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Page 42 Astorino et al. Neuroimmunol Neuroinflammation 2020;7:40-50 I http://dx.doi.org/10.20517/2347-8659.2019.11

The current study examined effects of chronic ABT on perceived quality of life, pain, body satisfaction,
and body composition in persons with SCI, which are related to subjective well being. Data from a recent
[27]
review of four studies containing 139 participants indicated no effect of ABT on quality of life, yet most
[29]
[30]
[28]
included studies were of low quality. Data from Dolbow et al. , Sharif et al. , and Sadowsky et al. show
greater quality of life after FES training, yet it is unknown if similar results can occur with multi-modal
ABT. It was hypothesized that ABT would improve measures of quality of life and body satisfaction, but
not pain, fat free mass (FFM), or fat mass (FM) in men and women with SCI. Resultant data can be used
towards identifying effective rehabilitation strategies targeting these outcomes, which are associated with
physical and psychological function and overall well-being of persons with SCI.

METHODS
Design: this study was a within-subjects longitudinal project
Participants initiated 6 months of exercise training, which was continuously supervised by personnel
trained in SCI rehabilitation at a local ABT facility. During a single session at baseline and at three and
six months, a survey was completed to assess variables including body satisfaction, pain, depression, and
quality of life, and participants underwent dual-energy X-ray absorptiometry (DXA) scans to determine
whole body and regional body composition. This session was overseen by the primary investigator. In
addition, a four-day food log was completed. Assessments were performed a minimum of 18 h after their
last training session. Time of day was maintained across all trials within participants. Compliance to
training was monitored each day by staff at the facility.

Participants
Twenty-nine men and women with SCI were initially recruited and subsequently initiated this study; they
were recruited by word-of-mouth. They comprised a convenience sample of patients completing ABT
at a local rehabilitation facility. Eighteen individuals were identified as Caucasian, six as Hispanic, three
as Middle Eastern, and two as African-American. Initially, participants’ health history was examined
with a brief survey to ensure they met these inclusion criteria: complete or incomplete SCI, injury level
lower than C2, non-ventilator dependent, and physician’s permission to engage in an intense exercise
program. Prospective participants were excluded if they completed regular ABT (locomotor training,
assisted/unassisted walking, etc.) in the preceding 12 months or were unwilling to abstain from additional
exercise other than wheelchair ambulation outside the study; lacked the physical function or had excess
pain to complete training; were taking medications altering body composition or mental status (such as
testosterone, antidepressants, and/or diabetic and/or cardiovascular drugs) other than calcium or vitamin
D supplements; had medical conditions besides paralysis that alter body composition, such as diabetes
or hyperthyroidism; were peri- or post-menopausal; or suffered an acute infection. Participants provided
informed consent to participate in the study, which was approved by the University Institutional Review
Board and was conducted in accordance with the Declaration of Helsinki.

Assessment of quality of life
Using an interview format, the primary investigator read each item to the participant and recorded his/
her response, as not all participants could use pen and paper. Initially, the 10-item body satisfaction survey
[31]
(BSS) was completed, with scores ranging from -3 (very dissatisfied) to +3 (very satisfied). This survey
has a range of scores from -30 to +30 and included questions pertaining to physical function (seven items)
and appearance (BSS-A) (three items), which were scored separately. Next, participants were asked “how
much bodily pain have you had in the last four weeks” and “how much did pain interfere with your normal
work/day-to-day activities”, which were scored from 1 (none) to 6 (very severe). These were taken from
[2]
the Short Form-36 survey (SF-36) scale and have been previously utilized in SCI . The 11-item PQOL
[32]
[2]
[33]
scale containing four additional items related to quality of life in SCI was then completed, in which
participants were asked their degree of satisfaction on a scale of 0-100.