Department of Physical Medicine & Rehabilitation, Harvard Medical School, Cambridge, MA.
Department of Physical Medicine & Rehabilitation, Harvard Medical School, Cambridge, MA.
Arch Phys Med Rehabil. 2023 Jun;104(6):909-917. doi: 10.1016/j.apmr.2022.12.001. Epub 2022 Dec 23.
To investigate the effects of 2 modes of exercise training, upper-body alone, and the addition of electrical stimulation of the lower body, to attenuate cardiac atrophy and loss of function in individuals with acute spinal cord injury (SCI).
Randomized controlled trial.
Rehabilitation Hospital.
Volunteers (N=27; 5 women, 22 men) who were <24 months post SCI.
Volunteers completed either 6 months of no structured exercise (Control), arm rowing (AO), or a combination of arm rowing with electrical stimulation of lower body paralyzed muscle (functional electrical stimulation [FES] rowing).
Transthoracic echocardiography was performed on each subject prior to and 6 months after the intervention. The relations between time since injury and exercise type to cardiac structure and function were assessed via 2-way repeated-measures analysis of variance and with multilevel linear regression.
Time since injury was significantly associated with a continuous decline in cardiac structure and systolic function, specifically, a reduction in left ventricular mass (0.197 g/month; P=.049), internal diameter during systole (0.255 mm/month; P<.001), and diastole (0.217 mm/month; P=.019), as well as cardiac output (0.048 L/month, P=.019), and left ventricular percent shortening (0.256 %/month; P=.027). These associations were not differentially affected by exercise (Control vs AO vs FES, P>.05).
These results indicate that within the subacute phase of recovery from SCI there is a linear loss of left ventricular cardiac structure and systolic function that is not attenuated by current rehabilitative aerobic exercise practices. Reductions in cardiac structure and function may increase the risk of cardiovascular disease in individuals with SCI and warrants further interventions to prevent cardiac decline.
研究 2 种运动训练模式（仅上半身和下半身电刺激）对上半身急性脊髓损伤（SCI）患者心脏萎缩和功能丧失的影响。
随机对照试验。
康复医院。
<24 个月 SCI 后志愿者（N=27；5 名女性，22 名男性）。
志愿者完成 6 个月无结构化运动（对照组）、手臂划船（AO）或手臂划船与下半身瘫痪肌肉电刺激（功能性电刺激[FES]划船）相结合。
每位受试者在干预前和 6 个月后进行经胸超声心动图检查。通过 2 因素重复测量方差分析和多水平线性回归评估损伤时间与运动类型对心脏结构和功能的关系。
损伤时间与心脏结构和收缩功能的连续下降显著相关，具体表现为左心室质量（0.197 g/月；P=.049）、收缩期内径（0.255 mm/月；P<.001）和舒张期内径（0.217 mm/月；P=.019）以及心输出量（0.048 L/月，P=.019）和左心室缩短率（0.256%/月；P=.027）的降低。这些关联不受运动的影响（对照组与 AO 组与 FES 组，P>.05）。
这些结果表明，在 SCI 恢复期的亚急性期内，左心室心脏结构和收缩功能呈线性下降，目前的康复有氧运动实践并不能减轻这种下降。心脏结构和功能的降低可能会增加 SCI 患者患心血管疾病的风险，需要进一步干预以防止心脏衰退。
