Obesity growing for people with spinal cord injury

After living with a spinal cord injury for 10 years, Mark Pascoe knows he needs to work hard to keep his weight down.

“I continue to gain weight and have to be careful with my diet. I was very active and strong before the injury and now it's limited those abilities,” says Pascoe, 46, who broke his neck when he fell off a jet ski and hit a rock in the water.

Pascoe is not alone in his weight worries. As the nation fights a growing obesity epidemic, the problem is even more dramatic for people with spinal cord injury.

Researchers at the University of Michigan Health System are looking at how people with spinal cord injury burn calories and how that is affected by their muscle mass and body weight. The goal is to make better recommendations to people with spinal cord injury, but the research will also translate into greater understanding of obesity in the general population as well.

“Individuals with spinal cord injury have significantly less bone mass and muscle mass. As a result, their body weight is comprised of much more fat and less muscle or bone than you would see in an able-bodied individual,” says David Gater, M.D., Ph.D., director of Spinal Cord Injury Medicine at UMHS and director of the Spinal Cord Injury Research Center at the VA Ann Arbor Healthcare System.

Muscle burns calories even when the body is at rest. For someone with a spinal cord injury – who has less muscle mass – resting metabolism can be as low as half that of a person without a spinal cord injury. And that means even when people with spinal cord injury exercise, they burn significantly fewer calories.

Burning calories at a reduced rate, combined with limitations on physical activity, contribute not just to obesity, but to all the associated health problems: high cholesterol, coronary artery disease, diabetes and cancer.

“Cardiovascular disease has recently become the greatest risk for mortality for somebody with a spinal cord injury,” Gater says. “We realize that related issues – pre-diabetes, diabetes and high cholesterol levels – are contributing factors. All of those things essentially contribute to an accelerated aging process for the person with a spinal cord injury. Subsequently, their expected lifespan is going to be shorter and the quality of life may be reduced, depending upon how those secondary factors impact them.”

Gater's team is looking at glucose tolerance, body composition and cardiovascular risk factors in people with spinal cord injury. A key question is how this group burns calories during different types of activities – from rolling their wheelchair to playing basketball. In his Spinal Cord Injury Exercise Lab at the VA, Gater has a device that measures oxygen consumption, which helps determine how many calories are burned. Another piece of equipment, called the “Bod Pod,” is used to measure a person's body density and help determine how much fat and how much muscle is in the person's body.

“This research will allow us to develop a table or compendium of physical activity energy expenditures so a person with spinal cord injury can take a look at the table and figure out how many calories they're going to burn doing this activity for a certain period of time,” Gater says. “Ultimately, our research will allow us to know how to better test and how to better prescribe exercise for people so they can burn more calories out in the community.”

James Minton, a 55-year-old who was injured in 1968 by a sniper in Vietnam, hopes Gater's research will help reverse the weight gain he's noticed recently in his own body. That's why he signed on as a research volunteer.

“I've been in a wheelchair for 36 years and recently, I'd say in the past three or four years, I've noticed a muscle breakdown in my tissue,” he says. “Before, I was really strong and didn't have a weight problem, didn't have to worry about a diet or any of that. Now I do. Muscle's gone and it's replaced with body fat.”

While Gater and his patients hope this research will lead to advances in spinal cord injury care, there's also potential for it to help with the overall obesity problem.

“Because of the unique impact of spinal cord injury on not just muscle mass but also whole body physiology, our research will have tremendous implications in able-bodied research, particularly as it relates to obesity and insulin sensitivity,” Gater says.

About spinal cord injury

* About 250,000 Americans are living with a spinal cord injury – roughly two times the capacity of the U-M football stadium.
* Men account for 82 percent of spinal cord injuries.
* The leading causes of injury are motor vehicle accidents, violence, falls and sports injuries.
* About 60 percent of people with spinal cord injuries are overweight or obese.


Resources

U-M Model Spinal Cord Injury Care System:
www.med.umich.edu/pmr/model_sci/

U-M Health Advisor: Spinal Cord Injury: www.med.umich.edu/1libr/aha/aha_spineinj_crs.htm

National Institute of Neurological Disorders and Stroke: www.ninds.nih.gov/disorders/sci/sci.htm

Christopher and Dana Reeve Paralysis Resource Center:
www.paralysis.org

Christopher Reeve Paralysis Foundation:
www.crpf.org

American Academy of Physical Medicine and Rehabilitation: http://www.aapmr.org/condtreat/injuries/sciadvance.htm

Written by Nicole Fawcett
Source: http://www.med.umich.edu/opm/newspage/2004/hmsci.htm

Wow, that was fast, you must have been waiting for this oppertunity.
good job, I'll be reading in this forum alot. thanks.

I have a good friend who is a Quad @ C5,6 incomplete. It has been 6 years since accident. He is experiencing alot of weight gain. He is currently taking Lipozene with no loss(only on 1st bottle).

He is in a motorized wheelchair. What can I do to help him lose some weight?? I am trying to work with some arm weights and throwing a ball back & forth. What else can I do for him???

He is 24 years old. He also has a problem with his urine having a foul smell. I think it's because of his consumption of soda & tea throughout the day instead of Propel.

What do you think??

fire just do the math: calories consumed minis calories burned if more are consumed than burned the extra will be converted to fat. I think people in chairs seek out comfort foods ie junk foods that are high in calories and low in nutrition. Soda is loaded with high fruitcos corn syrup and calories, if you want to fatten up a pig you feed it corn. Avoid crap like potatoe chips all things made with white flower and corn and food in a box (hamburger helper etc) that have more than 6 or so ingredients and have ingredients that you don't know what they are. All you need is high quality protein like fish eggs bison etc , fresh fruits and vegetables, whole grains, beans and nuts, real butter,cheese yogurt and whole milk, raw honey. Real food is what we are designed to run on not Ho Ho's Big Mac's or soda.

I understand all that, but what other kind of excerises can be done. It's hard to sit there and watch him get bigger and bigger. I know I have to motivate him more, but not too far. I know that
he's got to want to excerise. Does anyone have an input at all??

If you need a few ideas on what you can do at home, check out http://www.physiotherapyexercises.com It will allow you to filter results by level of injury and body parts. We also have videos of us working out our clients on our site that may help as well.

Indeed, I have linked to that site before and yesterday and earlier today too - there is a current thread with it :HERE>>>

Here is a copy of the post its mentioned in, hopefully it will help:

Do look into Access to recreation - a site which houses info on beach chairs, swimming lifts/aids and basically lots of assistyive devices to outdoor recreation..

However, for low cost exercise ideas:

excellent link!!
The following site http://www.physiotherapyexercises.com/ enables you to click on the level of fucntion you have, your general health and which areas you wish to exercise, and then advises on it. It is called PT exercises for people with SCI. It is a very, very good reference ( has illustrations/photos to guide).

Warm up, stretching and strengthening exercises can be catered to your function. A few Tetra/quad or limited upper body exercises include (but not restricted to):

every day casual exercise..LOL
Strapping/adding weight to your chair at home in order to increase load on muscles (if you use a manual chair) - be sure not to tip back and interfere with CoG too much!

Exercise bands to assist with stretching (hand control not needed, as long as you can put your arm through the loop). Passive motion of legs whilst toning up arms etc..


"Gentle Chest Press"...pectorals-chest, the Triceps- arm backs, the deltoids-shoulders

Using two wrist weights insitu, (or cans of beans if have hand function), hold arms shoulder height, facing them away from body so that they are parallel to the floor.

Next, squeeze the elbows and hands in toward the body, keeping arms at 90˚ ( so elbow to floor, hand up holding can if applicable)

make sure movements are slow and controlled, do 10 repeatitions, adding to them as you become more comfy with them.


"Bell ringer"
To improve the Back muscles ( lats, Trapezius) and the arm ( fronts-Biceps)

Get hold of a Pilates exercise band, or a length of rubber tubing.
Have the tubing secured over the top of a door, or at the ceiling if that is possible ( like at a beam)
If in wheelchair, place brakes on.
Place arms through band so it is at area just above wrist- loop it over hand ( or Grasp hold of the end of the band and grasp whilst facing forwards if have hand function to do so). So that there is tension,
Bring hands to point wider than shoulder width
lean back to allow band/tubing to be inline with chest.
In a slow and controlled movement, pull tube/band down toward sternum using arms ( or hands if able) so that elbows go out slightly behind you ( as if pulling a church bell, but more exaggerated)
Allow arms to go up to the ir original position.
Contract abdominal muscles as much as possible and keep as 'straight' as possible whilst doing all of this.

Using wrist weights again, (or Holding a large can of beans or similar if able) with both hands together above your head, and bringing it down your body, arms outstretched and muscles clentched can also be done. It is esp useful when starting out with these exercises.

"ABDO Crunch" (rectus abdominous- Stomach front)

Use the Pilates band/rubber inner tubing again
Have 2 secured above the door again/or ceiling beam/similar, one each side of head
so that they dangle one just above each shoulder
Loop arm thru the band ( or grab loop if have hand function to do so)
Tense abdominals as far as possible, and crunch body as if to knees, against the band ( as that will be wanting to pull you up!)
Whilst keeping tension, and using the band sit back up, stopping just before you reach 'neutral'.

Above exercise can also be done by holding a can of beans above head each side at shoulder level and then doing the rest as above.

I hope these give you some ideas. Once you are stronger, and with practice, things will become easier.

Of course ability to 'clench' muscles etc is dependent on level of function. IT is also dependent upon strength. Tetra/quad's with a complete injury are able to increase muscle mass and bulk by doing the above "passive type" exercises which have the benefit of actively exercising the (function) areas you do have.
Not everyone will be able to do all, but even if one type of exercise is mastered, it can be tailored and changed slightly to vary the routines and increase strength.

standing as exercise
Another thing to consider is a standing frame ( or similar). Care should be taken and if you have not used a standing frame before, or it has been a while since you did, it is best to seek an evaluation and ion some cases reinstate/start 'standing' in a frame under the instruction of a dr. This is due to the possible drop in Blood pressure (orthostatic hypotension OH**)
Standing is great for increasing and preserving bone density, circulation, spasms, tissue integrity, constipation, warding off contractures..etc etc..and gives a great cardio boost like a workout really..

Ok, I have waffled on far too long, I do hope this is off some use..Mainly it is low cost suggestions ( aside from the standing frame!). DO please check out the 2 link wayy at the top as it has diagrams and photos and you can select your exact areas to target and your function, etc...
Oh and if anything I have written is unclear, do let me know and I will try and explain.. The above may not be great if like me you dislocate a lot, though, so please don't injure yourself b/c of anything I said!


** OH -defined as when the systolic BP has a decrease of 20mmHg or more, or a reduction in diastolic blood pressure of 10mmHg or more, when the person's body position is changed from a supine (laying) position to an upright posture. In actuality, it is irrelevant if the person has any symptoms.


Take care,

K