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Aging and disease    2015, Vol. 6 Issue (4) : 271-281     DOI: 10.14336/AD.2014.0912
Review Article |
Does Upper Extremity Training Influence Body Composition after Spinal Cord Injury?
A. Fisher Justin1,2, A. McNelis Meredith1,2, S. Gorgey Ashraf1,3,*, R. Dolbow David4, L. Goetz Lance1,3
1 Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VAMC, Richmond, VA 23249, USA
2 Department of Health and Human Performance; Exercise Science; Virginia Commonwealth University
3 Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA 23249, USA
4 School of Human Performance and Recreation, University of Southern Mississippi, Hattiesburg, USA
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Spinal cord injury (SCI) leads to serious body composition adaptations characterized by increasing whole body fat mass and decreased soft tissue lean mass (LM). These adaptations in body composition may lead to several cardio-metabolic disorders that reduce the quality of life, increase patients’ and caregivers’ burden and eventually leads to mortality. Exercise, an appropriate dietary regimen, and an active lifestyle may alleviate several of the negative effects on body composition after a SCI. Today however, there is no established consensus on the recommended dose, frequency or type of exercise to ameliorate several of the body composition sequelae after an acute SCI. Resistance training has been previously recommended as an effective strategy to restore soft tissue LM and decrease fat mass (FM). The strategy can be simply implemented as a routine home-based training program using free weights or resistance bands after a SCI. Additionally, upper extremity (UE) circuit resistance training has been previously used to improve cardiovascular and metabolic parameters after a SCI; however compared to the vast knowledge regarding the able-bodied (AB) population, the effects of UE circuit resistance training on body composition after a SCI is not well established. In summary, the available evidence does not support the rationale that UE circuit resistance training can lead to positive adaptations in body composition after a SCI. Further studies are suggested to examine the effects of UE circuit resistance training on body composition.

Keywords spinal cord injury      body composition      cardio-metabolic factors      upper extremity      circuit resistance training      barriers to exercise      home-based training     
Corresponding Authors: S. Gorgey Ashraf   
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present address: Kunming Biomed International, Kunming, Yunnan, 650500, China

Issue Date: 01 August 2015
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A. Fisher Justin
A. McNelis Meredith
S. Gorgey Ashraf
R. Dolbow David
L. Goetz Lance
Cite this article:   
A. Fisher Justin,A. McNelis Meredith,S. Gorgey Ashraf, et al. Does Upper Extremity Training Influence Body Composition after Spinal Cord Injury?[J]. Aging and disease, 2015, 6(4): 271-281.
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ReferenceParticipantsMethodsCRT ProgramResultsConclusion
Jacobs, P. L et al. 2001[52]- 10 male subjects, age 28 - 44 years old
- SCI at T5 - L1
- Cardiorespiratory Training
- Resistance Training for 12 weeks. Completed 10 repetitions
- Military Press
- Horizontal Rows - Pec. Deck - Preacher Curls - Wide Grip -Lat. Pull down - Seated Dips
- Increase in VO2 peak by 29.7%
- 21% increase in muscular strength
- ↑Cardiorespiratory and Muscular fitness due to upper extremity circuit training
- No report of changes in body composition was found
Hicks et al. 2003[53]- 34 men and women with SCI.
- 19-65 years old - C4- L1, AIS A-D.
- 9 month study
- 2 session/ week - 9- 120 minutes - Resistance Training included weight training system - Power Training included 3, 5-7 min. sessions of arm cranking
- Up to 34% improvement in upper body muscular strength
- Up to an 81% increase in total power output
- ↑ in upper extremity muscular strength due to circuit resistance training
- No report of changes in body composition was found
Bizzarini et al.2005 [54]- 21 subjects with SCI
- 19-66 years old -C4-L2,AIS B,C.
- 5 days/week for 6 weeks.
- 90 min/day - 3 sets/ 8 repetitions - 40%-60% 1RM
- Latissimus (lat.) Dorsi
- Deltiformis - Pectoralis - Triceps Brachii - Biceps Brachii
- ↑ in workload (watts) for all participants over 6 week period- No report of changes in Body Composition
Durán et al. 2001[55]
- 12 men and 1 woman with SCI
- 15-38 years old -T3-T12, AIS A, B, C
- 3 sessions
- 40 min/day - 120 min/week - 16 weeks - 40%-80% maximal heart rate
- Bench Press
- Military press - Dumbbell (bicep) - Dumbbell (tricep) - Dumbbell (Shoulder abductor) - Butterfly Press - Curl Back Neck
- Significant % increase in weight (kg) and repetitions in resistance exercise- Upper extremity resistance training was shown to provide beneficial increases to muscular strength and endurance
Nash M, 2007[60]7 Healthy Men
- 39-58 years old - complete paraplegia -T5-T12
40-45 min sessions
- 3 times/ week - 16 weeks - 50-60% 1 RM
- Overhead Press
- Horizontal Row - Horizontal Butterfly - Bicep Curl - Lat. Pull down - Triceps Press
- 38.6% ↑
- 59.7% ↑ - 41.6% ↑ - 41.4% ↑ - 38.6% ↑ - 44.0% ↑
CRT provides favorable increases in muscular strength in individuals with SCI
- No report of changes in body composition
Jacobs P.L., 2009[61]- 18 subjects
- Complete Paraplegia - T6-T10
- 3 sessions/ week
- 12 weeks - Endurance Training: 30 minutes of arm crank at 70-85% HR(peak) - Resistance Training: 3 sets, 10 repetitions at 6 exercise station. 60-70% 1 rep max.
- Horizontal Press
- Horizontal Row - Overhead Press - Overhead Pull - Seated Dips - Arm Curls
- VO2 Peak increased by 15.1% in RT and 11.8% in
endurance training
- ↑ in upper extremity strength, aerobic capacity, muscular strength and power by participating in resistance training
- No changes were reported for body composition
Sasso & Backus, 2013[62]- 1 male with T12 SCI
- 44 years old.
- 3/days/week
-12 weeks - 6 UE exercises - 3 sets/ 10 reps - 65%-75% HRM - Arm Crank - 3 minutes - 65%-75% HRM
- Bicep Curls
- Seated Rows - Wide Grip Lat. Pull down - Seated Dips - Chest Fly - Shoulder press -Rapid, low intensity endurance exercise
- 14.3% ↑ in Lat. Pull down
- 13% ↑ in Bench press - 6.4% ↓ in HR at Anaerobic Threshold -13.4% ↑ in relative VO2 Peak
- A 12 week, at home exercise routine, was shown to improve cardiorespiratory and muscular strength in individuals with SCI
Table 1  A list of studies that have used circuit resistance training (CRT) on different health variables after SCI.
Figure 1.  Body composition changes following UE resistance training. Changes in body composition in a person with T4 complete SCI including a) total body mass, b) percentage fat mass, c) lean mass as measured by DXA following 12 weeks of circuit resistance training that was conducted once weekly. The pre/post-training results suggested no changes in regional (arms, legs, trunk, android, gynoid) or total body composition.
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