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Barton T, Low DA, Thijssen DHJ, Romviel S, Sloots M, Smit CAJ, Janssen TWJ. Twelve-Week Daily Gluteal and Hamstring Electrical Stimulation Improves Vascular Structure and Function, Limb Volume, and Sitting Pressure in Spinal Cord Injury: A Pilot Feasibility Study. Am J Phys Med Rehabil 2022; 101:913-919. [PMID: 36104843 DOI: 10.1097/phm.0000000000001929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We examined the long-term effects of low-intensity electrical stimulation on (micro)vasculature and sitting pressure of a home-based, wearable electrical stimulation device in a pilot feasibility study. DESIGN In a cohort observation before-after trial, nine middle-aged male (n = 8) and female (n = 1) individuals (48 ± 15 yrs) with American Spinal Injury Association A-C classified chronic (1-24 yrs) spinal cord injury underwent 12 wks of self-administered daily, low-intensity gluteal and hamstring electrical stimulation (50 Hz, 6 hrs [30-min electrical stimulation, 15-min rest]). Common femoral artery diameter and blood blow were determined with ultrasound, skin vascular function during local heating was assessed using Laser-Doppler flowmetry, thigh volume was estimated using leg circumferences and skinfolds, and interface sitting pressure was measured using pressure mapping. RESULTS Resting common femoral artery diameter increased (0.73 ± 0.20 to 0.79 ± 0.22 cm, P < 0.001) and baseline common femoral artery blood flow increased (0.28 ± 0.12 to 0.40 ± 0.15 l/min, P < 0.002). Gluteal cutaneous vascular conductance showed a time*temperature interaction (P = 0.01) with higher conductance at 42°C after 12 wks. Ischial peak pressure decreased (P = 0.003) by 32 ± 23 mm Hg and pressure gradient decreased (23 ± 7 to 16 ± 6 mm Hg, P = 0.007). Thigh volume increased (+19%, P = 0.01). CONCLUSIONS Twelve-week daily home-based gluteal and hamstring electrical stimulation is feasible and effective to improve (micro)vasculature and sitting pressure, and electrical stimulation may have clinical implications for ameliorating pressure ulcers and (micro)vascular complications in spinal cord injury.
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Affiliation(s)
- Thomas Barton
- From the Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom (TB, DAL, DHJT); Department of Physiology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands (DHJT); Amsterdam Rehabilitation Research Center, Reade, Amsterdam, the Netherlands (SR, MS, CAJS, TWJJ); Department of Rehabilitation and Sports Medicine for Top Athletes, University Medical Center Utrecht, Utrecht, the Netherlands (MS); and Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (TWJJ)
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Dolbow DR, Davis GM, Welsch M, Gorgey AS. Benefits and interval training in individuals with spinal cord injury: A thematic review. J Spinal Cord Med 2022; 45:327-338. [PMID: 34855568 PMCID: PMC9135438 DOI: 10.1080/10790268.2021.2002020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Arm crank ergometry (ACE), functional electrical stimulation leg cycling exercise (FES-LCE), and the combination of the two (FES hybrid exercise) have all been used as activities to help improve the fitness-related health of individuals with spinal cord injury (SCI). More recently, high-intensity interval training (HIIT) has become popular in the non-disabled community due to its ability to produce greater aerobic fitness benefits or equivalent benefits with reduced time commitment. OBJECTIVE This thematic review of the literature sought to determine the potential benefits and practicality of using ACE, FES-LCE, and FES hybrid exercise in an interval training format for individuals with SCI. METHODS Systematic literature searches were conducted in May 2020 and March 2021 focusing on interval training in individuals with SCI. Pre-defined nested search terms were used to narrow the available literature from 4273 citations to 1362 articles. The titles and abstracts were then reviewed to determine the appropriateness of the articles ending with fifteen articles. RESULTS The literature was limited to fifteen articles with low participant numbers (n = 1-20). However, in each article, HIIT protocols either demonstrated a greater improvement in cardiovascular, metabolic, or practicality scores compared to moderate intensity continuous training (MICT) protocols, or improvement during relatively brief time commitments. CONCLUSION The available literature lacked sufficient numbers of randomized control trials. However, the available evidence is encouraging concerning the potential benefits and practicality of using HIIT (ACE, FES-LCE, or FES hybrid exercise) to improve aerobic and anaerobic capacity and decrease cardiometabolic risk after SCI.
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Affiliation(s)
- David R. Dolbow
- Department of Physical Therapy and College of Osteopathic Medicine, William Carey University, Hattiesburg, Mississippi, USA,Correspondence to: David R. Dolbow, Department of Physical Therapy and College of Osteopathic Medicine, William Carey University, 710 William Carey Parkway, Hattiesburg, Mississippi39401, USA.
| | - Glen M. Davis
- Clinical Exercise and Rehabilitation Unit, Discipline of Exercise and Sports Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Michael Welsch
- School of Population Health, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Ashraf S. Gorgey
- Spinal Cord Injury & Disorders Center, Hunter Holmes McGuire VAMC and Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
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3
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Figoni SF, Dolbow DR, Crawford EC, White ML, Pattanaik S. Does aerobic exercise benefit persons with tetraplegia from spinal cord injury? A systematic review. J Spinal Cord Med 2021; 44:690-703. [PMID: 32043944 PMCID: PMC8477928 DOI: 10.1080/10790268.2020.1722935] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
CONTEXT This review synthesizes the findings of previous research studies on the cardiovascular and metabolic benefits of aerobic exercise for individuals with tetraplegia secondary to spinal cord injury. They are often less active due to muscular paralysis, sensory loss, and sympathetic nervous system dysfunction that result from injury. Consequently, these persons are at higher risk for exercise intolerance and secondary health conditions. OBJECTIVE To evaluate the evidence concerning efficacy of aerobic exercise training for improving health and exercise performance in persons with tetraplegia from cervical injury. METHODS The search engines PubMed and Google Scholar were used to locate published research. The final 75 papers were selected on the basis of inclusion criteria. The studies were then rank-ordered using Physiotherapy Evidence Database. RESULTS Studies combining individuals with tetraplegia and paraplegia show that voluntary arm-crank training can increase mean peak power output by 33%. Functional electrical stimulation leg cycling was shown to induce higher peak cardiac output and stroke volume than arm-crank exercise. A range of peak oxygen uptake (VO2peak) values have been reported (0.57-1.32 L/min). Both VO2peak and cardiac output may be enhanced via increased muscle pump in the legs and venous return to the heart. Hybrid exercise (arm-crank and functional electrical stimulation leg cycling) can result in greater peak oxygen uptake and cardiovascular responses. CONCLUSION Evidence gathered from this systematic review of literature is inconclusive due to the lack of research focusing on those with tetraplegia. Higher power studies (level 1-3) are needed with the focus on those with tetraplegia.
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Affiliation(s)
- Stephen F Figoni
- Spinal Cord Injury/Disorders Healthcare Group (128), Tibor Rubin VA Medical Center, Long Beach, California, USA
| | - David R Dolbow
- Physical Therapy Program, William Carey University, Hattiesburg, Mississippi, USA
| | - Edwin C Crawford
- Physical Therapy Program, William Carey University, Hattiesburg, Mississippi, USA
| | - Margaret L White
- Physical Therapy Program, William Carey University, Hattiesburg, Mississippi, USA
| | - Sambit Pattanaik
- College of Osteopathic Medicine, William Carey University, Hattiesburg, Mississippi, USA
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Harman KA, DeVeau KM, Squair JW, West CR, Krassioukov AV, Magnuson DSK. Effects of early exercise training on the severity of autonomic dysreflexia following incomplete spinal cord injury in rodents. Physiol Rep 2021; 9:e14969. [PMID: 34337884 PMCID: PMC8327165 DOI: 10.14814/phy2.14969] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 12/04/2022] Open
Abstract
Hemodynamic instability and cardiovascular (CV) dysfunction are hallmarks of patients living with cervical and high thoracic spinal cord injuries (SCI). Individuals experience bouts of autonomic dysreflexia (AD) and persistent hypotension which hamper the activities of daily living. Despite the widespread use of exercise training to improve health and CV function after SCI, little is known about how different training modalities impact hemodynamic stability and severity of AD in a model of incomplete SCI. In this study, we used implantable telemetry devices to assess animals with T2 contusions following 3.5 weeks of exercise training initiated 8 days post-injury: passive hindlimb cycling (T2-CYC, n = 5) or active forelimb swimming (T2-SW, n = 6). Uninjured and non-exercised SCI control groups were also included (CON, n = 6; T2-CON, n = 7; T10-CON, n = 6). Five weeks post-injury, both T2-CON and T2-CYC presented with resting hypotension compared to uninjured CON and T10-CON groups; no differences were noted in resting blood pressure in T2-SW versus CON and T10-CON. Furthermore, pressor responses to colorectal distention (AD) were larger in all T2-injured groups compared to T10-CON, and were not attenuated by either form of exercise training. Interestingly, when T2-injured animals were re-stratified based on terminal BBB scores (regardless of training group), animals with limited hindlimb recovery (T2-LOW, n = 7) had more severe AD responses. Our results suggest that the spontaneous recovery of locomotor and autonomic function after severe but incomplete T2 SCI also influences the severity of AD, and that short periods (3.5 weeks) of passive hindlimb cycling or active forelimb swimming are ineffective in this model.
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Affiliation(s)
- Kathryn A. Harman
- Department of Health & Sport SciencesUniversity of LouisvilleLouisvilleKYUSA
- Kentucky Spinal Cord Injury Research CenterUniversity of LouisvilleLouisvilleKYUSA
| | - Kathryn M. DeVeau
- Department of Anatomy and Cell BiologyGeorge Washington UniversityWashingtonD.C.USA
| | - Jordan W. Squair
- International Collaboration on Repair DiscoveriesUniversity of British ColumbiaVancouverBCCanada
| | - Christopher R. West
- International Collaboration on Repair DiscoveriesUniversity of British ColumbiaVancouverBCCanada
| | - Andrei V. Krassioukov
- International Collaboration on Repair DiscoveriesUniversity of British ColumbiaVancouverBCCanada
- GF Strong Rehabilitation CentreVancouver Health AuthorityVancouverCanada
| | - David S. K. Magnuson
- Kentucky Spinal Cord Injury Research CenterUniversity of LouisvilleLouisvilleKYUSA
- Department of Neurological SurgeryUniversity of LouisvilleLouisvilleKYUSA
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Jansen E, de Groot S, Smit CA, Thijssen DHJ, Te Hopman M, Janssen TWJ. Vascular adaptations in nonstimulated areas during hybrid cycling or handcycling in people with a spinal cord injury: a pilot study of 10 cases. Spinal Cord Ser Cases 2021; 7:54. [PMID: 34193818 PMCID: PMC8245507 DOI: 10.1038/s41394-021-00417-2] [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] [Received: 02/02/2020] [Revised: 05/04/2021] [Accepted: 06/04/2021] [Indexed: 11/08/2022] Open
Abstract
STUDY DESIGN Sub-study of a randomized controlled trial. OBJECTIVES To examine if hybrid cycling (cycling with the legs via electrical stimulation combined with voluntary handcycling) compared to handcycling leads to different systemic vascular adaptations in individuals with a long-term spinal cord injury (SCI). SETTING Two rehabilitation centers in the Netherlands. METHODS Ten individuals with a SCI trained on a hybrid bicycle (N = 5) or a handcycle (N = 5) for 16 weeks twice a week. Prior to and following the training the intima media thickness (IMT) of the common coronary artery (CCA) and superficial femoral artery (SFA) were measured and the flow-mediated dilation (FMD) of the brachial artery (BA) was analyzed. RESULTS Before training, there were no significant differences in any of the outcome measures between the groups. We found no change in CCA IMT (pre: 0.616 mm, post: 0.586 mm), or in SFA (pre: 0.512 mm, post: 0.520 mm) after hybrid cycling. We also found no change in FMD % of BA after hybrid cycling (pre: 9.040%, post: 9.220%). There were no changes in CCA IMT, SFA IMT, and FMD% after handcycling either. CONCLUSIONS It appears that 16 weeks of twice-weekly training of up to 30 min on a hybrid bicycle or handcycle does not lead to systemic vascular adaptations. A larger sample size and training protocol with more frequent and higher intensity training (which might involve a home-based setting and an adapted period prior to the training) might show different results.
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Affiliation(s)
- Evelien Jansen
- Amsterdam Rehabilitation Research Centre Reade, Amsterdam, The Netherlands.
- Centre Basalt Wassenaarseweg 501, Leiden, The Netherlands.
| | - Sonja de Groot
- Amsterdam Rehabilitation Research Center Reade, Amsterdam, The Netherlands
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Dick H J Thijssen
- Department of Physiology, Radboud University, Nijmegen, The Netherlands
- Cardiovascular Physiology and Exercise at Liverpool John Moores University, Liverpool, UK
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Farrow M, Nightingale TE, Maher J, McKay CD, Thompson D, Bilzon JL. Effect of Exercise on Cardiometabolic Risk Factors in Adults With Chronic Spinal Cord Injury: A Systematic Review. Arch Phys Med Rehabil 2020; 101:2177-2205. [DOI: 10.1016/j.apmr.2020.04.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 03/27/2020] [Accepted: 04/11/2020] [Indexed: 12/14/2022]
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7
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Williams JS, Del Giudice M, Gurd BJ, Pyke KE. Reproducible improvement in endothelial function following two separate periods of high-intensity interval training in young men. J Appl Physiol (1985) 2020; 129:725-731. [PMID: 32790591 DOI: 10.1152/japplphysiol.00054.2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
High-intensity interval training (HIIT) can improve vascular function, as assessed by brachial artery flow-mediated dilation (FMD). However, when separated by a period of detraining, the reproducibility of FMD responses to repeated periods of HIIT is unknown. The purpose of this study was to determine the group mean and intraindividual reproducibility of FMD responses to two 4-wk periods of HIIT, separated by 3 mo of detraining. Thirteen healthy, recreationally active men (21 ± 2 yr) completed the study. Each 4-wk HIIT period included 40 min of treadmill training four times/week. Each training session included four 7-min intervals: 4 min at 90%-95% heart rate maximum (HRmax) and 3 min at 70%-75% HRmax. Vascular (FMD) and cardiorespiratory fitness (maximal oxygen consumption [V̇o2max]) assessments were conducted before and following each 4-wk training period. Training resulted in significant improvements in V̇o2max (P < 0.001). Training also improved FMD (P < 0.001), with no differences between periods (P = 0.394), even after controlling for changes in baseline diameter and the shear rate stimulus. There was a significant, moderate relationship between the change in FMD in HIIT period 1 versus period 2 [R2 = 0.493, P = 0.011, intraclass correlation coefficient: 0.600, coefficient of variation: 17.3%]. Consecutive periods of HIIT separated by detraining resulted in similar improvements in FMD at the group level, and individual FMD changes in period 1 of HIIT predicted FMD changes in response to period 2. Considered alongside substantial between-participant variability in magnitude of FMD improvement, this suggests that there are reproducible, interindividual differences in the potential to improve vascular function with HIIT.NEW & NOTEWORTHY This is the first study examining endothelial function [flow-mediated dilation (FMD)] following repeated periods of high-intensity interval training (HIIT). Two periods of HIIT separated by detraining resulted in reproducible group-level improvements in FMD. Despite considerable between-subject variability in FMD adaptation, individual FMD changes with the first HIIT period predicted FMD changes in the second period. This indicates the existence of reproducible between-subject differences in susceptibility to FMD improvement with HIIT.
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Affiliation(s)
- J S Williams
- Cardiovascular Stress Response Lab, School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - M Del Giudice
- Muscle Physiology Lab, School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - B J Gurd
- Muscle Physiology Lab, School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - K E Pyke
- Cardiovascular Stress Response Lab, School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
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8
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A Review of Functional Electrical Stimulation Treatment in Spinal Cord Injury. Neuromolecular Med 2020; 22:447-463. [DOI: 10.1007/s12017-019-08589-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 12/28/2019] [Indexed: 12/11/2022]
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9
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Harman KA, States G, Wade A, Stepp C, Wainwright G, DeVeau K, King N, Shum-Siu A, Magnuson DSK. Temporal analysis of cardiovascular control and function following incomplete T3 and T10 spinal cord injury in rodents. Physiol Rep 2019; 6:e13634. [PMID: 29595874 PMCID: PMC5875543 DOI: 10.14814/phy2.13634] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 02/05/2018] [Indexed: 11/24/2022] Open
Abstract
Spinal cord injury (SCI) is a devastating condition that results in whole‐body dysfunction, notably cardiovascular (CV) disruption and disease. Injury‐induced destruction of autonomic pathways in conjunction with a progressive decline in physical fitness contribute to the poor CV status of SCI individuals. Despite the wide use of exercise training as a therapeutic option to reduce CV dysfunction, little is known about the acute hemodynamic responses to the exercise itself. We investigated CV responses to an exercise challenge (swimming) following both high and low thoracic contusion to determine if the CV system is able to respond appropriately to the challenge of swimming. Blood pressure (BP) telemetry and echocardiography were used to track the progression of dysfunction in rodents with T3 and T10 SCI (n = 8 each) for 10 weeks postcontusion. At 1 week postinjury, all animals displayed a drastic decline in heart rate (HR) during the exercise challenge, likely a consequence of neurogenic shock. Furthermore, over time, all groups developed a progressive inability to maintain BP within a narrow range during the exercise challenge despite displaying normal hemodynamic parameters at rest. Echocardiography of T10 animals revealed no persistent signs of cardiac dysfunction; T3 animals exhibited a transient decline in systolic function that returned to preinjury levels by 10 weeks postinjury. Novel evidence provided here illustrates that incomplete injuries produce hemodynamic instability that only becomes apparent during an exercise challenge. Further, this dysfunction lasts into the chronic phase of disease progression despite significant recovery of hindlimb locomotion and cardiac function.
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Affiliation(s)
- Kathryn A Harman
- Anatomical Sciences and Neurobiology, University of Louisville, Louisville, Kentucky.,Department of Neurological Surgery, University of Louisville, Louisville, Kentucky
| | - Gregory States
- Anatomical Sciences and Neurobiology, University of Louisville, Louisville, Kentucky.,Department of Neurological Surgery, University of Louisville, Louisville, Kentucky
| | - Abigail Wade
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky.,Biomedical Engineering, University of Louisville, Louisville, Kentucky
| | - Chad Stepp
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky.,Biomedical Engineering, University of Louisville, Louisville, Kentucky
| | - Grace Wainwright
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky.,Biomedical Engineering, University of Louisville, Louisville, Kentucky
| | - Kathryn DeVeau
- Anatomical Sciences and Neurobiology, University of Louisville, Louisville, Kentucky.,Department of Neurological Surgery, University of Louisville, Louisville, Kentucky
| | - Nicholas King
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky.,Biomedical Engineering, University of Louisville, Louisville, Kentucky
| | - Alice Shum-Siu
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky
| | - David S K Magnuson
- Anatomical Sciences and Neurobiology, University of Louisville, Louisville, Kentucky.,Department of Neurological Surgery, University of Louisville, Louisville, Kentucky.,Biomedical Engineering, University of Louisville, Louisville, Kentucky
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10
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Green DJ, Hopman MTE, Padilla J, Laughlin MH, Thijssen DHJ. Vascular Adaptation to Exercise in Humans: Role of Hemodynamic Stimuli. Physiol Rev 2017; 97:495-528. [PMID: 28151424 DOI: 10.1152/physrev.00014.2016] [Citation(s) in RCA: 423] [Impact Index Per Article: 60.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
On the 400th anniversary of Harvey's Lumleian lectures, this review focuses on "hemodynamic" forces associated with the movement of blood through arteries in humans and the functional and structural adaptations that result from repeated episodic exposure to such stimuli. The late 20th century discovery that endothelial cells modify arterial tone via paracrine transduction provoked studies exploring the direct mechanical effects of blood flow and pressure on vascular function and adaptation in vivo. In this review, we address the impact of distinct hemodynamic signals that occur in response to exercise, the interrelationships between these signals, the nature of the adaptive responses that manifest under different physiological conditions, and the implications for human health. Exercise modifies blood flow, luminal shear stress, arterial pressure, and tangential wall stress, all of which can transduce changes in arterial function, diameter, and wall thickness. There are important clinical implications of the adaptation that occurs as a consequence of repeated hemodynamic stimulation associated with exercise training in humans, including impacts on atherosclerotic risk in conduit arteries, the control of blood pressure in resistance vessels, oxygen delivery and diffusion, and microvascular health. Exercise training studies have demonstrated that direct hemodynamic impacts on the health of the artery wall contribute to the well-established decrease in cardiovascular risk attributed to physical activity.
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Affiliation(s)
- Daniel J Green
- School of Sport Science, Exercise and Health, The University of Western Australia, Crawley, Western Australia; Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom; Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Physiology, Nijmegen, The Netherlands; Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri; Department of Child Health, University of Missouri, Columbia, Missouri; Dalton Cardiovascular Research Center, University of Missouri, Columbia, Missouri; Department of Biomedical Sciences, University of Missouri, Columbia, Missouri; and Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, Missouri
| | - Maria T E Hopman
- School of Sport Science, Exercise and Health, The University of Western Australia, Crawley, Western Australia; Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom; Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Physiology, Nijmegen, The Netherlands; Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri; Department of Child Health, University of Missouri, Columbia, Missouri; Dalton Cardiovascular Research Center, University of Missouri, Columbia, Missouri; Department of Biomedical Sciences, University of Missouri, Columbia, Missouri; and Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, Missouri
| | - Jaume Padilla
- School of Sport Science, Exercise and Health, The University of Western Australia, Crawley, Western Australia; Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom; Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Physiology, Nijmegen, The Netherlands; Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri; Department of Child Health, University of Missouri, Columbia, Missouri; Dalton Cardiovascular Research Center, University of Missouri, Columbia, Missouri; Department of Biomedical Sciences, University of Missouri, Columbia, Missouri; and Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, Missouri
| | - M Harold Laughlin
- School of Sport Science, Exercise and Health, The University of Western Australia, Crawley, Western Australia; Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom; Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Physiology, Nijmegen, The Netherlands; Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri; Department of Child Health, University of Missouri, Columbia, Missouri; Dalton Cardiovascular Research Center, University of Missouri, Columbia, Missouri; Department of Biomedical Sciences, University of Missouri, Columbia, Missouri; and Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, Missouri
| | - Dick H J Thijssen
- School of Sport Science, Exercise and Health, The University of Western Australia, Crawley, Western Australia; Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom; Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Physiology, Nijmegen, The Netherlands; Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri; Department of Child Health, University of Missouri, Columbia, Missouri; Dalton Cardiovascular Research Center, University of Missouri, Columbia, Missouri; Department of Biomedical Sciences, University of Missouri, Columbia, Missouri; and Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, Missouri
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11
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Popok DW, West CR, McCracken L, Krassioukov AV. Effects of early and delayed initiation of exercise training on cardiac and haemodynamic function after spinal cord injury. Exp Physiol 2017; 102:154-163. [DOI: 10.1113/ep085978] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 11/28/2016] [Indexed: 11/08/2022]
Affiliation(s)
- David W. Popok
- International Collaboration on Repair Discoveries (ICORD); University of British Columbia; Vancouver BC Canada
| | - Christopher R. West
- International Collaboration on Repair Discoveries (ICORD); University of British Columbia; Vancouver BC Canada
- School of Kinesiology; Faculty of Education; University of British Columbia; Vancouver BC Canada
| | - Laura McCracken
- International Collaboration on Repair Discoveries (ICORD); University of British Columbia; Vancouver BC Canada
| | - Andrei V. Krassioukov
- International Collaboration on Repair Discoveries (ICORD); University of British Columbia; Vancouver BC Canada
- Faculty of Medicine; Division of Physical Medicine and Rehabilitation; University of British Columbia; Vancouver BC Canada
- GF Strong Rehabilitation Centre; Vancouver Coastal Health; Vancouver BC Canada
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12
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Chronic effects of simultaneous electromyostimulation and vibration on leg blood flow in spinal cord injury. Spinal Cord 2016; 54:1169-1175. [DOI: 10.1038/sc.2016.60] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 03/22/2016] [Accepted: 03/24/2016] [Indexed: 02/06/2023]
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13
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Totosy de Zepetnek J, Pelletier C, Hicks A, MacDonald M. The Authors Respond. Arch Phys Med Rehabil 2016; 97:171-3. [DOI: 10.1016/j.apmr.2015.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 09/22/2015] [Indexed: 10/22/2022]
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14
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Phillips AA, Krassioukov AV. Contemporary Cardiovascular Concerns after Spinal Cord Injury: Mechanisms, Maladaptations, and Management. J Neurotrauma 2015; 32:1927-42. [PMID: 25962761 DOI: 10.1089/neu.2015.3903] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Cardiovascular (CV) issues after spinal cord injury (SCI) are of paramount importance considering they are the leading cause of death in this population. Disruption of autonomic pathways leads to a highly unstable CV system, with impaired blood pressure (BP) and heart rate regulation. In addition to low resting BP, on a daily basis the majority of those with SCI suffer from transient episodes of aberrantly low and high BP (termed orthostatic hypotension and autonomic dysreflexia, respectively). In fact, autonomic issues, including resolution of autonomic dysreflexia, are frequently ranked by individuals with high-level SCI to be of greater priority than walking again. Owing to a combination of these autonomic disturbances and a myriad of lifestyle factors, the pernicious process of CV disease is accelerated post-SCI. Unfortunately, these secondary consequences of SCI are only beginning to receive appropriate clinical attention. Immediately after high-level SCI, major CV abnormalities present in the form of neurogenic shock. After subsiding, new issues related to BP instability arise, including orthostatic hypotension and autonomic dysreflexia. This review describes autonomic control over the CV system before injury and the mechanisms underlying CV abnormalities post-SCI, while also detailing the end-organ consequences, including those of the heart, as well as the systemic and cerebral vasculature. The tertiary impact of CV dysfunction will also be discussed, such as the potential impediment of rehabilitation, and impaired cognitive function. In the recent past, our understanding of autonomic dysfunctions post-SCI has been greatly enhanced; however, it is vital to further develop our understanding of the long-term consequences of these conditions, which will equip us to better manage CV disease morbidity and mortality in this population.
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Affiliation(s)
- Aaron A Phillips
- 1 Center for Heart, Lung, and Vascular Health, Faculty of Health and Social Development, University of British Columbia , Kelowna, British Columbia, Canada .,2 Experimental Medicine Program, Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada .,3 International Collaboration on Repair Discoveries (ICORD), University of British Columbia , Vancouver, British Columbia, Canada
| | - Andrei V Krassioukov
- 2 Experimental Medicine Program, Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada .,3 International Collaboration on Repair Discoveries (ICORD), University of British Columbia , Vancouver, British Columbia, Canada .,4 Department of Physical Medicine and Rehabilitation, University of British Columbia , Vancouver, British Columbia, Canada
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15
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Totosy de Zepetnek JO, Pelletier CA, Hicks AL, MacDonald MJ. Following the Physical Activity Guidelines for Adults With Spinal Cord Injury for 16 Weeks Does Not Improve Vascular Health: A Randomized Controlled Trial. Arch Phys Med Rehabil 2015; 96:1566-75. [PMID: 26070976 DOI: 10.1016/j.apmr.2015.05.019] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 04/22/2015] [Accepted: 05/27/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To evaluate the effects of following the physical activity guidelines (PAG) for adults with spinal cord injury (SCI) for 16 weeks. DESIGN Randomized controlled trial. SETTING Community exercise program. PARTICIPANTS Individuals with SCI (N=23; neurological level of injury, C3-T11; American Spinal Injury Association Impairment Scale A-C; time postinjury, 12.0±9.9 y; age, 41.4±11.6 y). INTERVENTIONS Participants were randomly assigned to PAG training (n=12) or active control (n=11) groups. PAG training involved ≥20 minutes of moderate-vigorous aerobic exercise (rating of perceived exertion 3-6 on 10-point scale) and 3×10 repetitions of upper-body strengthening exercises (50%-70% 1 repetition maximum) 2 times per week. The control group maintained existing physical activity levels with no guidance on training intensity. MAIN OUTCOME MEASURES Outcome measures were obtained pre- and postintervention. Vascular health indicators included arterial stiffness via carotid distensibility and pulse wave velocity, and endothelial function via flow-mediated-dilation. Fasted blood samples were analyzed for markers of cardiovascular disease (CVD) risk. Body composition was assessed via anthropometrics and with dual-energy x-ray absorptiometry. RESULTS Twenty-one individuals completed the intervention (PAG=12, control=9). Group-by-time interactions were observed for whole-body mass (P=.03), whole-body fat (P=.04), visceral adipose tissue (P=.04), and carotid artery distensibility (P=.05), suggesting maintained body composition and carotid stiffness in the PAG group concurrent with declines in the control group. No changes were found in any other outcome measure. CONCLUSIONS While 16 weeks of adherence to the PAG in adults with SCI is insufficient to improve many markers of CVD risk, it may prevent declines in others. The PAG should continue to be promoted as a means to increase physical fitness and maintain body composition in individuals with SCI, but changes may be needed to achieve other health outcomes.
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Affiliation(s)
| | | | - Audrey L Hicks
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
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16
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Galea MP, Dunlop SA, Marshall R, Clark J, Churilov L. Early exercise after spinal cord injury ('Switch-On'): study protocol for a randomised controlled trial. Trials 2015; 16:7. [PMID: 25563584 PMCID: PMC4320571 DOI: 10.1186/1745-6215-16-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 12/15/2014] [Indexed: 01/09/2023] Open
Abstract
Background Spinal cord injury (SCI) leads to a profound muscular atrophy, bone loss and bone fragility. While there is evidence that exercising paralysed muscles may lead to reversal of muscle atrophy in the chronic period after SCI, there is little evidence that exercise can prevent muscle changes early after injury. Moreover, whether exercise can prevent bone loss and microarchitectural decay is not clear. Methods/Design A multi-centre, parallel group, assessor-blinded randomised controlled trial will be conducted. Fifty participants with acute spinal cord injury will be recruited from four SCI units in Australia and New Zealand. Participants will be stratified by site and AIS status and randomised to an experimental or control group. Experimental participants will receive a 12-week programme of functional electrical stimulation (FES)-assisted cycling. Control participants will receive a 12-week programme of passive cycling. The primary outcome is muscle cross-sectional area of the thigh and calf measured using magnetic resonance images (MRI) of the leg. Secondary outcomes include serum biomarkers of SCI osteoporosis (sclerostin, P1NP and β-CTX), markers of immune function (IL-6, IL-10, FGF2, INF-γ, TNF-α), neurological function, body composition, depression and quality of life. Leg MRIs will be measured by a single blinded assessor based in Melbourne. Serum samples will be analysed in a central laboratory. All other characteristics will be measured at baseline and 12 weeks by blinded and trained assessors at each site. The first participant was randomised on 27 November 2012. Discussion The results of this trial will determine the relative effectiveness of a 12-week programme of FES-assisted cycling versus passive cycling in preventing muscle atrophy and maintaining skeletal integrity after spinal cord injury. Trial registration ACTRN12611001079932 (18 October 2011)
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Affiliation(s)
- Mary P Galea
- Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Parkville, VIC 3010, Australia.
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17
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Reynolds MA, McCully K, Burdett B, Manella C, Hawkins L, Backus D. Pilot study: evaluation of the effect of functional electrical stimulation cycling on muscle metabolism in nonambulatory people with multiple sclerosis. Arch Phys Med Rehabil 2014; 96:627-32. [PMID: 25450130 DOI: 10.1016/j.apmr.2014.10.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 10/13/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To investigate the changes in muscle oxygen consumption (mV˙O2) using near-infrared spectroscopy (NIRS) after 4 weeks of training with functional electrical stimulation (FES) cycling in nonambulatory people with multiple sclerosis (MS). DESIGN Four-week before-after trial to assess changes in mV˙O2 after an FES cycling intervention. SETTING Rehabilitation hospital. PARTICIPANTS People (N=8; 7 men, 1 women) from a volunteer/referred sample with moderate to severe MS (Expanded Disability Status Scale score>6.0). INTERVENTION Participants cycled 30 minutes per session, 3d/wk for 4 weeks or a total of 12 sessions. MAIN OUTCOME MEASURES mV˙O2 of the right vastus lateralis muscle was measured with NIRS before and within 1 week after the intervention. Six bouts of 15-second electrical stimulation increasing from 2 to 7Hz were used to activate the muscle. mV˙O2 was assessed by analyzing the slope of the NIRS oxygen signal during a 10-second arterial occlusion after each electrical stimulation bout. RESULTS Significant FES training by electrical stimulation frequency level interaction was observed (P=.031), with an average increase in mV˙O2 of 47% across frequencies with a main effect of training (P=.047). CONCLUSIONS FES cycling for 4 weeks improved mV˙O2, suggesting that FES cycling is a potential therapy for improving muscle health in people with MS who are nonambulatory.
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Affiliation(s)
| | - Kevin McCully
- Department of Kinesiology, University of Georgia, Athens, GA
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18
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Bakkum AJT, de Groot S, Onderwater MQ, de Jong J, Janssen TWJ. Metabolic rate and cardiorespiratory response during hybrid cycling versus handcycling at equal subjective exercise intensity levels in people with spinal cord injury. J Spinal Cord Med 2014; 37:758-64. [PMID: 24621028 PMCID: PMC4231964 DOI: 10.1179/2045772313y.0000000164] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE To compare the metabolic rate and cardiorespiratory response during hybrid cycling versus handcycling at equal subjective exercise intensity levels in people with spinal cord injury (SCI). DESIGN Cross-sectional study. SETTING Amsterdam Rehabilitation Research Centre | Reade, Amsterdam, The Netherlands. METHODS On separate days, nine individuals with a motor complete paraplegia or tetraplegia (eight men, age 40 ± 13 years, time since injury 12 ± 10 years) performed 5-minute bouts of hybrid cycling (day 1) and handcycling (day 2) at moderate (level 3 on a 10-point rating of perceived exertion (RPE) scale) and vigorous (RPE level 6) subjective exercise intensity, while respiratory gas exchange was measured by open-circuit spirometry and heart rate was monitored using radiotelemetry. OUTCOME MEASURES Metabolic rate (calculated with the Weir equation) and cardiorespiratory response (heart rate, oxygen pulse, and ventilation). RESULTS Overall, the metabolic rate during hybrid cycling was 3.4 kJ (16%) higher (P = 0.006) than during handcycling. Furthermore, compared with handcycling, the overall heart rate and ventilation during hybrid cycling was 11 bpm (11%) and 5.3 l/minute (18%) higher (P = 0.004 and 0.024), respectively, while the oxygen pulse was the same (P = 0.26). CONCLUSION Hybrid cycling induces a higher metabolic rate and cardiorespiratory response at equal RPE levels than handcycling, suggesting that hybrid cycling is more suitable for fighting obesity and increasing cardiorespiratory fitness in individuals with SCI.
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Affiliation(s)
- Arjan J. T. Bakkum
- Correspondence to: Arjan J. T. Bakkum, MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, Van der Boechorststraat 9, Amsterdam, 1081 BT, The Netherlands.
| | | | - Mark Q. Onderwater
- MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - Jelle de Jong
- MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands
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19
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West CR, Gee CM, Voss C, Hubli M, Currie KD, Schmid J, Krassioukov AV. Cardiovascular control, autonomic function, and elite endurance performance in spinal cord injury. Scand J Med Sci Sports 2014; 25:476-85. [DOI: 10.1111/sms.12308] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2014] [Indexed: 12/17/2022]
Affiliation(s)
- C. R. West
- International Collaboration on Repair Discoveries (ICORD); Faculty of Medicine; University of British Columbia; Vancouver British Columbia Canada
| | - C. M. Gee
- International Collaboration on Repair Discoveries (ICORD); Faculty of Medicine; University of British Columbia; Vancouver British Columbia Canada
| | - C. Voss
- Centre for Hip Health and Mobility; Faculty of Medicine; University of British Columbia; Vancouver British Columbia Canada
| | - M. Hubli
- International Collaboration on Repair Discoveries (ICORD); Faculty of Medicine; University of British Columbia; Vancouver British Columbia Canada
| | - K. D. Currie
- International Collaboration on Repair Discoveries (ICORD); Faculty of Medicine; University of British Columbia; Vancouver British Columbia Canada
| | - J. Schmid
- Paracycling Classification; International Cycling Union; Aigle Switzerland
| | - A. V. Krassioukov
- International Collaboration on Repair Discoveries (ICORD); Faculty of Medicine; University of British Columbia; Vancouver British Columbia Canada
- Division of Physical Medicine and Rehabilitation; Faculty of Medicine; University of British Columbia; Vancouver British Columbia Canada
- GF Strong Rehabilitation Centre; Vancouver Health Authority; Vancouver British Columbia Canada
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20
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Vasiliadis AV, Zafeiridis A, Dipla K, Galanis N, Chatzidimitriou D, Kyparos A, Nikolaidis MG, Vrabas IS. Circulating angiogenic biomolecules at rest and in response to upper-limb exercise in individuals with spinal cord injury. J Spinal Cord Med 2014; 37:226-32. [PMID: 24090471 PMCID: PMC4066432 DOI: 10.1179/2045772313y.0000000141] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE Individuals with spinal cord injury (SCI) show structural and functional vascular maladaptations and muscle loss in their lower limbs. Angiogenic biomolecules play important roles in physiological and pathological angiogenesis, and are implicated in the maintenance of muscle mass. This study examined the responses of angiogenic molecules during upper-limb aerobic exercise in patients with SCI and in able-bodied (AB) individuals. METHODS Eight SCI patients with thoracic lesions (T6-T12, ASIA A) and eight AB individuals performed an arm-cranking exercise for 30 minutes at 60% of their VO2max. Plasma concentrations of vascular endothelial growth factor (VEGF-A165), VEGF receptor 1 (sVEGFr-1), VEGF receptor 2 (sVEGFr-2), metalloproteinase 2 (MMP-2), and endostatin were measured at rest, after exercise, and at 1.5 and 3.0 hours during recovery. RESULTS The two-way analysis of variance showed non-significant main effects of "group" and significant main effects of "time/exercise" for all angiogenic biomolecules examined (P < 0.01-0.001). The arm-cranking exercise significantly increased plasma concentrations of VEGF, sVEGFr-1, sVEGFr-2, MMP-2, and endostatin in both groups (P < 0.001-0.01). The magnitude of the increase was similar in both patients with SCI and AB individuals, as shown by the non-significant group × time interaction for all angiogenic parameters. CONCLUSIONS Upper-limb exercise (arm-cranking for 30 minutes at 60% of VO2max) is a sufficient stimulus to trigger a coordinated circulating angiogenic response in patients with SCI. The response of angiogenic molecules to upper-limb aerobic exercise in SCI appears relatively similar to that observed in AB individuals.
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Affiliation(s)
- Angelo V. Vasiliadis
- Exercise Physiology and Biochemistry Laboratory, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Greece
| | - Andreas Zafeiridis
- Exercise Physiology and Biochemistry Laboratory, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Greece,Correspondence to: Andreas Zafeiridis, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Ag. Ioannis, 62110 Serres, Greece.
| | - Konstantina Dipla
- Exercise Physiology and Biochemistry Laboratory, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Greece
| | - Nikiforos Galanis
- Department of Orthopedics, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Greece
| | - Dimitrios Chatzidimitriou
- 2nd Department of Microbiology and National Influenza Center for Northern Greece, Medical School, Aristotle University of Thessaloniki, Greece
| | - Antonios Kyparos
- Exercise Physiology and Biochemistry Laboratory, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Greece
| | - Michalis G. Nikolaidis
- Exercise Physiology and Biochemistry Laboratory, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Greece
| | - Ioannis S. Vrabas
- Exercise Physiology and Biochemistry Laboratory, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Greece
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Phillips AA, Ainslie PN, Krassioukov AV, Warburton DER. Regulation of cerebral blood flow after spinal cord injury. J Neurotrauma 2013; 30:1551-63. [PMID: 23758347 DOI: 10.1089/neu.2013.2972] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Significant cardiovascular and autonomic dysfunction occurs after era spinal cord injury (SCI). Two major conditions arising from autonomic dysfunction are orthostatic hypotension and autonomic dysreflexia (i.e., severe acute hypertension). Effective regulation of cerebral blood flow (CBF) is essential to offset these drastic changes in cerebral perfusion pressure. In the context of orthostatic hypotension and autonomic dysreflexia, the purpose of this review is to critically examine the mechanisms underlying effective CBF after an SCI and propose future avenues for research. Although only 16 studies have examined CBF control in those with high-level SCI (above the sixth thoracic spinal segment), it appears that CBF regulation is markedly altered in this population. Cerebrovascular function comprises three major mechanisms: (1) cerebral autoregulation, (i.e., ΔCBF/Δ blood pressure); (2) cerebrovascular reactivity to changes in PaCO2 (i.e. ΔCBF/arterial gas concentration); and (3) neurovascular coupling (i.e., ΔCBF/Δ metabolic demand). While static cerebral autoregulation appears to be well maintained in high-level SCI, dynamic cerebral autoregulation, cerebrovascular reactivity, and neurovascular coupling appear to be markedly altered. Several adverse complications after high-level SCI may mediate the changes in CBF regulation including: systemic endothelial dysfunction, sleep apnea, dyslipidemia, decentralization of sympathetic control, and dominant parasympathetic activity. Future studies are needed to describe whether altered CBF responses after SCI aid or impede orthostatic tolerance. Further, simultaneous evaluation of extracranial and intracranial CBF, combined with modern structural and functional imaging, would allow for a more comprehensive evaluation of CBF regulatory processes. We are only beginning to understand the functional effects of dysfunctional CBF regulation on brain function on persons with SCI, which are likely to include increased risk of transient ischemic attacks, stroke, and cognitive dysfunction.
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Affiliation(s)
- Aaron A Phillips
- Cardiovascular Physiology and Rehabilitation Laboratory, University of British Columbia, Vancouver, Canada
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22
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Thijssen DHJ, Dawson EA, van den Munckhof ICL, Birk GK, Timothy Cable N, Green DJ. Local and systemic effects of leg cycling training on arterial wall thickness in healthy humans. Atherosclerosis 2013; 229:282-6. [PMID: 23880177 DOI: 10.1016/j.atherosclerosis.2013.05.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Revised: 04/17/2013] [Accepted: 05/01/2013] [Indexed: 12/21/2022]
Abstract
UNLABELLED Exercise training is associated with direct effects on conduit artery function and structure. Cross-sectional studies suggest the presence of systemic changes in wall thickness as a result of exercise in healthy subjects, but no previous study has examined this question in humans undertaking exercise training. OBJECTIVE To examine the change in superficial femoral (SFA, i.e. local effect) and carotid (CA, i.e. systemic effect) artery wall thickness across 8 weeks of lower limb cycle training in healthy young men. METHODS Fourteen healthy young male subjects were assigned to an 8-week training study of cycling exercise (n = 9) or a control period (n = 5). Before, during (2, 4 and 6 weeks) and after training, SFA and CA wall thickness was examined using automated edge-detection of high resolution ultrasound images. We also measured resting diameter and calculated the wall:lumen(W:L)-ratio. RESULTS Exercise training did not alter CA or SFA baseline diameter (P = 0.14), but was associated with gradual, consistent and significant decreases in wall thickness and W:L-ratio in both the CA and SFA (P < 0.001 and 0.002, respectively). Two-way ANOVA revealed a comparable magnitude of decrease in wall thickness and W:L-ratio in both arteries across the 8-week period (interaction-effect; P = 0.29 and 0.12, respectively). No changes in artery diameter, wall thickness or W:L-ratio were apparent in controls (0.82, 0.38 and 0.52, respectively). CONCLUSION We found that cycle exercise training in healthy young individuals is associated with modest, but significant, decreases in wall thickness in the superficial femoral and carotid arteries. These findings suggest that exercise training causes systemic adaptation of the arterial wall in healthy young subjects.
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Affiliation(s)
- Dick H J Thijssen
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool L3 3AF, United Kingdom.
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23
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Bell JW, Chen D, Bahls M, Newcomer SC. Altered resting hemodynamics in lower-extremity arteries of individuals with spinal cord injury. J Spinal Cord Med 2013; 36:104-11. [PMID: 23809524 PMCID: PMC3595957 DOI: 10.1179/2045772312y.0000000052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To investigate lower-extremity arterial hemodynamics in individuals with spinal cord injury (SCI). We hypothesized that oscillatory shear index would be altered and resting mean shear would be higher in the lower-extremity arteries of SCI. RESEARCH Cross-sectional study of men and women with SCIs compared to able-bodied controls. SUBJECTS Subjects included 105 ages 18-72 years with American Spinal Injury Association (ASIA) Impairment Scale grades A, B, or C and injury duration at least 5 years. Subjects were matched for age and cardiovascular disease risk factors with 156 able-bodied controls. METHODS Diameter and blood velocity were determined with subject at rest via ultrasound in superficial femoral, popliteal, brachial, and carotid arteries. Mean shear, antegrade shear, retrograde shear, and oscillatory shear index were calculated. RESULTS Oscillatory shear index was lower in SCI compared to controls for superficial femoral (0.16 ± 0.10 vs. 0.26 ± 0.06, P < 0.01) and popliteal arteries (0.20 ± 0.11 vs. 0.26 ± 0.05, P < 0.01). Mean shear rate was higher in SCI compared to controls for superficial femoral (43.54 ± 28.0 vs. 20.48 ± 13.1/second, P < 0.01) and popliteal arteries (30.43 ± 28.1 vs. 11.68 ± 9.5/second, P < 0.01). CONCLUSIONS The altered resting hemodynamics in SCI are consistent with an atheroprotective hemodynamic environment.
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Affiliation(s)
- Jeffrey W. Bell
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, USA; and Department of Science, Southwest Minnesota State University, Marshall, MN, USA
| | - David Chen
- Rehabilitation Institute of Chicago, Spinal Cord Injury Rehabilitation Program, Chicago, IL, USA
| | - Martin Bahls
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, USA
| | - Sean C. Newcomer
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, USA,Correspondence to: Sean C. Newcomer, Department of Health and Kinesiology, Purdue University, Lambert Fieldhouse, 800 West Stadium Avenue, West Lafayette, IN 47907, USA. E-mail:
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Murphy MN, Ichiyama RM, Iwamoto GA, Mitchell JH, Smith SA. Exercise pressor reflex function following acute hemi-section of the spinal cord in cats. Front Physiol 2013; 4:3. [PMID: 23403764 PMCID: PMC3566549 DOI: 10.3389/fphys.2013.00003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 01/07/2013] [Indexed: 12/29/2022] Open
Abstract
Cardiovascular disease is a leading cause of morbidity and mortality in patients post spinal cord injury (SCI). The prescription of exercise as a therapeutic modality for disease prevention in this population is promising. It is logical to suggest that the sooner an exercise program can begin the more benefit the patient will receive from the therapy. However, the time point after injury at which the requisite circulatory responses needed to support exercise are viable remains largely unknown. The skeletal muscle exercise pressor reflex (EPR) significantly contributes to cardiovascular control during exercise in healthy individuals. Experiments in patients with a chronic lateral hemi-section of the spinal cord (Brown-Séquard syndrome) suggest that the EPR, although blunted, is operational when examined months to years post injury. However, whether this critically important reflex remains functional immediately after lateral SCI or, in contrast, experiences a period of reduced capacity due to spinal shock has not been established. This study was designed to assess EPR function after acute lateral transection of the spinal cord. The EPR was selectively activated in seven decerebrate cats via electrically stimulated static contraction of the triceps surae muscles of each hindlimb before and after lateral hemi-section of the T13–L2 region of the spinal cord. Compared to responses prior to injury, increases in mean arterial pressure (MAP) were significantly decreased when contracting the hindlimb either ipsilateral to the lesion (MAP = 17 ± 3 mmHg before and 9 ± 2 mmHg after) or contralateral to the lesion (MAP = 22 ± 5 mmHg before and 12 ± 4 mmHg after). The heart rate (HR) response to stimulation of the EPR was largely unaffected by induction of acute SCI. The findings suggest that the EPR maintains the ability to importantly contribute to cardiovascular regulation during exercise immediately following a Brown-Séquard-like injury.
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Affiliation(s)
- Megan N Murphy
- Department of Physical Therapy, University of Texas Southwestern Medical Center Dallas, TX, USA ; Department of Applied Physiology and Wellness, Southern Methodist University Dallas, TX, USA
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25
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Kamradt T, Rasch C, Schuld C, Böttinger M, Mürle B, Hensel C, Fürstenberg CH, Weidner N, Rupp R, Hug A. Spinal cord injury: association with axonal peripheral neuropathy in severely paralysed limbs. Eur J Neurol 2013; 20:843-8. [DOI: 10.1111/ene.12082] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 11/21/2012] [Indexed: 11/29/2022]
Affiliation(s)
- T. Kamradt
- Spinal Cord Injury Center; Heidelberg University Hospital; Heidelberg; Germany
| | - C. Rasch
- Spinal Cord Injury Center; Heidelberg University Hospital; Heidelberg; Germany
| | - C. Schuld
- Spinal Cord Injury Center; Heidelberg University Hospital; Heidelberg; Germany
| | - M. Böttinger
- Spinal Cord Injury Center; Heidelberg University Hospital; Heidelberg; Germany
| | - B. Mürle
- Department of Radiology; Theresienkrankenhaus Mannheim; Mannheim; Germany
| | - C. Hensel
- Spinal Cord Injury Center; Heidelberg University Hospital; Heidelberg; Germany
| | - C. H. Fürstenberg
- Spinal Cord Injury Center; Heidelberg University Hospital; Heidelberg; Germany
| | - N. Weidner
- Spinal Cord Injury Center; Heidelberg University Hospital; Heidelberg; Germany
| | - R. Rupp
- Spinal Cord Injury Center; Heidelberg University Hospital; Heidelberg; Germany
| | - A. Hug
- Spinal Cord Injury Center; Heidelberg University Hospital; Heidelberg; Germany
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West CR, AlYahya A, Laher I, Krassioukov A. Peripheral vascular function in spinal cord injury: a systematic review. Spinal Cord 2012. [DOI: 10.1038/sc.2012.136] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Lammers G, van Duijnhoven NTL, Hoenderop JG, Horstman AM, de Haan A, Janssen TWJ, de Graaf MJJ, Pardoel EM, Verwiel ETP, Thijssen DHJ, Hopman MTE. The identification of genetic pathways involved in vascular adaptations after physical deconditioningversusexercise training in humans. Exp Physiol 2012; 98:710-21. [DOI: 10.1113/expphysiol.2012.068726] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bakkum AJT, de Groot S, van der Woude LHV, Janssen TWJ. The effects of hybrid cycle training in inactive people with long-term spinal cord injury: design of a multicenter randomized controlled trial. Disabil Rehabil 2012; 35:1127-32. [DOI: 10.3109/09638288.2012.715719] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Thijssen DHJ, Green DJ, Hopman MTE. Blood vessel remodeling and physical inactivity in humans. J Appl Physiol (1985) 2011; 111:1836-45. [PMID: 21737819 DOI: 10.1152/japplphysiol.00394.2011] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Physical inactivity is associated with an increase in cardiovascular risk that cannot be fully explained by traditional or novel risk factors. Inactivity is also associated with changes in hemodynamic stimuli, which exert direct effects on the vasculature leading to remodeling and a proatherogenic phenotype. In this review, we synthesize and summarize in vivo evidence relating to the impact of local and systemic models of physical inactivity on conduit arteries, resistance vessels, and the microcirculation in humans. Taken together, the literature suggests that a rapid inward structural remodeling of vessels occurs in response to physical inactivity. The magnitude of this response is dependent on the "dose" of inactivity. Moreover, changes in vascular function are found at resistance and microvessel levels in humans. In conduit arteries, a strong interaction between vascular function and structure is present, which results in conflicting data regarding the impact of inactivity on conduit artery function. While much of the cardioprotective effect of exercise is related to the nitric oxide pathway, deconditioning may primarily be associated with activation of vasoconstrictor pathways. The effects of deconditioning on the vasculature are therefore not simply the opposite of those in response to exercise training. Given the importance of sedentary behavior, future studies should provide further insight into the impact of inactivity on the vasculature and other (novel) markers of vascular health. Moreover, studies should examine the role of (hemodynamic) stimuli that underlie the characteristic vascular adaptations during deconditioning. Our review concludes with some suggestions for future research directions.
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Affiliation(s)
- Dick H J Thijssen
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom.
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Padilla J, Simmons GH, Bender SB, Arce-Esquivel AA, Whyte JJ, Laughlin MH. Vascular effects of exercise: endothelial adaptations beyond active muscle beds. Physiology (Bethesda) 2011; 26:132-45. [PMID: 21670160 PMCID: PMC3286126 DOI: 10.1152/physiol.00052.2010] [Citation(s) in RCA: 144] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Endothelial adaptations to exercise training are not exclusively conferred within the active muscle beds. Herein, we summarize key studies that have evaluated the impact of chronic exercise on the endothelium of vasculatures perfusing nonworking skeletal muscle, brain, viscera, and skin, concluding with discussion of potential mechanisms driving these endothelial adaptations.
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Affiliation(s)
- Jaume Padilla
- Biomedical Sciences, University of Missouri, Columbia, Missouri, USA.
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Phillips AA, Cote AT, Warburton DER. A systematic review of exercise as a therapeutic intervention to improve arterial function in persons living with spinal cord injury. Spinal Cord 2011; 49:702-14. [DOI: 10.1038/sc.2010.193] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Ivey FM, Hafer-Macko CE, Ryan AS, Macko RF. Impaired leg vasodilatory function after stroke: adaptations with treadmill exercise training. Stroke 2010; 41:2913-7. [PMID: 20966405 DOI: 10.1161/strokeaha.110.599977] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Resting and reactive hyperemic leg blood flows are significantly reduced in the paretic compared with the nonparetic limb after disabling stroke. Our objective was to compare the effects of regular treadmill exercise (TM) with an active control regimen of supervised stretching (CONTROL) on peripheral hemodynamic function. METHODS This intervention study used a randomized, controlled design, in which participants were randomized with stratification according to age and baseline walking capacity to ensure approximate balance between the 2 groups. Fifty-three chronic, ischemic stroke participants (29 TM and 24 CONTROL) with mild to moderate hemiparetic gait completed bilateral measurements of lower leg resting and reactive hyperemic blood flow using venous occlusion strain gauge plethysmography before and after the 6-month intervention period. Participants also underwent testing to track changes in peak aerobic fitness across time. RESULTS Resting and reactive hyperemic blood flows were significantly reduced in the paretic compared with the nonparetic limb at baseline before any intervention (-28% and -34%, respectively, P<0.01). TM increased both resting and reactive hyperemic blood flow in the paretic limb by 25% compared with decreases in CONTROL (P<0.001, between groups). Similarly, nonparetic leg blood flow was significantly improved with TM compared with controls (P<0.001). Peak aerobic fitness improved by 18% in TM and decreased by 4% in CONTROL (P<0.01, between groups), and there was a significant relationship between blood flow change and peak fitness change for the group as a whole (r=.30, P<0.05). CONCLUSIONS Peripheral hemodynamic function improves with regular aerobic exercise training after disabling stroke.
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Affiliation(s)
- Frederick M Ivey
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD 21201-1524, USA.
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Billinger SA, Guo LX, Pohl PS, Kluding PM. Single limb exercise: pilot study of physiological and functional responses to forced use of the hemiparetic lower extremity. Top Stroke Rehabil 2010; 17:128-39. [PMID: 20542855 DOI: 10.1310/tsr1702-128] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE Stroke-related deficits can impede both functional performance and walking tolerance. Individuals with hemiparesis rely on the stronger limb during exercise and functional tasks. The single limb exercise (SLE) intervention was a unique training protocol that focused only on the hemiparetic limb. Our objective was to determine the effect of the SLE intervention on cardiorespiratory fitness parameters. METHODS Twelve participants (5 male) with a mean age of 60.6 +/- 14.5 years and 69.1 +/- 82.2 months post stroke participated in the training intervention. All participants performed SLE using the hemiparetic leg three times a week for 4 weeks. The nonhemiparetic limb served as the control limb and did not engage in SLE. Peak oxygen uptake (VO2 peak) and oxygen uptake (VO2) were measured at baseline and post intervention in all 12 participants. At pre and post intervention, gait velocity was assessed in a subset of participants (n = 7) using the 10-m fast-walk test. RESULTS After the 4-week SLE training intervention, significant improvements were found for VO2 during submaximal work effort (P = .009) and gait velocity (n = 7) (P = .001). Peak oxygen uptake did not increase (P = .41) after the training intervention. CONCLUSION These data suggest that SLE training was an effective method for improving oxygen uptake and reducing energy expenditure during submaximal effort. Unilateral exercise focused on the hemiparetic leg may be an effective intervention strategy to consider for stroke rehabilitation.
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Affiliation(s)
- Sandra A Billinger
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas, USA
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Pennycott A, Hunt K. Cadence control system for paediatric functional electrical stimulation cycling. Biomed Signal Process Control 2010. [DOI: 10.1016/j.bspc.2010.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Impact of exercise training on oxidative stress in individuals with a spinal cord injury. Eur J Appl Physiol 2010; 109:1059-66. [PMID: 20364349 PMCID: PMC2908461 DOI: 10.1007/s00421-010-1398-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2010] [Indexed: 10/30/2022]
Abstract
Individuals with a spinal cord injury (SCI) have an increased cardiovascular risk. We hypothesize that (anti)oxidative imbalance is associated with the increased cardiovascular risk in SCI, while exercise can reverse this status. The aim of the study is to compare baseline levels of oxidative stress and antioxidative capacity between individuals with SCI and able-bodied (AB) subjects, and to assess acute and long-term effects of functional electrical stimulation (FES) exercise on oxidative stress and antioxidative capacity in SCI. Venous blood was taken from subjects with an SCI (n = 9) and age- and gender-matched AB subjects (n = 9) to examine oxidative stress through malondialdehyde (MDA) levels, while superoxide dismutase (SOD) and glutathione peroxidase (GPx) enzyme levels represented anti-oxidative capacity. Subsequently, subjects with an SCI performed an 8-week FES exercise training period. Blood was taken before and after the first exercise bout and after the last FES session to examine the acute and chronic effect of FES exercise, respectively. Baseline levels of MDA, SOD and GPx were not different between individuals with SCI and AB subjects. SCI demonstrated a correlation between initial fitness level and MDA (R = -0.83, P = 0.05). MDA, SOD and GPx levels were neither altered by a single FES exercise bout nor by 8 weeks FES training. In conclusion, although individuals with an SCI demonstrate a preserved (anti)oxidative status, the correlation between fitness level and (anti)oxidative balance suggests that higher fitness levels are related to improved (anti)oxidative status in SCI. Nonetheless, the FES exercise stimulus was insufficient to acutely or chronically change (anti)oxidative status in individuals with an SCI.
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Alomari MA, Mekary RA, Welsch MA. Rapid vascular modifications to localized rhythmic handgrip training and detraining: vascular conditioning and deconditioning. Eur J Appl Physiol 2010; 109:803-9. [PMID: 20225082 DOI: 10.1007/s00421-010-1367-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2010] [Indexed: 10/19/2022]
Abstract
Despite the evidence describing the rapid vascular function modifications to commencement and cessation of large muscle exercises (i.e. cycling), no studies examined the time-course vascular modifications to localized training and detraining. This study aimed to examine the effects of 4-week rhythmic handgrip exercise training and 2-week detraining on reactive hyperemic forearm blood flow and vascular resistance in 11 young men. Rhythmic handgrip exercise was performed in the non-dominant forearm for 20 min/day, 5 days/week, at 60% of maximum voluntary contraction for 4 weeks, followed by 2 weeks of no training. Forearm blood flow and vascular resistance were evaluated, in both arms, at rest and following arterial occlusion. These vascular function indices were obtained in five visits; before, after 1 and 4 week(s) of training as well as after 1 and 2 week(s) of training cessation. Resting cardiovascular measures were not altered during the study period. A 2 (arms) x 5 (visits) ANOVA revealed significant arms-by-visits interactions for reactive hyperemic forearm blood flow (p = 0.02) and vascular resistance (p = 0.02). Subsequent comparison demonstrated increased trained forearm reactive hyperemic blood flow 1 week after training, then returned to pre-training values 1 week following training cessation. In contrast, vascular resistance decreased 1 week after training commencement, only to return to pretraining level 1 week after training cessation. These results indicate a rapid, unilateral improvement in regional reactive hyperemic blood flow and vascular resistance following localized exercise-training. However, the improvements are transient and return to pretraining levels 1 week after detraining.
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Affiliation(s)
- Mahmoud A Alomari
- Division of Physical Therapy, Department of Allied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan.
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van Duijnhoven NTL, Thijssen DHJ, Green DJ, Felsenberg D, Belavý DL, Hopman MTE. Resistive exercise versus resistive vibration exercise to counteract vascular adaptations to bed rest. J Appl Physiol (1985) 2010; 108:28-33. [DOI: 10.1152/japplphysiol.00760.2009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Bed rest results in marked vascular adaptations, and resistive vibration exercise (RVE) has been shown to be an effective countermeasure. As vibration exercise has practical and logistical limitations, the use of resistive exercise (RES) alone has the preference under specific circumstances. However, it is unknown if RES is sufficient to prevent vascular adaptations to bed rest. Therefore, the purpose of the present study was to examine the impact of RES and RVE on the vascular function and structure of the superficial femoral artery in young men exposed to 60 days of bed rest. Eighteen healthy men (age: 31 ± 8 yr) were assigned to bed rest and randomly allocated to control, RES, or RVE groups. Exercise was applied 3 times/wk for 5–7 min/session. Resting diameter, blood flow, flow-mediated dilation (FMD), and dilator capacity of the superficial femoral artery were measured using echo-Doppler ultrasound. Bed rest decreased superficial femoral artery diameter and dilator capacity ( P < 0.001), which were significantly attenuated in the RVE group ( P < 0.01 and P < 0.05, respectively) but not in the RES group ( P = 0.202 and P = 0.696, respectively). Bed rest significantly increased FMD ( P < 0.001), an effect that was abolished by RVE ( P < 0.005) but not RES ( P = 0.078). Resting and hyperemic blood flow did not change in any of the groups. Thus, RVE abolished the marked increase in FMD and decrease in baseline diameter and dilator capacity normally associated with prolonged bed rest. However, the stimulus provided by RES alone was insufficient to counteract the vascular adaptations to bed rest.
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Affiliation(s)
| | - Dick H. J. Thijssen
- Department of Physiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- Research Institute for Sports and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom
| | - Daniel J. Green
- Research Institute for Sports and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom
- School of Sport Science, Exercise and Health, University of Western Australia, Crawley, Western Australia, Australia; and
| | - Dieter Felsenberg
- Centre for Muscle and Bone Research, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Daniel L. Belavý
- Centre for Muscle and Bone Research, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Maria T. E. Hopman
- Department of Physiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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BROWN MARYBETH, MILLARD-STAFFORD MINDYL, ALLISON ANDREWR. Running-Specific Prostheses Permit Energy Cost Similar to Nonamputees. Med Sci Sports Exerc 2009; 41:1080-7. [DOI: 10.1249/mss.0b013e3181923cee] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Hamzaid NA, Davis G. Health and Fitness Benefits of Functional Electrical Stimulation-Evoked Leg Exercise for Spinal Cord–Injured Individuals. Top Spinal Cord Inj Rehabil 2009. [DOI: 10.1310/sci1404-88] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Van Duijnhoven NTL, Janssen TWJ, Green DJ, Minson CT, Hopman MTE, Thijssen DHJ. Effect of functional electrostimulation on impaired skin vasodilator responses to local heating in spinal cord injury. J Appl Physiol (1985) 2009; 106:1065-71. [PMID: 19228983 DOI: 10.1152/japplphysiol.91611.2008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Spinal cord injury (SCI) induces vascular adaptations below the level of the lesion, such as impaired cutaneous vasodilation. However, the mechanisms underlying these differences are unclear. The aim of this study is to examine arm and leg cutaneous vascular conductance (CVC) responses to local heating in 17 able-bodied controls (39 +/- 13 yr) and 18 SCI subjects (42 +/- 8 yr). SCI subjects were counterbalanced for functional electrostimulation (FES) cycling exercise (SCI-EX, n = 9) or control (SCI-C, n = 9) and reanalyzed after 8 wk. Arm and leg skin blood flow were measured by laser-Doppler flowmetry during local heating (42 degrees C), resulting in an axon-reflex mediated first peak, nadir, and a primarily nitric oxide-dependent plateau phase. Data were expressed as a percentage of maximal CVC (44 degrees C). CVC responses to local heating in the paralyzed leg, but also in the forearm of SCI subjects, were lower than in able-bodied controls (P < 0.05 and 0.01, respectively). The 8-wk intervention did not change forearm and leg CVC responses to local heating in SCI-C and SCI-EX, but increased femoral artery diameter in SCI-EX (P < 0.05). Interestingly, findings in skin microvessels contrast with conduit arteries, where physical (in)activity contributes to adaptations in SCI. The lower CVC responses in the paralyzed legs might suggest a role for inactivity in SCI, but the presence of impaired CVC responses in the normally active forearm suggests other mechanisms. This is supported by a lack of adaptation in skin microcirculation after FES cycle training. This might relate to the less frequent and smaller magnitude of skin blood flow responses to heat stimuli, compared with controls, than physical inactivity per se.
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Affiliation(s)
- Noortje T L Van Duijnhoven
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom
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Ballaz L, Fusco N, Crétual A, Langella B, Brissot R. Peripheral Vascular Changes After Home-Based Passive Leg Cycle Exercise Training in People With Paraplegia: A Pilot Study. Arch Phys Med Rehabil 2008; 89:2162-6. [DOI: 10.1016/j.apmr.2008.04.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Revised: 04/11/2008] [Accepted: 04/15/2008] [Indexed: 11/28/2022]
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Thijssen DHJ, Hopman MTE. Counterpoint: exercise training does not induce vascular adaptations beyond the active muscle beds. J Appl Physiol (1985) 2008; 105:1004-6; discussion 1006-7. [PMID: 18779260 DOI: 10.1152/japplphysiol.90570.2008a] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Dick H J Thijssen
- Department of Physiology, Radboud University, Nijmegen Medical Centre, The Netherlands
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Frotzler A, Coupaud S, Perret C, Kakebeeke TH, Hunt KJ, Donaldson NDN, Eser P. High-volume FES-cycling partially reverses bone loss in people with chronic spinal cord injury. Bone 2008; 43:169-176. [PMID: 18440891 DOI: 10.1016/j.bone.2008.03.004] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Revised: 02/29/2008] [Accepted: 03/03/2008] [Indexed: 11/20/2022]
Abstract
Spinal cord injury (SCI) leads to severe bone loss in the paralysed limbs and to a resulting increased fracture risk thereof. Since long bone fractures can lead to comorbidities and a reduction in quality of life, it is important to improve bone strength in people with chronic SCI. In this prospective longitudinal cohort study, we investigated whether functional electrical stimulation (FES) induced high-volume cycle training can partially reverse the loss of bone substance in the legs after chronic complete SCI. Eleven participants with motor-sensory complete SCI (mean age 41.9+/-7.5 years; 11.0+/-7.1 years post injury) were recruited. After an initial phase of 14+/-7 weeks of FES muscle conditioning, participants performed on average 3.7+/-0.6 FES-cycling sessions per week, of 58+/-5 min each, over 12 months at each individual's highest power output. Bone and muscle parameters were investigated in the legs by means of peripheral quantitative computed tomography before the muscle conditioning (t1), and after six (t2) and 12 months (t3) of high-volume FES-cycle training. After 12 months of FES-cycling, trabecular and total bone mineral density (BMD) as well as total cross-sectional area in the distal femoral epiphysis increased significantly by 14.4+/-21.1%, 7.0+/-10.8% and 1.2+/-1.5%, respectively. Bone parameters in the femoral shaft showed small but significant decreases, with a reduction of 0.4+/-0.4% in cortical BMD, 1.8+/-3.0% in bone mineral content, and 1.5+/-2.1% in cortical thickness. These decreases mainly occurred between t1 and t2. No significant changes were found in any of the measured bone parameters in the tibia. Muscle CSA at the thigh increased significantly by 35.5+/-18.3%, while fat CSA at the shank decreased by 16.7+/-12.3%. Our results indicate that high-volume FES-cycle training leads to site-specific skeletal changes in the paralysed limbs, with an increase in bone parameters at the actively loaded distal femur but not the passively loaded tibia. Thus, we conclude that high-volume FES-induced cycle training has clinical relevance as it can partially reverse bone loss and thus may reduce fracture risk at this fracture prone site.
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Affiliation(s)
| | - Sylvie Coupaud
- Centre for Rehabilitation Engineering, Department of Mechanical Engineering, University of Glasgow, Glasgow, United Kingdom; Queen Elizabeth National Spinal Injuries Unit, Southern General Hospital, Glasgow, United Kingdom
| | | | | | - Kenneth J Hunt
- Centre for Rehabilitation Engineering, Department of Mechanical Engineering, University of Glasgow, Glasgow, United Kingdom; Queen Elizabeth National Spinal Injuries Unit, Southern General Hospital, Glasgow, United Kingdom
| | | | - Prisca Eser
- Clinic of Rheumatology and Clinical Immunology/Allergology, University Hospital Berne, Switzerland; Institute of Social and Preventive Medicine, University of Berne, Berne, Switzerland
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Haapala S, Faghri P, Adams D. Identifying an Effective Paradigm for FES-Induced Cycle Ergometry in Individuals with Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2008. [DOI: 10.1310/sci1401-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Green DJ, Maiorana AJ, Cable NT. Point: exercise training does induce vascular adaptations beyond the active muscle beds. J Appl Physiol (1985) 2008; 105:1002-4; discussion 1007. [PMID: 18483157 DOI: 10.1152/japplphysiol.90570.2008] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Haapala SA, Faghri PD, Adams DJ. Leg joint power output during progressive resistance FES-LCE cycling in SCI subjects: developing an index of fatigue. J Neuroeng Rehabil 2008; 5:14. [PMID: 18439300 PMCID: PMC2396645 DOI: 10.1186/1743-0003-5-14] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2007] [Accepted: 04/26/2008] [Indexed: 11/24/2022] Open
Abstract
Background The purpose of this study was to investigate the biomechanics of the hip, knee and ankle during a progressive resistance cycling protocol in an effort to detect and measure the presence of muscle fatigue. It was hypothesized that knee power output can be used as an indicator of fatigue in order to assess the cycling performance of SCI subjects. Methods Six spinal cord injured subjects (2 incomplete, 4 complete) between the ages of twenty and fifty years old and possessing either a complete or incomplete spinal cord injury at or below the fourth cervical vertebra participated in this study. Kinematic data and pedal forces were recorded during cycling at increasing levels of resistance. Ankle, knee and hip power outputs and resultant pedal force were calculated. Ergometer cadence and muscle stimulation intensity were also recorded. Results The main findings of this study were: (a) ankle and knee power outputs decreased, whereas hip power output increased with increasing resistance, (b) cadence, stimulation intensity and resultant pedal force in that combined order were significant predictors of knee power output and (c) knowing the value of these combined predictors at 10 rpm, an index of fatigue can be developed, quantitatively expressing the power capacity of the knee joint with respect to a baseline power level defined as fatigue. Conclusion An index of fatigue was successfully developed, proportionalizing knee power capacity during cycling to a predetermined value of fatigue. The fatigue index value at 0/8th kp, measured 90 seconds into active, unassisted pedaling was 1.6. This indicates initial power capacity at the knee to be 1.6 times greater than fatigue. The fatigue index decreased to 1.1 at 2/8th kp, representing approximately a 30% decrease in the knee's power capacity within a 4 minute timespan. These findings suggest that the present cycling protocol is not sufficient for a rider to gain the benefits of FES and thus raises speculation as to whether or not progressive resistance cycling is an appropriate protocol for SCI subjects.
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Affiliation(s)
- Stephenie A Haapala
- Functional Performance Laboratory, Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA.
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Rimaud D, Boissier C, Calmels P. Evaluation of the effects of compression stockings using venous plethysmography in persons with spinal cord injury. J Spinal Cord Med 2008; 31:202-7. [PMID: 18581669 PMCID: PMC2565483 DOI: 10.1080/10790268.2008.11760713] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND/OBJECTIVE To examine the effect of graduated compression stockings (GCS) on the properties of the venous vascular system, as characterized by venous capacitance (VC) and venous outflow (VO), in the lower extremities of individuals with spinal cord injury (SCI), according to injury level. METHODS Nine male subjects with SCI (5 with low paraplegia [LP], 4 with high paraplegia [HP]) performed 2 plethysmography tests: with and without graduated compression knee-length stockings (pressure of 21 mm/Hg). The VC, VO, and cardiovascular parameters (heart rate and blood pressure) were evaluated with and without GCS. RESULTS The VC and VO were lower in patients with HP than in those with LP. For all subjects, VC was significantly lower (-14%) with GCS than without (1.77 +/- 1.18 vs 1.53 +/- 1.09 vol%, P < 0.01). On the contrary, VO did not differ significantly when wearing or not wearing GCS. CONCLUSIONS This study demonstrated that 21-mm/Hg knee-length GCS are sufficient to prevent venous distension in individuals with SCI, even those with longstanding paraplegia, by significantly decreasing venous capacitance. This intervention may help to prevent deep vein thrombosis.
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Affiliation(s)
- Diana Rimaud
- Service de Médecine Physique et de Réadaptation, Unité de Recherche Physiologie et Physiopathologie de L'exercice et Handicap, Hôpital Bellevue, CHU Saint-Etienne, Saint-Etienne 42055 Cedex 2, France.
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Warburton DER, Eng JJ, Krassioukov A, Sproule S. Cardiovascular Health and Exercise Rehabilitation in Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2007; 13:98-122. [PMID: 22719205 DOI: 10.1310/sci1301-98] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
There appears to be an increased prevalence and earlier onset of cardiovascular disease (CVD) in persons with SCI. Physical inactivity is thought to be a key factor in the increased risk for CVD. Physical inactivity is highly prevalent in persons with SCI and it appears that activities of daily living are not sufficient to maintain cardiovascular fitness and health. This systematic review examines the current literature regarding the risk for CVD and the effectiveness of varied exercise rehabilitation programs in attenuating the risk for CVD in SCI.
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Affiliation(s)
- Darren E R Warburton
- Cardiovascular Physiology and Rehabilitation Laboratory, Experimental Medicine, Faculty of Medicine, University of British Columbia
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50
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Devillard X, Rimaud D, Roche F, Calmels P. Effects of training programs for spinal cord injury. ACTA ACUST UNITED AC 2007; 50:490-8, 480-9. [PMID: 17482709 DOI: 10.1016/j.annrmp.2007.04.013] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2007] [Accepted: 04/16/2007] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Endurance exercise training programs in patients with spinal cord injury (SCI) were largely studied to determine different types of adaptations. The aim of specific rehabilitation is to obtain maximal gains in quality-of-life (QoL) after SCI. OBJECTIVE To review the literature on the efficiency of training programs for SCI. METHODS We searched the MEDline database with the keywords SCI, paraplegia and quadriplegia and synonyms, then combined them with one of the following terms: rehabilitation, training, exercise conditioning, physical fitness, exercise prescription, adaptation, effect, or benefit. We found 65 articles related to the physiological and psychological effects of training programmes on patients with SCI. RESULTS AND DISCUSSION Training programs after SCI offer reconditioning cardiorespiratory, cardiovascular, cardiac, metabolic, bone, biomechanical, muscle adaptation, and QoL benefits. Reconditioning training increases VO2 max, reverses leg vascular resistance in the paralyzed legs and has possible cardiac and neural adaptations, favorable catecholamine responses and effects on platelet aggregation. Reconditioning can also modify lipid profile, reduce risk for cardiovascular diseases, prevent osteoporosis and increase maximal upper-extremity muscle strength, sprint power output and maximal power output. This effect allows for considerable improvement in mechanical efficiency and wheelchair propulsion technique. CONCLUSIONS Reconditioning training programs after SCI have a direct impact on function and QoL, permitting participation in physical activities in addition to daily living activities in subjects with SCI.
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Affiliation(s)
- X Devillard
- Unité PPEH EA 3062, faculté de médecine Jacques-Lisfranc, université Jean-Monnet, service de médecine physique et de réadaptation, hôpital Bellevue CHU, 42055 Saint-Etienne cedex 2, France.
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