LAUSR

OBJECTIVES To assess; (1) differences in red blood cell distribution width between individuals with chronic (>1year), motor-complete cervical (n=21), upper-thoracic (n=27) and thoracolumbar (n=15) spinal cord injury and, (2) associations between red blood cell distribution width and cardiorespiratory fitness. DESIGN Prospective multi-center, cross-sectional study. METHODS Peak oxygen uptake was determined using an upper-body arm-crank exercise test to volitional exhaustion and red blood cell distribution width was measured using an automated hematology system. RESULTS There were significant (p<0.009) differences between groups classified by level of injury in absolute and relative peak oxygen uptake, peak power output and red blood cell distribution width. A significant (p<0.001) large negative association (r = -0.524) was found between relative peak oxygen uptake and red blood cell distribution width. Unbiased recursive partitioning, while revealing study site specific differences in red blood cell distribution width, identified homogenous subgroups based specifically on cardiorespiratory fitness irrespective of additional demographic and injury characteristics. CONCLUSION The strong negative association between cardiorespiratory fitness and red blood cell distribution width in individuals with paraplegia parallel those previously observed in non-disabled individuals. Higher red blood cell distribution width values are an independent risk factor for increased cardiovascular mortality, heart failure, and coronary heart disease and may reflect several underlying exacerbated metabolic responses such as oxidative stress and systemic inflammation. These data emphasize the importance of maintaining a high aerobic capacity following spinal cord injury.