Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, UHealth/Jackson Memorial, Miami, Florida.
Department of Physical Medicine & Rehabilitation, University of Miami Leonard M. Miller School of Medicine, Miami, Florida.
Top Spinal Cord Inj Rehabil. 2021;27(1):109-120. doi: 10.46292/sci20-00058.
Spinal cord injury (SCI) results in an array of cardiometabolic complications, with obesity being the most common component risk of cardiometabolic disease (CMD) in this population. Recent Consortium for Spinal Cord Medicine Clinical Practice Guidelines for CMD in SCI recommend physical exercise as a primary treatment strategy for the management of CMD in SCI. However, the high prevalence of obesity in SCI and the pleiotropic nature of this body habitus warrant strategies for tailoring exercise to specifically target obesity. In general, exercise for obesity management should aim primarily to induce a negative energy balance and secondarily to increase the use of fat as a fuel source. In persons with SCI, reductions in the muscle mass that can be recruited during activity limit the capacity for exercise to induce a calorie deficit. Furthermore, the available musculature exhibits a decreased oxidative capacity, limiting the utilization of fat during exercise. These constraints must be considered when designing exercise interventions for obesity management in SCI. Certain forms of exercise have a greater therapeutic potential in this population partly due to impacts on metabolism during recovery from exercise and at rest. In this article, we propose that exercise for obesity in SCI should target large muscle groups and aim to induce hypertrophy to increase total energy expenditure response to training. Furthermore, although carbohydrate reliance will be high during activity, certain forms of exercise might induce meaningful postexercise shifts in the use of fat as a fuel. General activity in this population is important for many components of health, but low energy cost of daily activities and limitations in upper body volitional exercise mean that exercise interventions targeting utilization and hypertrophy of large muscle groups will likely be required for obesity management.
脊髓损伤 (SCI) 会导致一系列的心脏代谢并发症，肥胖是该人群中发生心脏代谢疾病 (CMD) 的最常见的合并症危险因素。最近的脊髓医学联盟临床实践指南建议将身体运动作为治疗 SCI 合并 CMD 的主要策略。然而，SCI 中肥胖的高患病率和这种身体形态的多效性需要制定针对肥胖的运动策略。一般来说，肥胖管理的运动主要目的应是诱导负能平衡，其次是增加脂肪作为燃料来源的利用率。在 SCI 患者中，活动期间可募集的肌肉量减少限制了运动诱导热量不足的能力。此外，可用的肌肉表现出氧化能力降低，限制了运动期间脂肪的利用。在为 SCI 肥胖患者设计运动干预措施时，必须考虑到这些限制。某些形式的运动对该人群具有更大的治疗潜力，部分原因是运动恢复和休息期间对代谢的影响。在本文中，我们提出 SCI 肥胖患者的运动应针对大肌肉群，并旨在诱导肥大以增加训练对总能量消耗的反应。此外，尽管在活动期间碳水化合物的依赖程度会很高，但某些形式的运动可能会在运动后诱导脂肪作为燃料的使用发生有意义的转变。该人群的一般活动对许多健康成分都很重要，但日常活动的能量消耗低，以及上半身自主运动的限制意味着，针对大肌肉群利用和肥大的运动干预措施可能是肥胖管理所必需的。
