Sports Medicine

, Volume 40, Issue 8, pp 681–696 | Cite as

Energy Expenditure and Metabolism during Exercise in Persons with a Spinal Cord Injury

  • Michael PriceEmail author
Review Article


Resting energy expenditure of persons with a spinal cord injury (SCI) is generally lower than that seen in able-bodied (AB) individuals due to the reduced amounts of muscle mass and sympathetic nervous system available. However, outside of clinical studies, much less data is available regarding athletes with an SCI. In order to predict the energy expenditure of persons with SCI, the generation and validation of prediction equations in relation to specific levels of SCI and training status are required. Specific prediction equations for the SCI would enable a quick and accurate estimate of energy requirements. When compared with the equivalent AB individuals, sports energy expenditure is generally reduced in SCI with values representing 30–75% of AB values. The lowest energy expenditure values are observed for sports involving athletes with tetraplegia and where the sport is a static version of that undertaken by the AB, such as fencing. As with AB sports there is a lack of SCI data for true competition situations due to methodological constraints. However, where energy expenditure during field tests are predicted from laboratory-based protocols, wheelchair ergometry is likely to be the most appropriate exercise mode. The physiological and metabolic responses of persons with SCI are similar to those for AB athletes, but at lower absolute levels. However, the underlying mechanisms pertaining to substrate utilization appear to differ between the AB and SCI. Carbohydrate feeding has been shown to improve endurance performance in athletes with generally low levels of SCI, but no data have been reported for mid to high levels of SCI or for sport-specific tests of an intermittent nature. Further research within the areas reviewed may help to bridge the gap between what is known regarding AB athletes and athletes with SCI (and other disabilities) during exercise and also the gap between clinical practice and performance.


Spinal Cord Injury Respiratory Exchange Ratio Rest Energy Expenditure Daily Energy Expenditure Spinal Cord Injury Group 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The author would like to acknowledge the help of Dr Rob James in proofreading the manuscript. No sources of funding were used to assist in the preparation of this review. The author has no conflicts of interest that are directly relevant to the content of this review


  1. 1.
    Schmid A, Huonker M, Barturen JM, et al. Catecholamines, heart rate, and oxygen uptake during exercise in personswith spinal cord injury. J Appl Physiol 1998; 85 (2): 635–41PubMedGoogle Scholar
  2. 2.
    Schmid A, Huonker M, Stahl F, et al. Free plasma catecholamines in spinal cord injured persons with differentinjury levels at rest and during exercise. J Auton Nerv Syst 1998; 19: 68 (1-2): 96–100PubMedCrossRefGoogle Scholar
  3. 3.
    Price MJ, Campbell IG. Thermoregulatory responses of able-bodied and paraplegic athletes to prolonged upperbody exercise. Eur J Appl Physiol 1997; 76: 552–60CrossRefGoogle Scholar
  4. 4.
    Price MJ, Campbell IG. Effects of spinal cord lesion level upon thermoregulation during exercise in the heat. Med Sci Sports Exerc 2003; 35 (7): 1100–7PubMedCrossRefGoogle Scholar
  5. 5.
    Price MJ. The effects of absolute exercise intensity on core temperature responses of athletes with a spinal cord injury. In: Cisneros AB, Goins BL, editors. Body temperature regulation. New York: Nova Biomedical Books Inc., 2009: 227–41Google Scholar
  6. 6.
    Hollinshead WH, Jenkins DB. Functional anatomy of the limb and back. 5th rev. ed. Philadelphia (PA): WB Saunders, 1981Google Scholar
  7. 7.
    Hopman MT. Circulatory responses during arm exercise in individualswith paraplegia. Int J Sports Med 1994; 15 (3): 126–31PubMedCrossRefGoogle Scholar
  8. 8.
    Tortora GJ. Principles of human anatomy. 8th rev ed. San Francisco (CA): Benjamin/Cummings Scientific Publishers, 1998Google Scholar
  9. 9.
    Guyton AC, Hall JE. Textbook of medical physiology. 9th rev. ed. Philadelphia (PA): WB Saunders, 1996: 770Google Scholar
  10. 10.
    Stallknecht B, Lorentsen J, Enevoldsen LH, et al. Role of the sympathoadrenergic system in adipose tissue metabolismduring exercise in humans. J Physiol 2001; 536 (Pt1): 283–94PubMedCrossRefGoogle Scholar
  11. 11.
    Steinberg LL, Lauro FA, Sposito MM, et al. Catecholamine response to exercise in individuals with different levels ofparaplegia. Braz J Med Biol Res 2000; 33 (8): 913–8PubMedCrossRefGoogle Scholar
  12. 12.
    Frey GC, McCubbin JA, Dunn JM, et al. Plasma catecholamine and lactate relationship during graded exercise in men withspinal cord injury. Med Sci Sports Exerc 1997; 29 (4): 451–6PubMedCrossRefGoogle Scholar
  13. 13.
    McArdle WD, Katch FI, Katch VL, et al. Exercise physiology: energy, nutition and human performance. 2nd ed. Philadelphia (PA): Lea and Febiger, 1986: 642–9Google Scholar
  14. 14.
    Ainsworth BE, Haskell WL, Whitt MC, et al. Compendiumof physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 2000; 32 (9 Suppl.): S498–504PubMedGoogle Scholar
  15. 15.
    Ainsworth BE, Haskell WL, Leon AS, et al. Compendium of physical activities: classification of energy costs of humanphysical activities. Med Sci Sports Exerc 1993; 25 (1): 71–80PubMedCrossRefGoogle Scholar
  16. 16.
    Buchholz AC, Pencharz PB. Energy expenditure in chronic spinal cord injury. Curr Opin Clin Nutr Metab Care 2004; 7 (6): 635–9PubMedCrossRefGoogle Scholar
  17. 17.
    Alexander LR, Spungen AM, Liu MH, et al. Resting metabolic rate in subjects with paraplegia: the effect of pressuresores. Arch Phys Med Rehabil 1995; 76 (9): 819–22PubMedCrossRefGoogle Scholar
  18. 18.
    Monroe MB, Tataranni PA, Pratley R, et al. Lower daily energy expenditure as measured by a respiratory chamberin subjects with spinal cord injury compared with controlsubjects. Am J Clin Nutr 1998; 68 (6): 1223–7PubMedGoogle Scholar
  19. 19.
    Liusuwan RA, Widman LM, Abresch RT, et al. Body composition and resting energy expenditure in patientsaged 11 to 21 years with spinal cord dysfunction comparedto controls: comparisons and relationships among thegroups. J Spinal Cord Med 2007; 30 Suppl.1: S105–11PubMedGoogle Scholar
  20. 20.
    Liusuwan A, Widman L, Abresch RT, et al. Altered body composition affects resting energy expenditure and interpretationof body mass index in children with spinal cordinjury. J Spinal Cord Med 2004; 27 Suppl.1: S24–8PubMedGoogle Scholar
  21. 21.
    Barco KT, Smith RA, Peerless JR, et al. Energy expenditure assessment and validation after acute spinal cord injury. Nutr Clin Pract 2002; 17 (5): 309–13PubMedCrossRefGoogle Scholar
  22. 22.
    Spungen AM, Bauman WA, Wang J, et al. The relationship between total body potassium and resting energy expenditurein individuals with paraplegia. Arch Phys Med Rehabil 1993; 74 (9): 965–8PubMedGoogle Scholar
  23. 23.
    Mollinger LA, Spurr GB, el Ghatit AZ, et al. Daily energy expenditure and basalmetabolic rates of patients with spinalcord injury. Arch Phys Med Rehabil 1985; 66 (7): 420–6PubMedGoogle Scholar
  24. 24.
    Kearns PJ, Thompson JD, Werner PC, et al. Nutritional and metabolic response to acute spinal-cord injury. J Parenter Enteral Nutr 1992; 16 (1): 11–5CrossRefGoogle Scholar
  25. 25.
    Patt PL, Agena SM, Vogel LC, et al. Estimation of resting energy expenditure in children with spinal cord injuries. J Spinal Cord Med 2007; 30 Suppl.1: S83–7Google Scholar
  26. 26.
    Chermesino C, Edelstein S. Energy expenditure after spinal cord injury: a case study. SCI Nurs 2003; 20 (4): 258–60PubMedGoogle Scholar
  27. 27.
    Sedlock DA, Laventure SJ. Body composition and resting energy expenditure in long term spinal cord injury. Paraplegia 1990; 28 (7): 448–54PubMedCrossRefGoogle Scholar
  28. 28.
    Schneider DA, Sedlock DA, Gass E, et al. VO2peak and the gas-exchange anaerobic threshold during incremental armcranking in able-bodied and paraplegic men. Eur J Appl Physiol Occup Physiol 1999; 80 (4): 292–7PubMedCrossRefGoogle Scholar
  29. 29.
    Price MJ, Campbell IG. Determination of peak oxygen uptake during upper body exercise. Ergonomics 1997; 40 (4): 491–9PubMedCrossRefGoogle Scholar
  30. 30.
    Smith PM, Price MJ, Doherty M. The influence of crank rate on peak oxygen uptake during arm crank ergometry. J Sports Sci 2001; 19: 955–60PubMedCrossRefGoogle Scholar
  31. 31.
    Abel T, Kröner M, Rojas Vega S, et al. Energy expenditure in wheelchair racing and handbiking: a basis for preventionof cardiovascular diseases in those with disabilities. EurJ Cardiovasc Prev Rehabil 2003; 10 (5): 371–6CrossRefGoogle Scholar
  32. 32.
    Abel T, Platen P, RojasVega S, et al. Energy expenditure in ball games for wheelchair users. Spinal Cord 2008; 46 (12): 785–90PubMedCrossRefGoogle Scholar
  33. 33.
    Yamasaki M, Irizawa M, Komura T, et al. Daily energy expenditure in active and inactive persons with spinal cordinjury. J Hum Ergol (Tokyo) 1992; 21 (2): 125–33Google Scholar
  34. 34.
    Hayes AM, Myers JN, Myers JN, et al. Heart rate as a predictor of energy expenditure in people with spinal cord injury. J Rehabil Res Dev 2005; 42 (5): 617–24PubMedCrossRefGoogle Scholar
  35. 35.
    Lakomy HK, Campbell I, Williams C. Treadmill performance and selected physiological characteristics of wheelchairathletes. Br J Sports Med 1987; 21 (3): 130–3PubMedCrossRefGoogle Scholar
  36. 36.
    Ramsbottom R, Nute MG, Williams C. Determinants of five kilometre running performance in active men andwomen. Br J Sports Med 1987; 21 (2): 9–13PubMedCrossRefGoogle Scholar
  37. 37.
    Knechtle B, Müller G, Willmann F, et al. Comparison of fat oxidation in arm cranking in spinal cord-injured peopleversus ergometry in cyclists. Eur J Appl Physiol 2003; 90 (5-6): 614–9PubMedCrossRefGoogle Scholar
  38. 38.
    Martin L, Doggart AL, Whyte GP. Comparison of physiological responses to morning and evening submaximalrunning. J Sports Sci 2001; 19 (12): 969–76PubMedCrossRefGoogle Scholar
  39. 39.
    Abel T, Schneider S, Platen P, et al. Performance diagnostics in handbiking during competition. Spinal Cord 2006; 44 (4): 211–6PubMedCrossRefGoogle Scholar
  40. 40.
    Loftin M, Sothern M, Koss C, et al. Energy expenditure and influence of physiologic factors during marathon running. J Strength Cond Res 2007; 21 (4): 1188–91PubMedGoogle Scholar
  41. 41.
    Gass GC, Camp EM. Effects of prolonged exercise in highly trained traumatic paraplegic men. J Appl Physiol 1987; 63 (5): 1846–52PubMedGoogle Scholar
  42. 42.
    Gass GC, Camp EM, Davis HA, et al. The effects of prolonged exercise on spinally injured subjects. Med Sci Sports Exerc 1981; 13 (5): 277–83PubMedGoogle Scholar
  43. 43.
    Gass GC, Camp EM. Physiological characteristics of trained Australian paraplegic and tetraplegic subjects. Med Sci Sports 1979; 11 (3): 256–9PubMedGoogle Scholar
  44. 44.
    Burke EJ, Auchinachie JA, Hayden R, et al. Energy cost of wheelchair basketball. Phys Sports Med 1985; 13 (3): 99–102Google Scholar
  45. 45.
    Bernardi M, Canale I, Felici F, et al. Field evaluation of the energy cost of different wheelchair sports. Int J Sports Cardiol 1988; 5: 58–61Google Scholar
  46. 46.
    Roy JL, Menear KS, Schmid MM, et al. Physiological responses of skilled players during a competitive wheelchairtennis match. J Strength Cond Res 2006; 20 (3): 665–71PubMedGoogle Scholar
  47. 47.
    Smekal G, von Duvillard SP, Rihacek C, et al. A physiological profile of tennis match play. Med Sci Sports Exerc 2001; 33 (6): 999–1005PubMedCrossRefGoogle Scholar
  48. 48.
    Fernandez-Fernandez J, Mendez-Villanueva A, Fernandez-Garcia B, et al. Match activity and physiological responsesduring a junior female singles tennis tournament. Br JSports Med 2007; 41 (11): 711–6CrossRefGoogle Scholar
  49. 49.
    Ferrauti A, Bergeron MF, Pluim BM, et al. Physiological responses in tennis and running with similar oxygen uptake. Eur J Appl Physiol 2001; 85 (1-2): 27–33PubMedCrossRefGoogle Scholar
  50. 50.
    Coutts A, Reaburn P, Abt G. Heart rate, blood lactate concentration and estimated energy expenditure in a semiprofessionalrugby league team during a match: a casestudy. J Sports Sci 2003; 21 (2): 97–103PubMedCrossRefGoogle Scholar
  51. 51.
    Novas AM, Rowbottom DG, Jenkins DG. A practical method of estimating energy expenditure during tennisplay. J Sci Med Sport 2003; 6 (1): 40–50PubMedCrossRefGoogle Scholar
  52. 52.
    Ballor DL, Burke LM, Knudson DV, et al. Comparison of threemethods of estimating energy expenditure: caltrac, heartrate, and video analysis. ResQ Exerc Sport 1989; 60 (4): 362–8Google Scholar
  53. 53.
    Spendiff O, Campbell IG. The effect of glucose ingestion on endurance upper-body exercise and performance. Int JSports Med 2002; 23 (2): 142–7CrossRefGoogle Scholar
  54. 54.
    Spendiff O, Campbell IG. Influence of glucose ingestion prior to prolonged exercise on selected responses ofwheelchair athletes. Adapt Phys Act Q 2003; 20: 80–90Google Scholar
  55. 55.
    McInnes SE, Carlson JS, Jones CJ, et al. The physiological load imposed on basketball players during competition. J Sports Sci 1995; 13 (5): 387–97PubMedCrossRefGoogle Scholar
  56. 56.
    Christmass MA, Richmond SE, Cable NT, et al. Exercise intensity and metabolic response in singles tennis. J Sports Sci 1998; 16 (8): 739–47PubMedCrossRefGoogle Scholar
  57. 57.
    Coutts KD. Heart rates of participants in wheelchair sports. Paraplegia 1988; 26: 43–9PubMedCrossRefGoogle Scholar
  58. 58.
    Hoch F, Werle E, Weicker H. Sympathoadrenergic regulation in elite fencers in training and competition. Int J Sports Med 1988; 9 Suppl.2: S141–5PubMedCrossRefGoogle Scholar
  59. 59.
    Christmass MA, Dawson B, Passeretto P, et al. A comparison of skeletal muscle oxygenation and fuel use in sustainedcontinuous and intermittent exercise. Eur J Appl Physiol Occup Physiol 1999; 80 (5): 423–35PubMedCrossRefGoogle Scholar
  60. 60.
    Price MJ, Campbell IG. Thermoregulatory and physiological responses of wheelchair athletes to prolonged arm crank andwheelchair exercise. Int J Sports Med 1999; 20 (7): 457–63PubMedCrossRefGoogle Scholar
  61. 61.
    McConnell TJ, Horvat MA, Beutel-Horvat TA, et al. Arm crank versus wheelchair treadmill ergometry to evaluate theperformance of paraplegics. Paraplegia 1989; 27 (4): 307–13PubMedCrossRefGoogle Scholar
  62. 62.
    Pitetti KH, Snell PG, Stray-Gundersen J. Maximal response of wheelchair-confined subjects to four types of arm exercise. Arch Phys Med Rehabil 1987; 68 (1): 10–3PubMedGoogle Scholar
  63. 63.
    Glaser RM, Sawka MN, Brune MF, et al. Physiological responses to maximal effort wheelchair and arm crank ergometry. J Appl Physiol 1980; 48 (6): 1060–4PubMedGoogle Scholar
  64. 64.
    Knechtle B, Müller G, Willmann F, et al. Fat oxidation at different intensities in wheelchair racing. Spinal Cord 2004; 42 (1): 24–8PubMedCrossRefGoogle Scholar
  65. 65.
    Price MJ, Campbell IG. Thermoregulatory responses of paraplegic and able-bodied athletes at rest and duringprolonged upper body exercise and passive recovery. EurJ Appl Physiol Occup Physiol 1997; 76 (6): 552–60CrossRefGoogle Scholar
  66. 66.
    Price MJ, Campbell IG. Thermoregulatory responses of spinal cord injured and able-bodied athletes to prolongedupper body exercise and recovery. Spinal Cord 1999; 37 (11): 772–9PubMedCrossRefGoogle Scholar
  67. 67.
    Spendiff O, Campbell IG. Influence of pre-exercise glucose ingestion of two concentrations on paraplegic athletes. J Sports Sci 2005; 23 (1): 21–30PubMedCrossRefGoogle Scholar
  68. 68.
    Skrinar GS, Evans WJ, Ornstein LJ, et al. Glycogen utilization in wheelchair-dependent athletes. Int J Sports Med 1982; 3 (4): 215–9PubMedCrossRefGoogle Scholar
  69. 69.
    Price MJ. Thermoregulatory responses of spinal cord injured and able-bodied athletes to prolonged exercise and thermal stress [PhD Thesis]. Manchester: Manchester MetropolitanUniversity, 1997Google Scholar
  70. 70.
    Campbell IG, Williams C, Lakomy HK. Physiological responses of wheelchair athletes at percentages of top speed. Br J Sports Med 1997; 31 (1): 36–40PubMedCrossRefGoogle Scholar
  71. 71.
    Bhambhani YN, Holland LJ, Eriksson P, et al. Physiological responses during wheelchair racing in quadriplegics andparaplegics. Paraplegia 1994; 32 (4): 253–60PubMedCrossRefGoogle Scholar
  72. 72.
    Bhambhani YN, Burnham RS, Wheeler GD, et al. Physiological correlates of simulated wheelchair racing in trainedquadriplegics. Can J Appl Physiol 1995; 20 (1): 65–77PubMedCrossRefGoogle Scholar
  73. 73.
    Asayama K, Nakamura Y, Ogata H, et al. Physical fitness of paraplegics in full wheelchair marathon racing. Paraplegia 1985; 23 (5): 277–87PubMedCrossRefGoogle Scholar
  74. 74.
    Knoepfli B, Riddell MC, Ganzoni E, et al. Off seasonal and pre-seasonal assessment of circulating energy sourcesduring prolonged running at the anaerobic threshold incompetitive triathletes. Br J Sports Med 2004; 38 (4): 402–7PubMedCrossRefGoogle Scholar
  75. 75.
    Howlett KF, Spriet LL, Hargreaves M. Carbohydrate metabolism during exercise in females: effect of reduced fatavailability. Metabolism 2001; 50 (4): 481–7PubMedCrossRefGoogle Scholar
  76. 76.
    Thomas TR, Feiock CW, Araujo J. Metabolic responses associated with four modes of prolonged exercise. J Sports Med Phys Fitness 1989; 29 (1): 77–82PubMedGoogle Scholar
  77. 77.
    Carey AL, Staudacher HM, Cummings NK, et al. Effects of fat adaptation and carbohydrate restoration on prolongedendurance exercise. J Appl Physiol 2001; 91 (1): 115–22PubMedGoogle Scholar
  78. 78.
    Bangsbo J, Jacobsen K, Nordberg N, et al. Acute and habitual caffeine ingestion and metabolic responses tosteady-state exercise. J Appl Physiol 1992; 72 (4): 1297–303PubMedCrossRefGoogle Scholar
  79. 79.
    Pillard F, Moro C, Harant I, et al. Lipid oxidation according to intensity and exercise duration in overweight men andwomen. Obesity 2007; 15 (9): 2256–62PubMedCrossRefGoogle Scholar
  80. 80.
    Bauman WA, Spungen AM. Carbohydrate and lipid metabolism in chronic spinal cord injury. J Spinal Cord Med 2001; 24 (4): 266–77PubMedGoogle Scholar

Copyright information

© Adis Data Information BV 2010

Authors and Affiliations

  1. 1.Department of Biomolecular and Sports SciencesFaculty of Health and Life Sciences, Coventry UniversityCoventryUK

Personalised recommendations