A secondary analysis of testosterone and electrically evoked resistance training versus testosterone only (TEREX-SCI) on untrained muscles after spinal cord injury: A pilot randomized clinical trial

Spinal Cord, 2020 · DOI: 10.1038/s41393-019-0364-3 · Published: March 1, 2020

Spinal Cord Injury Physiology Rehabilitation

Simple Explanation

This study investigates whether combining testosterone replacement therapy (TRT) with electrically stimulated resistance training (RT) can help increase muscle size in untrained muscles of individuals with spinal cord injury (SCI). The research focuses on muscles that are not directly targeted by the electrical stimulation, such as those in the trunk, glutes, and lower leg, to see if there's a broader benefit from this combined therapy. The goal is to find ways to counteract muscle atrophy, a common issue after SCI, which can lead to other health problems like pressure injuries.

Study Duration

16 weeks

Participants

22 men with chronic motor complete SCI

Evidence Level

Level 1, Randomized Clinical Trial, Secondary Analysis

Key Findings

1
The combination of low-dose TRT and RT resulted in significant hypertrophy of the glutei muscles compared to TRT alone.
2
A trend towards an interaction between the two groups (TRT+RT vs. TRT only) was observed for the quadratus lumborum (QL) and external/internal obliques (EIO) trunk muscles.
3
No significant effect was observed on the untrained lower leg muscles with the combined therapy.

Research Summary

This secondary analysis of a clinical trial examined the effects of combining low-dose testosterone replacement therapy (TRT) with neuromuscular electrical stimulation resistance training (NMES-RT) on untrained muscles in men with chronic spinal cord injury (SCI). The study found that the combination of TRT and RT led to significant hypertrophy of the glutei muscles compared to TRT alone, suggesting a potential benefit for preventing pressure injuries. While a trend towards improvement was noted in some trunk muscles, no significant changes were observed in the lower leg muscles, indicating that direct stimulation may be necessary for hypertrophy in those areas.

Practical Implications

Pressure Injury Prevention

The hypertrophy of glutei muscles resulting from combined TRT and RT may help reduce the incidence and severity of pelvic pressure injuries in individuals with SCI.

Exercise Protocol Development

The findings can inform the development of future exercise protocols that combine TRT and RT to increase muscle size, improve muscle quality, and enhance cardio-metabolic health in persons with SCI.

Targeted Muscle Stimulation

The lack of significant changes in lower leg and potentially trunk muscles suggests that direct stimulation of these muscle groups may be necessary to achieve hypertrophy.

Study Limitations

1
The age range was only limited to 18-50 years to ensure safety and avoid potential cardiovascular risk consequences that may result from using TRT.
2
Because of budgetary constraints, the design of the study did not include NMES-RT only or TRT placebo-controlled groups.
3
The overall final sample size may have impacted the findings of the current study.

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