Abstract
Objectives
To assess; (1) differences in red blood cell distribution width between individuals
with chronic (>1 year), motor-complete cervical (n = 21), upper-thoracic (n = 27) and thoracolumbar (n = 15) spinal cord injury and, (2) associations between red blood cell distribution width
and cardiorespiratory fitness.
Design
Prospective multi-center, cross-sectional study.
Methods
Peak oxygen uptake was determined using an upper-body arm-crank exercise test to volitional
exhaustion and red blood cell distribution width was measured using an automated hematology
system.
Results
There were significant (p < 0.009) differences between groups classified by level of injury in absolute and relative
peak oxygen uptake, peak power output and red blood cell distribution width. A significant
(p < 0.001) large negative association (r = −0.524) was found between relative peak oxygen uptake and red blood cell distribution
width. Unbiased recursive partitioning, while revealing study site specific differences
in red blood cell distribution width, identified homogenous subgroups based specifically
on cardiorespiratory fitness irrespective of additional demographic and injury characteristics.
Conclusion
The strong negative association between cardiorespiratory fitness and red blood cell
distribution width in individuals with paraplegia parallel those previously observed
in non-disabled individuals. Higher red blood cell distribution width values are an
independent risk factor for increased cardiovascular mortality, heart failure, and
coronary heart disease and may reflect several underlying exacerbated metabolic responses
such as oxidative stress and systemic inflammation. These data emphasize the importance
of maintaining a high aerobic capacity following spinal cord injury.
Keywords
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References
- Physical fitness and all-cause mortality. A prospective study of healthy men and women.JAMA. 1989; 262: 2395-2401
- Association of cardiorespiratory fitness with long-term mortality among adults undergoing exercise treadmill testing.JAMA Netw Open. 2018; 1e183605
- Cardiovascular disease in spinal cord injury: an overview of prevalence, risk, evaluation, and management.Am J Phys Med Rehabil. 2007; 86: 142-152
- Guideline approaches for cardioendocrine disease surveillance and treatment following spinal cord injury.Curr Phys Med Rehabil Rep. 2018; 6: 264-276
- Reference fitness values in the untrained spinal cord injury population.Arch Phys Med Rehabil. 2014; 95: 2272-2278
- The relationship between neurological level of injury and symptomatic cardiovascular disease risk in the aging spinal injured.Spinal Cord. 2001; 39: 310-317
- Disorders of carbohydrate and lipid metabolism in veterans with paraplegia or quadriplegia: a model of premature aging.Metab: Clin Exp. 1994; 43: 749-756
- Immune dysfunction and chronic inflammation following spinal cord injury.Spinal Cord. 2015; 53: 14-18
- Known and plausible modulators of depressed immune functions following spinal cord injuries.J Spinal Cord Med. 2000; 23: 111-120
- Autonomic nervous system and immune system interactions.Compr Physiol. 2014; 4: 1177-1200
- The evolving erythrocyte: red blood cells as modulators of innate immunity.J Immunol. 2018; 201: 1343-1351
- Red cell distribution width and risk of cardiovascular mortality: insights from National Health and Nutrition Examination Survey (NHANES)-III.Int J Cardiol. 2017; 232: 105-110
- The role of red blood cell distribution width in cardiovascular and thrombotic disorders.Clin Chem Lab Med. 2011; 50: 635-641
- Red blood cell distribution width: a novel predictive indicator for cardiovascular and cerebrovascular diseases.Dis Markers. 2017; 2017: 7089493
- Red cell distribution width, inflammatory markers and cardiorespiratory fitness: results from the National Health and Nutrition Examination Survey.Indian Heart J. 2012; 64: 380-387
- Associations between accelerometer-assessed sedentary behavior, physical activity and objectively-measured cardiorespiratory fitness with red blood cell distribution width.Int J Cardiol. 2016; 221: 755-758
- Mean platelet volume (MPV) predicts middle distance running performance.PLoS One. 2014; 9: e112892
- Identifying homogeneous subgroups in neurological disorders: unbiased recursive partitioning in cervical complete spinal cord injury.Neurorehabil Neural Repair. 2014; 28: 507-515
- Package’ party’: a laboratory for recursive partytioning.2013
- Red blood cell distribution width: a simple parameter with multiple clinical applications.Crit Rev Clin Lab Sci. 2015; 52: 86-105
- Red cell distribution width in relation to incidence of stroke and carotid atherosclerosis: a population-based cohort study.PLoS One. 2015; 10: e0124957
- Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients.Arch Pathol Lab Med. 2009; 133: 628-632
- Anemia of chronic disease.N Engl J Med. 2005; 352: 1011-1023
- C-reactive protein in adults with chronic spinal cord injury: increased chronic inflammation in tetraplegia vs paraplegia.Spinal Cord. 2008; 46: 616-621
- Different risk factor patterns for metabolic syndrome in men with spinal cord injury compared with able-bodied men despite similar prevalence rates.Arch Phys Med Rehabil. 2007; 88: 1198-1204
- Impact of exercise on cardiometabolic component risks in spinal cord-injured humans.Med Sci Sports Exerc. 2017; 49: 2469-2477
- Red cell distribution width is associated with physical inactivity and heart failure, independent of established risk factors, inflammation or iron metabolism; the EPIC-Norfolk study.Int J Cardiol. 2013; 168: 3550-3555
- Lower extremity functional electrical stimulation cycling promotes physical and functional recovery in chronic spinal cord injury.J Spinal Cord Med. 2013; 36: 623-631
- Comparison of 1-versus 3-minute stage duration during arm ergometry in individuals with spinal cord injury.Arch Phys Med Rehabil. 2016; 97: 1895-1900
- Role of the nervous system in sarcopenia and muscle atrophy with aging: strength training as a countermeasure.Scand J Med Sci Sports. 2010; 20: 49-64
- Cyclic variations in white cell subpopulations in the human menstrual cycle: correlations with progesterone and estradiol.Clin Immunol Immunopathol. 1979; 13: 246-253
- Leukocyte changes across menstruation, ovulation, and mid-luteal phase and association with sex hormone variation.Am J Hum Biol. 2016; 28: 721-728
- Spinal cord injury and type 2 diabetes: results from a population health survey.Neurology. 2013; 81: 1864-1868
- Prevalence of metabolic syndrome in veterans with spinal cord injury.J Spinal Cord Med. 2019; 42: 86-93
- Higher red blood cell distribution width is associated with the metabolic syndrome: results of the Ibermutuamur cardiovascular risk assessment study.Diabetes Care. 2010; 33: e40
- Reduced antioxidant defense and increased oxidative stress in spinal cord injured patients.Arch Phys Med Rehabil. 2012; 93 (2223–8.e2)
- Clinical correlates of elevated serum concentrations of cytokines and autoantibodies in patients with spinal cord injury.Arch Phys Med Rehabil. 2007; 88: 1384-1393
Article info
Publication history
Published online: August 21, 2019
Accepted:
August 16,
2019
Received in revised form:
August 13,
2019
Received:
April 18,
2019
Identification
Copyright
Crown Copyright © 2019 Published by Elsevier Ltd on behalf of Sports Medicine Australia. All rights reserved.
