Nutrient Supplementation Post Ambulation in Persons With Incomplete Spinal Cord Injuries: A Randomized, Double-Blinded, Placebo-Controlled Case Series

Abstract Nash MS, Meltzer NM, Martins SC, Burns PA, Lindley SD, Field-Fote EC. Nutrient supplementation post ambulation in persons with incomplete spinal cord injuries: a randomized, double-blinded, placebo-controlled case series. Objective To examine effects of protein-carbohydrate intake on ambulation performance in persons with incomplete spinal cord injury (SCI). Design Double-blinded treatment with washout and placebo crossover. Setting Academic medical center. Participants Three subjects aged 34 to 43 years with incomplete SCI at C5-T4. Interventions Subjects walked to fatigue on 5 consecutive days. On fatigue, participants consumed 48g of vanilla-flavored whey and 1g/kg of body weight of carbohydrate (CH2 O). Weekend rest followed, and the process was repeated. A 2-week washout was interposed and the process repeated using 48g of vanilla-flavored soy. Main Outcome Measures Oxygen consumed (V̇ o2 ; in L/min), carbon dioxide evolved (V̇ co2 ), respiratory exchange ratio (RER: V̇ co2 /V̇ o2 ), time (in minutes), and distance walked (in meters) were recorded. Caloric expenditure was computed as V̇ o2 by time by 21kJ/L (5kcal/L) of oxygen consumed. Data were averaged across the final 2 ambulation sessions for each testing condition. Results Despite slow ambulation velocities (range, .11–.34m/s), RERs near or above unity reflected reliance on CH2 O fuel substrates. Average ambulation time to fatigue was 17.8% longer; distance walked 37.9% longer, and energy expenditure 12.2% greater with the whey and CH2 O supplement than with the soy drink. Conclusions Whey and CH2 O ingestion after fatiguing ambulation enhanced ensuing ambulation by increasing ambulation distance, time, and caloric expenditure in persons with incomplete SCI.