fracture or dislocation within 6 months of participation. * History of head injury or seizures. * Inability to consent. * Restrictions in upper extremity range of motion that would prevent an individual from achieving an unhindered arm cycling motion or moving throughout a range needed to perform resistance maneuvers. * A pressure ulcer at ischial/gluteus, trochanteric, sacral, or heel sites within the last 3 months. * Imprisonment in state or federal jail or prison.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Rates of postprandial exogenous vs. endogenous fat use | 400 minutes | Indirect calorimetry data (rates of CO2 production and O2 consumption) will be input into stoichiometric equations to calculate the rate of whole body fat oxidation (grams/minute). Breath carbon-13 carbon dioxide (13CO2) enrichment data combined with the rate CO2 production from indirect calorimetry will allow for the determination of the individual rates of exogenous and endogenous fat use. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Contribution of exogenous fat to postprandial changes in plasma triglycerides | 400 minutes | Carbon-13 palmitate (\[U-13C\] enrichment data will allow for the determination of the contribution of exogenous fat to the total blood triglyceride concentration. The contribution of endogenous fat to the total blood triglyceride concentration will be calculated by subtracting the exogenous fat contribution from the total blood triglyceride concentration. |
| Concentration of fats in the blood | 460 minutes | Concentration of triglycerides, non-esterified fatty acids, and glycerol in the blood before and after a test meal. |
| Concentration of sugar in the blood | 460 minutes | Concentration of glucose in the blood before and after a test meal. |
| Concentration of hormones in the blood | 460 minutes | Concentration of insulin and catecholamines in the blood before and after a test meal. |
| Markers of systemic inflammation | Baseline | Concentration of high-sensitivity C-reactive protein (hs-CRP) in the blood |
Countries
United States
Outcome results
None listed