Effects of walking training on risk markers of cardiovascular disease in individuals with chronic spinal cord injury

Ramzi A Alajam; Abdulfattah S Alqahtani; Sanghee Moon; Caio V M Sarmento; Jason Frederick; Irina V Smirnova; Wen Liu

doi:10.1080/10790268.2020.1853332

Effects of walking training on risk markers of cardiovascular disease in individuals with chronic spinal cord injury

J Spinal Cord Med. 2022 Jul;45(4):622-630. doi: 10.1080/10790268.2020.1853332. Epub 2021 Jan 14.

Authors

Ramzi A Alajam^{1

2}, Abdulfattah S Alqahtani^{1

3}, Sanghee Moon¹, Caio V M Sarmento^{1

4}, Jason Frederick⁵, Irina V Smirnova¹, Wen Liu¹

Affiliations

¹ Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas, United States.
² Department of Physical Therapy, Jazan University, Jazan, Saudi Arabia.
³ Department of Health Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia.
⁴ Department of Physical Therapy, California State University, Fresno, California, United States.
⁵ Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City, Kansas, United States.

Abstract

Objective: To investigate the effects of an 8-week walking training program on glycemic control, lipid profile, and inflammatory markers in individuals with chronic spinal cord injury (SCI).

Design: A pilot, single-group, pretest-posttest study.

Setting: A neuromuscular research laboratory.

Participants: Eleven participants with chronic SCI.

Intervention: An 8-week walking training program using a treadmill, a body weight-supported system, and an assistive gait training device.

Outcome measures: Levels of glycated hemoglobin (HbA_1c), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), C-reactive protein (CRP), and interleukin-6 were assessed before and after the walking training.

Results: Following the walking training, there was a statistically significant decrease in HbA_1c level (P<0.01) of uncertain clinical significance. The lipid profile improved after training, as shown by a statistically and clinically significant increase in HDL-C level (P<0.01) and a statistically significant decrease in LDL-C level (P<0.1) of no clinical significance. The ratio of LDL-C to HDL-C was significantly reduced (P<0.01). In regard to inflammatory markers, concentrations of IL-6 showed a significant reduction after training (P=0.05) of unknown clinical significance, while those of CRP trended to decrease (P=0.13).

Conclusion: The findings of this pilot study suggest that an 8-week walking training program may produce favorable changes in risk markers of cardiovascular disease in individuals with chronic SCI as shown by clinically meaningful improvements in HDL-C, and small changes in the right direction, but uncertain clinical significance, in HbA1c, LDL-C and IL-6. A randomized controlled trial is needed to compare the effects of walking training on these outcome measures with those of other exercise modalities suitable for this population, and to see if more prolonged exercise exposure leads to favorable parameters of significant size to justify the exercise modality.

Keywords: Glycemic control; Inflammatory markers; Lipid profile; Spinal cord injury; Walking training.

MeSH terms

Cardiovascular Diseases* / etiology
Cardiovascular Diseases* / prevention & control
Cholesterol, LDL
Exercise Therapy
Humans
Interleukin-6
Pilot Projects
Spinal Cord Injuries* / complications
Walking

Substances

Cholesterol, LDL
Interleukin-6