Acute energy cost of multi-modal activity-based therapy in persons with spinal cord injury

Objective: To examine acute energy costs of multi-modal activity-based therapy (ABT) in men and women with spinal cord injury (SCI). Study design: Descriptive case series. Setting: An outpatient center in California. Participants: Seven men and women (age = 28.3 +/- 11.6 years; duration of injury = 4.3 +/- 2.5 years) with injury levels ranging from C5 to T8. Intervention: Activity-based therapy. Outcome measures: Oxygen uptake (VO2), energy expenditure (kcal/minute), SCI Metabolic Equivalent of Task (MET) (1 MET = 2.7 ml/kg/minute). Results: Oxygen uptake (VO2) during ABT ranged from 5.10 to 8.62 ml/kg/minute, with VO2 consistently higher during modalities involving load bearing versus non-load bearing (P = 0.08). SCI MET values ranged from 1.89 to 3.24 and were significantly higher in subjects with mid-thoracic injury versus low-cervical injury (P = 0.01). Conclusion: Data reveal that multi-modal ABT increases VO2 in persons with SCI, but energy expenditure is relatively low. Strategies must be identified to optimize energy expenditure in the SCI to reduce health risks. Modalities involving load bearing seem to be superior to non-load-bearing activities. VO2 was greater in response to load-bearing modalities than non-load-bearing modalities. It remains to be determined whether chronic ABT enhances cardiovascular fitness and reduces disease risks in this population.