3. Gestion du risque cardiovasculaire en présence de LM

Capsules pour l’action pour LM (2nd ed., 2013)

En présence de LM, gérez le risque CV comme chez un patient ambulatoire à risque élevé.

Le problème:

La sédentarité et une prévalence élevée de facteurs de risque de MCV tels que dyslipidémie, diabète de type 2, hypertension et obésité contribuent à un risque élevé de maladie cardiovasculaire (MCV) en présence de LM. L’inactivité et une alimentation inadéquate mènent à l’obésité et au déconditionnement, ce qui limite les activités quotidiennes.

Pratiques d’excellence fondées sur des preuves:

Le traitement énergique de la dyslipidémie, de l’obésité et du diabète est essentiel pour prévenir une augmentation du risque cardiovasculaire. En présence de LM chronique, la pharmacothérapie du cholestérol devrait être alignée sur les directives visant les patients à risque élevé. Le diabète devrait être traité comme dans la population générale.

On a estimé que 50-75 % des personnes ayant une LM sont obèses, et d’importants déficits nutritionnels ont été observés. Les valeurs seuils de l’indice de masse corporelle (IMC) doivent être ajustées pour tenir compte du changement de composition corporelle lié à la LM. On recommande de déplacer le seuil d’embonpoint à 22 contre 25 pour la population générale). La circonférence de la taille, le rapport taille-hanches et la circonférence du cou se sont avérées des substituts raisonnables de l’IMC, étant donné la difficulté de mesurer précisément le poids et la taille chez un patient en fauteuil roulant.

En présence de LM, les lignes directrices fondées sur des preuves touchant l’activité physique recommandent >20 minutes d’activité aérobie modérée ou vigoureuse, deux fois par semaine, ainsi qu’un entraînement en résistance de tous les groupes musculaires importants, deux fois par semaine. L’activité physique régulière a été associée à une amélioration de la condition physique, du profil lipidique, de l’équilibre glycémique, de la douleur et de la dépression. Plusieurs types d’exercice sont populaires, dont : ergomètre manuel, entraînement et sports en fauteuil roulant, natation, entraînement en résistance et ergométrie sous stimulation électrique. Avant de participer à une activité physique, le patient devrait être informé des risques de blessure par surentraînement (voir capsule no 7 : Gestion de la douleur musculosquelettique), d’hyperréflexie autonome et de perturbation de l’homéostasie thermique (voir capsule no 4 : Hyperréflexie autonome).

Source clé:

   Myers, J. (2009). Cardiovascular disease after SCI: Prevalence, instigators, and risk clusters. Topics in Spinal Cord Injury Rehabilitation14(3): 1-14.

Références supplémentaires:

    Anneken, V., Hanssen-Doose, A., Hirschfeld, S., Scheuer, T., & Thietje, R. (2010). Influence of physical exercise on quality of life in individuals with spinal cord injury. Spinal Cord48(5): 393-399.
    Arbour-Nicitopoulos, K.P., Ginis, K.A., & Latimer, A.E. (2009). Planning, leisure-time physical activity, and coping self-efficacy in persons with spinal cord injury: a randomized controlled trial. Archives of Physical Medicine & Rehabilitation90(12): 2003-11.
http://dx.doi.org/10.1016/j.apmr.2009.06.019
    Ashe, M.C., Eng., J.J., Krassioukov, A.V., Warburton, D.E.R., Hung, C., & Tawashy, A. (2010). Response to functional electrical stimulation cycling in women with spinal cord injuries using dual-energy X-ray absorptiometry and peripheral quantitative computed tomography: A case series. Journal of Spinal Cord Medicine33(1): 68-72.
    Bloeman-Vrencken, J.H., de Witte, L.P., Post, M.W., & van den Heuvel, W.J. (2006). Health behavior of persons with spinal cord injury. Spinal Cord45(3): 243-9.
    Brurok, B., Helgerud, J., Karisen, T., Leivseth, G., & Hoff, J. (2011). Effect of aerobic high-intensity hybrid training on stroke volume and peak oxygen consumption in men with spinal cord injury. American Journal of Physical Medicine & Rehabilitation90(5): 407-414.
    Buchholz, A.C., et al. (2009). Greater daily leisure time physical activity is associated with lower chronic disease risk in adults with spinal cord injury. Applied Physiology, Nutrition, & Metabolism = Physiologie Appliquee, Nutrition et Metabolisme34(4): 640-7.
http://dx.doi.org/10.1139/h09-050
    Buchholz, A.C., McGillivray, C.F., & Pencharz, P.B. (2003). Physical activity levels are low in free-living adults with chronic paraplegia. Obesity Research11(4): 563-70.
http://dx.doi.org/10.1038/oby.2003.79
    de Groot, P.C., et al. (2003). Effect of training intensity on physical capacity, lipid profile and insulin sensitivity in early rehabilitation of spinal cord injured individuals. Spinal Cord41(12): 673-9. http://dx.doi.org/10.1038/sj.sc.3101534
    Carison, M.J., & Krahn, G. (2006). Use of complementary and alternative medicine practitioners by people with physical disabilities: Estimates from a National US survey. Disability and Rehabilitation28(8): 505-13.
    Carpenter, C., Forwell, S.J., Jongbloed, L.E., & Backman, C.L. (2007). Community participation after spinal cord injury. Archives of Physical Medicine & Rehabilitation88(4): 427-33.
    Carvalho de Abreau, D.C., Cliquet, A., Rondina, M., & Cendes, F. (2009). Electrical stimulation during gait promotes increase in muscle cross-sectional area in quadriplegics: A preliminary study. Clinical Orthopaedics and Related Research467(2): 553-557.
    Chen, Y, Cao, Y., Allen, V., & Richards, J.S. (2011). Weight matters: Physical and psychosocial well being of persons with spinal cord injury in relation to body mass index. Archives of Physical Medicine & Rehabilitation92(3): 391-8.
    Cragg, J.J., Stone, J.A., & Lrassioukov, A.V. (2012). Management of cardiovascular disease risk factors in individuals with chronic spinal cord injury: An evidence based review. Journal of Neurotrauma29(11): 1999-2012.
    Dyson-Hudson, T.A., & Nash, M.S. (2009). Guideline-driven assessment of cardiovascular disease and related risks after spinal cord injury. Topics in Spinal Cord Injury Rehabilitation14(3): 32-45.
    El-Sayed, M.S., & Younesian, A. (2005). Lipid profiles are influenced by arm cranking exercise and training in individuals with spinal cord injury. Spinal Cord43(5): 299-305.
http://dx.doi.org/10.1038/sj.sc.3101698
    Feasal, S., & Groah, S.L. (2009). The impact of diet on cardiovascular disease risk in individuals with spinal cord injury. Topics in Spinal Cord Injury Rehabilitation, 14(3): 58-68.
    Fraser, C., Teasell, R.W., Mehta, S. (2012). Nutrition issues following spinal cord injury. In Eng, J.J., Teasell, R.W., Miller, W.C., Wolfe, D.L., Townson, A.F., Hseich, J.T.C., et al. editors. Spinal Cord Injury Rehabilitation Evidence. Version 4.0. Vancouver
    Frisbie, J.H. (2010). Anemia and hypoalbuminemia of chronic spinal cord injury: Prevalence and prognostic significance. Spinal Cord48(7): 566-569.
    Glinsky, J., Harvey, L., van Es, P., Chee, S., & Gandevia, S.C. (2009). The addition of electrical stimulation to progressive resistance training does not enhance the wrist strength of people with tetraplegia: A randomized controlled trial. Clinical Rehabilitation23(8): 696-704.
    Goldberg, R.B. (2009). Guideline-driven intervention on SCI-associated dyslipidemia, metabolic syndrome, and glucose intolerance using pharmacological agents. Topics in Spinal Cord Injury Rehabilitation14(3): 46-47.
    Griffen, L., Decker, M.J., Hwang, J.Y., Wang, B., Kitchen, K., Ding, Z., & Ivy, J.L. (2009). Functional electric stimulation cycling improves body composition, metabolic and neural factors in persons with spinal cord injury. Journal of Electromyography and Kinesiology19(4): 614-622.
    Groah, S.L., Nash, M.S., Ljungberg, I.H., Libin, A., Hamm, L.F., Ward, E., Burns, P.A., & Enfield, G. (2009). Nutrient intake and body habitus after spinal cord injury: An analysis by sex and level of injury. Journal of Spinal Cord Medicine32(1): 25-33.
    Groah, S.L., Spungen, M.I., & Bauman, W.A. (2009). Cardiovascular disease in individuals with spinal cord injury: Toward best practice. Topics in Spinal Cord Injury Rehabilitation14(3): 84-98.
    Hacker, C., Pandya, S., Sepahpanah, F., & Zaman, A.Y. (2010). Prevalence of diabetes mellitus in chronic spinal cord injury patients. PM and R conference: 71st Annual Assembly of the American Academy of Physical Medicine and Rehabilitation Seattle, WA.
    Hetz, S.P., Latimer, A.E., & Martin Ginis, K.A. (2009). Activities of daily living performed by individuals with SCI: Relationships with physical fitness and leisure time physical activity. Spinal Cord47(7): 550-554.
    Hicks, A.L., et al. (2003). Long-term exercise training in persons with spinal cord injury: effects on strength, arm ergometry performance and psychological well-being. Spinal Cord41(1): 34-43. http://dx.doi.org/10.1038/sj.sc.3101389
    Hicks, A.L., Martin Ginis, K.A., Pelletier, C.A., Ditor, D.S., Foulon, B., & Wolfe, D.L. (2011). The effects of exercise training on physical capacity, strength, body composition and functional performance among adults with spinal cord injury: A systematic review. Spinal Cord49(11): 1103-1127.
    Jack, L.P., Allan, D.B., & Hunt, K.J. (2009). Cardiopulmonary exercise testing during body weight supported treadmill exercise in incomplete spinal cord injury: A feasibility study. Technology and Health Care17(1): 13-23.
    Jacobs, P.L. (2009). Effects of resistance and endurance training in persons with paraplegia. Medicine and Science in Sports and Medicine41(5):992-997.
    Jacobs, P.L., & Nash, M.S. (2004). Exercise recommendations for individuals with spinal cord injury. Sports Medicine34(11): 727-51. http://dx.doi.org/10.2165/00007256-200434110-00003
    Janssen, T.W., et al. (1994). Relationship between physical strain during standardised ADL tasks and physical capacity in men with spinal cord injuries. Paraplegia32(12): 844-59.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=7708424
   Johnston, M.V., Diab, M.E., Chu, B.C., & Kirshblum, S. (2005). Preventative services and health behaviors among people with spinal cord injury. Journal of Spinal Cord Medicine28(1): 43-54.
   Kahn, N.N., Feldman, S.P., & Beauman, W.A. (2010). Lower-extremity functional electrical stimulation decreases platelet aggregation and blood coagulation in persons with chronic spinal cord injury: A pilot study. Journal of Spinal Cord Medicine33(2): 150-158.
   Kehn, M., & Kroll, T. (2009). Staying physically active after spinal cord injury: A qualitative exploration of barriers and facilitators to exercise participation. BMC Public Health9(168).
http://dx.doi.org/10.1186/1471-2458-9-168
    Kern, H., Carraro, U., Adami, N., Hofer, C., Loefler, S., Vogelauer, M., Mayr., W., et al. (2010). One year of home-based daily FES in complete lower motor neuron paraplegia: Recovery of tetanic contractility drives the structural improvements of denervated muscle. Neurology Research32(1): 5-12.
    Kinne, S., Patrick, D.L., & Maher, E.J. (1999). Correlates of exercise maintenance among people with mobility impairments. Disability & Rehabilitation21(1): 15-22.
http://dx.doi.org/10.1080/096382899298052
    Latimer, A.E., Ginis, K.A.M., & Arbour, K.P. (2006). The efficacy of an implementation intention intervention for promoting physical activity among individuals with spinal cord injury: A randomized controlled trial. Rehabilitation Psychology51(4): 273-280.
http://dx.doi.org/10.1037/0090-5550.51.4.273
    Laughton, G.E., Buchholz, A.C., Martin Ginis, K.A., Goy, R.E.; SHAPE Research Group (2009). Lowering body mass index cutoffs better identifies obese persons with spinal cord injury. Spinal Cord47(10): 757-62.
    Liang, H., Tomey, K., Chen, D., Saver, N.L., Rimmer, J.H., Braunscheig, C.L. (2008). Objective measures of neighborhood environment and self-reported physical activity in spinal cord injured men. Archives of Physical Medicine & Rehabilitation89(8): 1468-73.
    Martin Ginis, K.A., et al. (2003). Using exercise to enhance subjective well-being among people with spinal cord injury: The mediating influences of stress and pain. Rehabilitation Psychology48(3): 157-164. http://dx.doi.org/10.1037/0090-5550.48.3.157
    Martin Ginis, K.A., et al. (2010). Physical activity and subjective well-being among people with spinal cord injury: a meta-analysis. Spinal Cord48(1): 65-72.
http://dx.doi.org/10.1038/sc.2009.87
    Martin Ginis, K.A., Arbour-Nicitopoulos, K.P., Latimer, A.E., Buchholz, A.C., Bray, S.R., Craven, B.C., Hayes, K.C. et al. (2010). Leisure time physical activity in population-based sample of people with spinal cord injury part I: Demographic and injury-related correlates. Archives of Physical Medicine & Rehabilitation91(5), 722-728.
    Martin Ginis, K.A., Arbour-Nicitopoulos, K.P., Latimer, A.E., Buchholz, A.C., Bray, S.R., Craven, B.C., Hayes, K.C. et al. (2010). Leisure time physical activity in population-based sample of people with spinal cord injury part II: Activity types, intensities, and durations. Archives of Physical Medicine & Rehabilitation91(5), 729-733.
    Martin Ginis, K.A., Latimer, A.E., Buchholz, A.C., Bray, S.R., Craven, B.C., Hayes, K.C., Hicks, A.L., et al. (2007). Establishing evidence-based physical activity guidelines: Methods for the Study of Health and Activity in People with Spinal Cord Injury (SHAPE SCI). Spinal Cord46(3): 216-21.
    McMahon, D., Tutt, M., & Cook, A.M. (2009). Pharmacological management of hemodynamic complications following spinal cord injury. Orthopedics32(35): 331.
    Millar, P.J., Rakobowchuk, M., Adams, M.M., Hicks, A.L., McCartney, N., & MacDonald, M.J. (2009). Effects of short-term training on heart rate dynamics in individuals with spinal cord injury. Autonomic Neuroscience: Basic and Clinical150(1-2): 116-121.
    Nash, M.S. (2005). Exercise as a health-promoting activity following spinal cord injury. Journal of Neurologic Physical Therapy29(2): 87-103.
http://dx.doi.org/10.1097/01.NPT.0000282514.94093.c6
    Nash, M.S., et al. (2001). Circuit resistance training improves the atherogenic lipid profiles of persons with chronic paraplegia. Journal of Spinal Cord Medicine24(1): 2-9.
http://www.ncbi.nlm.nih.gov/pubmed/11587430
    Nash, M.S., Cowan, R.E., & Kressler, J. (2012). Evidence-based and heuristic approaches for customization of care in cardiometabolic syndrome after spinal cord injury. Journal of Spinal Cord Medicine35(5): 278-92.
    Nash, M.S., van Elk, N., & Johnson, B.M. (2007). Effects of circuit resistance training on fitness attributes and upper-extremity pain in middle-aged men with paraplegia. Archives of Physical Medicine & Rehabilitation88(1): 70-75. http://dx.doi.org/10.1016/j.apmr.2006.10.003
    Oleson, C.V., Patel, P.H., & Wuermser, L.A. (2010). Influence of season, ethnicity, and chronicity on vitamin D deficiency in traumatic spinal cord injury. Journal of Spinal Cord Medicine33(3): 202-213.
    Opperman, E.A., Buchholz, A.C., Darlington, G.A., Martin Ginis, K.A.; SHAPE-SCI Research Group (2010). Dietary supplement use in the spinal cord injury population. Spinal Cord48(1): 60-4.
    Phillips, A.A., Cote, A.T., & Warburton, D.E.R. (2011). A systematic review of exercise as a therapeutic intervention to improve arterial function in persons living with spinal cord injury. Spinal Cord49(6): 702-714.
    Ravensbergen, H.J.C., Keenleyside, M.C., Lear, S.A., & Claydon, V.E. (2012). What is the best marker for obesity in individuals with spinal cord injury? Clinical Autonomic Research Conference22(5): 245.
    Rick Hansen Institute, & SCI Action Canada (2011). Physical activity guidelines for adults with spinal cord injury. McMaster University, Hamilton, Ontario, Canada.
    Scelza, W.M., et al. (2005). Perceived barriers to exercise in people with spinal cord injury. American Journal of Physical Medicine & Rehabilitation84(8): 576-83.
http://dx.doi.org/10.1097/01.phm.0000171172.96290.67
     Stenson, K.W., Deutsch, A., Heinemann, A.W., & Chen, D. (2011). Obesity and inpatient rehabilitation outcomes for patients with traumatic spinal cord injury. Archives of Physical Medicine & Rehabilitation92(3): 384-90.
     Soyupek, F., Savas, S., Ozturk, O., Ilgun, E., Bircan, A., & Akkaya, A. (2009). Effects of body weight supported treadmill training on cardiac and pulmonary functions in the patients with incomplete spinal cord injury. Journal of Back and Musculoskeletal Rehabilitation22(4): 213-218.
    Tanhoffer, R.A., Tanhoffer, A.I., Raymond, J., Hills, A.P., & Davis, G.M. (2012). Comparison of methods to assess energy expenditure and physical activity in people with spinal cord injury. Journal of Spinal Cord Medicine35(1): 35-45.
    Tawashy, A.E., Eng, J.J., Lin, K.H., Tang, P.F., & Hung, C. (2009). Physical activity is related to lower levels of pain, fatigue and depression in individuals with spinal-cord injury: A correlational study. Spinal Cord47(4): 301-306.
    Taylor, J.A., Picard, G., & Widrick, J.J. (2011). Aerobic capacity with hybrid FES rowing in spinal cord injury: Comparison with arms-only exercise and preliminary findings with regular training. Physical Medicine and Rehabilitation3(9): 817-824.
    Turiel, M., Sitia, S., Cicala, S., Magagnin, V., Bo, I., Porta, A., Caini, E., et al. (2011). Robotic treadmill training improves cardiovascular function in spinal cord injury patients. International Journal of Cardiology149(3): 323-329.
    van den Berg-Emons, R.J., et al. (2008). A prospective study on physical activity levels after spinal cord injury during inpatient rehabilitation and the year after discharge. Archives of Physical Medicine & Rehabilitation89(11): 2094-101.
http://dx.doi.org/10.1016/j.apmr.2008.04.024
    Wahman, K., Nash, M.S., Lewis, J.E., Seiger, A., & Levi, R. (2011). Cardiovascular disease risk and the need for prevention after paraplegia determined by conventional multifactorial risk models: The Stockholm spinal cord injury study. Rehabilitation Medicine43(3): 237-242.
    Walters, J.L., Buchholz, A.C., Martin Ginis, K.A.; SHAPE-SCI Research Group (2009). Evidence of dietary inadequacy in adults with chronic spinal cord injury. Spinal Cord47(4): 318-22.
    Warburton, D.E.R., Charlesworth, S., Ivey, A., Nettlefold, L., & Bredin, S.S.D. (2010). A systematic review of the evidence for Canada’s Physical Activity Guidelines for Adults. International Journal of Behavioral Nutrition and Physical Activity7: article 39.
    Warburton, D.E.R., Sproule, S., Krassioukov, A., & Eng, J.J. (2012). Cardiovascular health and exercise following spinal cord injury. In Eng, J.J., Teasell, R.W., Miller, W.C., Wolfe, D.L., Townson, A.F., Hseich, J.T.C., et al. editors. Spinal Cord Injury Rehabilitation Evidence. Version 4.0. Vancouver
    Warms, C.A., et al. (2004). Lifestyle Physical Activity for Individuals with Spinal Cord Injury: A Pilot Study. American Journal of Health Promotion18(4): 288-291.
http://www.ncbi.nlm.nih.gov/pubmed/15011927
    Wolfe, D.L., Martin Ginis, K.A., Latimer, A.E., Foulon, B.L., Eng, J.J., Hicks, A.L., & Hsieh, J.T.C. (2012). Physical activity and SCI. In Eng, J.J., Teasell, R.W., Miller, W.C., Wolfe, D.L., Townson, A.F., Hseich, J.T.C., et al. editors. Spinal Cord Injury Rehabilitation Evidence. Version 4.0. Vancouver