Relationship Between Perceived Exertion and Physiologic Markers During Arm Exercise With Able-Bodied Participants and Participants With Poliomyelitis

Cardiopulmonary exercise testing in neuromuscular disease: a systematic review

INTRODUCTION

Cardiopulmonary exercise testing (CPET) is increasingly used to determine aerobic fitness in health and disability conditions. Patients with neuromuscular diseases (NMDs) often present with symptoms of cardiac and/or skeletal muscle dysfunction and fatigue that might impede the ability to deliver maximal cardiopulmonary effort. Although an increasing number of studies report on NMDs' physical fitness, the applicability of CPET remains largely unknown.

AREAS COVERED

This systematic review synthesized evidence about the quality and feasibility of CPET in NMDs and patient's aerobic fitness. The review followed the PRISMA guidelines (PROSPERO number CRD42020211068). Between September and October 2020 one independent reviewer searched the PubMed/MEDLINE, EMBASE, SCOPUS, and Web of Science databases. Excluding reviews and protocol description articles without baseline data, all study designs using CPET to assess adult or pediatric patients with NMDs were included. The methodological quality was assessed according to the American Thoracic Society/American College of Chest Physicians (ATS/ACCP) recommendations.

EXPERT OPINION

CPET is feasible for ambulatory patients with NMDs when their functional level and the exercise modality are taken into account. However, there is still a vast potential for standardizing and designing disease-specific CPET protocols for patients with NMDs. Moreover, future studies are urged to follow the ATS/ACCP recommendations.

Physiological responses between players with and without spinal cord injury in wheelchair basketball small-sided games

STUDY DESIGN

This is a comparative study between players with and without spinal cord injury (SCI) during a training task.

OBJECTIVE

This study examined physiological responses in commonly used small-sided games (SSGs) in well-experienced wheelchair basketball (WB) players with SCI and without SCI (Non-SCI).

SETTING

The study was conducted with a WB team in Vitoria-Gasteiz, Spain (2014).

METHODS

The team was divided into an SCI group (n=6) and a Non-SCI group (n=6). Absolute and relative heart rate (HR) along with tympanic temperature and perceived exertion (RPE) were recorded for both groups.

RESULTS

The two groups attained different absolute HR values for the same SSG. However, no significant differences were observed in relative HR between groups (%HRmean, %HRpeak and the percentage of the time spent in each HR zone: low, moderate, high and maximal) nor in tympanic temperature. Moreover, in relation to the bout evolution analysis (4 repetitions of 4 min), the Non-SCI group significantly increased (P<0.05) absolute HRmean and HRpeak during bouts, whereas the SCI group maintained them constant. Furthermore, the variations in the percentage of the time spent in each HR zone only were observed in the Non-SCI group.

CONCLUSION

In spite of the Non-SCI group attaining higher absolute HR values, the SCI and Non-SCI groups may have similar HR relative values during a specific WB training task. However, the SCI group reported significantly higher values in respiratory RPE in the last bout than the Non-SCI group for the same SSG.

Differentiated perceived exertion and self-regulated wheelchair exercise

OBJECTIVE

To investigate the utility of the differentiated rating of perceived exertion (RPE) for the self-regulation of submaximal wheelchair propulsion in novice users.

DESIGN

Each participant completed a submaximal incremental test and a graded test to exhaustion to determine peak oxygen consumption (Vo(2)peak) on a wheelchair ergometer. On a separate day, two 12-minute intermittent bouts consisting of three 4-minute stages were completed at individualized imposed power outputs equating to light (40% Vo(2)peak) and moderate (60% Vo(2)peak) intensity exercise. On a third occasion, participants were assigned to either the overall group or the peripheral group and were required to self-regulate 12-minute intermittent exercise according to either overall RPE or peripheral RPE reported during the corresponding imposed intensity trial.

SETTING

Laboratory facilities at a university.

PARTICIPANTS

Preliminary population of able-bodied participants with no prior experience of wheelchair propulsion (N=18).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Differences in oxygen consumption (Vo(2)), heart rate, blood lactate concentration, and power output between the imposed and self-regulated exercise trials.

RESULTS

No difference was found in physiological responses between the moderate-intensity imposed and RPE-regulated trials in the peripheral group, whereas a significant (P<.05) underproduction in Vo(2) (1.76±.31 vs 1.59±.25L/min) and blood lactate concentration (2.8±0.90 vs 2.21±.83mmol/L) was seen in the overall group. In contrast, a significant (P<.05) overproduction was seen in the peripheral group at a light exercise intensity, whereas no difference was found between all variables during the light-intensity imposed and RPE-regulated trials in the overall group.

CONCLUSIONS

Peripheral RPE enabled a more precise self-regulation during moderate-intensity wheelchair exercise in novice users. In contrast, overall RPE provided a more accurate stimulus when performing light-intensity propulsion.

The effects of a home-based arm ergometry exercise programme on physical fitness, fatigue and activity in polio survivors: protocol for a randomised controlled trial

Background

Many Polio survivors have reduced mobility, pain and fatigue, which make access to conventional forms of aerobic exercise difficult. Inactivity leads to increased risk of health problems, many of which are prevalent among Polio survivors. Aerobic exercise programmes in Polio survivors should utilise stable muscle groups and should be designed to minimise exacerbation of pain and fatigue. A home-based arm ergometry aerobic exercise programme may represent an affordable and accessible exercise modality, incorporating exercise prescription principles in this group.

Methods/design

This is a prospective, single blinded, randomised controlled trial. There are two arms; exercise intervention using arm ergometers and control. Polio survivors meeting eligibility criteria will be recruited and randomly allocated to intervention or control groups. Participants allocated to the intervention group will receive a small arm ergometer and a polar heart rate monitor. They will carry out a home-based moderate intensity (50-70% HRMax) aerobic exercise programme for eight weeks, following instruction by the treating physiotherapist. Assessments will occur at baseline and after eight weeks and will include tests of physical fitness, activity, energy cost of walking, fatigue and quality of life. Clinically feasible assessment tools including the Six Minute Arm Test, the Physical Activity Scale for People with Physical Disabilities questionnaire, the Physiological Cost Index, Fatigue Severity Scale and the SF-36v2 will be utilised.

Discussion

The efficacy of a home-based arm ergometry programme in Polio survivors will be examined. No previous trial has examined such a programme using a wide range of outcome measures pertinent to Polio survivors. This study will provide new information on the impact of arm ergometry on physical fitness, activity, body composition, fatigue, pain, muscle strength, and health related quality of life. Also, the study will provide information, which at present is lacking, on safety of aerobic exercise in Polio, as potential negative outcomes of activity including loss of muscle strength, increased pain and fatigue will be closely monitored.

Trial registration

Clinicaltrials.gov identifier: NCT01271530

Prediction of peak oxygen consumption from the ratings of perceived exertion during a graded exercise test and ramp exercise test in able-bodied participants and paraplegic persons

OBJECTIVE

To assess the accuracy of predicting peak oxygen consumption (Vo(2)peak) from a graded exercise test (GXT) and a ramp exercise test during arm exercise in able-bodied persons and persons with paraplegia using ratings of perceived exertion (RPEs).

DESIGN

Each participant performed a GXT (started at 30W and increased by 15W every 2min) and a ramp exercise test (started at 0W and increased by 15W·min(-1)).

SETTING

Universities' laboratories.

PARTICIPANTS

Able-bodied men (n=13; mean ± SD, 27.2±4.3y) and men with paraplegia (n=12; 31.1±5.7y). Six of the persons with paraplegia had flaccid paralysis as a result of poliomyelitis infection. The other 6 persons had complete spinal cord injuries with neurologic levels at and below T6.

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURES

Prediction of Vo(2)peak by extrapolating submaximal oxygen consumption (Vo(2)) and RPE values to RPE 20 on the Borg 6 to 20 RPE scale.

RESULTS

This study showed a very strong linear relationship between RPE and Vo(2) during the GXT and the ramp test for able-bodied persons (R(2)≥.95 and R(2)≥.96, respectively) and persons with paraplegia (R(2)≥.96 and R(2)≥.95, respectively). There was no significant difference between measured and predicted Vo(2)peak from RPEs before and including RPE 13, 15, and 17 during the GXT for persons with paraplegia (P>.05). For the able-bodied participants, there was no significant difference between measured and predicted Vo(2)peak from RPEs before and including RPE 15 and 17 during the ramp exercise test (P>.05).

CONCLUSION

The GXT provided acceptable predictions of Vo(2)peak for persons with paraplegia, and the ramp test provided acceptable predictions of Vo(2)peak for able-bodied persons.

Prediction of peak oxygen uptake from ratings of perceived exertion during arm exercise in able-bodied and persons with poliomyelitis

STUDY DESIGN

Each participant completed an arm-crank ramp exercise test to volitional exhaustion.

OBJECTIVE

To assess the utility of the rating of perceived exertion (RPE) to predict peak oxygen uptake (VO(2)peak) during arm ergometry in able-bodied participants and those with poliomyelitis.

SETTING

University of Jordan, Amman, Jordan.

PARTICIPANTS

In all, 16 able-bodied and 15 participants with poliomyelitis completed an arm-crank ramp exercise test to volitional exhaustion.

MAIN OUTCOME MEASURES

The prediction of VO(2)peak is calculated by extrapolating the sub-maximal RPE and VO(2) values by linear regression to RPE 20.

RESULTS

For the able-bodied participants, there were no significant differences between measured and predicted VO(2)peak from the three sub-maximal ranges of the RPE (RPEs before and including RPE 13, 15 and 17, P > 0.05). For the participants with poliomyelitis, the VO(2)peak predicted from RPEs before and including RPE 13 was significantly higher than measured VO(2)max (P < 0.05). The 95% limits of agreement of able-bodied participants for RPE 13, 15 and 17 (-3 ± 14, -1 ± 10 & 0 ± 8 ml kg(-1) min(-1), respectively) were lower than those observed for poliomyelitis participants (6 ± 19, 2 ± 12 and 1 ± 9 ml kg(-1) min(-1), respectively).

CONCLUSION

This study has shown that the estimation of VO(2)peak from submaximal RPE during arm ergometry is generally more accurate in able-bodied participants in comparison with those with poliomyelitis.