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A cross-sectional comparison between cardiorespiratory fitness, level of lesion and red blood cell distribution width in adults with chronic spinal cord injury

  • Author Footnotes
    1 Denotes equal contribution.
    Tom E. Nightingale
    Footnotes
    1 Denotes equal contribution.
    Affiliations
    International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Canada

    Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Canada

    Department for Health, University of Bath, UK
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  • Author Footnotes
    1 Denotes equal contribution.
    Gurjeet S. Bhangu
    Footnotes
    1 Denotes equal contribution.
    Affiliations
    International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Canada
    Search for articles by this author
  • James L.J. Bilzon
    Affiliations
    Department for Health, University of Bath, UK
    Search for articles by this author
  • Andrei V. Krassioukov
    Correspondence
    Corresponding author.
    Affiliations
    International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Canada

    Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Canada

    GF Strong Rehabilitation Center, Vancouver Coastal Health, Canada
    Search for articles by this author
  • Author Footnotes
    1 Denotes equal contribution.
Published:August 21, 2019DOI:https://doi.org/10.1016/j.jsams.2019.08.015

      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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