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Bone and non-contractile soft tissue changes following open kinetic chain resistance training and testosterone treatment in spinal cord injury: an exploratory study

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Abstract

Summary

Twenty men with spinal cord injury (SCI) were randomized into two 16-week intervention groups receiving testosterone treatment (TT) or TT combined with resistance training (TT + RT). TT + RT appears to hold the potential to reverse or slow down bone loss following SCI if provided over a longer period.

Introduction

Persons with SCI experience bone loss below the level of injury. The combined effects of resistance training and TT on bone quality following SCI remain unknown.

Methods

Men with SCI were randomized into 16-week treatments receiving TT or TT + RT. Magnetic resonance imaging (MRI) of the right lower extremity before participation and post-intervention was used to visualize the proximal, middle, and distal femoral shaft, the quadriceps tendon, and the intermuscular fascia of the quadriceps. For the TT + RT group, MRI microarchitecture techniques were utilized to elucidate trabecular changes around the knee. Individual mixed models were used to estimate effect sizes.

Results

Twenty participants completed the pilot trial. A small effect for yellow marrow in the distal femur was indicated as increases following TT and decreases following TT + RT were observed. Another small effect was observed as the TT + RT group displayed greater increases in intermuscular fascia length than the TT arm. Distal femur trabecular changes for the TT + RT group were generally small in effect (decreased trabecular thickness variability, spacing, and spacing variability; increased network area). Medium effects were generally observed in the proximal tibia (increased plate width, trabecular thickness, and network area; decreased trabecular spacing and spacing variability).

Conclusions

This pilot suggests longer TT + RT interventions may be a viable rehabilitation technique to combat bone loss following SCI.

Clinical trial registration

Registered with clinicaltrials.gov: NCT01652040 (07/27/2012).

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Data availability

The corresponding author will make the data available upon request.

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Acknowledgments

This work was supported by the United States Department of Veterans Affairs (VA-RRD CDA2). We thank the participants and the research staff who made the current study possible. We also thank the Hunter Holmes McGuire Research Institute and the Spinal Cord Injury and Disorders Services for providing the environment to conduct the clinical research.

Funding

The study was funded by the United States Department of Veterans Affairs: VA-RRD CDA2 (B7867-W).

Author information

Authors and Affiliations

  1. Spinal Cord Injury and Disorders, Hunter Holmes McGuire VAMC, Richmond, VA, 23249, USA

    M.E. Holman, M.P. Ghatas, R.A. Adler & A. S. Gorgey

  2. Department of Radiology, NYU School of Medicine, New York, NY, 10016, USA

    G. Chang

  3. Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA, 52242, USA

    P.K. Saha & X. Zhang

  4. Department of Radiology, University of Iowa, Iowa City, IA, 52242, USA

    P.K. Saha

  5. Department of Radiology, Hunter Holmes McGuire VAMC, Richmond, VA, 23249, USA

    M.R. Khan

  6. Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, 23284, USA

    A.P. Sima

  7. Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University, Richmond, VA, 23284, USA

    A. S. Gorgey

Authors
  1. M.E. Holman
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  2. G. Chang
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  9. A. S. Gorgey
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Correspondence to A. S. Gorgey.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Custom software was used for computing trabecular bone measures from magnetic resonance images. Other software utilized is commercially available.

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Holman, M., Chang, G., Ghatas, M. et al. Bone and non-contractile soft tissue changes following open kinetic chain resistance training and testosterone treatment in spinal cord injury: an exploratory study. Osteoporos Int 32, 1321–1332 (2021). https://doi.org/10.1007/s00198-020-05778-2

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