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Aging With Spinal Cord Injuries:  Dr. Mark Nash Pursues Evidence-Based Countermeasures and Best Practice Changes


Mark S. Nash, Ph.D.September 2009 -- When Dr. Mark Nash joined the faculty of Neurological Surgery in 1984 the notion of aging with SCI was far from his mind. “Everyone was 25 years old,” remembers Nash, so he asked Dr. Barth Green what a 60-year old person with SCI would look like. “I can’t say,” he recalled Green saying, “We haven’t seen too many of them yet.” Twenty-five years later the young people have aged, and have been joined by increasing numbers of others who are sustaining injuries in later life. Together, these populations have provided an entirely new set of challenges in surgery, medical care, and health maintenance that didn’t exist in the early 1980’s.


Concern for aging with SCI was first sounded at an NIDRR-sponsored conference in 1991 where Dr. Nash was a featured speaker on immune system decline and infection risks. Warning signals for every major body system were sounded. Recalls Nash, “Suddenly there was recognition that health could decline, pain could develop and personal independence could be lost, even among the most recreationally active, healthy and vital of the injured population.”


Fortunately, there already existed a pathway to enhance health through exercise and diet, although it wasn’t as simple as undertaking lifestyle changes. Much of the exercise before the early 1990’s was either electrical stimulated cycling or arm ergometry, making access to equipment and long-term compliance important issues. Looking for something different and more effective, Nash set out to develop and test a resistance-training model. Many were cynical at the notion of persons with tetraplegia and paraplegia lifting weights. Nonetheless, the exercise model has proved both more effective and interesting than arm cycling and even provided an inexpensive home-based system that can be built and adapted to an individual’s exercise needs and capacities.


Unlike the exercise revolution, dietary recommendations have evolved more slowly. The first important step is to look beyond the old suggestions of eating a ‘balanced diet’. We know that dietary intervention needs to begin in rehabilitation where people with SCI burn many fewer calories. The hypercaloric diets consumed after rehabilitation discharge are a ticket to an overweight body, and have even earned a name: “obesogenic environment”. Our research has also stopped focusing so much attention on the fasted states of lipids and body metabolism. “We don’t live in the fasted state,” reminds Nash. “We live in the fed states.” These studies are far more complex to perform, but also far more revealing, and have earned funding from the NIDRR and the Craig H. Nielsen Foundation. Miami Project researchers are pursuing a better understanding of nutrient and caloric balance, and how exercise can round out the picture, especially as people live longer more active lifestyles.


The Final Frontier for Aging Related Health


Today, the health-centered research and clinical exercise activities of The Miami Project are focusing to a greater extent on persons aged 50 and older, with some still exercising regularly into their 60’s and 70’s. “They really notice the difference, not just in the way that they feel but also in their levels of energy and life interests,” notes Nash who has long been an advocate for this type of primary prevention. “If we allow people to gain weight, establish sedentary habits and injure their shoulders, it’s an uphill battle to repair the damage and reverse the body weight gain,” he added. Despite the myriad of things that need to be taught after injury, lifestyle habits of activity and eating need to be a priority. Otherwise, a roadmap for inactivity, pain, and lost independence in later life will be set in motion. The willingness of The Miami Project to recognize and pursue this work maintains our substantial commitment to preserving health, activity, productivity and life-satisfaction across the lifespan.





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