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Background: The Canadian Physical Activity Guidelines for Adults with Multiple Sclerosis (PAGs) were released in 2013 but have yet to be validated. We aimed to test the effectiveness of the PAGs in improving fitness, mobility, fatigue symptoms, and quality of life (QOL) in a large cohort of adults with multiple sclerosis (MS). Methods: As part of an ongoing randomized controlled trial examining implementation of the PAGs, participants were randomized to either a direct referral group (physician referral to an exercise program following the PAGs; n = 42) or a control group (provided a print copy of the PAGs; n = 37). Physical activity behavior was assessed through weekly physical activity logs. Fitness, mobility, fatigue symptoms, and QOL were assessed at baseline and after 16 weeks. Participants were categorized as either PAG adherers (n = 30) or nonadherers (n = 49) to the PAGs based on achieving the weekly exercise recommendations at least 75% of the time. Results: Adherence to the PAGs was twice as high in the referral group compared with the control group. Adherers experienced significantly greater improvements in peak oxygen consumption (29%), strength (7%-18%), mobility (16%), fatigue symptoms (--36%), and QOL (17%-22%) compared with nonadherers (P < .05). Conclusions: Following the PAGs for at least 12 of 16 weeks results in improvements in fitness, mobility, fatigue symptoms, and QOL, confirming their effectiveness for improving health in people with MS. [ABSTRACT FROM AUTHOR]

The ZeroG provides dynamic body weight support (BWS) using a harness while individuals with mobility impairments (e.g., spinal cord injury) ambulate overground. Muscle activity during locomotion using this device was studied in13 nondisabled adults (age 23.8 +/- 2.7 yr). Electromyography (EMG) recordings were collected from tibialis anterior (TA), medial gastrocnemius (MG), rectus femoris (RF), and biceps femoris muscles during randomized walking trials at preferred speeds under five levels of BWS (0%, 20%, 40%, 60%, 80%). Filtered EMG signals from each trial were normalized to 0% BWS and correlated with gait phases. Muscle activity, averaged across muscles, decreased significantly at heel strike by 33.4% with increasing BWS. Offloading significantly decreased heel strike activity of RF (62.8%), MG (35.5%), and TA (25.9%). Gait cycle completion time increased with BWS primarily because of increased swing phase time. These results summarizing the effect of BWS on muscle activation during ambulation can now be compared with clinical populations using the ZeroG. [ABSTRACT FROM AUTHOR]

Study design:The study design used is cross-sectional.Objectives:The aim of this study is to examine muscle contractile and excitability characteristics during fatigue of the tibialis anterior in six individuals with chronic spinal cord injury (SCI) and matched able-bodied (AB) controls.Setting:McMaster University, Hamilton, ON, Canada.Methods:Muscle compound action potential (M-wave) characteristics, muscle twitch properties, and summated force were examined during a 2 min fatigue protocol of intermittent bursts at 30 Hz (4 s tetanus, 2 s rest) or maximal voluntary contraction (MVC). Evoked twitch responses were followed during a recovery period.Results:M-wave amplitude was smaller in SCI (2.5±1.6 mV in SCI, 5.7±3.2 mV in AB) at baseline, but there was no change in M-wave amplitude or area during fatigue in either group. There was an increase in M-wave duration toward the end of recovery in the SCI group. Peak torque (PT) was not different between groups at baseline (3.8±1.8 Nm in SCI, 3.7±0.6 Nm in AB); PT potentiated significantly during fatigue in the AB, but not SCI group. There was significantly greater fatigue of both PT (43% decline) and summated force (57% decline) in the SCI group compared with the AB group (13% increase and 22% decline for PT and MVC, respectively).Conclusion:The dorsiflexor muscles in people with SCI are significantly more fatiguable than those in AB controls, but decreases in muscle excitability do not seem to be an important contributor to the increased fatiguability. The mechanisms behind the increased fatigue must lie distal to the muscle membrane. [ABSTRACT FROM AUTHOR]

Study design:Cross-sectional, observational study.Objectives:To quantify, in adults with chronic spinal cord injury (SCI): (1) presence of metabolic syndrome versus the general North American population (GP) and (2) 10-year coronary heart disease (CHD) risk using Framingham risk scoring (FRS).Setting:Ontario, Canada.Methods:Fasting anthropometric and biochemical data were collected from 75 adults with chronic SCI. Metabolic syndrome was determined using four internationally recognized definitions and FRS using the most recent (2001) algorithm.Results:Prevalence of metabolic syndrome was up to 5.4 times lower in SCI participants compared to GP, and FRS categorized 3.1% of participants as being at high 10-year CHD risk. However, high-sensitivity C-reactive protein (CRP) values indicated 36.7% of participants as being at high CHD risk.Conclusion:Current metabolic syndrome definitions and FRS may underestimate true CHD risk in people with SCI. Tools that better identify CHD risk require validation in the SCI population. CRP may be a potential factor to consider in the development of SCI-specific screening tools.Spinal Cord (2008) 46, 608–615; doi:10.1038/sc.2008.21; published online 11 March 2008 [ABSTRACT FROM AUTHOR]

Study design:Cross-sectional.Objectives:In community-dwelling adults with chronic spinal cord injury (SCI), to (1) quantify C-reactive protein (CRP), a marker of inflammation and cardiovascular disease (CVD) risk; (2) determine factors associated with CRP.Setting:Hamilton, Ontario, Canada.Methods:We examined CVD risk factors in 69 participants. Measurements included length, weight, waist circumference, blood pressure, percent fat mass (bioelectrical impedance analysis) and fasting blood parameters (high-sensitivity CRP, lipids, insulin, glucose, insulin resistance by homeostasis model assessment (HOMA)).Results:Mean CRP of the group was 3.37±2.86 mg−l−1, consistent with the American Heart Association (AHA) definition of high risk of CVD. CRP was 74% higher in persons with tetraplegia (4.31±2.97) than those with paraplegia (2.47±2.47 mg l−1, P=0.002), consistent with high CVD risk. Participants with high CRP (3.1–9.9 mg l−1) had greater waist circumference, BMI, percent fat mass and HOMA values than those with lower CRP (3.0 mg l−1, all P<0.05). LogCRP was independently correlated with waist circumference (r=0.612), logTriglycerides (r=0.342), logInsulin (r=0.309) and logHOMA (r=0.316, all P<0.05). Only level of lesion and waist circumference remained significantly associated with logCRP when variables with significant bivariate correlations were included in multiple regression analysis.Conclusion:Mean CRP values in this sample of adults with chronic SCI were consistent with the AHA classification of high CVD risk, especially those of persons with tetraplegia. Level of lesion and waist circumference are independently associated with CRP in this population.Spinal Cord (2008) 46, 616–621; doi:10.1038/sc.2008.32; published online 15 April 2008 [ABSTRACT FROM AUTHOR]

Study Design: Prospective, observational cohort study., Objectives: This paper describes the rationale and methodology for the Study of Health and Activity in People with Spinal Cord Injury (SHAPE SCI). The study aims to (1) describe physical activity levels of people with different injury levels and completeness, (2) examine the relationship between physical activity, risk and/or presence of secondary health complications and risk of chronic disease, and (3) identify determinants of physical activity in the SCI population., Setting: Ontario, Canada., Methods: Seven hundred and twenty men and women who have incurred a traumatic SCI complete self-report measures of physical activity, physical activity determinants, secondary health problems and subjective well-being during a telephone interview. A representative subsample (n=81) participate in chronic disease risk factor testing for obesity, insulin resistance and coronary heart disease. Measures are taken at baseline, 6 and 18 months., Conclusion: SHAPE SCI will provide much-needed epidemiological information on physical activity patterns, determinants and health in people with SCI. This information will provide a foundation for the establishment of evidence-based physical activity guidelines and interventions tailored to the SCI community.