Robotic Walking to Mitigate Bone Mineral Density Decline and Adverse Body Composition in Individuals With Incomplete Spinal Cord Injury A Pilot Randomized Clinical Trial

Objective The aim of the study was to determine whether 24 wks of robotic locomotor training or activity-based training was sufficient time to induce bone mineral density and body composition changes in individuals with spinal cord injury. This study reports the secondary analysis of a randomized pilot trial. Design Participants with chronic motor incomplete tetraplegia (N = 16) were recruited. Interventions involved 60-min sessions, 3x per week, over 24 wks. Robotic locomotor training involved walking in the Ekso GT suit. Activity-based training involved a combination of resistance, cardiovascular, and weight-bearing exercise. Results Hip bone mineral density was maintained during robotic locomotor training; however, it was significantly reduced (P = 0.04, effect size = 0.86) during activity-based training by 0.03 (-0.29 to 0.23) g/cm(2) after intervention. Both interventions improved arm fat-free soft tissue mass, but neither group experienced changes in leg fat-free soft tissue mass. The activity-based training group had a significant decrease in visceral adipose tissue (P = 0.04, effect size = 0.72) and gynoid fat mass (P = 0.01, effect size = 0.62). Conclusions Twenty-four weeks of robotic locomotor training is possibly a sufficient duration to prevent the progressive decline of bone mineral density usually occurring in this population. A longitudinal period of activity-based training serves as an effective rehabilitation strategy to reduce indices of fat mass in individuals with spinal cord injury.

Automated summary

The study found that 24 weeks of robotic locomotor training can maintain hip bone mineral density, while activity-based training significantly reduces it. Both interventions improved arm fat-free soft tissue mass, but had no effect on leg fat-free soft tissue mass. The activity-based training group experienced a significant decrease in visceral adipose tissue and gynoid fat mass.