Acute energy cost of multi-modal activity-based therapy in persons with spinal cord injury

Abstract

Objective

To examine acute energy costs of multi-modal activity-based therapy (ABT) in men and women with spinal cord injury (SCI).

Study design

Descriptive case series.

Setting

An outpatient center in California.

Participants

Seven men and women (age = 28.3 ± 11.6 years; duration of injury = 4.3 ± 2.5 years) with injury levels ranging from C5 to T8.

Intervention

Activity-based therapy.

Outcome measures

Oxygen uptake (VO₂), energy expenditure (kcal/minute), SCI Metabolic Equivalent of Task (MET) (1 MET = 2.7 ml/kg/minute).

Results

Oxygen uptake (VO₂) during ABT ranged from 5.10 to 8.62 ml/kg/minute, with VO₂ consistently higher during modalities involving load bearing versus non-load bearing (P = 0.08). SCI MET values ranged from 1.89 to 3.24 and were significantly higher in subjects with mid-thoracic injury versus low-cervical injury (P = 0.01).

Conclusion

Data reveal that multi-modal ABT increases VO₂ in persons with SCI, but energy expenditure is relatively low. Strategies must be identified to optimize energy expenditure in the SCI to reduce health risks. Modalities involving load bearing seem to be superior to non-load-bearing activities. VO₂ was greater in response to load-bearing modalities than non-load-bearing modalities. It remains to be determined whether chronic ABT enhances cardiovascular fitness and reduces disease risks in this population.

Keywords:

• Activity-based therapy
• Spinal cord injuries
• Rehabilitation
• Paraplegia
• Tetraplegia
• Energy expenditure
• MET
• Resistance training
• Ergometry
• Functional electrical stimulation
• Assisted standing

Acknowledgment

The authors thank Fred Kolkhurst, PhD, for providing the portable metabolic unit used in this study, and Kimberly Howell for her assistance with data analysis.