Leisure time physical activity among older adults with long-term spinal cord injury.

STUDY DESIGN: Cross-sectional. OBJECTIVES: To describe participation in leisure time physical activity (LTPA) (amount, intensity and type) among older adults with long-term spinal cord injury (SCI), and to investigate the associations with sociodemographics, injury characteristics and secondary health conditions (SHCs). SETTING: Home settings in southern Sweden. METHODS: Data from the Swedish Aging with Spinal Cord Injury Study (SASCIS). The physical activity recall assessment for people with SCI was used to assess LTPA among 84 men and 35 women (mean age 63.5 years, mean time since injury 24 years, injury levels C1-L5, American Spinal Injury Association Impairment Scale A-D). Associations were analyzed statistically using hierarchical multivariable regression. RESULTS: Twenty-nine percent reported no LTPA, whereas 53% performed moderate-to-heavy intensity LTPA. The mean minutes per day of total LTPA was 34.7 (±41.5, median 15, range 0-171.7) and of moderate-to-heavy LTPA 22.5 (±35.1, median 5.0, range 0-140.0). The most frequently performed activities were walking and wheeling. Sociodemographics, injury characteristics and SHCs (bowel-related and bladder-related problems, spasticity and pain) explained 10.6% and 13.4%, respectively, of the variance in total and moderate-to-heavy LTPA. Age and wheelchair use were significantly, negatively associated with total LTPA. Women, wheelchair users and employed participants performed significantly less moderate-to-heavy LTPA than men, those using walking devices/no mobility device and unemployed participants. CONCLUSION: Many older adults with long-term SCI do not reach the amount or intensity of LTPA needed to achieve fitness benefits. Research is needed on how to increase LTPA and to identify modifiable factors that could enhance their participation.

Online training improves paramedics' knowledge of autonomic dysreflexia management guidelines.

STUDY DESIGN: Single-group pre-/post-test with 3- and 6-month follow-ups. OBJECTIVES: To test the effects of the 'ABCs of AD' educational module on immediate and longer-term changes in paramedics' knowledge and beliefs about using the autonomic dysreflexia clinical practice guidelines (AD-CPGs). SETTING: Canada. METHODS: A total of 119 paramedics completed an AD knowledge test and measures of attitudes, perceived control, self-efficacy, social pressure from patients and health-care professionals, and intentions to use the AD-CPGs before and 1 week, 3 months and 6 months after viewing 'ABCs of AD'. RESULTS: There were significant improvements in AD knowledge, attitudes and social pressure from patients to use the AD-CPGs from baseline to 1 week, 3 months and 6 months post viewing (all P<0.001). Self-efficacy and intentions increased 1 week post viewing (P<0.001), but returned to baseline levels at 3 and 6 months (P>0.05). There was no change in perceived control or social pressure from health-care professionals. AD knowledge and beliefs explained 50-61% of the variance in intentions to use the AD-CPGs. Attitudes, social pressure from patients and perceived behavioural control were significant unique predictors of intentions at all time points (P<0.05); AD knowledge was a significant predictor at 6 months only (P=0.048). No other predictors were significant. CONCLUSION: 'ABCs of AD' has immediate and sustained effects on paramedics' knowledge of attitudes toward and perceived pressure from patients to use the AD-CPGs. Updates to paramedic patient care guidelines and standards are needed to increase paramedics' perceived control and self-efficacy to implement the guidelines, and their intentions to use the AD-CPGs. SPONSORSHIP: Canadian Institutes of Health Research (2011-CIHR- 260877).

Type, intensity and duration of daily physical activities performed by adults with spinal cord injury.

STUDY DESIGN: Secondary analysis of cross-sectional data. OBJECTIVES: To describe and compare (1) self-reported intensities and durations of specific types of daily physical activities and (2) minutes per day spent on daily physical activities across key demographic groups. SETTING: Community (Ontario, Canada). METHODS: Participants were 695 adults with spinal cord injury (SCI; 76% male, Mage=46.81±13.41 years, Myears post injury=15.19±11.10 years). Daily activities were assessed over the telephone using the Physical Activity Recall Assessment for People with SCI. Multivariate analyses of variance (MANOVA) were computed to test for differences in intensities and durations of different daily activities (objective 1) and between-group differences in minutes per day of daily activities (objective 2). RESULTS: Overall, participants reported 127.92±142.79 min per day of daily physical activities with significantly more time spent in mild intensity (78.93±104.62 min per day) than moderate- (40.23±68.71 min per day) or heavy-intensity activities (8.75±24.53 min per day). Four patterns emerged with respect to type, duration and intensity, with some activities being typically performed at lighter or heavier intensities than others. There were significant differences in minutes per day of activity intensity and duration between groups based on education, injury severity and mode of mobility (P<0.05). CONCLUSION: Given that some groups were more likely to engage in moderate-heavy-intensity activities, and some activities were more likely to be performed at moderate-heavy intensities, interventions that target key groups to increase certain daily activities may be one strategy to enhance overall physical activity participation among people with SCI.

Differences in health, participation and life satisfaction outcomes in adults following paediatric- versus adult-sustained spinal cord injury.

STUDY DESIGN: Cross-sectional. OBJECTIVES: To compare differences in self-reported health status, participation and life satisfaction outcomes between adults with a spinal cord injury (SCI) sustained during paediatric (P) versus adulthood (A) years. SETTING: Ontario, Canada. METHODS: Secondary analysis of data from the Study of Health and Activity in People with SCI. Eighty-seven participants who sustained an SCI prior to age 19 (M±s.e.=25±1.5 years postinjury (YPI)) were matched for lesion level (C2-L5), severity (complete/incomplete), gender, age, education and ethnicity with 87 participants who sustained an SCI at ⩾age 19 years (MYPI=12.8±1.1). RESULTS: Those with a paediatric SCI reported significantly less pain, fewer visits to the physician in the past year, greater functional independence, social participation, occupational participation and minutes per day of moderate-to-vigorous physical activity than those who sustained an SCI in adulthood. No significant differences were found for the measures of depression, perceived health status or life satisfaction (P>0.05). With the exception of moderate-to-vigorous physical activity and visits to the physician in the past year, between-group differences were independent of YPI. CONCLUSIONS: Regardless of time since injury, people who sustained a paediatric SCI reported better health and greater participation than those injured in adulthood. Nevertheless, both groups scored well below able-bodied normative values for all measures. The results highlight the importance of a comprehensive life-course approach to SCI rehabilitation, irrespective of age at the time of injury.

A description and estimate of very low-intensity activity and inactive awake time in community-dwelling adults with chronic spinal cord injury.

STUDY DESIGN: Secondary analysis of cross-sectional data. OBJECTIVES: To estimate the amount of very low-intensity activity (VLPA) or inactive daily awake time that people with spinal cord injury (SCI) engage in and to determine correlates of VLPA/inactivity in this population. SETTING: Community (Ontario, Canada). METHODS: Participants with SCI (n=695; Mage=47 years; Myears post-injury=15 years, 76% men) completed telephone interviews. Demographic details and injury-related characteristics were self-reported. Total daily physical activity (for example, mild, moderate and heavy intensity) was measured using the Physical Activity Recall Assessment for People with SCI (PARA-SCI). VLPA/inactivity was calculated by subtracting total daily physical activity time from daily awake time. Correlates of VLPA/inactivity were assessed using a hierarchical linear regression where demographic variables were entered on the first step and injury-related characteristics were entered second. RESULTS: Participants reported VLPA/inactivity for approximately 768±169 min per day, or 84%, of their awake time. The regression model predicting VLPA/inactivity was not significant. CONCLUSION: People with SCI spend the majority of their awake time in VLPA/inactivity. However, VLPA/inactivity did not differ as a function of demographic or injury-related variables, suggesting that all segments of the SCI population could benefit from strategies to reduce inactivity.

Active Living Leaders Training Program for adults with spinal cord injury: a pilot study.

STUDY DESIGN: Quasi-experimental pre-post design with 6-month follow-up. OBJECTIVES: Active Living Leaders Training Program (ALLTP) equips individuals with knowledge and skills to encourage those with spinal cord injury (SCI) to increase their leisure-time physical activity (LTPA). The purpose of this pilot study was to, first, (i) evaluate participants' perceptions of the relevance/usefulness of ALLTP material/presentation, (ii) examine changes in participants' self-efficacy to promote LTPA, (iii) identify program components associated with greater self-efficacy and, second, measure participants' use of ALLTP skills and resources over the subsequent 6 months. SETTING: Canada. METHODS: Six SCI fitness trainers and six adults with SCI completed the three sections of ALLTP and, after each section, provided feedback. Six months later, participants' use of resources and skills was assessed. Means, standard deviations, repeated measures analysis of variance and Pearson's correlations were computed. RESULTS: Relevance/usefulness of the program was rated favorably. Self-efficacy to speak about and encourage LTPA remained high throughout the ALLTP and was positively correlated with the relevance/usefulness of program content and presentation. At follow-up, participants had discussed LTPA with an average of seven people with disabilities and reported using at least one skill and resource from the ALLTP during those discussions. CONCLUSIONS: Users had positive perceptions of ALLTP and reported using the training to promote LTPA to others with disabilities. Participant feedback has been used to improve ALLTP. ALLTP can now be used to train people with SCI and SCI fitness trainers to promote LTPA to others with disabilities.

Development of an evidence-informed leisure time physical activity resource for adults with spinal cord injury: the SCI Get Fit Toolkit.

OBJECTIVES: To systematically develop an evidence-informed leisure time physical activity (LTPA) resource for adults with spinal cord injury (SCI). SETTING: Canada. METHODS: The Appraisal of Guidelines, Research and Evaluation (AGREE) II protocol was used to develop a toolkit to teach and encourage adults with SCI how to make smart and informed choices about being physically active. A multidisciplinary expert panel appraised the evidence and generated specific recommendations for the content of the toolkit. Pilot testing was conducted to refine the toolkit's presentation. RESULTS: Recommendations emanating from the consultation process were that the toolkit be a brief, evidence-based resource that contains images of adults with tetraplegia and paraplegia, and links to more detailed online information. The content of the toolkit should include the physical activity guidelines (PAGs) for adults with SCI, activities tailored to manual and power chair users, the benefits of LTPA, and strategies to overcome common LTPA barriers for adults with SCI. The inclusion of action plans and safety tips was also recommended. CONCLUSION: These recommendations have resulted in the development of an evidence-informed LTPA resource to assist adults with SCI in meeting the PAGs. This toolkit will have important implications for consumers, health care professionals and policy makers for encouraging LTPA in the SCI community.

The effects of exercise training on physical capacity, strength, body composition and functional performance among adults with spinal cord injury: a systematic review.

STUDY DESIGN: Systematic review. OBJECTIVES: To conduct a systematic review of evidence surrounding the effects of exercise on physical fitness in people with spinal cord injury (SCI). SETTING: Canada. METHODS: The review was limited to English-language studies (published prior to March 2010) of people with SCI that evaluated the effects of an exercise intervention on at least one of the four main components of physical fitness (physical capacity, muscular strength, body composition and functional performance). Studies reported at least one of the following outcomes: oxygen uptake/consumption, power output, peak work capacity, muscle strength, body composition, exercise performance or functional performance. A total of 166 studies were identified. After screening, 82 studies (69 chronic SCI; 13 acute SCI) were included in the review. The quality of evidence derived from each study was evaluated using established procedures. RESULTS: Most studies were of low quality; however, the evidence was consistent that exercise is effective in improving aspects of fitness. There is strong evidence that exercise, performed 2-3 times per week at moderate-to-vigorous intensity, increases physical capacity and muscular strength in the chronic SCI population; the evidence is not strong with respect to the effects of exercise on body composition or functional performance. There were insufficient high-quality studies in the acute SCI population to draw any conclusions. CONCLUSIONS: In the chronic SCI population, there is good evidence that exercise is effective in improving both physical capacity and muscular strength, but insufficient quality evidence to draw meaningful conclusions on its effect on body composition or functional capacity.

Leisure-time physical activity and diet quality are not associated in people with chronic spinal cord injury.

STUDY DESIGN: Cross-sectional. OBJECTIVE: To determine the association between leisure-time physical activity (LTPA) and adherence to Eating Well with Canada's Food Guide (CFG) in community-dwelling adults with chronic Spinal Cord Injury (SCI). SETTING: Ontario, Canada. METHODS: Participants were recruited as part of the Study of Health and Activity in People with SCI (SHAPE-SCI). Dietary data were collected using 24-h recalls and analysed for adherence to CFG recommendations by age group and gender. LTPA was assessed using the Physical Activity Recall Assessment for Persons with SCI. Statistical analysis comprised correlations, multiple regression and χ(2). RESULTS: We studied 75 adults (n=61 M; 42.4±11.8 years; 25.5±5.2 kg m(-2)) with chronic (≥1-year post-injury) SCI. Of these, 37% of participants were inactive, 29% were low-active and 33% were high-active. Fewer than 5% of participants were 100% adherent with CFG; 85% were adherent to ≤50%. Activity level and overall adherence to CFG were not correlated (r=-0.052, P=0.666). Although there were no associations between LTPA and vegetables and fruit, grain products, milk and alternatives, or other foods (all P>0.05), high activity was associated with consuming less than the minimum number of recommended servings of meat and alternatives (φ=-0.258, P=0.026). CONCLUSION: Clinicians need to be aware of the poor diet quality, and low levels of physical activity, of people with chronic SCI. They should not assume that those who are more active consume better quality diets than those who are low active or inactive. SPONSORSHIP: Canadian Institutes of Health Research.

Secondary complications and subjective well-being in individuals with chronic spinal cord injury: associations with self-reported adiposity.

STUDY DESIGN: This is a cross-sectional study. OBJECTIVES: To examine the associations between adiposity, secondary complications and subjective well-being (SWB) in individuals with spinal cord injury (SCI). SETTING: Parkwood Hospital (London); Hamilton Health Sciences-Chedoke Site and McMaster University (Hamilton); Toronto Rehabilitation Institute, Lyndhurst Centre (Toronto); and St Mary's of the Lake Hospital and Queen's University (Kingston), Ontario, Canada. METHODS: A total of 531 men and 164 women (N=695) enrolled in the Study of Health and Activity in People with Spinal Cord Injury (SHAPE-SCI) completed the Secondary Health Complications Survey, SF-36 pain subscale, Satisfaction with Life Scale (SWLS) and the Patient Health Questionnaire-9 (PHQ) during a telephone interview. Body mass index (BMI) measurements were obtained from a subsample of the SHAPE-SCI participants (n=73) during a home visit. RESULTS: Controlling for covariates, individuals who reported being overweight were more likely to have a history of overuse injuries and fatigue, experienced a greater impact of overuse injuries and fatigue, had greater pain and depressive symptoms, and had lower satisfaction with life than individuals who did not report being overweight. BMI was only associated with an increased likelihood of reporting spasticity. CONCLUSION: Self-reported overweight status was associated with an increased prevalence of certain secondary complications and lower SWB. Future prospective studies should examine whether reductions in adiposity are associated with changes in the prevalence and the impact of secondary complications and SWB.

Dietary supplement use in the spinal cord injury population.

STUDY DESIGN: Longitudinal, non-experimental. OBJECTIVES: To determine the following: (1) prevalence of supplement use in a representative sample of the chronic spinal cord injury (SCI) population; (2) most frequently consumed supplements; and (3) characteristics of consistent supplement users. SETTING: Ontario, Canada. METHODS: A structured questionnaire was used to collect demographic information from 77 community-dwelling adults with chronic SCI (50.6% paraplegia, 81.8% male, 42.4 + or - 11.9 years, body mass index (BMI) 25.4 + or - 5.1 kg m(-2)). A standardized form was used to record dietary intake, including supplements, in the previous 24 h, at three time points (baseline, 6 months and 18 months). Logistic regression and multivariate logistic regression were used to determine which characteristic(s) was (were) associated with consistent supplement use. RESULTS: Seventy-one percent of the sample reported using supplements at least once, with 50.6% being classified as consistent supplement users (at least twice across the three time points). The top three supplements consumed were multivitamins (25%), calcium (20%) and vitamin D (16%). Supplement use status was not associated with gender, level of injury, age, education, physical activity, BMI, smoking or alcohol intake. CONCLUSIONS: Dietary supplement use was common in our sample of individuals with long-standing SCI, but no common characteristics distinguished users from non-users. We suggest that health practitioners be aware of the high dietary supplement use in this population so that they can probe for type, dose and frequency, as supplements may have an important influence on dietary assessment results.

Physical activity and subjective well-being among people with spinal cord injury: a meta-analysis.

STUDY DESIGN: Meta-analysis of cross-sectional, quasi-experimental and experimental studies. OBJECTIVE: To determine if there is an association between physical activity (PA) and subjective well-being (SWB) among people living with spinal cord injury (SCI). METHODS: Literature searches were conducted using multiple databases (Embase, CINAHL, Medline, PsychINFO and SPORTDiscus) to identify studies involving people with SCI that included a measure of PA and at least one measure of SWB (for example, symptoms of depression, life satisfaction, mood). Relevant data were extracted from the studies and subjected to meta-analysis. RESULTS: A total of 21 studies were retrieved yielding 78 effect sizes and a total sample size of 2354. Overall, there were statistically significant, small- to medium-sized effects for the relationships between PA and SWB (broadly defined), PA and depressive symptoms, and PA and life satisfaction. Studies using experimental and quasi-experimental designs yielded larger effects for SWB (broadly defined) and life satisfaction, than studies using nonexperimental study designs. CONCLUSIONS: There is a small- to medium-sized positive relationship between PA and SWB among people with SCI that holds across a wide range of measures and operational definitions of these constructs.

Lowering body mass index cutoffs better identifies obese persons with spinal cord injury.

STUDY DESIGN: Cross-sectional, non-experimental design. OBJECTIVES: (1) Determine the sensitivity and specificity of the general population body mass index (BMI) cutoff for obesity (30 kg m(-2)) in a representative sample of persons with spinal cord injury (SCI); (2) develop a more sensitive BMI cutoff for obesity based on percentage of fat mass (%FM) and C-reactive protein (CRP). SETTING: Ontario, Canada. METHODS: A total of 77 community-dwelling adults with chronic SCI underwent anthropometric measures (%FM by bioelectrical impedance analysis, length, weight, BMI (kg m(-2))) and provided blood samples to determine CRP. Sensitivity and specificity analyses, piecewise regression, non-linear regression, and receiver-operator characteristic curves were used to determine new BMI cutoffs. RESULTS: A BMI cutoff of 30 kg m(-2) failed to identify 73.9% of obese participants vs 26.1% at a lowered cutoff of 25 kg m(-2). BMI cutoffs based on risk levels of the %FM and CRP considered together ranged from 22.1 kg m(-2)-26.5 kg m(-2). CONCLUSIONS: People with chronic SCI and BMI values >22 kg m(-2) should be considered as being at high risk for obesity and obesity-related chronic diseases. SPONSORSHIP: Canadian Institutes of Health Research.

A pilot study examining correlates of body image among women living with SCI.

STUDY DESIGN: Cross-sectional pilot study. OBJECTIVES: To explore correlates of body image among women with spinal cord injury (SCI), within the framework of Cash's cognitive behavioral model of body image. SETTING: Hamilton, Ontario, Canada. METHODS: Women with SCI (N=11, 64% with tetraplegia) reported their functional and appearance body image (Adult Body Satisfaction Questionnaire). A 3-day recall of leisure time physical activity (LTPA), three measures of body composition (that is, weight, waist circumference, body fat) and several demographic variables were assessed as potential correlates. RESULTS: Appearance satisfaction was negatively correlated with all three measures of body composition and positively correlated with years postinjury. Functional satisfaction was positively correlated with years postinjury, and negatively correlated with various LTPA variables. CONCLUSION: Functional and appearance body image may improve with time following SCI. Body composition may impact satisfaction with physical appearance for some women. The negative relationship between LTPA and functional satisfaction merits further examination, as functional dissatisfaction may motivate individuals to engage in certain types and intensities of LTPA. Correlates of body image differ between appearance and functional satisfaction. Future research should examine appearance and functional satisfaction separately among women with SCI.

Evidence of dietary inadequacy in adults with chronic spinal cord injury.

STUDY DESIGN: Cross-sectional, observational study. OBJECTIVE: Estimate prevalence of inadequate dietary intakes in community-dwelling men and women with chronic spinal cord injury (SCI). SETTING: Ontario, Canada. METHODS: In-home interviewer administered multiple-pass 24-h recalls were collected at baseline (n=77) and at 6 months (n=68). Dietary intake (adjusted to remove intra-individual variation) was compared with the dietary reference intakes (DRIs), specifically the estimated average requirement, adequate intake (AI) and acceptable macronutrient distribution ranges (AMDR). RESULTS: Macronutrient intakes, as percentages of daily energy, for men (16% protein, 52% carbohydrate, 30% fat) and women (17% protein, 53% carbohydrate, 28% fat) were within the AMDR. Despite this, inadequate intakes for men (n=63) and women (n=14) were determined for vitamin A (92 and 57%), magnesium (89 and 71%), folate (75 and 79%), zinc (71 and 29%), vitamin C (52 and 14%), thiamine (22 and 14%), vitamin B12 (6 and 29%), riboflavin (5% men) and vitamin B6 (24% men). Mean usual intakes of fiber, vitamin D, calcium and potassium fell below the AI for men and women. In all, 53% of participants consumed a micronutrient supplement in the previous 24 h at baseline and at 6 months-specifically, calcium (29, 19%), multivitamin (26, 25%), vitamin D (22, 12%) and vitamin C (9, 6%). CONCLUSION: Our results show numerous nutrient inadequacies, relative to the DRIs, for men and women with SCI. This study has important implications for clinical dietetic practice in the SCI population.

More than looking good: impact on quality of life moderates the relationship between functional body image and physical activity in men with SCI.

STUDY DESIGN: Cross-sectional. OBJECTIVES: To examine the relationship between body image and leisure time physical activity (LTPA) among men with spinal cord injury (SCI). Specifically, to examine the moderating function of the perceived impact of body image on quality of life (QOL). SETTING: Ontario, Canada. METHODS: Men with SCI (N=50, 50% paraplegic) reported, (a) their functional and appearance body image (Adult Body Satisfaction Questionnaire), (b) their perceived impact of body image on QOL and (c) LTPA performed over the previous 3 days. RESULTS: Body image was in the 'normal' range compared with the general population. Linear regression analysis found a significant LTPA x body image impact on QOL interaction beta=0.39, P<0.05. Post hoc analysis showed that among individuals who reported a negative effect of body image on QOL, those who engaged in LTPA were less satisfied with their physical function than those who did not. For those who did not perceive their body image to negatively impact their QOL, there was generally no difference in functional body image between those who engaged in LTPA and those who did not. CONCLUSION: Appearance body image is not related to LTPA for men with SCI. It has been suggested that body dissatisfaction may motivate some individuals to engage in LTPA. However, for men living with SCI, functional body image may be associated with LTPA only when a negative effect on QOL is perceived. Future research should consider the moderating function of the perceived impact of body image on QOL when examining the relationship between LTPA and body image among men living with SCI.

Improving body image one step at a time: greater pedometer step counts produce greater body image improvements.

This randomized controlled trial examined whether the number of steps walked during an 11-week action planning intervention would mediate changes in sedentary women's body image. Seventy-five healthy, sedentary women were randomly assigned to either a control group, where they were required to self-monitor their daily pedometer-determined step count, or to an experimental group, where they were asked to self-monitor and form specific action plans for walking. Of the 75 participants randomized, 41 were included in the efficacy analyses. Measured outcomes were satisfaction with physical functioning and physical appearance, and daily pedometer-determined step counts. Greater satisfaction with physical functioning and higher step counts were found for the experimental group. Moreover, the total number of steps walked over Weeks 2-11 was shown to partially mediate the effect of the intervention on satisfaction with physical functioning. These findings suggest that walking greater distances is associated with greater improvement in at least one aspect of women's body images.

C-Reactive protein in adults with chronic spinal cord injury: increased chronic inflammation in tetraplegia vs paraplegia.

STUDY DESIGN: Cross-sectional. OBJECTIVES: In community-dwelling adults with chronic spinal cord injury (SCI), to (1) quantify C-reactive protein (CRP), a marker of inflammation and cardiovascular disease (CVD) risk; (2) determine factors associated with CRP. SETTING: Hamilton, Ontario, Canada. METHODS: We examined CVD risk factors in 69 participants. Measurements included length, weight, waist circumference, blood pressure, percent fat mass (bioelectrical impedance analysis) and fasting blood parameters (high-sensitivity CRP, lipids, insulin, glucose, insulin resistance by homeostasis model assessment (HOMA)). RESULTS: Mean CRP of the group was 3.37+/-2.86 mg-l(-1), consistent with the American Heart Association (AHA) definition of high risk of CVD. CRP was 74% higher in persons with tetraplegia (4.31+/-2.97) than those with paraplegia (2.47+/-2.47 mg l(-1), P=0.002), consistent with high CVD risk. Participants with high CRP (3.1-9.9 mg l(-1)) had greater waist circumference, BMI, percent fat mass and HOMA values than those with lower CRP (< or =3.0 mg l(-1), all P<0.05). LogCRP was independently correlated with waist circumference (r=0.612), logTriglycerides (r=0.342), logInsulin (r=0.309) and logHOMA (r=0.316, all P<0.05). Only level of lesion and waist circumference remained significantly associated with logCRP when variables with significant bivariate correlations were included in multiple regression analysis. CONCLUSION: Mean CRP values in this sample of adults with chronic SCI were consistent with the AHA classification of high CVD risk, especially those of persons with tetraplegia. Level of lesion and waist circumference are independently associated with CRP in this population.

Current coronary heart disease risk assessment tools may underestimate risk in community-dwelling persons with chronic spinal cord injury.

STUDY DESIGN: Cross-sectional, observational study. OBJECTIVES: To quantify, in adults with chronic spinal cord injury (SCI): (1) presence of metabolic syndrome versus the general North American population (GP) and (2) 10-year coronary heart disease (CHD) risk using Framingham risk scoring (FRS). SETTING: Ontario, Canada. METHODS: Fasting anthropometric and biochemical data were collected from 75 adults with chronic SCI. Metabolic syndrome was determined using four internationally recognized definitions and FRS using the most recent (2001) algorithm. RESULTS: Prevalence of metabolic syndrome was up to 5.4 times lower in SCI participants compared to GP, and FRS categorized 3.1% of participants as being at high 10-year CHD risk. However, high-sensitivity C-reactive protein (CRP) values indicated 36.7% of participants as being at high CHD risk. CONCLUSION: Current metabolic syndrome definitions and FRS may underestimate true CHD risk in people with SCI. Tools that better identify CHD risk require validation in the SCI population. CRP may be a potential factor to consider in the development of SCI-specific screening tools.