Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Serum concentrations of ketones increase after hand-ergometer exercise in persons with cervical spinal cord injuries: a preliminary prospective study


Study design

Experimental study.


To compare lipid profiles during moderate-intensity exercise between persons with cervical spinal cord injuries (SCIC) and able-bodied controls (AB).


Wakayama Medical University, Japan.


Six participants with SCIC and six AB performed 30-min arm-crank exercise at 50% VO2peak. Blood samples were collected before (PRE), immediately (POST), and 60 min after exercise (REC). Concentrations of serum free fatty acids ([FFA]s), total ketone bodies ([tKB]s), acetoacetic acid ([AcAc]s), insulin ([Ins]s), and plasma catecholamines and glucose ([Glc]p) were assessed.


Catecholamine concentrations in SCIC were lower than AB throughout the experiment (P < 0.001) and remained unchanged, while increased at POST in AB (P < 0.01). [FFA]s remained unchanged in both groups with no differences between groups. [tKB]s in SCIC tended to increase at REC from PRE (P = 0.043), while remaining unchanged in AB (P > 0.42). [AcAc]s in SCIC increased at REC from PRE and POST (P < 0.01) while remaining unchanged in AB (interactions of Group × Time P = 0.014). [Glc]p and [Ins]s were comparable between the groups throughout the study.


Serum ketone bodies in SCIC increased after exercise while remaining unchanged in AB, suggesting that suppressed uptakes of serum ketone bodies from blood to the muscles in SCIC would partially contribute the increased serum ketones.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Get just this article for as long as you need it


Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Plasma concentrations of adrenaline and noradrenaline.
Fig. 2: Serum concentrations.
Fig. 3: Plasma concentrations of glucose and serum concentrations of insulin.

Data availability

The dataset generated and analyzed during the current study is available from the corresponding author upon reasonable request.


  1. Yekutiel M, Brooks ME, Ohry A, Yarom J, Carel R. The prevalence of hypertension, ischaemic heart disease and diabetes in traumatic spinal cord injured patients and amputees. Paraplegia. 1989;27:58–62.

    CAS  Google Scholar 

  2. Office of Sports Promotion for the Disabled, Health and Sports Division, Japan Sports Agency. Report on "Project for the Promotion of Sports for Persons with Disabilities in Local Communities (Survey and Research on the Promotion of Sports Participation by Persons with Disabilities). Sasakawa Sports Foundation, Tokyo, 2018. (In Japanese).

  3. Guttmann L, Silver J, Wyndham CH. Thermoregulation in spinal man. J Physiol. 1958;142:406–19.

    Article  CAS  Google Scholar 

  4. Kjaer M, Dela F, Sørensen FB, Secher NH, Bangsbo J, Mohr T, et al. Fatty acid kinetics and carbohydrate metabolism during electrical exercise in spinal cord-injured humans. Am J Physiol Regul Integr Comp Physiol. 2001;281:R1492–8.

    Article  CAS  Google Scholar 

  5. Burnham R, Martin T, Stein R, Bell G, MacLean I, Steadward R. Skeletal muscle fibre type transformation following spinal cord injury. Spinal Cord. 1997;35:86–91.

    Article  CAS  Google Scholar 

  6. Gilbert O, Croffoot JR, Taylor AJ, Nash M, Schomer K, Groah S. Serum lipid concentrations among persons with spinal cord injury - a systematic review and meta-analysis of the literature. Atherosclerosis. 2014;232:305–12.

    Article  CAS  Google Scholar 

  7. Puchalska P, Crawford PA. Multi-dimensional roles of ketone bodies in fuel metabolism, signaling, and therapeutics. Cell Metab. 2017;25:262–84.

    Article  CAS  Google Scholar 

  8. Lasko-McCarthey P, Davis JA. Protocol dependency of VO2max during arm cycle ergometry in males with quadriplegia. Med Sci Sports Exerc. 1991;23:1097–101.

    Article  CAS  Google Scholar 

  9. Sato C, Kamijo YI, Sakurai Y, Araki S, Sakata Y, Ishigame A, et al. Three-week exercise and protein intake immediately after exercise increases the 6-min walking distance with simultaneously improved plasma volume in patients with chronic cerebrovascular disease: a preliminary prospective study. BMC Sports Sci Med Rehabil. 2022;14:38.

    Article  Google Scholar 

  10. Kamijo Y, Takeno Y, Sakai A, Inaki M, Okumoto T, Itoh J, et al. Plasma lactate concentration and muscle blood flow during dynamic exercise with negative-pressure breathing. J Appl Physiol. 2000;89:2196–205.

    Article  CAS  Google Scholar 

  11. Kouda K, Furusawa K, Sugiyama H, Sumiya T, Ito T, Tajima F, et al. Does 20-min arm crank ergometer exercise increase plasma interleukin-6 in individuals with cervical spinal cord injury? Eur J Appl Physiol. 2012;112:597–604.

    Article  Google Scholar 

  12. Han I, Mukaimoto T, Ueda H, Kiyota H, Ohno M. Effects of intermittent bouts of aerobic exercise on oxygen consumption during and after exercise. NSSU J Sport Sci. 2012;1:1–7.

    Google Scholar 

  13. Martin Ginis KA, van der Scheer JW, Latimer-Cheung AE, Barrow A, Bourne C, Carruthers P, et al. Evidence-based scientific exercise guidelines for adults with spinal cord injury: an update and a new guideline. Spinal Cord. 2018;56:308–21.

    Article  Google Scholar 

  14. Karvonen MJ, Kentala E, Mustala O. The effects of training on heart rate: a longitudinal study. Ann Med Exp Biol Fenn. 1957;35:307–15.

    CAS  Google Scholar 

  15. Nishiyama K, Kamijo YI, van der Scheer JW, Kinoshita T, Goosey-Tolfrey VL, Hoekstra SP, et al. Lipid metabolism after mild cold stress in persons with a cervical spinal cord injury. Spinal Cord. 2022.

  16. Zimmermann G, Bolter LM, Sluka R, Höller Y, Bathke AC, Thomschewski A, et al. Sample sizes and statistical methods in interventional studies on individuals with spinal cord injury: a systematic review. J Evid Based Med. 2019;12:200–8.

    Article  Google Scholar 

  17. Ranallo RF, Rhodes EC. Lipid metabolism during exercise. Sports Med. 1998;26:29–42.

    Article  CAS  Google Scholar 

  18. Kimber NE, Heigenhauser GJF, Spriet LL, Dyck DJ. Skeletal muscle fat and carbohydrate metabolism during recovery from glycogen-depleting exercise in humans. J Physiol. 2003;548:919–27.

    Article  CAS  Google Scholar 

  19. Gorgey AS, Dudley GA. Skeletal muscle atrophy and increased intramuscular fat after incomplete spinal cord injury. Spinal Cord. 2007;45:304–9.

    Article  CAS  Google Scholar 

  20. Elder CP, Apple DF, Bickel CS, Meyer RA, Dudley GA. Intramuscular fat and glucose tolerance after spinal cord injury –a cross-sectional study. Spinal Cord. 2004;42:711–6.

    Article  CAS  Google Scholar 

  21. Shah PK, Stevens JE, Gregory CM, Pathare NC, Jayaraman A, Bickel SC, et al. Lower-extremity muscle cross-sectional area after incomplete spinal cord injury. Arch Phys Med Rehabil. 2006;87:772–8.

    Article  Google Scholar 

  22. Grabacka M, Pierzchalska M, Dean M, Reiss K. Regulation of ketone body metabolism and the role of PPARα. Int J Mol Sci. 2016;17:2093.

    Article  Google Scholar 

  23. Bauman WA, Adkins RH, Spungen AM, Waters RL. The effect of residual neurological deficit on oral glucose tolerance in persons with chronic spinal cord injury. Spinal Cord. 1999;37:765–71.

    Article  CAS  Google Scholar 

  24. Karlsson AK. Insulin resistance and sympathetic function in high spinal cord injury. Spinal Cord. 1999;37:494–500.

    Article  CAS  Google Scholar 

  25. Bluvshtein V, Korczyn AD, Pinhas I, Vered Y, Gelernter I, Catz A. Insulin resistance in tetraplegia but not in mid-thoracic paraplegia: is the mid-thoracic spinal cord involved in glucose regulation? Spinal Cord. 2011;49:648–52.

    Article  CAS  Google Scholar 

  26. Rodwell VW, Bender DA, Botham KM, et al. Overview of metabolism & the provision of metabolic fuels. In: Harper’s illustrated biochemistry. New York: McGraw-Hill Medical; 2015. p. 139–51.

  27. Dionyssiotis Y. Malnutrition in spinal cord injury: more than nutritional deficiency. J Clin Med Res. 2012;4:227–36.

    CAS  Google Scholar 

  28. Macdonald IA, Bennett T, Fellows IW. Catecholamines and the control of metabolism in man. Clin Sci. 1985;68:613–9.

    Article  CAS  Google Scholar 

  29. Arner P, Kriegholm E, Engfeldt P, Bolinder J. Adrenergic regulation of lipolysis in situ at rest and during exercise. J Clin Investig. 1990;85:893–8.

    Article  CAS  Google Scholar 

  30. Palmisano BT, Zhu L, Eckel RH, Stafford JM. Sex differences in lipid and lipoprotein metabolism. Mol Metab. 2018;15:45–55.

    Article  CAS  Google Scholar 

Download references


We thank all participants for their cooperation in our study. We also appreciate the service of Dr. Sven Hoekstra, Ph.D. from Loughborough University for kindly editing this manuscript. Grants: Mitacs-Japan Society for the Promotion of Science (JSPS) Internship program in 2017 (FT as host supervisor to JA).


This study was supported by grants from Nachikatsuura Research Foundation (L1221) to FT and also supported by funding from the Japan Society for the Promotion of Science through JSPS Postdoctoral Fellowships for Research in Japan (Summer Program; ID# SP17401; 2017).

Author information

Authors and Affiliations



KN, Y-iK, YN, and FT conceived and designed research; KN, Y-iK, JSA, TM, YM, YU, KK, and TO performed the experiments; KN and Y-iK analyzed the data; KN, Y-iK, JSA, YN, and FT interpreted the results; KN prepared the figures; KN and Y-iK drafted the manuscript; all authors edited and revised the manuscript; all authors approved the final version of the manuscript.

Corresponding author

Correspondence to Yukihide Nishimuara.

Ethics declarations

Competing interests

The authors declare no competing interests.


The study protocol and the methods applied in this study conformed to the guidelines of the Declaration of Helsinki and were approved by the Review Board on Human Experiments, Wakayama Medical University.

Informed consent

Informed consent for inclusion in this study was obtained from the participants.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Nishiyama, K., Nishimuara, Y., Au, J.S. et al. Serum concentrations of ketones increase after hand-ergometer exercise in persons with cervical spinal cord injuries: a preliminary prospective study. Spinal Cord 61, 139–144 (2023).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


Quick links