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Page 48 Astorino et al. Neuroimmunol Neuroinflammation 2020;7:40-50 I http://dx.doi.org/10.20517/2347-8659.2019.11

severity, and completeness that may reduce our ability to gauge the efficacy of ABT, especially in persons
[4]
with acute SCI who are experiencing changes in body fat and FFM. However, in a previous study , regular
physical activity improved various physical and psychological outcomes in persons with SCI irrespective
of their level or completeness of injury. The Short Form-36 is widely used in populations including SCI
[29]
to monitor changes in health-related quality of life . However, other than its two pain-related items, we
did not use it as it was found to be too burdensome on our sample. Although all participants received
comprehensive ABT, the make-up and volume of said training varied based on participants’ existing
function, their progress through training, and, lastly, their ability to pay for training, which was not
covered by insurance. This requirement to pay for training may have led to more favorable outcomes
related to QOL. The latter factor led to different doses of training performed by each participant. However,
there was no relationship between weekly volume of training and the change in %BF, FFM, or any of the
psychological variables. In addition, the increases in PQOL and body satisfaction were evident irrespective
of whether participants completed a low or high volume of ABT. These findings suggest that disparate
volumes of training had little impact on our results. In addition, FES comprised a small portion of habitual
training, which may have led to the non-significant changes in body composition. However, our study is
strengthened by a sample size that is greater than those used in most studies examining PQOL. Our sample
included persons of varied injury level and injury duration, which allows generalization of our findings to
the entire population with SCI rather than one homogeneous group. In addition, we tracked food intake
through dietary logs, and data showed minimal changes in energy intake during the study, which gives
us greater confidence that observed changes in body composition were not due to variations in dietary
patterns.

In conclusion, Six months of ABT slightly improved various indices of quality of life but did not induce
changes in body fat or FFM. Pain was also associated with the changes in quality of life and body
satisfaction observed in response to training. The changes seen in this study are small. Due to our small
and heterogenous sample recruited by convenience, lack of a control group, and non-standardized training
regimen, additional work is needed to confirm these data. Future studies should explore the potential for
alternative modalities of exercise to enhance quality of life due to its relationship with exercise adherence in
SCI.

DECLARATIONS
Acknowledgments
The authors thank the participants for their dedication to this study as well as the staff at the rehabilitation
facility for overseeing day-to-day training of the subjects.

Authors’ contributions
Conceived the study: Astorino TA, Harness ET
Analyzed the data and wrote the final draft of the manuscript: Astorino TA, which Harness ET reviewed
ETH supervised all training sessions; whereas: Harness ET
Supervised all assessments: Astorino TA

Availability of data and materials
De-identified data could be made available to readers upon request.

Financial support and sponsorship
National Institutes of Health SC3GM095416-02.

Conflicts of interest
All authors declared that there are no conflicts of interest.