Amaç: Çalışmanın amacı spinal kord yaralanmalı (SKY) bireylerde obezite ve dislipideminin manuel tekerlekli sandalye mobilizasyonuna etkisini araştırmaktır. Gereç ve Yöntemler: Yaralanma süresi ≥1 yıl olan, 18- 60 yaş arası, 102 kronik motor komplet SKY’li birey dâhil edildi. Obezite değerlendirmesinde beden kitle indeksi (BKİ) kullanıldı. Lipit profili olarak yüksek yoğunluklu lipoprotein [High Density Lipoprotein (HDL)]-kolesterol (HDL-K), düşük yoğunluklu lipoprotein [Low Density Lipoprotein (LDL)]-kolesterol (LDL-K), trigliserid (TG) ve total kolesterol (TK) değerleri ölçüldü. Mobilizasyonu değerlendirmek için manuel tekerlekli sandalye itme testleri (MTSİT) (20 m itme testi, slalom testi, 6 dk itme testi) uygulandı. SKY’ye özgü BKİ⩾22 kg/m² obez olarak sınıflandırılırken, <22 kg/m² obez olmayan olarak sınıflandırıldı. HDL-K<40 mg/dL düşük kabul edilirken, LDL-K≥130 mg/dL, TG≥150 mg/dL ve TK≥200 mg/dL yüksek olarak değerlendirildi. Katılımcılar ikili gruplara ayrıldı ve manuel tekerlekli sandalye itme testi sonuçları karşılaştırıldı. Bulgular: Katılımcıların %71,6’sının (n=73) obez olduğu, %69,6’sında HDL-K düşüklüğü, %27,4’ünde LDL-K yüksekliği, %45,1’inde TG yüksekliği ve %22,5’inde TK yüksekliği bulundu. TG<150 mg/dl olan grupta TG≥150 mg/dl olan gruba göre 20 m itme testi süresi anlamlı olarak daha düşük bulundu (p=0,014) ancak HDL-K, LDL-K ve TK düzeylerinin manuel tekerlekli sandalye itme testlerine etkisi anlamlı bulunmadı (p>0,05). BKİ<22 kg/m2 olan grupta BKİ≥22 kg/m2 olan gruba göre 20 metre itme testi süresi ve slalom testi süresi kısalığı ile 6 dk itme testi performansının yüksekliği anlamlı olarak bulundu (sırasıyla p=0,014, p=0,008, p=0,035). Sonuç: Kronik SKY’li bireylerde obezite ve hipertrigliserideminin manuel tekerlekli sandalye mobilizasyonunu olumsuz etkilediği gösterilmiştir.

Objective: This study investigated the impact of obesity and dyslipidemia on manual wheelchair mobility in individuals with spinal cord injury (SCI). Material and Methods: A total of 102 individuals with chronic motor-complete SCI, aged 18-60 years, with an injury duration of ≥1 year, were included. The body mass index (BMI) was used to assess obesity. The lipid profiles were measured, including high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), and total cholesterol (TC). Manual wheelchair propulsion tests (MWPTs) (20-meter propulsion test, slalom test, and 6-minute propulsion test) were conducted to evaluate mobility. SCI-specific BMI⩾22 kg/m² was classified as obese, while <22 kg/m² was classified as non-obese. HDLC< 40 mg/dL was considered low, whereas LDL-C ≥130 mg/dL, TG ≥150 mg/dL, and TC ≥200 mg/dL were considered high. Participants were stratified into binary groups, and their MWPT results were compared. Results: Among participants, 71.6% (n=73) were classified as obese, 69.6% had low HDL-C, 27.4% had high LDL-C, 45.1% had high TG, and 22.5% had high TC. Participants with TG<150 mg/dL demonstrated significantly shorter 20- meter propulsion times than those with TG≥150 mg/dL (p=0.014), while HDL-C, LDL-C, and TC levels did not significantly affect test outcomes (p>0.05). Participants with BMI <22 kg/m² exhibited shorter 20-m and slalom test times and better 6-min propulsion performance than those with BMI ≥22 kg/m² (p=0.014, p=0.008, p=0.035, respectively). Conclusion: Obesity and hypertriglyceridemia negatively impact manual wheelchair mobility in individuals with chronic SCI.

1. Rajan S, McNeely MJ, Warms C, et al. Clinical assessment and management of obesity in individuals with spinal cord injury: a review. J Spinal Cord Med. 2008;31:361-72. [PubMed]  [PMC] 
2. de Groot S, Post MW, Postma K, et al. Prospective analysis of body mass index during and up to 5 years after discharge from inpatient spinal cord injury rehabilitation. J Rehabil Med. 2010;42:922-8. [PubMed] 
3. Crane DA, Little JW, Burns SP. Weight gain following spinal cord injury: a pilot study. J Spinal Cord Med. 2011;34:227-32. [Crossref]  [PubMed]  [PMC] 
4. Gater DR Jr. Obesity after spinal cord injury. Phys Med Rehabil Clin N Am. 2007;18:333-51, vii. [PubMed] 
5. Eriks-Hoogland I, Hilfiker R, Baumberger M, et al. Clinical assessment of obesity in persons with spinal cord injury: validity of waist circumference, body mass index, and anthropometric index. J Spinal Cord Med. 2011;34:416-22. [Crossref]  [PubMed]  [PMC] 
6. Flegal KM, Carroll MD, Ogden CL, et al. Prevalence and trends in obesity among US adults, 1999-2000. JAMA. 2002;288:1723-7. [PubMed] 
7. Spungen AM, Adkins RH, Stewart CA, et al. Factors influencing body composition in persons with spinal cord injury: a cross-sectional study. J Appl Physiol (1985). 2003;95:2398-407. [PubMed] 
8. Wilmet E, Ismail AA, Heilporn A, et al. Longitudinal study of the bone mineral content and of soft tissue composition after spinal cord section. Paraplegia. 1995;33:674-7. [PubMed] 
9. Gorgey AS, Gater DR. Regional and relative adiposity patterns in relation to carbohydrate and lipid metabolism in men with spinal cord injury. Appl Physiol Nutr Metab. 2011;36:107-14. [PubMed] 
10. Bauman WA, Spungen AM, Zhong YG, et al. Depressed serum high density lipoprotein cholesterol levels in veterans with spinal cord injury. Paraplegia. 1992;30:697-703. [PubMed] 
11. Bauman WA, Spungen AM. Carbohydrate and lipid metabolism in chronic spinal cord injury. J Spinal Cord Med. 2001;24:266-77. [PubMed] 
12. Bauman WA, Spungen AM. Metabolic changes in persons after spinal cord injury. Phys Med Rehabil Clin N Am. 2000;11:109-40. [PubMed] 
13. Gilbert O, Croffoot JR, Taylor AJ, et al. Serum lipid concentrations among persons with spinal cord injury - a systematic review and meta-analysis of the literature. Atherosclerosis. 2014;232:305-12. [Crossref]  [PubMed] 
14. Koyuncu E, Nakipoğlu Yüzer GF, Yenigün D, et al. The analysis of serum lipid levels in patients with spinal cord injury. J Spinal Cord Med. 2017;40:567-72. [PubMed]  [PMC] 
15. Peterson MD, Berri M, Lin P, et al. Cardiovascular and metabolic morbidity following spinal cord injury. Spine J. 2021;21(9):1520-7. [Crossref]  [PubMed]  [PMC] 
16. Tallqvist S, Kauppila AM, Vainionpää A, et al. Prevalence of comorbidities and secondary health conditions among the Finnish population with spinal cord injury. Spinal Cord. 2022;60:618-27. [PubMed]  [PMC] 
17. Goktepe AS, Tugcu I, Yilmaz B, et al. Does standing protect bone density in patients with chronic spinal cord injury? J Spinal Cord Med. 2008;31:197-201. [PubMed]  [PMC] 
18. Gagnon DH, Roy A, Verrier MC, et al. Do performance-based wheelchair propulsion tests detect changes among manual wheelchair users with spinal cord injury during inpatient rehabilitation in quebec? Arch Phys Med Rehabil. 2016;97:1214-8. [Crossref]  [PubMed] 
19. Harrison GG, Buskirk ER, Carter JE. Skinfold thicknesses and measurement technique. In: Lohman T, Roche A, Martorell R, eds. Anthropometric Standardization Reference Manual. Champaign: Human Kinetics Books; 1988. p. 55-80.
20. Silveira SL, Ledoux TA, Robinson-Whelen S, et al. Methods for classifying obesity in spinal cord injury: a review. Spinal Cord. 2017;55:812-7. [PubMed] 
21. Laughton GE, Buchholz AC, Martin Ginis KA, et al; SHAPE SCI Research Group. Lowering body mass index cutoffs better identifies obese persons with spinal cord injury. Spinal Cord. 2009;47:757-62. [PubMed] 
22. World Health Organization. (10.6. 2024c). A healthy lifestyle - WHO recommendations: Body Mass İndex. [Link] 
23. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18:499-502. [PubMed] 
24. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002;106:3143-421. [PubMed] 
25. Svircev JN. Cardiovascular disease in persons with spinal cord dysfunction-an update on select topics. Phys Med Rehabil Clin N Am. 2009;20:737-47. [Crossref]  [PubMed] 
26. Groah SL, Nash MS, Ward EA, et al. Cardiometabolic risk in community-dwelling persons with chronic spinal cord injury. J Cardiopulm Rehabil Prev. 2011;31:73-80. [PubMed] 
27. Gater DR Jr, Farkas GJ, Tiozzo E. Pathophysiology of neurogenic obesity after spinal cord injury. Top Spinal Cord Inj Rehabil. 2021;27:1-10. [Crossref]  [PubMed]  [PMC] 
28. Hatchett PE, Mulroy SJ, Eberly VJ, et al. Body mass index changes over 3 years and effect of obesity on community mobility for persons with chronic spinal cord injury. J Spinal Cord Med. 2016;39:421-32. [Crossref]  [PubMed]  [PMC] 
29. Pelletier CA, Miyatani M, Giangregorio L, et al. Sarcopenic obesity in adults with spinal cord injury: a cross-sectional study. Arch Phys Med Rehabil. 2016;97:1931-7. [PubMed] 
30. Jörgensen S, Hill M, Lexell J. Cardiovascular risk factors among older adults with long-term spinal cord injury. PM R. 2019;11:8-16. [Crossref]  [PubMed] 
31. Solinsky R, Betancourt L, Schmidt-Read M, et al. Acute spinal cord ınjury ıs associated with prevalent cardiometabolic risk factors. Arch Phys Med Rehabil. 2022;103:696-701. [PubMed] 
32. Wahman K, Nash MS, Westgren N, et al. Cardiovascular disease risk factors in persons with paraplegia: the Stockholm spinal cord injury study. J Rehabil Med. 2010;42:272-8. [PubMed] 
33. Bauman WA, Adkins RH, Spungen AM, et al. Is immobilization associated with an abnormal lipoprotein profile? observations from a diverse cohort. Spinal Cord. 1999;37:485-93. [PubMed] 
34. Köseoğlu BF, Safer VB, Öken Ö, et al. Cardiovascular disease risk in people with spinal cord injury: is there a possible association between reduced lung function and increased risk of diabetes and hypertension? Spinal Cord. 2017;55:87-93. [PubMed] 
35. Paim LR, Schreiber R, Matos-Souza JR, et al. Oxidized low-density lipoprotein, matrix-metalloproteinase-8 and carotid atherosclerosis in spinal cord injured subjects. Atherosclerosis. 2013;231:341-5. [PubMed] 
36. Vichiansiri R, Saengsuwan J, Manimmanakorn N, et al. The prevalence of dyslipidemia in patients with spinal cord lesion in Thailand. Cholesterol. 2012;2012:847462. [PubMed]  [PMC] 
37. Gorgey AS, Farkas GJ, Dolbow DR, et al. Gender dimorphism in central adiposity may explain metabolic dysfunction after spinal cord ınjury. PM R. 2018;10:338-48. [Crossref]  [PubMed] 
38. Nash MS, Jacobs PL, Mendez AJ, et al. Circuit resistance training improves the atherogenic lipid profiles of persons with chronic paraplegia. J Spinal Cord Med. 2001;24:2-9. [PubMed] 
39. Akbal A, Kurtaran A, Selçuk B, et al. H-FABP, cardiovascular risk factors, and functional status in asymptomatic spinal cord injury patients. Herz. 2013;38:629-35. [Crossref]  [PubMed] 
40. Fliess-Douer O, Vanlandewijck YC, Lubel Manor G, et al. A systematic review of wheelchair skills tests for manual wheelchair users with a spinal cord injury: towards a standardized outcome measure. Clin Rehabil. 2010;24:867-86. [PubMed] 
41. Kilkens OJ, Dallmeijer AJ, De Witte LP, et al. The wheelchair circuit: construct validity and responsiveness of a test to assess manual wheelchair mobility in persons with spinal cord injury. Arch Phys Med Rehabil. 2004;85:424-31. [PubMed] 
42. Kilkens OJ, Post MW, van der Woude LH, et al. The wheelchair circuit: reliability of a test to assess mobility in persons with spinal cord injuries. Arch Phys Med Rehabil. 2002;83:1783-8. [Crossref]  [PubMed] 
43. Kirby RL, Swuste J, Dupuis DJ, et al. The wheelchair skills test: a pilot study of a new outcome measure. Arch Phys Med Rehabil. 2002;83:10-8. [Crossref]  [PubMed] 
44. Gagnon D, Verrier M, Masani K, et al. Effects of trunk impairments on manual wheelchair propulsion among individuals with a spinal cord injury: a brief overview and future challenges. Topics in Spinal Cord Injury Rehabilitation. 2009;15:59-70. [Crossref] 
45. Vives Alvarado JR, Felix ER, Gater DR Jr. Upper extremity overuse injuries and obesity after spinal cord injury. Top Spinal Cord Inj Rehabil. 2021;27:68-74. [PubMed]  [PMC] 
46. Gater DR, Farkas GJ. Alterations in body composition after SCI and the mitigating role of exercise. In: Taylor JA, eds. The Physiology of Exercise in Spinal Cord Injury. Boston: Springer; 2016. p.175-98. [Crossref]  [PubMed] 
47. Stenson KW, Deutsch A, Heinemann AW, et al. Obesity and inpatient rehabilitation outcomes for patients with a traumatic spinal cord injury. Arch Phys Med Rehabil. 2011;92:384-90. [PubMed] 
48. Mercer JL, Boninger ML, Koontz AM, Pearlman J, Boninger D, Cooper RA. Effect of weight on wheelchair propulsion over various surfaces. In: Proceedings of the 28th Annual RESNA Conference [on CD-ROM]; June 25- 27, 2005; Atlanta, GA. [Crossref] 
49. Nash MS, Farkas GJ, Tiozzo E, et al. Exercise to mitigate cardiometabolic disorders after spinal cord injury. Curr Opin Pharmacol. 2022;62:4-11. [Crossref]  [PubMed] 
50. D'Oliveira GL, Figueiredo FA, Passos MC, et al. Physical exercise is associated with better fat mass distribution and lower insulin resistance in spinal cord injured individuals. J Spinal Cord Med. 2014;37:79-84. [Crossref]  [PubMed]  [PMC] 
51. Farkas GJ, Gorgey AS, Dolbow DR, et al. The influence of level of spinal cord injury on adipose tissue and its relationship to inflammatory adipokines and cardiometabolic profiles. J Spinal Cord Med. 2018;41:407-15. [PubMed]  [PMC]