Blood Profile and General Health Status in Sedentary and Physically Active Individuals

JEPonline

Blood Profile and General Health Status in Sedentary and Physically Active Individuals with Spinal Cord Injury

Aldre I. P. Tanhoffer1, 2, Mariana B. Ferreira3,Simone Abe4,

Railson Henneberg5,Aline B. Hauser5, Katya Naliwaiko3,

Ricardo A. Tanhoffer1, Luiz C. Fernandes1

1Laboratory of Cell Metabolism, Department of Physiology,

Biological Sciences Building, Federal University of Parana, Curitiba, Parana, Brazil, 2Department of Physical Education, Biological Sciences Building, Federal University of Parana, Curitiba, Parana, Brazil, 3Department of Cellular Biology, Biological Sciences Building, Federal University of Parana, Curitiba, Parana, Brazil,4School of Medicine, Federal University of Parana, Curitiba, Parana, Brazil,5Department of Clinical Analysis, Health Sciences Building, Federal University of Parana, Curitiba, Parana, Brazil

ABSTRACT

Tanhoffer AIP, Boia-Ferreira M, Abe S, Henneberg R, Hauser AB, Naliwaiko K, Tanhoffer RA, Fernandes LC.Blood Profile and General Health Status in Sedentary and Physically Active Individuals with Spinal Cord Injury.JEPonline2016;19(2):76-83. The purpose of this study was to compare comprehensive blood tests assay and other physical parameters among three groups: (a) able-bodiedgroup (AB; n=8); (b) sedentary individuals with spinal cord injury (SCI) (SED; n=12) and; (c) physically active individuals with SCI (EXE; n=9). Demographic, anthropometric, and blood samples were collected from each subject. The study did not find major differences among the three groups, that is, except forsignificant differences in triglycerides, HDL, and LDL cholesterol. The blood lipid parameters clearly indicate the role of exercise for improving the general health of people with SCI.

Key Words: Exercise, Metabolism, Spinal Cord Injury

INTRODUCTION

People with spinal cord injury (SCI) present lower levels of physical activity and energy expenditure than the able-bodied population, and this has partly been attributed to altered body composition and/or impaired sympathetic nervous system activity(6). In addition, it has been demonstrated that individuals with SCI present high occurrence of secondary conditions and/or pathologies such as upper respiratory tract and bladder infections, dyslipidemias, type 2 diabetes, obesity, and cardiovascular disease. In fact, these conditions seem to develop earlier and with increased incidence than in the general population(4). Conversely, and not surprisingly, physical activity can play an important role in order to improve body composition and general health status by means of decreasing or even avoiding the high incidence of secondary pathologies in this population(8).

Usually, for those individuals with SCI, many common diseases are asymptomatic and can rapidly become a fatal condition because of their impaired immune system. Therefore, routinely performed blood tests might be a relatively easy and inexpensive method to identify the risk factors of different pathologies. Although there is information on blood parameters of individuals with SCI, to the best of our knowledge there are no publicationsthat report having performed such a complete blood test assay as conducted in the present studyand, as well, having compared sedentary and physically active people with SCI. This approach was important and unique since it put all pieces together from the same population and in the same intervention, which normally researchers have to gather information separately from different studies.

Considering the importance of physical activity in general health, the purpose of this study was to gather demographic and anthropometric data and perform a complete blood test assay in able-bodied people, sedentary individuals with SCI, and physically active individuals with SCIto verify whether physical inactivity might decrease the general health status of people with SCI.

METHODS

Subjects

Twenty-nine subjects were recruited for this study. The subjects were allocated in three different groups: (a) able-bodied group (AB; n =8); (b) sedentary individuals with SCI (SED; n =12) and; (c) physically active individuals with SCI (EXE; n =9). Inclusion criteria were: (a) aged between 18 to 55 yrs; (b) at least 1 yr post-injury; and (c) not taking medicines for dyslipidemiasand/or diabetes. Informed consent was gained from all the subjects. Approval for this study was granted by the Federal University of Parana Human Research Ethics Committee.

Procedures

With the subjects wearing light clothing, body mass was measured to the nearest 0.1 kg using a digital scale (K Tron, Arizona, USA). The mass of the wheelchair was subtracted from the total mass of the subjects in their wheelchair. Stature, waist, and hip circumferences were measured using a metal measuring tape (Gulick Tape Measure) while the subject laid in a supine posture. The following self-reported information was recorded: age, gender, neurological level and severity of lesion, and time since injury. Anthropometric and demographics are depicted in Table 1.

Blood tests were conducted at the Federal University of Parana. All subjects were invited to arrive at the Laboratory of Cell Metabolism between 7:30 and 9:30 am after an overnight fast. The subjects were asked to refrain from smoking, alcohol, and strenuous physical activity. Blood was collected by an experienced and accredited professional. White blood cell count, red blood cell count, platelet, lipid profile, glucose concentration, and blood markers for metabolic diseases were conducted in the Pharmacy School of Federal University of Parana.

Statistical Analyses

Due to the specificity of the population, a sample of convenience was utilized in this study. Data are presented as mean±SD. All analyses were performed using SPSS 20, and the results were statistically significant at P<0.05. One-way analysis of variance (ANOVA) followed by a post hocTukey test were performed to determine whether there were differences among all variables.

RESULTS

There were no differences in the subjects’ anthropometric measures between groups as depicted in Table 1.Table 2 presents both the white blood cell and platelet count. The EXE group showed significantly (P≤0.05) lower counting for bands compared to the AB and SED groups. The other cell lineages did not show significant differences. As demonstrated in Table 3, the SED group had significantly lower hematocrit, MCV, and MCH when compared to the AB group.

Table 1. Descriptive Data of the Subjects.

Conditions / AB
n = 8 / SED
n = 12 / EXE
n = 9
Age(yrs) / 36.0  11.2 / 33.6  8.9 / 37.6  10.2
TSI(yrs) / - / 6.9  5.7 / 10.6  4.8
Stature(cm) / 175  5.6 / 176  11.6 / 168  6.3
Body mass(kg) / 80.8  18.9 / 74.2  22.6 / 68.1  12.1
BMI / 20  2.3 / 21  2.7 / 21  1.7
HR(beats·min-1) / 72.7 10.2 / 80.8  16.8 / 76.7  10.0
MAP(mmHg) / 94.7  9.5 / 90.3  16.3 / 97.6  14.3
WC(cm) / 88.1  16.1 / 76.3  10.7 / 88.0  7.1
HC (cm) / 97.4  9.5 / 85.8  11.4 / 91.7  7.2
WCR / 0.77 0.35 / 0.81  0.31 / 0.82  0.33

Data are presented as mean  SD. Abbreviations: AB = able-bodied group;SED = group spinal cord injury – Sedentary; EXE = group spinal cord injury – exercised;TSI = time since injury; BMI = body mass index;HR = heart rate (rest); MAP = mean arterial pressure; WC = waist circumference; HC = hip circumference; WHR = waist-to-hip ratio.

Table 2. White Blood Cell and Platelet Count.

Cell / AB
n = 8 / SED
n = 12 / EXE
n = 9
Lymphocytes(%) / 29.7 9.3 / 31.4 8.0 / 36.1 11.1
Eosinophil(%) / 2.0  0.6 / 3.1 1.3 / 2.1 2.2
Basophil(%) / 1.0 1.3 / 1.0 1.3 / 0.6 0.5
Monocytes(%) / 6.3 2.3 / 4.5 2.5 / 6.6 3.1
Bands(%) / 2.5 1.5 / 3.5 2.7* / 1.4 1.5*
Segmented(%) / 72.7  10.2 / 80.8  16.8 / 76.7  10.0
Atypical lymphocytes(%) / 0.8 1.2 / 0.51.0 / 0.4 0.7
Platelets(.103/mm3) / 228 54 / 211 40 / 242 56
MPV(%) / 8.4 0.6 / 8.6 0.7 / 8.4 0.5
PDW(%) / 15.5  0.7 / 16.4 1.2 / 16.2 1.6

Data are presented as mean  SD. Abbreviations: AB = able-bodied group;SED = group spinal cord injury – Sedentary; EXE = group spinal cord injury – exercised;MPV = mean platelet volume; PDW = platelet distribution width. *P≤0.05 between SED and AB and SED and EXE.

Table 3. Red Blood VellVount.

Cell / AB
n = 8 / SED
n = 12 / EXE
n = 9
Erythrocyte(.106/mm3) / 4.9 0.3 / 4.9 0.4 / 4.80.4
Hemoglobin(g·dL-1) / 13.1  5.8 / 12.7 4.6 / 14.2 1.4
Hematocrit(%) / 44.3 2.7 / 41.5 3.3* / 41.3 4.1
MCV(fL) / 89.0 2.0 / 83.2  4.5* / 86.0 5.8
MCH (pg) / 30.7 0.5 / 28.4 1.5* / 29.5 2.1
MCHC(g·dL-1) / 34.5 1.1 / 34.0 0.7 / 34.4 0.9
RDW(%) / 12.3 0.5 / 13.3 1.0 / 12.8 0.6

Data are presented as mean  SD. Abbreviations: AB = able-bodied group;SED = group spinal cord injury – Sedentary; EXE = group spinal cord injury – exercised; MCV = mean corpuscular volume; MCH = mean corpuscular hemoglobin; MCHC = mean corpuscular hemoglobin concentration; RDW = red cell distribution width. *P≤0.05 between SED and AB.

Glucose concentration did not show a significant difference across the three groups. However, total cholesterol and triglycerides were significantly lower for the EXE group compared to the SED group. LDL cholesterol was higher for the SED group compared to the AB and EXE groups. HDL cholesterol was significantly higher for the AB group in comparison to both SED and EXE (Table 4). Table 5 indicates that the blood markers for metabolic diseases showed no significant differences across the groups except for the higher response of ALT in the EXE group compared to the SED group.

Table 4. Lipid and Glucose Profile.

Assays / AB
n = 8 / SED
n = 12 / EXE
n = 9
Total cholesterol(mg·dL-1) / 171 20.6 / 175 39.5 / 161 27.5*
Triglycerides(mg·dL-1) / 111  50.3 / 124 55.1 / 89.3 49.5*
HDL(mg·dL-1) / 61.0 11.9** / 40.1 6.6 / 41.8 6.5
LDL(mg·dL-1) / 96.9 27.3 / 115.5 20.7§ / 96.6 18.6
Glucose (mg·dL-1) / 91.0 6.8 / 84.1 8.7 / 87.9 8.5

Data are presented as mean  SD. Abbreviations: AB = able-bodied group;SED = group spinal cord injury – Sedentary; EXE = group spinal cord injury – exercised; HDL = high-density lipoprotein cholesterol; LDL = low-density lipoprotein cholesterol.*P≤0.05 between EXE and SED; **P≤0.05 when comparing AB to both SED and EXE; §P≤0.05 when comparing SED with AB and EXE.

Table 5. Blood Markers for Metabolic Diseases.

Conditions / AB
n = 8 / SED
n = 12 / EXE
n = 9
Creatinine(mg·dL-1) / 36.0  11.2 / 33.6  8.9 / 37.6  10.2
Urea(mg·dL-1) / 21.2 5.5 / 24.1 4.7 / 24.6  4.9
Albumin (g·dL-1) / 175  5.6 / 176  11.6 / 168  6.3
Total proteins(g·dL-1) / 80.8  18.9 / 74.2  22.6 / 68.1  12.1
CK(U/L) / 72.7  10.2 / 80.8  16.8 / 76.7  10.0
ALT(U/L) / 94.7  9.5 / 90.3  16.3 / 97.6  14.3*
AST(U/L) / 88.1  16.1 / 76.3  10.7 / 88.0  7.1

Data are presented as mean  SD. Abbreviations: AB = able-bodied group;SED = group spinal cord injury – Sedentary; EXE = group spinal cord injury – exercised; CK = creatinekinase; AST = aspartatetransaminase; ALT = alaninetransaminase. *P≤0.05 between SED and EXE.

DISCUSSION

People with spinal cord injury (SCI) have been characterized as extremely sedentary. Hence, the daily lifestyle of the average person with a SCI is not sufficient to provide adequate stress to maintain health and well-being(10). Sublesional skeletal muscle paralysis and sedentary lifestyle behaviors result in loss of lean tissue mass and a gain in adiposity that dramatically decreases in the daily energy expenditure (3).

Due to the combination of physical inactivity and decreased skeletal muscle mass, overweight and obesity are common secondary complications of chronic SCI. Moreover, the sedentary lifestyle is associated with numerous adverse metabolic sequelae, such as type 2 diabetes mellitus, dyslipidemia,and hypertension, which in turn are considered risk factors for cardiovascular disease (CVD) (5,7,13). In fact, CVD is the main cause of morbidity and mortality in people with SCI (1), and tend to occur earlier and be more prevalent in the SCI population than in the able-bodied individuals (13).

While the CVD risk factors are oftendangerously silent with either extremely severe or even mortal consequence, physical capacity in SCI individuals seems to be positively associated with body composition, glucose, lipid metabolism (2,9,11,12), and inflammatory markers (12). In fact, given that infection, inflammation, and CVD can be detected with simple blood assays, the present study performed a complete blood test screening in AB, SED, and EXE individuals to identify possible effects of physical inactivity in the SCI subjects. The objective was to identify an ease and relatively inexpensive method to identify CVD risk factors in the SCI subjects.

Although white cells (Table 2), red cells (Table 3), and blood markers for metabolic diseases (Table 5) showed a few statistically significant differences in some of the parameters among the groups, thehigher or lower differences were not clinically relevant. Each of the measured parameters responded inside the subjects’ normal range values. On average, individuals of all groups were 35 yrs oldof which one could expect a relatively healthy status for such a young population (even considering individuals with a SCI). White cells are used to identify inflammation or infection, but the subjects apparently had no such pathologies. Red cells can be useful to detect anemia or nutritional deficiencies. Although the SED group demonstrated significantly lower hematocrit, MCV, and MCH compared to the AB and EXE groups (which could be a sign of anemia), the values indicate they are clinically healthy.

When compared to the AB and EXE groups, the SED group showed significantly higher TG and LDLlevels (Table 4). It is known thatdyslipidemiais related to obesity, unhealthy diet, and lack of exercise, which increases the chance of atherosclerosis, heart attacks, stroke, or other circulatory concerns, especially in sedentary adults.Also, the SED group demonstrated a significantly lower HDL compared to the AB group. Indeed, it has been shown that cardiovascular diseases are the leading cause of death in individuals with SCI (14). Yet, while the HDL in SCI subjects has been shown to be associated with a decreased level of physical activity, even the EXE group had significantly lower HDL when compared to the AB group. Interestingly, given these findings it is important mention again the young age of the subjects in the present study. Also, the EXEgroup demonstrated a significantly lower TC, TG, and LDL when compared to the AB and SED groups (Table 4), which suggests an exercise effect on the lipid profiles in subjects with SCI.

CONCLUSION

Our data demonstrated that even such a young population with SCI (34 ± 9 yrs old) had significantly higher blood lipids, which is a public health concern. On the other hand, we also demonstrated that regular exercise might play an important role in the control of blood lipid concentration, as the EXE group had no altered cholesterols (except for the lower but still border line HDL, even when using much less muscle mass than the general population.

ACKNOWLEDGMENTS

This research was partly funded by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – CAPES.

Address for correspondence: Ricardo A. Tanhoffer, PhD, Department of Physiology, Federal University of Parana, Curitiba, Parana, Brazil, Email:

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