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ALKEMADE PUCK, EIJSVOGELS THIJSMH, JANSSEN THOMASWJ, JANSEN KASPARMB, KINGMA BORISRM, DAANEN HEINAM. Upper-Body versus Lower-Body Cooling in Individuals with Paraplegia during Arm-Crank Exercise in the Heat. Med Sci Sports Exerc 2023; 55:2014-2024. [PMID: 37418241 PMCID: PMC10581408 DOI: 10.1249/mss.0000000000003244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
PURPOSE For wheelchair users with a spinal cord injury, the lower body may be a more convenient cooling site than the upper body. However, it remains unknown if leg cooling reduces thermal strain in these individuals. We compared the impact of upper-body versus lower-body cooling on physiological and perceptual outcomes during submaximal arm-crank exercise under heat stress in individuals with paraplegia. METHODS Twelve male participants with paraplegia (T4-L2, 50% complete lesion) performed a maximal exercise test in temperate conditions, and three heat stress tests (32°C, 40% relative humidity) in which they received upper-body cooling (COOL-UB), lower-body cooling (COOL-LB), or no cooling (CON) in a randomized counterbalanced order. Each heat stress test consisted of four exercise blocks of 15 min at 50% of peak power output, with 3 min of rest in between. Cooling was applied using water-perfused pads, with 14.8-m tubing in both COOL-UB and COOL-LB. RESULTS Gastrointestinal temperature was 0.2°C (95% confidence interval (CI), 0.1°C to 0.3°C) lower during exercise in COOL-UB versus CON (37.5°C ± 0.4°C vs 37.7°C ± 0.3°C, P = 0.009), with no difference between COOL-LB and CON ( P = 1.0). Heart rate was lower in both COOL-UB (-7 bpm; 95% CI, -11 to -3 bpm; P = 0.01) and COOL-LB (-5 bpm; 95% CI, -9 to -1 bpm; P = 0.049) compared with CON. The skin temperature reduction at the cooled skin sites was larger in COOL-LB (-10.8°C ± 1.1°C) than in COOL-UB (-6.7°C ± 1.4°C, P < 0.001), which limited the cooling capacity in COOL-LB. Thermal sensation of the cooled skin sites was improved and overall thermal discomfort was lower in COOL-UB ( P = 0.01 and P = 0.04) but not in COOL-LB ( P = 0.17 and P = 0.59) compared with CON. CONCLUSIONS Upper-body cooling more effectively reduced thermal strain than lower-body cooling in individuals with paraplegia, as it induced greater thermophysiological and perceptual benefits.
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Affiliation(s)
- PUCK ALKEMADE
- Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, THE NETHERLANDS
| | - THIJS M. H. EIJSVOGELS
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, THE NETHERLANDS
| | - THOMAS W. J. JANSSEN
- Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, THE NETHERLANDS
- Amsterdam Institute of Sport Science, Amsterdam, THE NETHERLANDS
| | - KASPAR M. B. JANSEN
- Department of Design Engineering, Delft University of Technology, Delft, THE NETHERLANDS
| | - BORIS R. M. KINGMA
- Department Human Performance, Unit Defence, Safety and Security, TNO, The Netherlands Organization for Applied Sciences, Soesterberg, THE NETHERLANDS
| | - HEIN A. M. DAANEN
- Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, THE NETHERLANDS
- Amsterdam Institute of Sport Science, Amsterdam, THE NETHERLANDS
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Alkemade P, Daanen HAM, Janssen TWJ, Broad E, Goosey-Tolfrey VL, Ibusuki T, Kneepkens H, Périard JD, Eijsvogels TMH. Heat preparedness and exertional heat illness in Paralympic athletes: A Tokyo 2020 survey. Temperature (Austin) 2022; 10:264-275. [PMID: 37332304 PMCID: PMC10274519 DOI: 10.1080/23328940.2022.2147364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/08/2022] [Accepted: 11/08/2022] [Indexed: 11/18/2022] Open
Abstract
Paralympic athletes may be at increased risk for exertional heat illness (EHI) due to reduced thermoregulatory ability as a consequence of their impairment. This study investigated the occurrence of heat-stress related symptoms and EHI, and the use of heat mitigation strategies in Paralympic athletes, both in relation to the Tokyo 2020 Paralympic Games and previous events. Paralympic athletes competing in Tokyo 2020 were invited to complete an online survey five weeks prior to the Paralympics and up to eight weeks after the Games. 107 athletes (30 [24-38] years, 52% female, 20 nationalities, 21 sports) completed the survey. 57% of respondents had previously experienced heat-stress related symptoms, while 9% had been medically diagnosed with EHI. In Tokyo, 21% experienced at least one heat-stress related symptom, while none reported an EHI. The most common symptom and EHI were, respectively, dizziness and dehydration. In preparation for Tokyo, 58% of respondents used a heat acclimation strategy, most commonly heat acclimatization, which was more than in preparation for previous events (45%; P = 0.007). Cooling strategies were used by 77% of athletes in Tokyo, compared to 66% during past events (P = 0.18). Cold towels and packs were used most commonly. Respondents reported no medically-diagnosed EHIs during the Tokyo 2020 Paralympic Games, despite the hot and humid conditions in the first seven days of competition. Heat acclimation and cooling strategies were used by the majority of athletes, with heat acclimation being adopted more often than for previous competitions.
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Affiliation(s)
- Puck Alkemade
- Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Hein A. M. Daanen
- Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Thomas W. J. Janssen
- Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | | | - Victoria L. Goosey-Tolfrey
- Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LeicestershireLE11 3TU, UK
| | - Tatsuru Ibusuki
- Department of Rehabilitation Medicine, Akeno Central Hospital, Oita, Japan
| | - Hiske Kneepkens
- Sport Medisch Centrum Papendal, NOC*NSF, Arnhem, The Netherlands
| | - Julien D. Périard
- University of Canberra Research Institute for Sport and Exercise, Bruce, New south wales, Australia
| | - Thijs M. H. Eijsvogels
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
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Hosokawa Y, Adami PE, Stephenson BT, Blauwet C, Bermon S, Webborn N, Racinais S, Derman W, Goosey-Tolfrey VL. Prehospital management of exertional heat stroke at sports competitions for Paralympic athletes. Br J Sports Med 2022; 56:599-604. [PMID: 34620604 PMCID: PMC9120375 DOI: 10.1136/bjsports-2021-104786] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To adapt key components of exertional heat stroke (EHS) prehospital management proposed by the Intenational Olympic Committee Adverse Weather Impact Expert Working Group for the Olympic Games Tokyo 2020 so that it is applicable for the Paralympic athletes. METHODS An expert working group representing members with research, clinical and lived sports experience from a Para sports perspective reviewed and revised the IOC consensus document of current best practice regarding the prehospital management of EHS. RESULTS Similar to Olympic competitions, Paralympic competitions are also scheduled under high environmental heat stress; thus, policies and procedures for EHS prehospital management should also be established and followed. For Olympic athletes, the basic principles of EHS prehospital care are: early recognition, early diagnosis, rapid, on-site cooling and advanced clinical care. Although these principles also apply for Paralympic athletes, slight differences related to athlete physiology (eg, autonomic dysfunction) and mechanisms for hands-on management (eg, transferring the collapsed athlete or techniques for whole-body cooling) may require adaptation for care of the Paralympic athlete. CONCLUSIONS Prehospital management of EHS in the Paralympic setting employs the same procedures as for Olympic athletes with some important alterations.
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Affiliation(s)
- Yuri Hosokawa
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
| | | | - Ben Thomas Stephenson
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- English Institute of Sport, Loughborough University, Loughborough, UK
| | - Cheri Blauwet
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation; Spaulding Hospital/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Medical Committee, International Paralympic Committee, Bonn, Germany
| | - Stephane Bermon
- Health and Science Department, World Athletics, Monaco
- LAHMESS, Universite Cote d'Azur, Nice, Provence-Alpes-Cote d'Azu, France
| | - Nick Webborn
- Medical Committee, International Paralympic Committee, Bonn, Germany
- Centre for Sport and Exercise Science and Medicine (SESAME), School of Sport and Service Management, University of Brighton, Brighton, UK
| | - Sebastien Racinais
- Research Education Centre, ASPETAR - Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Wayne Derman
- Institute of Sport and Exercise Medicine, Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- IOC Research Center, University of Stellenbosch, Cape Town, South Africa
| | - Victoria L Goosey-Tolfrey
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- IOC Research Center, The National Centre for Sports Exercise and Medicine, Loughborough University, Loughborough, UK
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Rosales-Antequera C, Viscor G, Araneda OF. Inflammation and Oxidative Stress as Common Mechanisms of Pulmonary, Autonomic and Musculoskeletal Dysfunction after Spinal Cord Injury. BIOLOGY 2022; 11:biology11040550. [PMID: 35453749 PMCID: PMC9032591 DOI: 10.3390/biology11040550] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/19/2022] [Accepted: 03/28/2022] [Indexed: 11/16/2022]
Abstract
Simple Summary When a spinal cord injury occurs, the neurons that regulate our voluntary movements, those involved in environment and somatic perception and those that regulate vegetative functions are affected. Once neuronal damage is established, the cells of other tissues are also affected in their functions, altering the interaction between organs and altering the proper functioning of the organism. Multiple studies in animal models, as well as in humans, have recognized as factors involved in organ damage the imbalance between the formation of highly reactive molecules called pro-oxidants and defensive mechanisms called antioxidants. Closely associated with this phenomenon, the inflammatory response is also pathologically activated. In this narrative review, we have analyzed the information involving these pathological processes at the level of the lung, the autonomic nervous system and the skeletal musculature after spinal cord injury. Knowing the abnormal functioning mechanisms that occur after a spinal cord injury not only offers a better understanding of the organic events but also offers future possibilities for therapeutic interventions that may benefit the thousands of patients suffering this pathology. Abstract One of the etiopathogenic factors frequently associated with generalized organ damage after spinal cord injury corresponds to the imbalance of the redox state and inflammation, particularly of the respiratory, autonomic and musculoskeletal systems. Our goal in this review was to gain a better understanding of this phenomenon by reviewing both animal and human studies. At the respiratory level, the presence of tissue damage is notable in situations that require increased ventilation due to lower thoracic distensibility and alveolar inflammation caused by higher levels of leptin as a result of increased fatty tissue. Increased airway reactivity, due to loss of sympathetic innervation, and levels of nitric oxide in exhaled air that are similar to those seen in asthmatic patients have also been reported. In addition, the loss of autonomic control efficiency leads to an uncontrolled release of catecholamines and glucocorticoids that induce immunosuppression, as well as a predisposition to autoimmune reactions. Simultaneously, blood pressure regulation is altered with vascular damage and atherogenesis associated with oxidative damage. At the muscular level, chronically elevated levels of prooxidants and lipoperoxidation associated with myofibrillar atrophy are described, with no reduction or reversibility of this process through antioxidant supplementation.
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Affiliation(s)
- Cristián Rosales-Antequera
- Physical Medicine and Rehabilitation Unit, Clínica Universidad de los Andes, Santiago 8320000, Chile;
- Integrative Laboratory of Biomechanics and Physiology of Effort, LIBFE, School of Kinesiology, Faculty of Medicine, Universidad de los Andes, Santiago 8320000, Chile
| | - Ginés Viscor
- Physiology Section, Department of Cell Biology, Physiology and Immunology, Faculty of Biology, Universitat de Barcelona, 08028 Barcelona, Spain;
| | - Oscar F. Araneda
- Integrative Laboratory of Biomechanics and Physiology of Effort, LIBFE, School of Kinesiology, Faculty of Medicine, Universidad de los Andes, Santiago 8320000, Chile
- Correspondence:
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O'Brien TJ, Lunt KM, Stephenson BT, Goosey-Tolfrey VL. The effect of pre-cooling or per-cooling in athletes with a spinal cord injury: a systematic review and meta-analysis. J Sci Med Sport 2022; 25:606-614. [DOI: 10.1016/j.jsams.2022.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 02/09/2022] [Accepted: 02/14/2022] [Indexed: 01/22/2023]
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Skin temperature measurement in individuals with spinal cord injury during and after exercise: Systematic review. J Therm Biol 2021; 105:103146. [DOI: 10.1016/j.jtherbio.2021.103146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 11/14/2021] [Accepted: 11/29/2021] [Indexed: 11/24/2022]
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Goodlin GT, Steinbeck L, Bergfeld D, Haselhorst A. Adaptive Cycling: Injuries and Health Concerns. Phys Med Rehabil Clin N Am 2021; 33:45-60. [PMID: 34799002 DOI: 10.1016/j.pmr.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Para-cycling has high rates of acute injuries. The underlying medical conditions of para-athletes predispose these cyclists to injury patterns and sequelae different from those of their able-bodied counterparts. Such injuries include an increased incidence of upper-extremity and soft tissue injuries, along with predisposition for respiratory, skin, genitourinary, and heat-related illnesses. There are no validated sideline assessment tools or return-to-play protocols for sports-related concussion in wheelchair user para-athletes or those with balance deficits. Para-cyclists may be at increased risk for relative energy deficiency in sport due to competitive pressure to maintain certain weights and increased incidence of low bone mineral density.
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Affiliation(s)
- Gabrielle T Goodlin
- Physical Medicine & Rehabilitation, Department of Neurology, The University of Texas at Austin, Dell Medical School, 1400 North IH-35, Suite 2.230, Austin, TX 78701, USA. https://twitter.com/gabi_goodlin
| | - Lindsey Steinbeck
- Physical Medicine & Rehabilitation, Department of Neurology, The University of Texas at Austin, Dell Medical School, 1400 North IH-35, Suite 2.230, Austin, TX 78701, USA
| | - Deborah Bergfeld
- Physical Medicine & Rehabilitation, Department of Neurology, The University of Texas at Austin, Dell Medical School, 1400 North IH-35, Suite 2.230, Austin, TX 78701, USA
| | - Alexandria Haselhorst
- Physical Medicine & Rehabilitation, Department of Neurology, The University of Texas at Austin, Dell Medical School, 1400 North IH-35, Suite 2.230, Austin, TX 78701, USA.
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Gee CM, Lacroix MA, Pethick WA, Côté P, Stellingwerff T, West CR. Cardiovascular responses to heat acclimatisation in athletes with spinal cord injury. J Sci Med Sport 2021; 24:756-762. [DOI: 10.1016/j.jsams.2021.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 12/07/2020] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
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Grossmann F, Flueck JL, Perret C, Meeusen R, Roelands B. The Thermoregulatory and Thermal Responses of Individuals With a Spinal Cord Injury During Exercise, Acclimation and by Using Cooling Strategies-A Systematic Review. Front Physiol 2021; 12:636997. [PMID: 33868002 PMCID: PMC8049141 DOI: 10.3389/fphys.2021.636997] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/09/2021] [Indexed: 11/25/2022] Open
Abstract
Background: In individuals with a spinal cord injury thermoregulatory mechanisms are fully or partially interrupted. This could lead to exercise-induced hyperthermia in temperate conditions which can be even more distinct in hot conditions. Hyperthermia has been suggested to impair physiological mechanisms in athletes, which could negatively influence physical performance and subjective well-being or cause mild to severe health issues. Objective: The aim was to evaluate the literature on the thermoregulatory and thermal responses of individuals with a spinal cord injury during exercise in temperate and hot conditions taking the effects of cooling techniques and heat acclimation into account. Data sources: Two electronic databases, PubMed and Web of Science were searched. Studies were eligible if they observed the influence of exercise on various thermoregulatory parameters (e.g., core and skin temperature, sweat rate, thermal sensation) in individuals with a spinal cord injury. Results: In total 32 articles were included of which 26 were of strong, 3 of moderate and 3 of weak quality. Individuals with a high lesion level, especially those with a tetraplegia, reached a higher core and skin temperature with a lower sweat rate. The use of cooling techniques before and during exercise can positively affect the burden of the impaired thermoregulatory system in all individuals with a spinal cord injury. Conclusion: Due to the absence of normal thermoregulatory abilities, individuals with a high-level spinal cord injury need special attention when they are exercising in temperate and hot conditions to prevent them from potential heat related issues. The use of cooling techniques can reduce this risk.
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Affiliation(s)
- Fabian Grossmann
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium.,Sports Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland
| | | | - Claudio Perret
- Sports Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Romain Meeusen
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Bart Roelands
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium.,School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, United Kingdom
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Stephenson BT, Stone B, Mason BS, Goosey‐Tolfrey VL. Physiology of handcycling: A current sports perspective. Scand J Med Sci Sports 2020; 31:4-20. [DOI: 10.1111/sms.13835] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/28/2020] [Accepted: 09/15/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Ben T. Stephenson
- Peter Harrison Centre for Disability Sport School of Sport, Exercise and Health Sciences Loughborough University Loughborough UK
- English Institute of Sport Performance Centre Loughborough University Loughborough UK
| | - Benjamin Stone
- Peter Harrison Centre for Disability Sport School of Sport, Exercise and Health Sciences Loughborough University Loughborough UK
| | - Barry S. Mason
- Peter Harrison Centre for Disability Sport School of Sport, Exercise and Health Sciences Loughborough University Loughborough UK
| | - Victoria L. Goosey‐Tolfrey
- Peter Harrison Centre for Disability Sport School of Sport, Exercise and Health Sciences Loughborough University Loughborough UK
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Dehghansai N, Lemez S, Wattie N, Pinder RA, Baker J. Understanding the Development of Elite Parasport Athletes Using a Constraint-Led Approach: Considerations for Coaches and Practitioners. Front Psychol 2020; 11:502981. [PMID: 33101110 PMCID: PMC7554586 DOI: 10.3389/fpsyg.2020.502981] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 09/08/2020] [Indexed: 11/25/2022] Open
Abstract
For the past half-century, the Paralympic Games has continued to grow, evident through increased participation, media recognition, and rising research focus in Para sport. While the competitive pool of athletes has increased, athlete development models have stayed relatively the same. Currently, coaches rely mainly on experiential knowledge, informal communication with colleagues, and theory transferred from able-bodied contexts as main resources to support development for themselves and their athletes. The purpose of this paper was to introduce Newell’s constraint-led model and its multidimensional spectrum and practical scope to address the complexities of athlete development. The model consists of three overarching constraint categories (i.e., individual, task, and environment) along with proposed additional sub-categories to capture nuances associated in Para sport in order to provide additional context to coaches regarding athlete development. Utilizing this theoretical framework, we present a holistic approach for coaches and practitioners to consider while addressing athletes’ short- and long-term developmental plans. This approach highlights the interactions among factors from a wide range of categories that indirectly and directly impact one another and ultimately influence athletes’ developmental processes. It is important to consider the dynamic interaction of constraints over various timescales during development and identify underlying issues to improve athlete experience and maximize developmental opportunities. Coaches and practitioners can use the proposed framework as a guide to key factors to consider for their cohort of athletes. This approach provides a context-specific approach that considers unique factors associated with athletes and their environment.
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Affiliation(s)
- Nima Dehghansai
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Srdjan Lemez
- Department of Kinesiology and Health Promotion, California State Polytechnic University, Pomona, Pomona, CA, United States
| | - Nick Wattie
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada
| | - Ross A Pinder
- Paralympic Innovation, Paralympics Australia, Adelaide, SA, Australia
| | - Joe Baker
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
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12
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Mneimneh F, Moussalem C, Ghaddar N, Ghali K, Omeis I. Experimental study on the effectiveness of the PCM cooling vest in persons with paraplegia of varying levels. J Therm Biol 2020; 91:102634. [PMID: 32716876 DOI: 10.1016/j.jtherbio.2020.102634] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/23/2020] [Accepted: 05/27/2020] [Indexed: 11/17/2022]
Abstract
Persons with paraplegia (PA) from thoracic spinal cord injury (T1-T12) are prone to thermal stress during exercise due to impaired thermoregulation. This study evaluates the effectiveness of phase change material (PCM) cooling vests on persons with PA of different levels of injury during exercise in hot exposure. Sixteen participants were recruited and divided to three groups based on injury level; high-thoracic T1-T3, mid-thoracic T4-T8, and low thoracic T9-T12 to perform a 30-min arm-crank exercise at a 30 °C room condition. Two types of PCM vests at melting temperature of 20 °C were tested: i) V1 with PCM covering the trunk of 3.4 kg overall vest mass and ii) V2 with PCM covering chest and upper back of 2.17 kg overall vest mass. High thoracic and low-thoracic groups performed NV and V1 tests; whereas, mid-thoracic group performed NV, V1, and V2 tests. Heart rate, core, and skin temperatures were monitored during 15-min preconditioning, 30-min exercise, and 15-min recovery. In addition, thermal comfort, sensation, skin wettedness, and perceived exertion were recorded during exercise only. The main findings were that the effectiveness of the cooling vest was dependent on injury level and portion of sensate skin of trunk covered by the PCM packets. Rise in core temperature (ΔTcr) was reduced significantly for the low-thoracic group during exercise and recovery (ΔTcr=0.41°C, 0.26°C for NV and V1; respectively, p<0.05). For the mid-thoracic group, both V1 (p = 0.001) and V2 (p = 0.008) were effective in reducing ΔTcr compared to the NV test at the end of the recovery period (0.74°C,0.42°C,0.56°C, for NV, V1 and V2; respectively). For the high-thoracic group, V1 was not effective in reducing core temperature (p>0.05). For the mid-thoracic group, V2 at 36% lower mass significantly improved thermal comfort (p = 0.0004) compared to the NV test and was as effective compared to V1 in reducing core temperature.
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Affiliation(s)
- Farah Mneimneh
- Mechanical Engineering Department, American University of Beirut, P.O. Box 11-0236, Beirut, 1107-2020, Lebanon
| | - Charbel Moussalem
- Division of Neurosurgery, Department of Surgery, American University of Beirut Medical Center, P.O. Box: 11-0236, Riad El Solh Beirut, 1107 2020, Beirut, Lebanon
| | - Nesreen Ghaddar
- Mechanical Engineering Department, American University of Beirut, P.O. Box 11-0236, Beirut, 1107-2020, Lebanon.
| | - Kamel Ghali
- Mechanical Engineering Department, American University of Beirut, P.O. Box 11-0236, Beirut, 1107-2020, Lebanon
| | - Ibrahim Omeis
- Division of Neurosurgery, Department of Surgery, American University of Beirut Medical Center, P.O. Box: 11-0236, Riad El Solh Beirut, 1107 2020, Beirut, Lebanon
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Zhang Y, Bishop PA. Risks of Heat Illness in Athletes With Spinal Cord Injury: Current Evidence and Needs. Front Sports Act Living 2020; 1:68. [PMID: 33344991 PMCID: PMC7739687 DOI: 10.3389/fspor.2019.00068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 12/10/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Phillip A Bishop
- Department of Kinesiology, The University of Alabama, Tuscaloosa, AL, United States
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Rogers AE, Baker J, Beutler A, Witkop C, Leggit JC. Injury and Illness Surveillance During the 2016 Department of Defense Warrior Games: Review of Methods and Results. Mil Med 2019; 184:e616-e621. [PMID: 30941408 DOI: 10.1093/milmed/usz063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/11/2019] [Accepted: 03/11/2019] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Surveillance systems have become a valuable tool to capture epidemiological data at multi-sport events, with findings serving to predict and prevent injury, reduce illness, and guide efficient utilization of medical resources. In 2016, the first injury and illness surveillance tool for the Department of Defense (DoD) Warrior Games was established to inform the required medical footprint. The purpose of this paper is to describe the methods and findings from the 2016 DoD Warrior Games surveillance system, which included a database of injuries and illness. MATERIALS AND METHODS A total of 245 wounded warrior (WW) athletes were followed over 19 days, to include train-up and competition periods, as they competed for their respective teams of Army, Navy, Air Force, Marines, Special Operations, and United Kingdom. Medical personnel recorded injuries and illnesses treated utilizing a standardized surveillance form and data were entered into a daily tracker to examine patterns or areas for prevention. Reports included sex, age, event discipline, previous injury or illness, reason for presentation, and treatment provided. RESULTS From June 3 to June 21, 2016, 114 individual encounters were recorded on the standard form and entered into the surveillance database. Athletes accounted for 67% of all encounters. Illness accounted for 30.7% of all visits, while injuries accounted for 69.2%. The incident proportion of injuries in athletes was 23.3 injuries per 100 athletes (95% CI 17.6, 30.1) and incident rate of 12.2 injuries per 1000 athlete days. Integrative medicine treatments including acupuncture, osteopathic manipulative treatment (OMT), massage therapy, and gua sha accounted for the largest forms of treatment (31%). CONCLUSIONS From the surveillance data, staff levels and treatment supplies can be adjusted. In addition an improved surveillance tool can be created. Continuous surveillance is required to provide information on trends in injury and illness to support prevention strategies.
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Affiliation(s)
- Amy E Rogers
- Navy Environmental and Preventive Medicine Unit TWO, 1285 West D Street, BLDG U-238, Norfolk, VA 23511
| | - Joshua Baker
- Uniformed Services University, Department of Family Medicine, 4301 Jones Bridge Rd, Bethesda MD 20814
| | - Anthony Beutler
- Uniformed Services University, Department of Family Medicine, 4301 Jones Bridge Rd, Bethesda MD 20814
| | - Catherine Witkop
- Uniformed Services University, Preventive Medicine and Biostatistics, 4301 Jones Bridge Rd, Bethesda MD 20814
| | - Jeffrey C Leggit
- Uniformed Services University, Department of Family Medicine, 4301 Jones Bridge Rd, Bethesda MD 20814
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Gibson OR, James CA, Mee JA, Willmott AG, Turner G, Hayes M, Maxwell NS. Heat alleviation strategies for athletic performance: A review and practitioner guidelines. Temperature (Austin) 2019; 7:3-36. [PMID: 32166103 PMCID: PMC7053966 DOI: 10.1080/23328940.2019.1666624] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 09/06/2019] [Accepted: 09/08/2019] [Indexed: 12/19/2022] Open
Abstract
International competition inevitably presents logistical challenges for athletes. Events such as the Tokyo 2020 Olympic Games require further consideration given historical climate data suggest athletes will experience significant heat stress. Given the expected climate, athletes face major challenges to health and performance. With this in mind, heat alleviation strategies should be a fundamental consideration. This review provides a focused perspective of the relevant literature describing how practitioners can structure male and female athlete preparations for performance in hot, humid conditions. Whilst scientific literature commonly describes experimental work, with a primary focus on maximizing magnitudes of adaptive responses, this may sacrifice ecological validity, particularly for athletes whom must balance logistical considerations aligned with integrating environmental preparation around training, tapering and travel plans. Additionally, opportunities for sophisticated interventions may not be possible in the constrained environment of the athlete village or event arenas. This review therefore takes knowledge gained from robust experimental work, interprets it and provides direction on how practitioners/coaches can optimize their athletes' heat alleviation strategies. This review identifies two distinct heat alleviation themes that should be considered to form an individualized strategy for the athlete to enhance thermoregulatory/performance physiology. First, chronic heat alleviation techniques are outlined, these describe interventions such as heat acclimation, which are implemented pre, during and post-training to prepare for the increased heat stress. Second, acute heat alleviation techniques that are implemented immediately prior to, and sometimes during the event are discussed. Abbreviations: CWI: Cold water immersion; HA: Heat acclimation; HR: Heart rate; HSP: Heat shock protein; HWI: Hot water immersion; LTHA: Long-term heat acclimation; MTHA: Medium-term heat acclimation; ODHA: Once-daily heat acclimation; RH: Relative humidity; RPE: Rating of perceived exertion; STHA: Short-term heat acclimation; TCORE: Core temperature; TDHA: Twice-daily heat acclimation; TS: Thermal sensation; TSKIN: Skin temperature; V̇O2max: Maximal oxygen uptake; WGBT: Wet bulb globe temperature.
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Affiliation(s)
- Oliver R. Gibson
- Centre for Human Performance, Exercise and Rehabilitation (CHPER), Division of Sport, Health and Exercise Sciences, Brunel University London, Uxbridge, UK
| | - Carl A. James
- Institut Sukan Negara (National Sports Institute), Kuala Lumpur, Malaysia
| | - Jessica A. Mee
- School of Sport and Exercise Sciences, University of Worcester, Worcester, UK
| | - Ashley G.B. Willmott
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Gareth Turner
- Bisham Abbey National High-Performance Centre, English Institute of Sport, EIS Performance Centre, Marlow, UK
| | - Mark Hayes
- Environmental Extremes Laboratory, School of Sport and Service Management, University of Brighton, Eastbourne, UK
| | - Neil S. Maxwell
- Environmental Extremes Laboratory, School of Sport and Service Management, University of Brighton, Eastbourne, UK
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Griggs KE, Stephenson BT, Price MJ, Goosey-Tolfrey VL. Heat-related issues and practical applications for Paralympic athletes at Tokyo 2020. Temperature (Austin) 2019; 7:37-57. [PMID: 32166104 PMCID: PMC7053936 DOI: 10.1080/23328940.2019.1617030] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/02/2019] [Accepted: 05/06/2019] [Indexed: 02/07/2023] Open
Abstract
International sporting competitions, including the Paralympic Games, are increasingly being held in hot and/or humid environmental conditions. Thus, a greater emphasis is being placed on preparing athletes for the potentially challenging environmental conditions of the host cities, such as the upcoming Games in Tokyo in 2020. However, evidence-based practices are limited for the impairment groups that are eligible to compete in Paralympic sport. This review aims to provide an overview of heat-related issues for Paralympic athletes alongside current recommendations to reduce thermal strain and technological advancements in the lead up to the Tokyo 2020 Paralympic Games. When competing in challenging environmental conditions, a number of factors may contribute to an athlete's predisposition to heightened thermal strain. These include the characteristics of the sport itself (type, intensity, duration, modality, and environmental conditions), the complexity and severity of the impairment and classification of the athlete. For heat vulnerable Paralympic athletes, strategies such as the implementation of cooling methods and heat acclimation can be used to combat the increase in heat strain. At an organizational level, regulations and specific heat policies should be considered for several Paralympic sports. Both the utilization of individual strategies and specific heat health policies should be employed to ensure that Paralympics athletes' health and sporting performance are not negatively affected during the competition in the heat at the Tokyo 2020 Paralympic Games.
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Affiliation(s)
- Katy E. Griggs
- Department of Engineering, School of Science and Technology, Nottingham Trent University, Nottingham, UK
| | - Ben T. Stephenson
- Loughborough Performance Centre, English Institute of Sport, Loughborough University, Loughborough, UK
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Michael J. Price
- School of Life Sciences, Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry, UK
| | - Victoria L. Goosey-Tolfrey
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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Trbovich MB, Handrakis JP, Kumar NS, Price MJ. Impact of passive heat stress on persons with spinal cord injury: Implications for Olympic spectators. Temperature (Austin) 2019; 7:114-128. [PMID: 33015240 PMCID: PMC7518736 DOI: 10.1080/23328940.2019.1631730] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 06/05/2019] [Accepted: 06/07/2019] [Indexed: 01/26/2023] Open
Abstract
Environmental heat stress can negatively impact health, work capacity, and athletic performance and potentially to lead to life-threatening consequences if not mitigated. With the upcoming Toyko Olympic games to be held during anticipated warm ambient temperatures (up to 29°C), and with spectators potentially spending long durations of time outdoors, certain populations of persons with impaired thermoregulatory capacity will be at higher risk of heat-related illness from passive heat stress. Persons with spinal cord injury (SCI) are one of these groups as a result of a decentralized sympathetic nervous system, which leaves them with impairment in convective and evaporative cooling via vasodilation and sweating, respectively. This review summarizes (1) thermoregulatory physiological responses of persons with SCI under passive heat stress: the effect of level and completeness of injury; (2) the impact of passive heat stress on quality of life (QOL), outdoor participation, behavioral thermoregulation, and cognition; (3) recommendations and education for clinicians providing health care for persons with SCI; and (4) suggestions of future directions for exploring the gaps in the literature on passive heat stress in persons with SCI. This article aims to equip consumers with SCI and health-care professionals with the most up-to-date knowledge on passive heat stress responses in persons with SCI, so that their attendance at the Olympic games can be done with maximal safety and enjoyment.
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Affiliation(s)
- Michelle B. Trbovich
- Department of Rehabilitation Medicine, UT Health Science Center at San Antonio, San Antonio, TX, USA
- Spinal cord injury center, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - John P. Handrakis
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J Peters VA Medical Center, Bronx, NY, USA
- New York Institute of Technology, Department of Physical Therapy, School of Health Professions, Old Westbury, NY, USA
| | - Nina S. Kumar
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J Peters VA Medical Center, Bronx, NY, USA
| | - Mike J. Price
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
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Trbovich M, Koek W, Ortega C. Efficacy of water spray for evaporative cooling in athletes with spinal cord injury. Spinal Cord Ser Cases 2019; 5:51. [PMID: 31632709 PMCID: PMC6786376 DOI: 10.1038/s41394-019-0194-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/29/2019] [Accepted: 05/09/2019] [Indexed: 01/01/2023] Open
Abstract
Study design Interventional crossover study. Objective Spinal cord injury (SCI) disrupts afferent input to the hypothalamus and impairs efferent vaso- and sudomotor output, especially in lesions above the sympathetic chain (T1-L2). In consequence, persons with SCI under heat stress experience impairment in the ability to dissipate heat proportional to the lesion level. Thermoregulatory dysfunction places an individual at high risk of hyperthermia, which can be life threatening, especially for athletes with SCI during exercise. Current evidence on therapeutic cooling techniques in athletes with SCI is limited, but basic physiologic and research data suggest water spray (WS) might be efficacious, particularly in athletes with tetraplegia (TP), who are most impaired in thermoregulation. The aim of this study was to evaluate the effect of WS on core temperature (Tc) during exercise in athletes with SCI. Setting Texas, USA. Methods Eleven individuals with SCI: seven with TP, four with paraplegia (PP); and sixteen able-bodied (AB) controls underwent a wheelchair intermittent sprint exercise for 90 min under two conditions: (1) WS application every 15 min and (2) control (C), without WS. Tc was measured every 15 min and was analyzed for the effect of group (TP, PP, and AB) and time. Change in Tc (ΔTc) was also compared between groups. Results ΔTc was significantly higher in TP vs. PP (p < 0.0001) and TP vs. AB (p < 0.0001) groups under C treatment. WS significantly attenuated ΔTc in TP (p = 0.001), but did not change ΔTc in PP or AB. Conclusion WS effectively attenuated Tc elevation during exercise in athletes with TP. Sponsorship Texas chapter of the Paralyzed Veterans of America.
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Affiliation(s)
- Michelle Trbovich
- Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX USA
| | - Wouter Koek
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX USA
| | - Catherine Ortega
- School of Health Professions, Physical Therapy Department, University of Texas Health Science Center at San Antonio, San Antonio, TX USA
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Mneimneh F, Ghaddar N, Ghali K, Moussalem C, Omeis I. Would personal cooling vest be effective for use during exercise by people with thoracic spinal cord injury? J Therm Biol 2019; 82:123-141. [PMID: 31128640 DOI: 10.1016/j.jtherbio.2019.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/08/2019] [Accepted: 04/09/2019] [Indexed: 10/27/2022]
Abstract
People with thoracic spinal cord injury (SCI), named people with paraplegia (PA), are vulnerable to thermal heat stress during exercise due to disruption in their thermal physiology. Using personal cooling vests with phase change material (PCM) or ice presents a possible solution for PA to suppress the increase in core temperature and body heat storage. With the limited published experimental studies about effective cooling vest for PA, this work aims to develop an altered PA bioheat model combined with cooling vest model to study cooling vest performance during exercise. The integrated PA bioheat and vest models predict core and skin temperatures, latent and sensible heat losses and change in body heat storage for PA with and without a cooling vest. The models were validated with published experimental data on PA without the cooling vest and on PA with two cooling vests; one using PCM at melting temperature of 15 °C and the other using ice packets during exercise. It was observed that sensible heat losses at the four torso segments (abdomen, lower back, chest and upper back) increased with the vest case compared to the no-vest case; while, latent heat losses decreased compared to the no-vest case. However, insignificant change was seen in core temperatures and body heat storage as was also reported experimentally. The performance of each of the cooling vest during exercise on PA was dependent on skin coverage area and melting temperatures.
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Affiliation(s)
- Farah Mneimneh
- Mechanical Engineering Department, American University of Beirut, P.O. Box 11-0236, Beirut, 1107-2020, Lebanon
| | - Nesreen Ghaddar
- Mechanical Engineering Department, American University of Beirut, P.O. Box 11-0236, Beirut, 1107-2020, Lebanon.
| | - Kamel Ghali
- Mechanical Engineering Department, American University of Beirut, P.O. Box 11-0236, Beirut, 1107-2020, Lebanon
| | - Charbel Moussalem
- Division of Neurosurgery, Department of Surgery, American University of Beirut Medical Center, P.O. Box: 11-0236, Riad El Solh Beirut, 1107 2020, Beirut, Lebanon
| | - Ibrahim Omeis
- Division of Neurosurgery, Department of Surgery, American University of Beirut Medical Center, P.O. Box: 11-0236, Riad El Solh Beirut, 1107 2020, Beirut, Lebanon
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20
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Grobler L, Derman W, Racinais S, Ngai ASH, van de Vliet P. Illness at a Para Athletics Track and Field World Championships under Hot and Humid Ambient Conditions. PM R 2019; 11:919-925. [PMID: 30690925 DOI: 10.1002/pmrj.12086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 12/14/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Heat-related illness, including heat exhaustion and heat stroke, is seen as a major risk for athletes with a physical impairment. OBJECTIVE Primary: To survey the illness statistics during the 2015 Para Athletics World Championships and report on any cases of significant heat-related illnesses. Secondary: To document the heat countermeasures taken on behalf of the organizing committee. DESIGN Retrospective audit. SETTING Medical records collected at medical centers during the 2015 Para Athletics World Championships. PARTICIPANTS Athletes participating in the 2015 Para Athletics World Championships. METHODS Illness statistics and records of hospitalizations of athletes participating in the championships were recorded by the medical officials during the precompetition (3 days) and competition (10 days) periods. Furthermore, wet-bulb globe temperatures (WBGTs) were measured at the competition venues. MAIN OUTCOME MEASUREMENTS Incidence rates of illness during the precompetition and competition periods. RESULTS WBGTs ranged from 24.6°C to 36.0°C, regularly exceeding the American College of Sports Medicine (ACSM) and International Association of Athletics Federations (IAAF) guidelines for cancelation in the morning both during the competition (ACSM, 52%; IAAF, 97%) and precompetition periods (ACSM, 75%; IAAF, 100%). These guidelines were not exceeded as regularly during the evening and noon for both the precompetition and competition periods (ACSM, 0%-5%; IAAF, 0%-58%). The illness incidence rate was 2.89 per 1000 athlete-days (incidence proportion = 3.76%; confidence interval = 2.69%-4.83%). Only seven cases of heat-related illness were recorded, of which three required hospitalization. CONCLUSION This study indicates low rates of illness, including hospitalization and intravenous administration for heat-related illness among athletes participating in the 2015 Para Athletics World Championships. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Lara Grobler
- Institute of Sport and Exercise Medicine, Faculty of Health and Medical Sciences, Department of Sport Science, Faculty of Education, Stellenbosch University, Cape Town, South Africa
| | - Wayne Derman
- Institute of Sport and Exercise Medicine, Faculty of Health and Medical Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sebastien Racinais
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | | | - Peter van de Vliet
- Medical & Scientific Department, International Paralympic Committee, Bonn, Germany
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FORSYTH PETA, MILLER JOANNA, PUMPA KATE, THOMPSON KEVING, JAY OLLIE. Independent Influence of Spinal Cord Injury Level on Thermoregulation during Exercise. Med Sci Sports Exerc 2019; 51:1710-1719. [DOI: 10.1249/mss.0000000000001978] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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22
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Cowley KC. A new conceptual framework for the integrated neural control of locomotor and sympathetic function: implications for exercise after spinal cord injury. Appl Physiol Nutr Metab 2019; 43:1140-1150. [PMID: 30071179 DOI: 10.1139/apnm-2018-0310] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
All mammals, including humans, are designed to produce sustained locomotor movements. Many higher centres are involved in movement, but ultimately these centres act upon a core "rhythm-generating" network within the brainstem-spinal cord. In addition, endurance-based locomotor exercise requires sympathetic neural support to maintain homeostasis and to provide needed metabolic resources. This review focuses on the roles and integration of these 2 neural systems. Part I reviews the cardiovascular, thermoregulatory, and metabolic functions under spinal sympathetic control as revealed by spinal cord injury at different levels. Part II examines the integration between brainstem-spinal sympathetic pathways and the neural circuitry producing motor rhythms. In particular, the rostroventral medulla (RVM) contains the neural circuitry that (i) integrates heart rate, contractility, and blood flow in response to postural changes; (ii) initiates and maintains cardiovascular adaptations for exercise; (iii) provides direct descending innervation to preganglionic neurons innervating the adrenal glands, white adipose tissue, and tissues responsible for cooling the body; (iv) integrates descending sympathetic drive for energy substrate mobilization (lipolysis); and (v) is the relay for descending locomotor commands arising from higher brain centres. A unifying conceptual framework is presented, in which the RVM serves as the final descending supraspinal "exercise integration centre" linking the descending locomotor command signal with the metabolic and homeostatic support needed to produce prolonged rhythmic activities. The role and rationale for an ascending sympathetic and locomotor drive from the lower to upper limbs within this framework is presented. Examples of new research directions based on this unifying framework are discussed.
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Affiliation(s)
- Kristine C Cowley
- Department of Physiology and Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0J9, Canada.,Department of Physiology and Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0J9, Canada
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23
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Dutton RA. Medical and Musculoskeletal Concerns for the Wheelchair Athlete: A Review of Preventative Strategies. Curr Sports Med Rep 2019; 18:9-16. [PMID: 30624329 DOI: 10.1249/jsr.0000000000000560] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Adaptive sports refers to organized sporting activities that are practiced by individuals with disabilities and are worthwhile to maintain physical and psychological health. As adaptive sports participation continues to rise, health care providers must have an enhanced understanding of injury and illness patterns specific to the adaptive athlete. Early recognition and prevention are important to ensure safe and successful participation in sport. The present review aims to provide a framework for diagnosis and prevention of common conditions specific to the wheelchair athlete. In particular, autonomic dysreflexia, impaired thermoregulation, urinary tract infection, and pressure injuries, as well as shoulder pain, upper-extremity entrapment neuropathies, and osteoporotic fractures will be discussed.
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Affiliation(s)
- Rebecca A Dutton
- University of New Mexico, Department of Orthopaedics and Rehabilitation
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24
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Griggs KE, Havenith G, Price MJ, Goosey-Tolfrey VL. Infographic. Thermoregulatory impairment in athletes with a spinal cord injury. Br J Sports Med 2019; 53:1305-1306. [PMID: 30610000 DOI: 10.1136/bjsports-2018-099853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Katy Ellen Griggs
- School of Sport, Exercise and Health Sciences, The Peter Harrison Centre for Disability Sport, The National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, Leicestershire, UK.,Department of Engineering, School of Science and Technology, Nottingham Trent University - Clifton Campus, Nottingham, UK
| | - George Havenith
- Design School, Environmental Ergonomics Research Centre, Loughborough University, Loughborough, Leicestershire, UK
| | - Michael J Price
- School of Life Sciences, Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry, UK
| | - Victoria L Goosey-Tolfrey
- School of Sport, Exercise and Health Sciences, The Peter Harrison Centre for Disability Sport, The National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, Leicestershire, UK
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Trbovich M. Efficacy of Various Cooling Techniques During Exercise in Persons With Spinal Cord Injury: A Pilot Crossover Intervention Study. Top Spinal Cord Inj Rehabil 2019; 25:74-82. [PMID: 30774291 PMCID: PMC6368108 DOI: 10.1310/sci2501-74] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: Decentralization of the sympathetic nervous system in persons with spinal cord injury (SCI) results in impaired vasomotor and sudomotor activity and, subsequently, impaired thermoregulatory capacity during exercise in the heat. Hyperthermia can be life-threatening and, as such, cooling interventions are needed to prevent this sequela. Objectives: To measure change in core temperature (ΔTC) over time during exercise in normothermic and high ambient heat conditions to compare thermoregulatory capacity in persons with varying degrees of intact vasomotor and sudomotor activity and to determine the efficacy of three cooling interventions in mitigating TC rise. Methods: Three persons participated: a 51-year-old with complete (AIS A) tetraplegia (TP), a 32-year-old with AIS A paraplegia (PP), and a 40-year-old without SCI (AB). Each exercised for 30 minutes on a wheelchair treadmill propelled at 30 revolutions per minute under five different conditions: (1) cool (C) = 75°F without cooling, (2) hot (H) = 90°F without cooling, (3) 90°F with cooling vest (CV), (4) 90°F with water spray (WS), and (5) 90°F with ice slurry ingestion (IS). ΔTC was compared for all conditions in all participants. Results: ΔTC in the C and H conditions was proportional to the neurological level of injury, with Tc rising highest in the TP followed by the PP then AB. WS was most efficacious at mitigating rise in TC followed by IS and CV in TP and PP. None of the cooling interventions provided an added TC cooling effect in AB. Conclusion: WS was most efficacious at mitigating rise in TC in TP>PP during exercise in the heat and should be studied in a larger SCI population.
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Abstract
Cold water or ice slurry ingestion during exercise seems to be an effective and practical means to improve endurance exercise performance in the heat. However, transient reductions in sweating appear to decrease the potential for evaporative heat loss from the skin by a magnitude that at least negates the additional internal heat loss as a cold ingested fluid warms up to equilibrate with body temperature; thus explaining equivalent core temperatures during exercise at a fixed heat production irrespective of the ingested fluid temperature. Internal heat transfer with cold fluid/ice is always 100% efficient; therefore, when a decrement occurs in the efficiency that sweat evaporates from the skin surface (i.e. sweating efficiency), a net cooling effect should begin to develop. Using established relationships between activity, climate and sweating efficiency, the boundary conditions beyond which cold ingested fluids are beneficial in terms of increasing net heat loss can be calculated. These conditions are warmer and more humid for cycling relative to running by virtue of the greater skin surface airflow, which promotes evaporation, for a given metabolic heat production and thus sweat rate. Within these boundary conditions, athletes should ingest fluids at the temperature they find most palatable, which likely varies from athlete to athlete, and therefore best maintain hydration status. The cooling benefits of cold fluid/ice ingestion during exercise are likely disproportionately greater for athletes with physiological disruptions to sweating, such as those with a spinal cord injury or burn injuries, as their capacity for skin surface evaporative heat loss is much lower; however, more research examining these groups is needed.
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Nash MS, Bilzon JLJ. Guideline Approaches for Cardioendocrine Disease Surveillance and Treatment Following Spinal Cord Injury. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2018; 6:264-276. [PMID: 30546969 PMCID: PMC6267529 DOI: 10.1007/s40141-018-0203-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW Persons with spinal cord injuries (SCI) commonly experience individual risks and coalesced health hazards of the cardiometabolic syndrome (CMS). This review will examinethe role of exercise and nutritional intervention as countermeasures to these disease risks. RECENT FINDINGS The CMS hazards of overweight/obesity, insulin resistance, hypertension, and dyslipidemia are strongly associated with physical deconditioning and are common after SCI. Both the CMS diagnosis and physical deconditioning worsen the prognosis for all-cause cardiovascular disease occurring early after SCI. Evidence supports a therapeutic role for physical activity after SCI as an effective countermeasure to these risks and often represents the first-line approach to CMS abatement. This evidence is supported by authoritative systematic reviews and associated guidelines that recommend specific activities, frequencies, and activities of work. In many cases, the most effective exercise programming uses more intense periods of work with limited rest. As SCI is also associated with poor dietary habits, including excessive energy intake and saturated fat consumption, more comprehensive lifestyle management incorporating both exercise and nutrition represents a preferred approach for overall health management. SUMMARY Irrespective of the interventional strategy, improved surveillance of the population for CMS risks and encouraged incorporation of exercise and nutritional management according to recent population-specific guidelines will most likely play an important role in the preservation of activity, optimal health, and independence throughout the lifespan.
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Affiliation(s)
- Mark S. Nash
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL USA
- Departments of Neurological Surgery and Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine, Miami, FL USA
| | - James L. J. Bilzon
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL USA
- Department for Health, University of Bath, Bath, Somerset UK
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Shea JR, Shay BL, Leiter J, Cowley KC. Energy Expenditure as a Function of Activity Level After Spinal Cord Injury: The Need for Tetraplegia-Specific Energy Balance Guidelines. Front Physiol 2018; 9:1286. [PMID: 30283348 PMCID: PMC6156377 DOI: 10.3389/fphys.2018.01286] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 08/27/2018] [Indexed: 01/08/2023] Open
Abstract
The World Health Organization recognizes obesity as a global and increasing problem for the general population. Because of their reduced physical functioning, people with spinal cord injury (SCI) face additional challenges for maintaining an appropriate whole body energy balance, and the majority with SCI are overweight or obese. SCI also reduces exercise capacity, particularly in those with higher-level injury (tetraplegia). Tetraplegia-specific caloric energy expenditure (EE) data is scarce. Therefore, we measured resting and exercise-based energy expenditure in participants with tetraplegia and explored the accuracy of general population-based energy use predictors. Body composition and resting energy expenditure (REE) were measured in 25 adults with tetraplegia (C4/5 to C8) and in a sex-age-height matched group. Oxygen uptake, carbon dioxide production, heart rate, perceived exertion, and exercise intensity were also measured in 125 steady state exercise trials. Those with motor-complete tetraplegia, but not controls, had measured REE lower than predicted (mean = 22% less, p < 0.0001). REE was also lower than controls when expressed per kilogram of lean mass. Nine had REE below 1200 kcal/day. We developed a graphic compendium of steady state EE during arm ergometry, wheeling, and hand-cycling. This compendium is in a format that can be used by persons with tetraplegia for exercise prescription (calories, at known absolute intensities). EE was low (55–450 kcal/h) at the intensities participants with tetraplegia were capable of maintaining. If people with tetraplegia followed SCI-specific activity guidelines (220 min/week) at the median intensities we measured, they would expend 563–1031 kcal/week. Participants with tetraplegia would therefore require significant time (4 to over 20 h) to meet a weekly 2000 kcal exercise target. We estimated total daily EE for a range of activity levels in tetraplegia and compared them to predicted values for the general population. Our analysis indicated that the EE values for sedentary through moderate levels of activity in tetraplegia fall well below predicted sedentary levels of activity for the general population. These findings help explain sub-optimal responses to exercise interventions after tetraplegia, and support the need to develop tetraplegia-specific energy-balance guidelines that reflects their unique EE situation.
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Affiliation(s)
- Jessie R Shea
- Department of Physiology and Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Barbara L Shay
- Department of Physical Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Jeff Leiter
- Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Pan Am Clinic Foundation, Winnipeg, MB, Canada
| | - Kristine C Cowley
- Department of Physiology and Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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Trbovich M, Li C, Lee S. Does the CDC Definition of Fever Accurately Predict Inflammation and Infection in Persons With SCI? Top Spinal Cord Inj Rehabil 2018; 22:260-268. [PMID: 29339867 DOI: 10.1310/sci2016-00049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Pneumonia and septicemia have the greatest impact on reduced life expectancy in persons with spinal cord injury (SCI). Fever is often the first presenting symptom of infection or inflammation. Thermoregulatory dysfunction in persons with SCI may preclude a typical febrile response to infection or inflammation and thus delay diagnostic workup. Objective: To determine the core temperature of persons with SCI in the setting of infection or inflammation and the frequency with which it meets criteria for the CDC definition of fever (>100.4°F). Methods: Retrospective review of hospitalized SCI patients over 5 years with a diagnosis of infection or inflammation (DI), defined by serum leukocytosis. In this study, 458 persons with paraplegia (PP) and 483 persons with tetraplegia (TP) had 4,191 DI episodes. Aural temperatures (Tau) on the day of DI, 7 days prior, and 14 days afterwards were abstracted from medical records. Main outcome measures were average Tau at DI, frequency of temperatures >100.4°F at DI, and average baseline temperatures before and after DI. Results: Average Tau at DI was 98.2°F (±1.5) and 98.2°F (±1.4) in the TP and PP groups, respectively, with only 11.6% to 14% of DI resulting in Tau >100.4°F. Baseline temperatures ranged from 97.9°F (±0.7) to 98.0°F (±0.8). Conclusion: SCI persons with leukocytosis infrequently mount a fever as defined by the CDC, and baseline temperatures were subnormal (<98.6°F). Thermoregulatory dysfunction likely accounts for these findings. Tau >100.4°F is not a sensitive predictor of infection or inflammation in persons with SCI. Clinicians should be vigilant for alternative symptoms of infection and inflammation in these patients, so diagnostic workup is not delayed.
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Affiliation(s)
| | - Carol Li
- Audie L. Murphy VA, San Antonio, Texas
| | - Shuko Lee
- Audie L. Murphy VA, San Antonio, Texas
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Abstract
Spinal cord injury results in physiologic adaptations affecting heat production (reduced muscle mass) and heat dissipation (blood redistribution and reduced sweating capacity below the level of lesion). However, it is the balance between these factors which determines whether heat balance is achieved. Core temperature estimates are generally consistent with those for the able-bodied, with cooler values reported in some instances. More notable differences are demonstrated through cooler lower-body skin temperatures at rest and a loss of anticipatory control during exposure to heat and cold when compared to the able-bodied. During exercise in cool conditions persons with paraplegia demonstrate similar body temperature responses as for the able-bodied but retain heat during recovery. Persons with tetraplegia demonstrate continual increases in core temperature and thus thermal imbalance along with greater heat retention. During exercise in the heat, athletes with paraplegia appear to be able to regulate body temperature to a similar extent as the able-bodied. Those with tetraplegia again show thermal imbalance but to a much greater extent than in the cold. Future work should focus upon specific sweating responses and adaptations following spinal cord injury, the effects of completeness of lesion, perceptual responses to environmental challenges, and how these translate to undertaking activities of daily living.
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Affiliation(s)
- Mike J Price
- School of Life Sciences, Coventry University, Coventry, United Kingdom.
| | - Michelle Trbovich
- Spinal Cord Injury Unit, San Antonio Veterans Hospital, San Antonio, TX, United States
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Handrakis JP, Trbovich M, Hagen EM, Price M. Thermodysregulation in persons with spinal cord injury: case series on use of the autonomic standards. Spinal Cord Ser Cases 2017; 3:17086. [PMID: 29423292 PMCID: PMC5798926 DOI: 10.1038/s41394-017-0026-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 10/11/2017] [Accepted: 10/12/2017] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION The ability to maintain core body temperature (Tcore) within a narrow range (37 ± 0.6 °C), despite exposure to a wide range of ambient temperatures, is essential in order to provide an optimal environment for vital organs, the central nervous system (CNS), and cellular processes to function. High-level (above T6) spinal cord injury (SCI) interrupts the autonomic nervous system's ability to carry out hypothalamic regulation of thermoregulatory mechanisms for both heat dissipation and conservation. This interruption leaves persons with high-level SCI vulnerable to hyper and hypothermia even during exposure to relatively mild ambient temperatures. The goal of the Autonomic Standards is to enable the clinician to quickly identify those individuals with SCI who may be most at risk for thermoregulatory dysfunction. CASE PRESENTATION Case 1: Heat Exhaustion, Case 2: Heat Stroke in absence of CNS symptoms, Case 3: Heat Exhaustion. DISCUSSION The three cases demonstrate the signs and symptoms that may accompany hyperthermia in persons with SCI. The onset may be quite rapid and the condition persistent, despite ambient temperatures being much less intense than expected to be necessary to induce similar conditions in able-bodied (AB) persons. The responses of the persons in the case studies to the temperature regulation and autonomic control of sweating sections of the Autonomic Standards would identify them as being vulnerable and warrant providing appropriate exposure guidelines and precautions to them and their caregivers.
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Affiliation(s)
- John P. Handrakis
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, NY USA
- New York Institute of Technology, Department of Physical Therapy, School of Health Professions, Old Westbury, NY USA
| | | | - Ellen Merete Hagen
- National Hospital for Neurology and Neurosurgery, Autonomic unit, London, UK
| | - Michael Price
- School of Life Sciences, Coventry University, Coventry, UK
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Martin Ginis KA, van der Scheer JW, Latimer-Cheung AE, Barrow A, Bourne C, Carruthers P, Bernardi M, Ditor DS, Gaudet S, de Groot S, Hayes KC, Hicks AL, Leicht CA, Lexell J, Macaluso S, Manns PJ, McBride CB, Noonan VK, Pomerleau P, Rimmer JH, Shaw RB, Smith B, Smith KM, Steeves JD, Tussler D, West CR, Wolfe DL, Goosey-Tolfrey VL. Evidence-based scientific exercise guidelines for adults with spinal cord injury: an update and a new guideline. Spinal Cord 2017; 56:308-321. [PMID: 29070812 DOI: 10.1038/s41393-017-0017-3] [Citation(s) in RCA: 250] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 09/14/2017] [Accepted: 09/20/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To describe the process and outcomes of using a new evidence base to develop scientific guidelines that specify the type and minimum dose of exercise necessary to improve fitness and cardiometabolic health in adults with spinal cord injury (SCI). SETTING International. METHODS Using Appraisal of Guidelines, Research and Evaluation (AGREE) II reporting criteria, steps included (a) determining the guidelines' scope; (b) conducting a systematic review of relevant literature; (c) holding three consensus panel meetings (European, Canadian and International) to formulate the guidelines; (d) obtaining stakeholder feedback; and (e) process evaluation by an AGREE II consultant. Stakeholders were actively involved in steps (c) and (d). RESULTS For cardiorespiratory fitness and muscle strength benefits, adults with a SCI should engage in at least 20 min of moderate to vigorous intensity aerobic exercise 2 times per week AND 3 sets of strength exercises for each major functioning muscle group, at a moderate to vigorous intensity, 2 times per week (strong recommendation). For cardiometabolic health benefits, adults with a SCI are suggested to engage in at least 30 min of moderate to vigorous intensity aerobic exercise 3 times per week (conditional recommendation). CONCLUSIONS Through a systematic, rigorous, and participatory process involving international scientists and stakeholders, a new exercise guideline was formulated for cardiometabolic health benefits. A previously published SCI guideline was endorsed for achieving fitness benefits. These guidelines represent an important step toward international harmonization of exercise guidelines for adults with SCI, and a foundation for developing exercise policies and programs for people with SCI around the world.
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Affiliation(s)
| | | | | | - Andy Barrow
- Paralympian and Inspirational Speaker, London, UK
| | | | | | | | | | - Sonja Gaudet
- Spinal Cord Injury British Columbia, Vancouver, Canada
| | | | | | | | | | | | | | | | | | | | - Pierre Pomerleau
- Institut de Réadaptation en Déficience Physique de Québec, Ville de Québec, Canada
| | | | | | | | | | | | - Dot Tussler
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK
| | | | - Dalton L Wolfe
- Parkwood Institute, Lawson Health Research Institute, London, Canada
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Nightingale TE, Metcalfe RS, Vollaard NB, Bilzon JL. Exercise Guidelines to Promote Cardiometabolic Health in Spinal Cord Injured Humans: Time to Raise the Intensity? Arch Phys Med Rehabil 2017; 98:1693-1704. [DOI: 10.1016/j.apmr.2016.12.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 12/15/2016] [Indexed: 10/20/2022]
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van der Scheer JW, Martin Ginis KA, Ditor DS, Goosey-Tolfrey VL, Hicks AL, West CR, Wolfe DL. Effects of exercise on fitness and health of adults with spinal cord injury: A systematic review. Neurology 2017; 89:736-745. [PMID: 28733344 DOI: 10.1212/wnl.0000000000004224] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 05/15/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To synthesize and appraise research testing the effects of exercise interventions on fitness, cardiometabolic health, and bone health among adults with spinal cord injury (SCI). METHODS Electronic databases were searched (1980-2016). Included studies employed exercise interventions for a period ≥2 weeks, involved adults with acute or chronic SCI, and measured fitness (cardiorespiratory fitness, power output, or muscle strength), cardiometabolic health (body composition or cardiovascular risk factors), or bone health outcomes. Evidence was synthesized and appraised using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). RESULTS A total of 211 studies met the inclusion criteria (22 acute, 189 chronic). For chronic SCI, GRADE confidence ratings were moderate to high for evidence showing exercise can improve all of the reviewed outcomes except bone health. For acute SCI, GRADE ratings were very low for all outcomes. For chronic SCI, there was low to moderate confidence in the evidence showing that 2-3 sessions/week of upper body aerobic exercise at a moderate to vigorous intensity for 20-40 minutes, plus upper body strength exercise (3 sets of 10 repetitions at 50%-80% 1-repetition maximum for all large muscle groups), can improve cardiorespiratory fitness, power output, and muscle strength. For chronic SCI, there was low to moderate confidence in the evidence showing that 3-5 sessions per week of upper body aerobic exercise at a moderate to vigorous intensity for 20-44 minutes can improve cardiorespiratory fitness, muscle strength, body composition, and cardiovascular risk. CONCLUSIONS Exercise improves fitness and cardiometabolic health of adults with chronic SCI. The evidence on effective exercise types, frequencies, intensities, and durations should be used to formulate exercise guidelines for adults with SCI.
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Affiliation(s)
- Jan W van der Scheer
- From the School for Sports, Exercise and Health Sciences (J.W.v.d.S., V.L.G.-T.), Peter Harrison Centre for Disability Sport, National Centre for Sport and Exercise Medicine, Loughborough University, UK; School of Health and Exercise Sciences (K.A.M.G.), University of British Columbia, Kelowna; ICORD (K.A.M.G., C.R.W.) and School of Kinesiology (C.R.W.), University of British Columbia, Vancouver; Department of Kinesiology (D.S.D.), Brock University, St. Catharines; Department of Kinesiology (A.L.H.), McMaster University, Hamilton; and Parkwood Institute (D.L.W.), Lawson Health Research Institute, London, Canada
| | - Kathleen A Martin Ginis
- From the School for Sports, Exercise and Health Sciences (J.W.v.d.S., V.L.G.-T.), Peter Harrison Centre for Disability Sport, National Centre for Sport and Exercise Medicine, Loughborough University, UK; School of Health and Exercise Sciences (K.A.M.G.), University of British Columbia, Kelowna; ICORD (K.A.M.G., C.R.W.) and School of Kinesiology (C.R.W.), University of British Columbia, Vancouver; Department of Kinesiology (D.S.D.), Brock University, St. Catharines; Department of Kinesiology (A.L.H.), McMaster University, Hamilton; and Parkwood Institute (D.L.W.), Lawson Health Research Institute, London, Canada.
| | - David S Ditor
- From the School for Sports, Exercise and Health Sciences (J.W.v.d.S., V.L.G.-T.), Peter Harrison Centre for Disability Sport, National Centre for Sport and Exercise Medicine, Loughborough University, UK; School of Health and Exercise Sciences (K.A.M.G.), University of British Columbia, Kelowna; ICORD (K.A.M.G., C.R.W.) and School of Kinesiology (C.R.W.), University of British Columbia, Vancouver; Department of Kinesiology (D.S.D.), Brock University, St. Catharines; Department of Kinesiology (A.L.H.), McMaster University, Hamilton; and Parkwood Institute (D.L.W.), Lawson Health Research Institute, London, Canada
| | - Victoria L Goosey-Tolfrey
- From the School for Sports, Exercise and Health Sciences (J.W.v.d.S., V.L.G.-T.), Peter Harrison Centre for Disability Sport, National Centre for Sport and Exercise Medicine, Loughborough University, UK; School of Health and Exercise Sciences (K.A.M.G.), University of British Columbia, Kelowna; ICORD (K.A.M.G., C.R.W.) and School of Kinesiology (C.R.W.), University of British Columbia, Vancouver; Department of Kinesiology (D.S.D.), Brock University, St. Catharines; Department of Kinesiology (A.L.H.), McMaster University, Hamilton; and Parkwood Institute (D.L.W.), Lawson Health Research Institute, London, Canada
| | - Audrey L Hicks
- From the School for Sports, Exercise and Health Sciences (J.W.v.d.S., V.L.G.-T.), Peter Harrison Centre for Disability Sport, National Centre for Sport and Exercise Medicine, Loughborough University, UK; School of Health and Exercise Sciences (K.A.M.G.), University of British Columbia, Kelowna; ICORD (K.A.M.G., C.R.W.) and School of Kinesiology (C.R.W.), University of British Columbia, Vancouver; Department of Kinesiology (D.S.D.), Brock University, St. Catharines; Department of Kinesiology (A.L.H.), McMaster University, Hamilton; and Parkwood Institute (D.L.W.), Lawson Health Research Institute, London, Canada
| | - Christopher R West
- From the School for Sports, Exercise and Health Sciences (J.W.v.d.S., V.L.G.-T.), Peter Harrison Centre for Disability Sport, National Centre for Sport and Exercise Medicine, Loughborough University, UK; School of Health and Exercise Sciences (K.A.M.G.), University of British Columbia, Kelowna; ICORD (K.A.M.G., C.R.W.) and School of Kinesiology (C.R.W.), University of British Columbia, Vancouver; Department of Kinesiology (D.S.D.), Brock University, St. Catharines; Department of Kinesiology (A.L.H.), McMaster University, Hamilton; and Parkwood Institute (D.L.W.), Lawson Health Research Institute, London, Canada
| | - Dalton L Wolfe
- From the School for Sports, Exercise and Health Sciences (J.W.v.d.S., V.L.G.-T.), Peter Harrison Centre for Disability Sport, National Centre for Sport and Exercise Medicine, Loughborough University, UK; School of Health and Exercise Sciences (K.A.M.G.), University of British Columbia, Kelowna; ICORD (K.A.M.G., C.R.W.) and School of Kinesiology (C.R.W.), University of British Columbia, Vancouver; Department of Kinesiology (D.S.D.), Brock University, St. Catharines; Department of Kinesiology (A.L.H.), McMaster University, Hamilton; and Parkwood Institute (D.L.W.), Lawson Health Research Institute, London, Canada
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Griggs KE, Havenith G, Paulson TAW, J Price M, Goosey-Tolfrey VL. Effects of cooling before and during simulated match play on thermoregulatory responses of athletes with tetraplegia. J Sci Med Sport 2017; 20:819-824. [PMID: 28389216 DOI: 10.1016/j.jsams.2017.03.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 02/02/2017] [Accepted: 03/05/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Athletes with high level spinal cord injuries (tetraplegia) are under greater thermal strain during exercise than the able-bodied. The purpose of this study was to investigate the effectiveness of pre-cooling using an ice vest and the combination of pre-cooling and cooling during play using water sprays in athletes with tetraplegia. DESIGN Counter-balanced, cross-over design. METHODS Eight wheelchair rugby players with tetraplegia completed a 60min intermittent sprint protocol (ISP) on a wheelchair ergometer in 20.2°C±0.2°C and 33.0%±3.1% relative humidity. The ISP was conducted on three occasions; no cooling (NC), pre-cooling with an ice vest (P) and pre-cooling with an ice vest and water sprays between quarters (PW). Gastrointestinal (Tgi) temperature, mean skin temperature (Tsk) and perceptual responses were measured throughout. RESULTS At the end of pre-cooling, the change in Tgi was not significantly different between conditions (P>0.05) but the change in Tsk was significantly greater in P and PW compared to NC (P<0.001). The change in Tgi over the ISP was significantly lower in PW and P compared to NC (P<0.05), whilst the change in Tsk was lower in PW compared to P and NC (P<0.05). Cooling had no effect on performance or perceptual responses (P>0.05). CONCLUSIONS Water spraying between quarters combined with pre-cooling using an ice vest lowers thermal strain to a greater degree than pre-cooling only in athletes with tetraplegia, but has no effect on simulated wheelchair rugby performance or perceptual responses.
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Affiliation(s)
- Katy E Griggs
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, UK
| | - George Havenith
- Environmental Ergonomics Research Centre, Design School, Loughborough University, UK
| | - Thomas A W Paulson
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, UK
| | - Michael J Price
- Department of Biomolecular and Sports Science, Coventry University, UK
| | - Victoria L Goosey-Tolfrey
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, UK.
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Forsyth P, Pumpa K, Knight E, Miller J. Physiological and perceptual effects of precooling in wheelchair basketball athletes. J Spinal Cord Med 2016; 39:671-678. [PMID: 27192132 PMCID: PMC5137577 DOI: 10.1080/10790268.2016.1180098] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To investigate the physiological and perceptual effects of three precooling strategies during pre-exercise rest in athletes with a spinal cord injury (SCI). DESIGN Randomized, counterbalanced. Participants were precooled, then rested for 60 minutes (22.7 ± 0.2°C, 64.2 ± 2.6%RH). SETTING National Wheelchair Basketball Training Centre, Australia. PARTICIPANTS Sixteen wheelchair basketball athletes with a SCI. INTERVENTIONS Participants were precooled through; 1) 10 minutes of 15.8°C cold water immersion (CWI), 2) ingestion of 6.8 g/kg-1 of slushie (S) from sports drink; 3) ingestion of 6.8 g/kg-1 of slushie with application of iced towels to the legs, torso and back/arms (ST); or 4) ingestion of 6.8 g/kg-1 of room temperature (22.3°C) sports drink (CON). OUTCOME MEASURES Core temperature (Tgi), skin temperature (Tsk), heart rate (HR), and thermal and gastrointestinal comfort. RESULTS Following CWI, a significant reduction in Tgi was observed compared to CON, with a greatest reduction of 1.58°C occurring 40 minutes post-cooling (95% CI [1.07, 2.10]). A significant reduction in Tgi following ST compared to CON was also observed at 20 minutes (0.56°C; [0.03, 1.09]) and 30 minutes (0.56°C; [0.04, 1.09]) post-cooling. Additionally, a significant interaction between impairment level and time was observed for Tgi and HR, demonstrating athletes with a higher level of impairment experienced a greater reduction in HR and significant decrease in rate of decline in Tgi, compared to lesser impaired athletes. CONCLUSION CWI and ST can effectively lower body temperature in athletes with a SCI, and may assist in tolerating warm conditions.
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Affiliation(s)
- Peta Forsyth
- Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia,Physiology Department, Australian Institute of Sport, Canberra, ACT, Australia,Correspondence to: Peta Forsyth, C/- Physiology Department, Australian Institute of Sport, Leverrier Street, ACT, Australia, 2617.
| | - Kate Pumpa
- Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia
| | - Emma Knight
- Performance Research, Australian Institute of Sport, Canberra, ACT, Australia
| | - Joanna Miller
- Physiology Department, Australian Institute of Sport, Canberra, ACT, Australia
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Griggs K, Goosey-Tolfrey V, Paulson T. Supporting Paralympic wheelchair sport performance through technological, physiological and environmental considerations. Ann Hum Biol 2016; 44:295-296. [DOI: 10.1080/03014460.2016.1234644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- K. Griggs
- Peter Harrison Centre for Disability Sport, Loughborough University, Loughborough, UK
| | - V. Goosey-Tolfrey
- Peter Harrison Centre for Disability Sport, Loughborough University, Loughborough, UK
| | - T. Paulson
- Peter Harrison Centre for Disability Sport, Loughborough University, Loughborough, UK
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Effects of Cooling During Exercise on Thermoregulatory Responses of Men With Paraplegia. Phys Ther 2016; 96:650-8. [PMID: 26472295 DOI: 10.2522/ptj.20150266] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 10/04/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND People with spinal cord injury (SCI) have an altered afferent input to the thermoregulatory center, resulting in a reduced efferent response (vasomotor control and sweating capacity) below the level of the lesion. Consequently, core body temperature rises more rapidly during exercise in individuals with SCI compared with people who are able-bodied. Cooling strategies may reduce the thermophysiological strain in SCI. OBJECTIVE The aim of this study was to examine the effects of a cooling vest on the core body temperature response of people with a thoracic SCI during submaximal exercise. METHODS Ten men (mean age=44 years, SD=11) with a thoracic lesion (T4-T5 or below) participated in this randomized crossover study. Participants performed two 45-minute exercise bouts at 50% maximal workload (ambient temperature 25°C), with participants randomized to a group wearing a cooling vest or a group wearing no vest (separate days). Core body temperature and skin temperature were continuously measured, and thermal sensation was assessed every 3 minutes. RESULTS Exercise resulted in an increased core body temperature, skin temperature, and thermal sensation, whereas cooling did not affect core body temperature. The cooling vest effectively decreased skin temperature, increased the core-to-trunk skin temperature gradient, and tended to lower thermal sensation compared with the control condition. LIMITATIONS The lack of differences in core body temperature among conditions may be a result of the relative moderate ambient temperature in which the exercise was performed. CONCLUSIONS Despite effectively lowering skin temperature and increasing the core-to-trunk skin temperature gradient, there was no impact of the cooling vest on the exercise-induced increase in core body temperature in men with low thoracic SCI.
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Price MJ. Preparation of Paralympic Athletes; Environmental Concerns and Heat Acclimation. Front Physiol 2016; 6:415. [PMID: 26834641 PMCID: PMC4712300 DOI: 10.3389/fphys.2015.00415] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 12/17/2015] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mike J Price
- Faculty of Health and Life Sciences, School of Life Sciences, Applied Biology and Exercise Science Research Centre, Coventry University Coventry, UK
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40
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Girard O. Thermoregulation in wheelchair tennis-How to manage heat stress? Front Physiol 2015; 6:175. [PMID: 26082724 PMCID: PMC4451356 DOI: 10.3389/fphys.2015.00175] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 05/22/2015] [Indexed: 11/15/2022] Open
Affiliation(s)
- Olivier Girard
- Department of Physiology, Faculty of Biology and Medicine, Institute of Sport Sciences, University of Lausanne Lausanne, Switzerland
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