Three times a week, Patrick Keating starts his day with a workout of running and weightlifting.

Like many people who exercise, he wants to prolong his life through a healthy lifestyle. But unlike most workout warriors, Keating is paralyzed from the waist down.

His workout is made possible by electrical stimulation to his legs, with the help of scientists at the University of Georgia’s Exercise Vascular Biology Laboratory.

The lab’s research focuses on the benefits of physical activity for those who aren’t able to exercise on their own.

Since Keating began these workouts last summer and changed his eating habits, he has lost 68 pounds.

Everyone realizes the importance of health and wellness activities, including exercise. But in patients with disabilities such as spinal cord injuries, these basics often take a backseat to wound care and treatment of bladder infections and depression, said Kevin McCully, who runs the UGA laboratory.

In the future, he said, “primary care in patients with disabilities will still focus on patient health care issues such as wound care, but encouraging wellness is going to be increasingly important.”

Expanded insights

McCully’s lab has spent the past nine years assessing the benefits of exercise — through electrical stimulation — in people whose spinal cord injuries prevent them from moving their legs under ordinary circumstances.

Several labs across the country have tested the effects of exercise on the health of partially paralyzed individuals.

The UGA lab is unique, however, in its separate assessment of weight training versus endurance training, McCully said. He and his colleagues are also developing innovative ways of measuring participants’ energy-producing capacity.

Their original goal was only to measure the cardiovascular benefits of weight training in paralyzed individuals, but the researchers have come to believe that electrically stimulated weight and endurance training can prevent diabetes, too.

“People in wheelchairs have the tendency to gain some weight, to have less muscle mass and more fat. Their bodies are susceptible to metabolic syndrome – being more resistant to insulin and then developing Type 2 diabetes,” said Keith Tansey, director of spinal cord injury research at the Shepherd Center in Atlanta.

Physicians from the Shepherd Center, one of the top rehabilitation hospitals in the nation, have referred patients to participate in McCully’s study, helped analyze findings and provided medical guidance.

The importance of exercise for individuals with spinal cord injuries has long been underestimated, Tansey said. “Everyone was worried about ‘Did we give patients the right wheelchair?’ instead of asking questions about ‘Are we doing the right things for their metabolic health?’ ”

According to UGA’s Institute on Human Disability and Development, disabled adults are 58 percent more likely than their able-bodied counterparts to be obese.

Tansey added, “Life is tough as a partially paralyzed individual, and now we add metabolic insult on top of it.”

McCully and his colleagues believe that weight training combined with endurance training can lead to better processing of glucose and insulin, thereby preventing diabetes. Considering 70 percent of the body’s sugar is taken up by the muscles, people with limited muscle mobility are at a higher risk.

For the 45-year-old Keating, a sales consultant for Hewlett Packard, preventing diabetes means the potential for a longer, healthier life.

“I was definitely overweight,” said Keating. “I started to realize that health and diet need to be a huge part of my life if I’m going to be around to see my grandchildren.”

Keating lost the ability to move his legs because of a car accident 24 years ago. Until recently, he had avoided regular exercise because of the strain it placed on his already overused upper body. Keating believes this overuse is what caused the damage to his left rotator cuff, for which he will likely need surgery.

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‘Running’ in a chair

It’s well known that exercise leads to better health, so it seems sensible that electrical stimulation in paralyzed individuals might also help. But the effectiveness of the technique, which emerged in 1967, is yet to be formally evaluated.

“You can say that more muscle activity would be good, but we don’t know how much more, and you don’t necessarily want to be strapped to an electrical stimulation device all day long if you only need 10 or 15 minutes,” said Tansey.

Keating described what it’s like to be strapped to the device. “The easiest way to describe it is if you’re sitting in a chair and somebody’s kicking the back of the chair. I really feel the bouncing and reaction.”

McCully and his colleagues prescribe a combination of leg lifts and weightlifting. Participants’ legs are stimulated to lift weights strapped to their calves in four sets of 10. Once participants are able to perform the weightlifting three days in a row without becoming fatigued, two more pounds are added.

“At the end of four months, we can get people to lift 20 pounds, 40 times with each leg. It’s amazing,” said McCully.

Endurance exercises — which Keating calls “running” — take place three times a week.

While participants are seated, their legs are being constantly stimulated, resulting in twitching of the muscles. The more they train, the faster their legs are stimulated to twitch, and the longer they “run” — starting at 10 minutes and going up to 60 minutes.

Many of the research participants live hours from the Athens laboratory. Keating, for instance, is from the town of Dallas, 100 miles away and on the other side of Atlanta. Traveling such distances can be especially inconvenient for people with disabilities.

The lab has found a way around this. After the first training, McCully’s research assistants coach participants over the phone. The participants are provided with the electrode pads and weights they need. The assistants tell them where to place the electrodes, offer encouragement and help them monitor their progress.

Long-distance coaching is just one way the researchers have maximized the potential benefits of exercise for individuals with spinal cord injuries.

McCully also allows paralyzed students on campus who are not research participants to use the lab’s functional electrical stimulation bicycle.

“Health, wellness and preventive health are just as important, if not more important, in this population,” he said. “This is a population that we need to help. And we need to do more research on how we can improve their quality of life.”

Chelsea Toledo completed her master’s degree in Health and Medical Journalism from the University of Georgia in May 2012. This summer, she will intern as a science writer at the National Institute of General Medical Sciences, a branch of the National Institutes of Health in Bethesda, Md.