Publications by authors named "Gary Farkas"

Emanating from several decades of study into the effects of the aging process after spinal cord injury (SCI), "accelerated aging" has become a common expression as the SCI accelerates the onset of age-related pathologies. However, the aging process follows a distinct trajectory, characterized by unique patterns of decline that differ from those observed in the general population without SCI. Aging brings significant changes to muscles, bones, and hormones, impacting overall physical function.

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Article Synopsis
  • The study aimed to identify tools for measuring diet and nutrition knowledge in adults with spinal cord injuries and disorders (SCI/D) by reviewing literature from 1992-2022.
  • Out of 48 articles reviewed, only five were relevant, revealing a lack of validated nutrition knowledge questionnaires specifically for individuals with SCI/D; most studies focused on either athletes or those with acute injuries.
  • The findings highlight a need for a validated questionnaire that addresses the unique nutritional needs of the SCI/D population, as current tools mostly provide general nutrition knowledge without considering specific conditions.
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Objectives: To establish recommendations for designing, delivering, evaluating, and reporting exercise intervention research to improve fitness-related outcomes in people living with spinal cord injury (PwSCI).

Design: International consensus process.

Setting: (1) An expert panel was established consisting of 9 members of the governing panel of the International Spinal Cord Society Physical Activity Special Interest Group and 9 additional scientists who authored or co-authored ≥1 exercise randomized controlled trial paper involving PwSCI.

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  • The study explores the health impacts of poor diet on individuals with spinal cord injuries and disorders (SCI/D) by conducting in-depth interviews with healthcare providers.
  • Key findings highlight seven major health consequences linked to inadequate nutrition, including weight gain, cardiometabolic issues, bowel dysfunction, and poor mental health.
  • The authors recommend increasing awareness among SCI/D patients regarding these risks and the need for tailored nutrition interventions to address these health issues.
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  • Anti-obesity medications (AOMs) are being considered for managing obesity in individuals with spinal cord injury and disease (SCI/D), but there's limited understanding of their use in this population.
  • Healthcare providers (HCPs) identified four main barriers to AOM use: concerning side effects in SCI/D patients, promotion of poor eating habits, issues with availability and administration, and insufficient evidence or knowledge regarding AOM effectiveness for this group.
  • Despite recognizing these barriers and the risks associated with AOMs for SCI/D patients, HCPs expressed a desire for more information to better support their patients.
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Aromatase inhibitors are prescribed in breast cancer due to their associated lower rate of cancer recurrence compared to tamoxifen. However, aromatase inhibitor-induced arthralgia (AIIA) is one of the leading causes of treatment nonadherence, increasing the risk of cancer recurrence. The pathophysiology of AIIA is poorly understood, and although current recommendations for AIIA include lifestyle changes and analgesics depending on the severity of symptoms, there is no established effective treatment.

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Purpose/objective: Nutrition knowledge, beliefs, and behaviors have important implications for managing and preventing chronic and injury-related secondary conditions in persons with spinal cord injuries and disorders (SCI/D). Yet, the unique dietary and nutritional needs and recommendations specific to individuals with SCI/D and their eating beliefs and behaviors have been understudied. Aim is to describe nutrition and eating beliefs and behaviors from the perspectives of individuals with SCI/D.

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Overeating associated with neurogenic obesity after spinal cord injury (SCI) may be related to how persons with SCI experience satiation (processes leading to meal termination), their eating frequency, and the context in which they eat their meals. In an online, cross-sectional study, adults with (n = 688) and without (Controls; n = 420) SCI completed the Reasons Individuals Stop Eating Questionnaire-15 (RISE-Q-15), which measures individual differences in the experience of factors contributing to meal termination on five scales: Physical Satisfaction, Planned Amount, Decreased Food Appeal, Self-Consciousness, and Decreased Priority of Eating. Participants also reported weekly meal and snack frequency and who prepares, serves, and eats dinner with them at a typical dinner meal.

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Purpose Of Review: Spinal cord injury (SCI) heightens susceptibility to cardiometabolic risk (CMR), predisposing individuals to cardiovascular disease. This monograph aims to assess the optimal duration and intensity of physical activity (PA) for managing CMR factors, particularly obesity, after SCI and provide modality-specific PA durations for optimal energy expenditure.

Recent Findings: PA guidelines recommend at least 150 min/week of moderate-intensity activity.

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In chronic spinal cord injury (SCI), individuals experience dietary inadequacies complicated by an understudied research area. Our objectives were to assess (1) the agreement between methods of estimating energy requirement (EER) and estimated energy intake (EEI) and (2) whether dietary protein intake met SCI-specific protein guidelines. Persons with chronic SCI ( = 43) completed 3-day food records to assess EEI and dietary protein intake.

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Background: A spinal cord injury (SCI) from trauma or disease impairs sensorimotor pathways in somatic and autonomic divisions of the nervous system, affecting multiple body systems. Improved medical practices have increased survivability and life expectancy after SCI, allowing for the development of extensive metabolic comorbidities and profound changes in body composition that culminate in prevalent obesity.

Summary: Obesity is the most common cardiometabolic component risk in people living with SCI, with a diagnostic body mass index cutoff of 22 kg/m2 to account for a phenotype of high adiposity and low lean mass.

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Spinal cord injury (SCI) results in a high prevalence of neurogenic obesity and metabolic dysfunction. The increased risk for neurogenic obesity and metabolic dysfunction is mainly due to the loss of energy balance because of significantly reduced energy expenditure following SCI. Consequently, excessive energy intake (positive energy balance) leads to adipose tissue accumulation at a rapid rate, resulting in neurogenic obesity, systemic inflammation, and metabolic dysfunction.

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Objective: To investigate the relationships between percentage fat mass (%FM), percentage lean mass (%LM), and the ratio of %FM to %LM with pro-inflammatory adipokines and metabolic syndrome in individuals with chronic spinal cord injury (SCI).

Design: Observational, cross-sectional. Linear and logistic regression were used to examine the associations between the %FM, %LM, and the %FM to %LM ratio with inflammatory markers and metabolic syndrome, respectively.

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Individuals with spinal cord injuries (SCI) commonly present with component risk factors for cardiometabolic risk and combined risk factors for cardiometabolic syndrome (CMS). These primary risk factors include obesity, dyslipidemia, dysglycemia/insulin resistance, and hypertension. Commonly referred to as "silent killers", cardiometabolic risk and CMS increase the threat of cardiovascular disease, a leading cause of death after SCI.

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Predictors of academic success in anatomy have been studied, but not in Doctor of Physical Therapy (DPT) students. The objectives of this study were to (1) explore predictors of academic success in a DPT anatomy course, (2) evaluate sex-based differences in the predictors of academic success and their influence on anatomy course grade, and (3) investigate the influence of the DPT anatomy course on visual-spatial ability. Forty-nine DPT students completed a demographic questionnaire, Learning and Study Strategies Inventory (LASSI), and Mental Rotations Test (MRT) before the ten-week anatomy course (MRT-1) and repeated the MRT at the end of the course (MRT-2).

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Article Synopsis
  • This study aimed to evaluate how well different measures of glucose metabolism align with insulin sensitivity in individuals with chronic spinal cord injury (SCI).
  • A total of 29 participants (mostly men) were analyzed using various indices, including QUICKI, HOMA, and HbA1C, against insulin sensitivity measured by an intravenous glucose tolerance test.
  • The results showed that QUICKI had the strongest correlation with insulin sensitivity, while traditional measures like HbA1C and fasting plasma glucose showed weaker relationships.
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  • Cardiometabolic disorder (CMD) is a syndrome that combines risks from cardiovascular, endocrine, pro-thrombotic, and inflammatory health issues, creating dangers similar to coronary artery disease and type 2 diabetes.
  • CMD is typically identified by the presence of three or more out of five key risk factors, including obesity, insulin resistance, hypertension, high triglycerides, and low HDL cholesterol.
  • Recent guidelines emphasize that individuals with spinal cord injuries (SCI) are significantly affected by CMD and suggest early lifestyle interventions like exercise and proper nutrition as effective measures to combat these health risks.
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  • The COVID-19 pandemic significantly disrupted anatomy education, resulting in decreased cadaver usage among various medical and therapy programs, with a notable reduction from 74.1% to 50.3%.
  • During this period, online teaching methods prevailed, with 59% of laboratories conducted synchronously and a reliance on digital resources, though practical examinations shifted to computer and image-based formats.
  • Despite the challenges, anatomy educators adapted by increasing the availability of digital resources such as dissection media and interactive software, ensuring instructional continuity throughout the pandemic.
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Many persons with spinal cord injury (SCI) have one or more preventable chronic diseases related to excessive energetic intake and poor eating patterns. Appropriate nutrient consumption relative to need becomes a concern despite authoritative dietary recommendations from around the world. These recommendations were developed for the non-disabled population and do not account for the injury-induced changes in body composition, hypometabolic rate, hormonal dysregulation and nutrition status after SCI.

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The risk of developing Type 2 Diabetes Mellitus in people living with HIV (PLWH) can be four times greater and can occur at an earlier age and even without the presence of obesity compared to those without HIV. Therefore, the purpose of this analytical cross-sectional study was to determine the relationship between HIV duration and glucose metabolism among PLWH. Eighty-two PLWH were categorized into shorter (≤15 years) or longer HIV duration (≥16 years) and then compared for differences in demographics, physical and clinical characteristics, biomarkers, and dietary intake.

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  • The study aimed to evaluate how a session of arm crank ergometry (ACE) exercise affects carbohydrate metabolism in individuals with paraplegia compared to able-bodied controls.
  • Participants included 11 people with paraplegia and 6 able-bodied controls, who completed 45 minutes of ACE exercise at 75% of their maximum oxygen uptake.
  • Results showed that while ACE exercise improved glucose metabolism immediately in paraplegic individuals, the benefits did not last beyond 24 hours, suggesting the importance of regular exercise for better glucose management in those with spinal cord injuries.
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Purpose: Visceral adipose tissue (VAT) is associated with cardiometabolic disease risk in able-bodied (AB) populations. However, the underlying mechanisms of VAT-induced disease risk are unknown in persons with spinal cord injury (SCI). Potential mechanisms of VAT-induced cardiometabolic dysfunction in persons with SCI include systemic inflammation, liver adiposity, mitochondrial dysfunction, and anabolic deficiency.

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Physical deconditioning and inactivity following spinal cord injury (SCI) are associated with multiple cardiometabolic risks. To mitigate cardiometabolic risk, exercise is recommended, but it is poorly established whether arm cycling exercise (ACE) or functional electrical stimulation (FES) leg cycling yields superior benefits. To determine the adaptations of 16 weeks of FES cycling and ACE on exercise energy expenditure (EEE), cardiorespiratory fitness (CRF), and obesity after SCI.

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Following spinal cord injury (SCI), individuals are at high risk for obesity and several chronic cardiometabolic disorders due to a deterioration in body composition, hypometabolic rate, and endometabolic dysregulation. Countermeasures to the consequences of an SCI include adopting a healthy diet that provides adequate nutrition to maintain good body habitus and cardiometabolic health. A proper diet for individuals with SCI should distribute carbohydrates, protein, and fat to optimize a lower energy intake requirement and should stress foods with low caloric yet high nutrient density.

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