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Farrow M, Maher J, Deere R, Spellanzon B, Williams S, Thompson D, Bilzon JLJ. Effect of high-intensity interval training on cardiometabolic component risks in persons with paraplegia: Results of a randomized controlled trial. Exp Physiol 2024; 109:1253-1266. [PMID: 38924175 PMCID: PMC11291867 DOI: 10.1113/ep091803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/29/2024] [Indexed: 06/28/2024]
Abstract
The aim of this work is to determine the effect of upper-body high intensity interval training (HIIT) on cardiometabolic risks in individuals with chronic paraplegia. Twenty-seven individuals (14 females, 13 males, mean ± SD age: 46 ± 9 years) with chronic paraplegia (spinal cord injury between T2 and L5 >1-year post-injury) took part in a randomized controlled trial and were included in the final analysis. Participants in the HIIT group (n = 18) performed ∼30 min of arm crank exercise (60 s intervals at 80%-90% peak heart rate) four times per week, for 6 weeks. Participants in the control (CON) group (n = 9) were asked to maintain their habitual diet and physical activity patterns over the study period. Outcome measures were taken at baseline and follow-up. The primary outcome measures were fasting insulin, peak power output (PPO) and peak aerobic capacity (V ̇ O 2 peak ${{\dot{V}}_{{{{\mathrm{O}}}_{\mathrm{2}}}{\mathrm{peak}}}}$ ). Secondary outcome measures included body composition, postprandial glycaemic control, fasting blood lipids, inflammatory biomarkers and resting blood pressure. Differences between groups were assessed by ANCOVA, using baseline values as a covariate. PPO was higher in the HIIT (101 W, 97-106) compared to the CON (90 W, 83-96) group at follow-up (P = 0.006). There were no differences in fasting insulin (P = 0.415) or relativeV ̇ O 2 peak ${{\dot{V}}_{{{{\mathrm{O}}}_{\mathrm{2}}}{\mathrm{peak}}}}$ (P = 0.417). Postprandial Matsuda insulin sensitivity index (ISIMatsuda) was higher in the HIIT (5.42, 4.69-6.15) compared to the CON (3.75, 2.46-5.04) group at follow-up (P = 0.036). Six weeks of upper-body HIIT increased PPO and ISIMatsuda, with no other beneficial effect on cardiometabolic component risks in persons with chronic paraplegia. HIGHLIGHTS: What is the central question of this study? What is the effect of upper-body high intensity interval training (HIIT) on cardiometabolic component risks in individuals with chronic paraplegia? What is the main finding and its importance? Six weeks of upper-body HIIT increased PPO and improved insulin sensitivity, but had no beneficial effect on other cardiometabolic component risks in persons with chronic paraplegia. The large effect size observed for insulin sensitivity may be important in terms of reducing the risk of type-2 diabetes in this population.
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Affiliation(s)
- Matthew Farrow
- Department for HealthUniversity of BathBathUK
- Centre for Nutrition and Exercise Metabolism (CNEM)University of BathBathUK
- Department of Physical Medicine & RehabilitationOhio State UniversityColumbusOhioUSA
| | - Jennifer Maher
- Department for HealthUniversity of BathBathUK
- Centre for Nutrition and Exercise Metabolism (CNEM)University of BathBathUK
| | - Rachel Deere
- Department for HealthUniversity of BathBathUK
- Centre for Nutrition and Exercise Metabolism (CNEM)University of BathBathUK
- Centre for Trials Research, College of Biomedical & Life SciencesCardiff UniversityCardiffUK
| | - Bruno Spellanzon
- Department for HealthUniversity of BathBathUK
- Centre for Nutrition and Exercise Metabolism (CNEM)University of BathBathUK
| | | | - Dylan Thompson
- Department for HealthUniversity of BathBathUK
- Centre for Nutrition and Exercise Metabolism (CNEM)University of BathBathUK
| | - James L. J. Bilzon
- Department for HealthUniversity of BathBathUK
- Centre for Nutrition and Exercise Metabolism (CNEM)University of BathBathUK
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Peters J, Halloran K, Focht M, Huang K, Kersh M, Rice I. Cardiorespiratory Responses to an Acute Bout of High Intensity Interval Training and Moderate Intensity Continuous Training on a Recumbent Handcycle in People With Spinal Cord Injury: A Within-Subject Design. Top Spinal Cord Inj Rehabil 2023; 29:16-26. [PMID: 38076492 PMCID: PMC10704215 DOI: 10.46292/sci23-00026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Objectives To compare acute cardiorespiratory responses during high intensity interval training (HIIT) and moderate intensity continuous training (MICT) on a recumbent handcycle in persons with spinal cord injury (PwSCI). Methods Eleven males and nine females with chronic SCI (T3 - L5), aged 23 (9) years, participated in this within-subject design. Based off peak power outputs from an incremental test to exhaustion, participants engaged in a HIIT and MICT session at matched workloads on a recumbent handcycle. Workloads (Joules), time, oxygen uptake (VO2), metabolic equivalent of task (MET), heart rate (HR), and energy expenditure (kcal) were recorded during HIIT and MICT. Results Total workload was similar across HIIT (87820 ± 24021 Joules) and MICT sessions (89044 ± 23696 Joules; p > .05). HIIT (20.00 [.03] minutes) was shorter in duration than MICT (23.20 [2.56]; p < .01). Average VO2 (20.96 ± 4.84 vs. 129.38 ± 19.13 mL/kg/min O2), MET (7.54 ± 2.00 vs. 6.21 ± 1.25), and HR (146.26 ± 13.80 vs. 129.38 ± 19.13 beats per minute) responses were significantly greater during HIIT than MICT (p < .01). Participants burned significantly more kilocalories during HIIT (128.08 ± 35.65) than MICT (118.93 ± 29.58; p < .01) and at a faster rate (6.40 ± 1.78 [HIIT] vs. 5.09 ± 1.14 [MICT] kcal/min; p < .01). Conclusion HIIT elicits greater increases in oxygen uptake and HR than MICT in PwSCI. In significantly less time, HIIT also burned more calories than MICT.
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Affiliation(s)
- Joseph Peters
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign
- The Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign
- Disability Resources and Educational Services, University of Illinois at Urbana-Champaign
| | - Kellie Halloran
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign
| | - Michael Focht
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign
| | - Kathryn Huang
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign
| | - Mariana Kersh
- The Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign
| | - Ian Rice
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign
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Veith DD, Linde MB, Wiggins CC, Zhao KD, Garlanger KL. Intervention Design of High-Intensity Interval Training in Individuals With Spinal Cord Injury: Narrative Review and Future Perspectives. Top Spinal Cord Inj Rehabil 2023; 29:1-15. [PMID: 38076494 PMCID: PMC10704212 DOI: 10.46292/sci22-00045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Background Individuals with spinal cord injury (SCI) have lower levels of physical activity compared to the nondisabled population. Exercise guidelines recommend moderate or vigorous exercise to improve cardiovascular health and reduce cardiometabolic risk factors in persons with SCI. High-intensity interval training (HIIT) is a popular exercise choice and encompasses brief periods of vigorous exercise paired with intermittent periods of recovery. Objectives This review describes the available literature on HIIT for individuals with SCI, including differences in protocol design and suggested areas of further investigation. Methods Our institution's library system performed the comprehensive search. The primary keywords and phrases used to search included spinal cord injury, high-intensity interval training, tetraplegia, paraplegia, and several other related terms. Results Initially 62 records were screened, and 36 were deemed outside the scope of this review. Twenty-six studies published between 2001 and 2021 fulfilled the eligibility criteria and were divided among two researchers for review and analysis. All records required persons with SCI and a standardized HIIT intervention. Study design varied widely with respect to mode of exercise, prescribed intensity, duration of performance intervals, and session duration. This variability necessitates further investigation into the specifics of a HIIT prescription and the associated outcomes for persons with SCI. Conclusion Standardization of HIIT protocols may lead to more robust conclusions regarding its effects on cardiorespiratory fitness as well as mitigation of cardiometabolic risk factors. Meta-analyses will eventually be needed on proper dosing and session parameters to improve cardiorespiratory fitness and cardiometabolic risk factors.
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Affiliation(s)
- Daniel D. Veith
- Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - Margaux B. Linde
- Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - Chad C. Wiggins
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Kristin D. Zhao
- Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - Kristin L. Garlanger
- Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota
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Linde MB, Webb KL, Veith DD, Morkeberg OH, Gill ML, Van Straaten MG, Laskowski ER, Joyner MJ, Beck LA, Zhao KD, Wiggins CC, Garlanger KL. At-Home High-Intensity Interval Training for Individuals with Paraplegia Following Spinal Cord Injury: A Pilot Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.06.21.23291711. [PMID: 37425869 PMCID: PMC10327239 DOI: 10.1101/2023.06.21.23291711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Objective This pilot study aimed to assess the efficacy of a 16-week at-home high-intensity interval training (HIIT) program among individuals with spinal cord injury (SCI). Methods Eight individuals (age: 47±11 (SD) years, 3 females) with SCI below the sixth thoracic vertebrae participated in a 16-week at-home HIIT program using an arm ergometer. Participants completed baseline graded exercise tests to determine target heart rate zones. HIIT was prescribed thrice per week. Each training session consisted of six one-minute bouts with a target heart rate ~80% heart rate reserve (HRR), interspersed with two minutes of recovery at ~30% HRR. A portable heart rate monitor and phone application provided visual feedback during training and allowed for measurements of adherence and compliance. Graded exercise tests were completed after 8 and 16 weeks of HIIT. Surveys were administered to assess participation, self-efficacy, and satisfaction. Results Participants demonstrated a decrease in submaximal cardiac output (P=0.028) and an increase in exercise capacity (peak power output, P=0.027) following HIIT, indicative of improved exercise economy and maximal work capacity. An 87% adherence rate was achieved during the HIIT program. Participants reached a high intensity of 70% HRR or greater during ~80% of intervals. The recovery HRR target was reached during only ~35% of intervals. Self-reported metrics of satisfaction and self-efficacy with at-home HIIT scored moderate to high. Conclusion Participants demonstrated an improvement in exercise economy and maximal work capacity following at-home HIIT. Additionally, participant adherence, compliance, satisfaction, and self-efficacy metrics suggest that at-home HIIT was easily implemented and enjoyable.
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Affiliation(s)
- Margaux B. Linde
- Mayo Clinic, Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Rochester, MN
| | - Kevin L. Webb
- Mayo Clinic, Department of Anesthesiology & Perioperative Medicine, Rochester, MN
| | - Daniel D. Veith
- Mayo Clinic, Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Rochester, MN
| | - Olaf H. Morkeberg
- Mayo Clinic, Department of Anesthesiology & Perioperative Medicine, Rochester, MN
| | - Megan L Gill
- Mayo Clinic, Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Rochester, MN
| | - Meegan G. Van Straaten
- Mayo Clinic, Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Rochester, MN
| | - Edward R. Laskowski
- Mayo Clinic, Department of Physical Medicine & Rehabilitation and Division of Sports Medicine, Department of Orthopedics, Rochester, MN
| | - Michael J. Joyner
- Mayo Clinic, Department of Anesthesiology & Perioperative Medicine, Rochester, MN
| | - Lisa A. Beck
- Mayo Clinic, Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Rochester, MN
| | - Kristin D. Zhao
- Mayo Clinic, Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Rochester, MN
| | - Chad C. Wiggins
- Mayo Clinic, Department of Anesthesiology & Perioperative Medicine, Rochester, MN
| | - Kristin L. Garlanger
- Mayo Clinic, Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Rochester, MN
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Peters J, Teague A, Halloran K, Sung J, Rice LA, Rice I. The influence of gender on shoulder kinematics and head-hip technique during non-level transfers in full-time wheelchair users. Clin Biomech (Bristol, Avon) 2023; 105:105969. [PMID: 37087880 DOI: 10.1016/j.clinbiomech.2023.105969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 04/11/2023] [Accepted: 04/17/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Non-level transfers are some of the most demanding tasks for manual wheelchair users. Safely performing these transfer tasks may be needed for maintaining long-term upper limb health. This cross-sectional study aimed to examine the influence of gender on the head-hip technique and lead arm kinematics during multi-height transfers in manual wheelchair users. METHODS Motion analysis was used to obtain lead-arm shoulder kinematics (flexion/extension and abduction/adduction) and trunk flexion during level, uphill, and floor-to-table transfers in full-time manual wheelchair users. FINDINGS Twelve male (N = 12) and fifteen female (N = 15) manual wheelchair users with a mean age of 23 ± 5 years and no signs of shoulder pain participated in the study. Lead-arm shoulder flexion and abduction increased as vertical displacement requirements increased during the various transfer tasks (p < 0.01). Women displaced greater trunk flexion during level transfers at approaching significant levels (p = 0.07). During uphill transfers, women displayed significantly greater trunk flexion than men (p < 0.05). INTERPRETATION Manual wheelchair users use unique kinematic requirements when using the head-hip during level and non-level transfers. Women may be at decreased risk of chronic shoulder pain due to a greater use of the head-hip technique during non-level transfers. Nonetheless, more research that integrates kinetics and strength assessments during non-level transfer biomechanical analyses is needed to better understand technical requirements of non-level transfers in manual wheelchair users.
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Affiliation(s)
- Joseph Peters
- The Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA; Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA; Disability Resources and Educational Services, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
| | - Alexander Teague
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Kellie Halloran
- Department of Mechanical Science and Engineering, College of Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | | | - Laura A Rice
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Ian Rice
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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Andrabi MS, Mumba M, Key B, Motl R. Physical activity programs for cardiovascular outcomes in community wheelchair users: A systematic review. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:1007778. [DOI: 10.3389/fresc.2022.1007778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022]
Abstract
PurposePhysical inactivity is one of the important factors leading to chronic diseases including cardiovascular disease (CVD) in individuals with disabilities. However, not many Physical Activity (PA) interventions are available for improving the efficacy of PA and cardiovascular outcomes among community wheelchair users. Therefore, this systematic review will appraise the existing PA interventions for the community dwelling wheelchair users; we especially examined features of the PA programs that showed the improvements in PA and the CVD outcomes compared to the interventions that did not show any improvements in these outcomes among these population. The study also aimed to provide some recommendations for future research.Materials and MethodsA comprehensive and systematic search of literature published between 2015 and 2020 using the databases Scopus, Pubmed, Embase, and Cochrane CENTRAL was conducted. This review has followed the Preferred Reporting Items for Systematic Review (PRISMA) guidelines. The quality of the evidence was assessed by Using Joanna Briggs Institute's critical appraisal tool. Studies that tested the efficacy of PA interventions for community-dwelling adult wheelchair users and published in English were involved. Two reviewers reviewed the literature and any disagreements among these reviewers were resolved by a third reviewer.ResultsFourteen articles were selected for this review. Most of the studies reported improvements in PA. A few studies followed up the participants and majority of the studies have looked at the CVD outcomes.ConclusionLarge-scale studies with follow-ups, and community participatory research that evaluates the effect of PA interventions on PA and CVD outcomes among wheelchair users are needed.
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Recent Updates in Nutrition After Spinal Cord Injury: 2015 Through 2021. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022. [DOI: 10.1007/s40141-022-00367-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Low drop-out rates in the HandbikeBattle free-living training study: understanding the reasons for dropping out. Spinal Cord Ser Cases 2022; 8:20. [PMID: 35132066 PMCID: PMC8821557 DOI: 10.1038/s41394-022-00490-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 01/25/2022] [Accepted: 01/28/2022] [Indexed: 11/08/2022] Open
Abstract
STUDY DESIGN Longitudinal observational study. OBJECTIVES During the five-month free-living training period for the HandbikeBattle event several participants dropped out. The aim of this study was to clarify the numbers and reasons for drop out, and to characterize the differences between study participants who did (dropouts) and did not (competitors) drop out during the training period for the HandbikeBattle event. SETTING Former participants of the HandbikeBattle, a handcycling race on an Austrian mountain. METHODS Participants (N = 313 (N = 209 (67%) with spinal cord injury or spina bifida)) enrolled between 2013-2018. Drop out and reasons for drop out were registered. Competitors and dropouts were compared regarding personal, disability, physical, and psychological factors, which were measured at the start of the training period. RESULTS Forty-five participants (14%) dropped out during the training period with medical complications (49%) and motivational problems (29%) as main reasons. The only differences were that competitors participated more in sports before the study (p = 0.01) and achieved a higher peak power output (p = 0.04) compared to dropouts. CONCLUSIONS The drop-out rate of the HandbikeBattle study was low compared to previous exercise intervention studies, which might be related to the less strictly imposed free-living training. Persons with less experience in sport and a lower fitness level might need more attention during a training intervention to prevent them from dropping out.
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de Groot S, Cowan RE. Exercise for people with SCI: so important but difficult to achieve. Spinal Cord 2021; 59:1-2. [PMID: 33469192 PMCID: PMC7813972 DOI: 10.1038/s41393-020-00587-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/05/2020] [Accepted: 11/05/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Sonja de Groot
- Amsterdam Rehabilitation Research Center
- Reade, Amsterdam, the Netherlands. .,Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Rachel E Cowan
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
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