Metabolic and endocrine changes in persons aging with spinal cord injury

Persons with spinal cord injury (SCI) have secondary medical disabilities t hat impair their ability to function. With paralysis, dramatic deleterious changes in body composition occur acutely with further adverse changes ensu ing with increasing duration of injury. Lean mass, composed of skeletal mus cle and bone, is lost and adiposity is relatively increased. The body compo sition changes may be further exacerbated by associated reductions in anabo lic hormones, testosterone, and growth hormone. Individuals with SCI also h ave decreased levels of activity, These body composition and activity chang es are associated with insulin resistance, disorders in carbohydrate and li pid metabolism, and may be associated with premature cardiovascular disease . Although limited information is available, upper body exercise and cycle ergometry of the lower extremities by functional electrical stimulation (FE S) have been reported to have a salutary effect on these body composition a nd metabolic sequelae of paralysis. Perhaps other innovative, externally me diated forms of active exercise of the paralyzed extremities will result in an increased functional capacity, metabolic improvement, and reduction of atherosclerotic vascular disease.