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Astorino et al. Neuroimmunol Neuroinflammation 2020;7:40-50 I http://dx.doi.org/10.20517/2347-8659.2019.11 Page 45

Table 2. Changes in indices of quality of life (mean ± SD) in response to six months of activity-based therapy in persons with
SCI
Parameter Zero months Three months Six months
BSS -0.36 ± 1.62 0.22 ± 1.48 0.44 ± 1.38*
BSS-A -0.82 ± 1.59 -0.01 ± 1.80* 0.04 ± 1.54*
PQOL 60.4 ± 18.2 59.7 ± 19.8 64.5 ± 20.6a
CESD 21.3 ± 6.9 20.8 ± 5.7 19.7 ± 5.3
Pain 4.5 ± 1.3 4.4 ± 1.4 4.5 ± 1.3
Don’t have secondary complications (%) 48.1 ± 16.8 41.9 ± 21.7 43.0 ± 18.6
Bothersome secondary complications (%) 7.2 ± 9.9 4.4 ± 7.4 3.6 ± 5.6
BSS: body satisfaction survey; BSS-A: body satisfaction survey - appearance; PQOL: perceived quality of life; CESD: Center for
a
Epidemiological Studies depression scale; SCI: spinal cord injury; SD: standard deviation. *P < 0.05 vs. zero-month value; P < 0.05 vs.
three-month value

Change in perceived quality of life and depression in response to ABT
Perceived quality of life differed with training (P = 0.04, η = 0.11) and post hoc analyses showed that the
2
p
six-month value was higher than at three months [Table 2] by approximately five units (d = 0.8). Change
in PQOL from baseline to six months was higher in persons with acute (+7.6 ± 12.9) or incomplete injury
(+7.5 ± 11.2) compared to chronic (+0.7 ± 7.4) or complete injury (+0.9 ± 11.6), although it failed to reach
significance (P = 0.10). The results show no change in depression (P = 0.30) from baseline to six months
and there were no effects of injury level, completeness, or volume of physical activity on this response.

Regression data
Various two-predictor models were developed to identify the best predictors of change in PQOL and body
satisfaction in response to training. A model (r = 0.63, F = 7.05, P = 0.004) consisting of age (r = -0.41, P = 0.02)
and change in pain (r = -0.48, P = 0.007) explained 39% of the variance in change in PQOL. Although percent
body fat was correlated with change in BSS (r = 0.33, P = 0.049), no significant models were found. For change
in BSS-A, a significant model (r = 0.504, F = 4.08, P = 0.03) consisted of body fat (r = 0.36, P = 0.03) and baseline
pain (r = 0.27, P = 0.08).

Change in body composition in response to ABT
Body composition results are revealed in Table 3. Body mass (P = 0.30) did not change but %BF (body fat)
2
increased (P = 0.02, η = 0.17) from baseline to six months by 1%. Whole-body FFM did not change across
p
time (P = 0.11), but there was a training × group interaction in that it declined by approximately 2 kg in
individuals with complete SCI (n = 9, 50.8 ± 7.9 kg to 48.7 ± 7.0 kg), but did not change in participants with
incomplete injury (n = 16, 47.7 ± 7.4 kg to 47.5 ± 7.5 kg). Leg FFM (P = 0.88), leg %BF (P = 0.08), and waist
circumference (P = 0.80) were unchanged during the study. There was a tendency for trunk FFM to decline
during the study (P = 0.06). Trunk %BF increased (P = 0.03), and post hoc analyses showed that three- and
six-month values were higher by 1.2%-1.3% than at baseline. There were no differences in arm FFM (P
= 0.20) or %BF (P = 0.13) during the study. Arm FFM was higher (P = 0.003) in persons with paraplegia
versus tetraplegia. From baseline to six months of training, whole-body %BF declined by more than the
coefficient of variation of the measure in 24% of participants, and 32% of participants showed increases in
whole-body FFM.

Change in dietary intake
Data revealed that total energy intake declined from baseline (1769.1 ± 349.3 kcal, 1650.3 ± 410.4 kcal, and
1660.9 ± 366.9 kcal, P = 0.03), whereas fat (64.9 ± 15.0 g, 59.7 ± 15.8 g, and 60.6 ± 16.2 g, P = 0.20), CHO
(211.6 ± 53.0 g, 197.2 ± 53.6 g, and 201.0 ± 54.5 g, P = 0.17), and protein intake (78.3 ± 21.1 g, 80.6 ± 26.0 g,
and 74.2 ± 28.5 g, P = 0.27) were unaltered.