Resistance Training and Testosterone After Spinal Cord Injury
| Status: | Completed |
|---|---|
| Conditions: | Hospital, Orthopedic |
| Therapuetic Areas: | Orthopedics / Podiatry, Other |
| Healthy: | No |
| Age Range: | 18 - 50 |
| Updated: | 5/5/2018 |
| Start Date: | July 2, 2012 |
| End Date: | December 30, 2017 |
Effects of Evoked Resistance Training and Testosterone After Spinal Cord Injury
The goal of this proposal is to investigate the efficacy of a complimentary approach of
evoked resistance training and testosterone replacement therapy on the changes in body
composition and metabolic profile after SCI. The proposed method could become a recommended
and simple intervention especially for individuals with limited access and poor tolerance to
exercise. The rationale is based on the evidence that individuals with SCI experience decline
in anabolic hormones which may be responsible for the deterioration in body composition and
metabolic profiles and leads to increase obesity, type 2 diabetes mellitus, dyslipidemia and
subsequently cardiovascular disease. The designed study will provide explanation to the
adaptations in the energy source of the muscle cells in response to training.
evoked resistance training and testosterone replacement therapy on the changes in body
composition and metabolic profile after SCI. The proposed method could become a recommended
and simple intervention especially for individuals with limited access and poor tolerance to
exercise. The rationale is based on the evidence that individuals with SCI experience decline
in anabolic hormones which may be responsible for the deterioration in body composition and
metabolic profiles and leads to increase obesity, type 2 diabetes mellitus, dyslipidemia and
subsequently cardiovascular disease. The designed study will provide explanation to the
adaptations in the energy source of the muscle cells in response to training.
Individuals with spinal cord injury (SCI) are at a lifelong risk of increasing obesity and
several chronic metabolic disorders such as glucose intolerance, insulin resistance and
dyslipidemia secondary to deterioration in body composition. Within few weeks of injury,
there are significant decrease in whole body fat-free mass (FFM), particularly lower
extremity skeletal muscle mass and subsequent increase in fat mass (FM). Resistance training
(RT) is an important type of exercise that has been shown to induce positive physiological
adaptations such as increasing lean mass and reducing metabolic disorders in other clinical
populations.
In a pilot work, the investigators provided evidence that evoked RT using surface
neuromuscular electrical stimulation (NMES) for knee extensor muscle group resulted in
significant increase skeletal muscle cross-sectional area (CSA), reduction in % leg FM and a
trend towards decrease in visceral adipose tissue (VAT) CSA. The favorable adaptations in
body composition were associated with decrease in plasma insulin area under the curve and
plasma triglycerides. The investigators attributed the adaptations in body composition and
metabolic profile to an associated increase in plasma insulin-like growth factor (IGF-1). The
investigators concluded that twelve weeks of evoked RT targeted towards evoking skeletal
muscle hypertrophy could result in significant body composition and metabolic adaptations in
individuals with SCI.
It is unclear if a longer RT program greater than 12 weeks would provide additional benefits
to Veterans with SCI. It is also unknown whether enhancing the decline anabolic homeostasis
by providing testosterone (T) replacement therapy (TRT) would reverse body composition and
metabolic profile changes in Veterans with SCI. The major research goal of this proposal is
to investigate the effects of 16 weeks of evoked RT+TRT vs. TRT on body composition (muscle
CSA, VAT, %FM) and the metabolic profiles (glucose and lipid metabolism) in individuals with
motor complete SCI. To address this goal, surface NMES accompanied with ankle weights will be
conducted twice weekly to exercise the knee extensor skeletal muscle groups from sitting
position. After 4 weeks of delayed entry approach, participants (n =24) will be randomly
assigned into RT+TRT (n =12) or TRT (n =12) groups. The TRT will be provided via transdermal
T patches that will be alternated on both shoulders over the course of the study. The
investigators also propose to study the effects of detraining on body composition and
metabolic profiles.
The research plan includes three specific aims
Specific aim 1 will demonstrate the effects of NMES RT and/or Testosterone patches (Tp) on
the CSA of thighs and legs skeletal muscle groups, percentage FFM, and the CSA of VAT,
intramuscular fat and percentage FM after 16 weeks of training+Tp and 16 weeks of detraining.
Specific aim 2 will determine the changes in metabolic milieu (resting energy expenditure,
glucose homeostasis, lipid profile, free fatty acids, serum total and free testosterone and
IGF-1), and cytokines (c-reactive protein, tumor necrosis factor alpha and IL-6 as
inflammatory biomarkers) after 16 weeks of training+Tp and detraining.
Specific aim 3 will determine if 16 weeks of evoked RT and Tp will increase GLUT-4
concentration, muscle IGF-1 and peroxisome-proliferator-activated receptor-gamma co-activator
1 (PGC-1) expressions, altered fiber type distribution and enhance the mitochondrial
enzymatic activities (electron transport chain) compared to Tp only.
several chronic metabolic disorders such as glucose intolerance, insulin resistance and
dyslipidemia secondary to deterioration in body composition. Within few weeks of injury,
there are significant decrease in whole body fat-free mass (FFM), particularly lower
extremity skeletal muscle mass and subsequent increase in fat mass (FM). Resistance training
(RT) is an important type of exercise that has been shown to induce positive physiological
adaptations such as increasing lean mass and reducing metabolic disorders in other clinical
populations.
In a pilot work, the investigators provided evidence that evoked RT using surface
neuromuscular electrical stimulation (NMES) for knee extensor muscle group resulted in
significant increase skeletal muscle cross-sectional area (CSA), reduction in % leg FM and a
trend towards decrease in visceral adipose tissue (VAT) CSA. The favorable adaptations in
body composition were associated with decrease in plasma insulin area under the curve and
plasma triglycerides. The investigators attributed the adaptations in body composition and
metabolic profile to an associated increase in plasma insulin-like growth factor (IGF-1). The
investigators concluded that twelve weeks of evoked RT targeted towards evoking skeletal
muscle hypertrophy could result in significant body composition and metabolic adaptations in
individuals with SCI.
It is unclear if a longer RT program greater than 12 weeks would provide additional benefits
to Veterans with SCI. It is also unknown whether enhancing the decline anabolic homeostasis
by providing testosterone (T) replacement therapy (TRT) would reverse body composition and
metabolic profile changes in Veterans with SCI. The major research goal of this proposal is
to investigate the effects of 16 weeks of evoked RT+TRT vs. TRT on body composition (muscle
CSA, VAT, %FM) and the metabolic profiles (glucose and lipid metabolism) in individuals with
motor complete SCI. To address this goal, surface NMES accompanied with ankle weights will be
conducted twice weekly to exercise the knee extensor skeletal muscle groups from sitting
position. After 4 weeks of delayed entry approach, participants (n =24) will be randomly
assigned into RT+TRT (n =12) or TRT (n =12) groups. The TRT will be provided via transdermal
T patches that will be alternated on both shoulders over the course of the study. The
investigators also propose to study the effects of detraining on body composition and
metabolic profiles.
The research plan includes three specific aims
Specific aim 1 will demonstrate the effects of NMES RT and/or Testosterone patches (Tp) on
the CSA of thighs and legs skeletal muscle groups, percentage FFM, and the CSA of VAT,
intramuscular fat and percentage FM after 16 weeks of training+Tp and 16 weeks of detraining.
Specific aim 2 will determine the changes in metabolic milieu (resting energy expenditure,
glucose homeostasis, lipid profile, free fatty acids, serum total and free testosterone and
IGF-1), and cytokines (c-reactive protein, tumor necrosis factor alpha and IL-6 as
inflammatory biomarkers) after 16 weeks of training+Tp and detraining.
Specific aim 3 will determine if 16 weeks of evoked RT and Tp will increase GLUT-4
concentration, muscle IGF-1 and peroxisome-proliferator-activated receptor-gamma co-activator
1 (PGC-1) expressions, altered fiber type distribution and enhance the mitochondrial
enzymatic activities (electron transport chain) compared to Tp only.
Inclusion Criteria:
- Male with Spinal Cord Injury
- Between 18-50 years old
- BMI < 30 Kg/m2
- Traumatic motor complete C5-L2 level of injury
- American Spinal Injury Classification (A and B; i.e. motor deficit below the level of
injury)
Exclusion Criteria:
- Cardiovascular disease
- Uncontrolled type II DM and those on insulin
- Pressures sores stage 2 or greater
- Supra-physiological T level
- Hematocrit above 50%
- Urinary tract infection or symptoms
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