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Page 46 Astorino et al. Neuroimmunol Neuroinflammation 2020;7:40-50 I http://dx.doi.org/10.20517/2347-8659.2019.11

Table 3. Changes in body weight and body composition (mean ± SD) in response to six months of activity-based therapy in
persons with SCI
Parameter Zero months Three months Six months
Mass (kg) 76.3 ± 13.2 77.1 ± 13.1 77.0 ± 13.4
Whole-body FFM (kg) 48.8 ± 7.9 48.6 ± 7.4 47.9 ± 7.2
%BF 32.7 ± 12.2 33.6 ± 11.7* 33.8 ± 11.2*
WC (cm) 91.0 ± 13.0 90.7 ± 14.6 90.1 ± 13.4
Leg FFM (kg) 14.3 ± 3.0 14.3 ± 3.1 14.3 ± 2.9
Leg %BF 36.4 ± 11.9 37.3 ± 11.3 37.5 ± 10.8
Trunk FFM (kg) 24.2 ± 3.6 23.9 ± 3.3 23.6 ± 3.4
Trunk %BF 33.4 ± 13.5 34.6 ± 13.4* 34.7 ± 12.7*
Arm FFM (kg) 6.1 ± 1.9 6.3 ± 1.8 6.3 ± 1.9
Arm %BF 27.1 ± 13.7 27.6 ± 14.3 28.6 ± 13.2
kg: kilograms; FFM: fat-free mass; BF: body fat; WC: waist circumference; SD: standard deviation; SCI: spinal cord injury. *P < 0.05 vs.
baseline

DISCUSSION
Despite no significant improvements in FFM or FM, bodily pain, or depression, individuals with SCI
undergoing six months of ABT revealed small but significant increases in PQOL and body satisfaction.
Although our data cannot explain what led to this improved quality of life, previous reports indicate that
exercise improves sense of control and mastery that people have regarding their physical function .
[44]
[3]
Due to the potential link between quality of life and exercise participation in SCI , structuring exercise
programs targeting these outcomes may help promote exercise adherence in this population.

Supporting our findings, improved PQOL has been reported in response to exercise training in SCI. In
[4]
men and women at least one year post-SCI , nine months of resistance training and arm cycling improved
PQOL, which was coincident with reduced pain, depression, and greater muscle strength and arm cycling
performance that, in turn, might elicit an improved mental health profile. Similarly, improved PQOL
occurred in patients undergoing 12 weeks of FES ambulation training despite no change in depression .
[29]
Nevertheless, in persons with complete SCI, 18 months of incorporation of ABT into daily activities had
no effect on functional independence or quality of life (measured with the Short Form-36) . Jones et al.
[23]
[45]
reported no change in quality of life despite increased walking speed in men and women with incomplete
SCI undergoing six months of ABT. Potential explanations for no change in PQOL can be due to a ceiling
effect or inclusion of participants with varying injury duration, as persons with chronic SCI may come to
terms with their injury and may believe that it no longer alters their quality of life. Alternatively, we had
many individuals within one year of injury who likely struggle with the challenges of acute SCI and report
a low quality of life. Our ABT regime was also held in a facility providing social interactions to clients that
also may enhance PQOL.

[3]
In 695 men and women with SCI , a greater incidence of pain and depression and lower life satisfaction
was found in overweight versus normal weight individuals, likely due to greater difficulty in completing
[46]
[47]
activities of daily living. Previous studies also suggest that body satisfaction may be higher or lower in
persons with greater physical activity. Our body satisfaction values are lower than those reported in men
[48]
approximately 15 years post-SCI , likely due to their more recent injury status and higher levels of body
fat. Similar to our findings, 10 weeks of exercise training in a heterogeneous group of men and women with
[49]
SCI improved functional and appearance-related body satisfaction . Overall, various modes of exercise
including ABT have the potential to improve body satisfaction in persons with SCI. Because of our small
sample and lack of a control group, our results showing enhanced body satisfaction are preliminary and
require further study to confirm.