Effects of dose de-escalation following testosterone treatment and evoked resistance exercise on body composition, metabolic profile, and neuromuscular parameters in persons with spinal cord injury

Ashraf S Gorgey, Refka E Khalil, Ranjodh Gill, Rehan Khan, Robert A Adler, Ashraf S Gorgey, Refka E Khalil, Ranjodh Gill, Rehan Khan, Robert A Adler

Abstract

The dose de-escalation (DD) effects of testosterone and evoked resistance training (RT) on body composition, cardiometabolic, and neuromuscular variables were investigated. Thirteen men with chronic complete spinal cord injury (SCI) were followed for additional 16 weeks after receiving either testosterone treatment only (TT) or TT+RT. During the 16-week DD period, the TT+RT group underwent a program of once weekly electrical stimulation with gradually decreasing ankle weights and testosterone patches of 2 mg day-1 (TT+RT group). The TT only group did not receive any intervention throughout the detraining period (no-TT group). Body composition was tested using anthropometrics, dual energy X-ray absorptiometry, and magnetic resonance imaging. After an overnight fast, basal metabolic rate (BMR), lipid panel, serum testosterone, inflammatory biomarkers, glucose effectiveness, and insulin sensitivity were measured. Finally, peak isometric and isokinetic torques were measured only in the TT+RT group. All measurements were conducted at the beginning and at the end of DD. Absolute thigh muscle cross-sectional areas (CSAs) demonstrated interaction effects (p < 0.05) between the TT+RT (-8.15%, -6.5%) and no-TT (2.3%, 4.4%) groups. Similarly, absolute knee extensor muscle CSA demonstrated interaction effects (p < 0.05) between the TT+RT (-11%, -7.0%) and no-TT (2.6%, 3.8%) groups. There was a trend (p = 0.07) of increasing visceral adipose tissue (VAT) CSAs in the TT+RT (18%) and in the no-TT (16% cm2 ) groups. There was an interaction (p = 0.005) between TT+RT (decreased by 3.7%) and no-TT groups (increased by 9.0%) in BMR. No interactions were evident between groups over time for biomarkers related to carbohydrate, lipid metabolism, or inflammation. Finally, there were no changes (p > 0.05) in peak isometric or isokinetic torques and rise time following 16 weeks of the DD period in the TT+RT group. TT+RT during 16 weeks of DD was minimally effective at preventing detraining relative to no-TT on muscle size, BMR, and VAT. However, neuromuscular gains were successfully maintained.

Trial registration: ClinicalTrials.gov NCT01652040.

Keywords: basal metabolic rate; body composition; dose de-escalation NMES; glucose effectiveness; inflammatory and anabolic biomarkers; resistance training; spinal cord injury; testosterone treatment; visceral adipose tissue.

Conflict of interest statement

The authors have no competing interests to declare.

© 2021 The Authors. Physiological Reports published by Wiley Periodicals LLC on behalf of The Physiological Society and the American Physiological Society.

Figures

FIGURE 1
FIGURE 1
Timeline of phase I (effects of TT+RT vs. TT only) and phase II (DD of TT+RT vs. no‐TT) on cardiometabolic risk factors and neuromuscular parameters in persons with chronic SCI. Dark blue reflects intervention in phase I (Gorgey, Khalil, et al., 2019) and light blue reflects the DD phase. DD, dose de‐escalation; RT, resistance training; TT, testosterone treatment
FIGURE 2
FIGURE 2
Representative MRI images of the mid‐thigh showing a step‐by‐step procedure of capturing and analysis (a) raw image; (b) whole thigh CSA after segmentation and tracing on the outside subdermal border and excluding the bone CSA. The whole thigh CSA includes thigh subcutaneous adipose tissue (SAT) and whole thigh muscle CSA; (c) whole thigh muscle CSA is measured after tracing on the deep subfascial border after excluding SAT (i.e., white adipose tissue surrounded by the two large green circles) and bone CSAs. The whole thigh muscle CSA includes absolute muscle CSA and intramuscular fat (i.e., white adipose tissue infiltrated within the anatomical boundaries of different muscle groups and inside the inner green circle). CSA, cross‐sectional area; MRI, magnetic resonance imaging
FIGURE 3
FIGURE 3
Changes in (a) VAT CSA and (b) VAT:SAT ratio following 16 weeks of DD period in the TT+RT and no‐TT groups. Considering the non‐uniform distribution of VAT, VAT CSAs were measured at different anatomical landmarks including the regions between liver and kidneys (Liv.‐Kid.), kidneys and umbilicus (Kid.‐Umb.), iliac crests and femoral heads (IC‐FH), and finally the average of all trunk MRI slices (total VAT). P‐values reflected main effects of time. CSA, cross‐sectional area; DD, dose de‐escalation; MRI, magnetic resonance imaging; RT, resistance training; SAT, subcutaneous adipose tissue; TT, testosterone treatment; VAT, visceral adipose tissue

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