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Hodgkiss DD, Williams AMM, Shackleton CS, Samejima S, Balthazaar SJT, Lam T, Krassioukov AV, Nightingale TE. Ergogenic effects of spinal cord stimulation on exercise performance following spinal cord injury. Front Neurosci 2024; 18:1435716. [PMID: 39268039 PMCID: PMC11390595 DOI: 10.3389/fnins.2024.1435716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 08/05/2024] [Indexed: 09/15/2024] Open
Abstract
Cervical or upper-thoracic spinal cord injury (SCI, ≥T6) often leads to low resting blood pressure (BP) and impaired cardiovascular responses to acute exercise due to disrupted supraspinal sympathetic drive. Epidural spinal cord stimulation (invasive, ESCS) and transcutaneous spinal cord stimulation (non-invasive, TSCS) have previously been used to target dormant sympathetic circuits and modulate cardiovascular responses. This case series compared the effects of cardiovascular-optimised ESCS and TSCS versus sham ESCS and TSCS on modulating cardiovascular responses and improving submaximal upper-body exercise performance in individuals with SCI. Seven males with a chronic, motor-complete SCI between C6 and T4 underwent a mapping session to identify cardiovascular responses to spinal cord stimulation. Subsequently, four participants (two ESCS and two TSCS) completed submaximal exercise testing. Stimulation parameters (waveform, frequency, intensity, epidural electrode array configuration, and transcutaneous electrode locations in the lumbosacral region) were optimised to elevate cardiovascular responses (CV-SCS). A sham condition (SHAM-SCS) served as a comparison. Participants performed arm-crank exercise to exhaustion at a fixed workload corresponding to above ventilatory threshold, on separate days, with CV-SCS or SHAM-SCS. At rest, CV-SCS increased BP and predicted left ventricular cardiac contractility and total peripheral resistance. During exercise, CV-SCS increased time to exhaustion and peak oxygen pulse (a surrogate for stroke volume), relative to SHAM-SCS. Ratings of perceived exertion also tended to be lower with CV-SCS than SHAM-SCS. Comparable improvements in time to exhaustion with ESCS and TSCS suggest that both approaches could be promising ergogenic aids to support exercise performance or rehabilitation, along with reducing fatigue during activities of daily living in individuals with SCI.
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Affiliation(s)
- Daniel D Hodgkiss
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Alison M M Williams
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Claire S Shackleton
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Soshi Samejima
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Shane J T Balthazaar
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
- Division of Cardiology, Department of Echocardiography, Vancouver General and St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Tania Lam
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Andrei V Krassioukov
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Tom E Nightingale
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
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Conger SA, Herrmann SD, Willis EA, Nightingale TE, Sherman JR, Ainsworth BE. 2024 Wheelchair Compendium of Physical Activities: An update of activity codes and energy expenditure values. JOURNAL OF SPORT AND HEALTH SCIENCE 2024; 13:18-23. [PMID: 38242594 PMCID: PMC10818147 DOI: 10.1016/j.jshs.2023.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/20/2023] [Accepted: 10/26/2023] [Indexed: 01/21/2024]
Abstract
PURPOSE This paper presents an update of the 2011 Wheelchair Compendium of Physical Activities designed for wheelchair users and is referred to as the 2024 Wheelchair Compendium. The Wheelchair Compendium aims to curate existing knowledge of the energy expenditure for wheelchair physical activities (PAs). METHODS A systematic review of the published energy expenditure of PA for wheelchair users was completed between 2011 and May 2023. We added these data to the 2011 Wheelchair Compendium data that was compiled previously in a systematic review through 2011. RESULTS A total of 47 studies were included, and 124 different wheelchair PA reported energy expenditure values ranging from 0.8 metabolic equivalents for wheelchair users (filing papers, light effort) to 11.8 metabolic equivalents for wheelchair users (Nordic sit skiing). CONCLUSION In introducing the updated 2024 Wheelchair Compendium, we hope to bridge the resource gap and challenge the prevailing narratives that inadvertently exclude wheelchair users from physical fitness and health PAs.
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Affiliation(s)
- Scott A Conger
- Department of Kinesiology, Boise State University, Boise, ID 83725, USA.
| | - Stephen D Herrmann
- Kansas Center for Metabolism and Obesity Research, The University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Erik A Willis
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Tom E Nightingale
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham AL B152TT, UK; Centre for Trauma Sciences Research, University of Birmingham, Edgbaston, Birmingham AL B152TT, UK
| | - Joseph R Sherman
- Kansas Center for Metabolism and Obesity Research, The University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Barbara E Ainsworth
- College of Health Solutions, Arizona State University, Phoenix, AZ 85003, USA; School of Exercise and Health, Shanghai University of Sport, Shanghai 200438, China
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Pelletier C. Exercise prescription for persons with spinal cord injury: a review of physiological considerations and evidence-based guidelines. Appl Physiol Nutr Metab 2023; 48:882-895. [PMID: 37816259 DOI: 10.1139/apnm-2023-0227] [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: 10/12/2023]
Abstract
Persons with spinal cord injury (SCI) experience gains in fitness, physical and mental health from regular participation in exercise and physical activity. Due to changes in physiological function of the cardiovascular, nervous, and muscular systems, general population physical activity guidelines and traditional exercise prescription methods are not appropriate for the SCI population. Exercise guidelines specific to persons with SCI recommend progressive training beginning at 20 min of moderate to vigorous intensity aerobic exercise twice per week transitioning to 30 min three times per week, with strength training of the major muscle groups two times per week. These population-specific guidelines were designed considering the substantial barriers to physical activity for persons with SCI and can be used to frame an individual exercise prescription. Rating of perceived exertion (i.e., perceptually regulated exercise) is a practical way to indicate moderate to vigorous intensity exercise in community settings. Adapted exercise modes include arm cycle ergometry, hybrid arm-leg cycling, and recumbent elliptical equipment. Body weight-supported treadmill training and other rehabilitation modalities may improve some aspects of health and fitness for people with SCI if completed at sufficient intensity. Disability-specific community programs offer beneficial opportunities for persons with SCI to experience quality exercise opportunities but are not universally available.
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Affiliation(s)
- Chelsea Pelletier
- School of Health Sciences, Faculty of Human and Health Sciences, University of Northern British Columbia, Prince George, BC, Canada
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Hodgkiss DD, Bhangu GS, Lunny C, Jutzeler CR, Chiou SY, Walter M, Lucas SJE, Krassioukov AV, Nightingale TE. Exercise and aerobic capacity in individuals with spinal cord injury: A systematic review with meta-analysis and meta-regression. PLoS Med 2023; 20:e1004082. [PMID: 38011304 PMCID: PMC10712898 DOI: 10.1371/journal.pmed.1004082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 12/11/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND A low level of cardiorespiratory fitness [CRF; defined as peak oxygen uptake ([Formula: see text]O2peak) or peak power output (PPO)] is a widely reported consequence of spinal cord injury (SCI) and a major risk factor associated with chronic disease. However, CRF can be modified by exercise. This systematic review with meta-analysis and meta-regression aimed to assess whether certain SCI characteristics and/or specific exercise considerations are moderators of changes in CRF. METHODS AND FINDINGS Databases (MEDLINE, EMBASE, CENTRAL, and Web of Science) were searched from inception to March 2023. A primary meta-analysis was conducted including randomised controlled trials (RCTs; exercise interventions lasting >2 weeks relative to control groups). A secondary meta-analysis pooled independent exercise interventions >2 weeks from longitudinal pre-post and RCT studies to explore whether subgroup differences in injury characteristics and/or exercise intervention parameters explained CRF changes. Further analyses included cohort, cross-sectional, and observational study designs. Outcome measures of interest were absolute (A[Formula: see text]O2peak) or relative [Formula: see text]O2peak (R[Formula: see text]O2peak), and/or PPO. Bias/quality was assessed via The Cochrane Risk of Bias 2 and the National Institute of Health Quality Assessment Tools. Certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Random effects models were used in all meta-analyses and meta-regressions. Of 21,020 identified records, 120 studies comprising 29 RCTs, 67 pre-post studies, 11 cohort, 7 cross-sectional, and 6 observational studies were included. The primary meta-analysis revealed significant improvements in A[Formula: see text]O2peak [0.16 (0.07, 0.25) L/min], R[Formula: see text]O2peak [2.9 (1.8, 3.9) mL/kg/min], and PPO [9 (5, 14) W] with exercise, relative to controls (p < 0.001). Ninety-six studies (117 independent exercise interventions comprising 1,331 adults with SCI) were included in the secondary, pooled meta-analysis which demonstrated significant increases in A[Formula: see text]O2peak [0.22 (0.17, 0.26) L/min], R[Formula: see text]O2peak [2.8 (2.2, 3.3) mL/kg/min], and PPO [11 (9, 13) W] (p < 0.001) following exercise interventions. There were subgroup differences for R[Formula: see text]O2peak based on exercise modality (p = 0.002) and intervention length (p = 0.01), but there were no differences for A[Formula: see text]O2peak. There were subgroup differences (p ≤ 0.018) for PPO based on time since injury, neurological level of injury, exercise modality, and frequency. The meta-regression found that studies with a higher mean age of participants were associated with smaller changes in A[Formula: see text]O2peak and R[Formula: see text]O2peak (p < 0.10). GRADE indicated a moderate level of certainty in the estimated effect for R[Formula: see text]O2peak, but low levels for A[Formula: see text]O2peak and PPO. This review may be limited by the small number of RCTs, which prevented a subgroup analysis within this specific study design. CONCLUSIONS Our primary meta-analysis confirms that performing exercise >2 weeks results in significant improvements to A[Formula: see text]O2peak, R[Formula: see text]O2peak, and PPO in individuals with SCI. The pooled meta-analysis subgroup comparisons identified that exercise interventions lasting up to 12 weeks yield the greatest change in R[Formula: see text]O2peak. Upper-body aerobic exercise and resistance training also appear the most effective at improving R[Formula: see text]O2peak and PPO. Furthermore, acutely injured, individuals with paraplegia, exercising for ≥3 sessions/week will likely experience the greatest change in PPO. Ageing seemingly diminishes the adaptive CRF responses to exercise training in individuals with SCI. REGISTRATION PROSPERO: CRD42018104342.
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Affiliation(s)
- Daniel D. Hodgkiss
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Gurjeet S. Bhangu
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
- MD Undergraduate Program, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Carole Lunny
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, and University of British Columbia, Vancouver, Canada
| | - Catherine R. Jutzeler
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Schulthess Clinic, Zurich, Switzerland
| | - Shin-Yi Chiou
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, United Kingdom
- Centre for Trauma Science Research, University of Birmingham, Birmingham, United Kingdom
| | - Matthias Walter
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
- Department of Urology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Samuel J. E. Lucas
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
| | - Andrei V. Krassioukov
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, Canada
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, Canada
| | - Tom E. Nightingale
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
- Centre for Trauma Science Research, University of Birmingham, Birmingham, United Kingdom
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Nightingale TE, Eginyan G, Balthazaar SJT, Williams AMM, Lam T, Krassioukov AV. Accidental boosting in an individual with tetraplegia - considerations for the interpretation of cardiopulmonary exercise testing. J Spinal Cord Med 2022; 45:969-974. [PMID: 33513073 PMCID: PMC9661994 DOI: 10.1080/10790268.2020.1871253] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
CONTEXT Autonomic dysreflexia (AD), characterized by a transient increase in systolic blood pressure (BP), is experienced by individuals with spinal cord injury (SCI) and can be purposefully induced ('boosting') to counteract autonomic dysfunction that impairs cardiovascular responses to exercise. Herein, we demonstrate the impact of unintentional boosting observed during cardiopulmonary exercise testing (CPET) in an inactive male with SCI (C5, motor-complete). FINDINGS On two separate occasions the individual performed a standard arm-crank CPET (1-min stages, 7W increase in resistance) following by a longer CPET (4-min stages, 12W increase in resistance), both to volitional exhaustion. The second CPET was performed to confirm the accuracy of exercise intensity prescription and verify peak exercise parameters. Immediately following the second CPET on the initial visit, the individual reported symptoms of AD, verified as a 58mmHg increase in systolic BP from baseline. Relative to the first CPET, performed only 35 min earlier, there were pronounced differences in peak exercise responses. In comparison to the longer CPET performed on the second visit without a concomitant episode of AD (thereby controlling for the type of CPET protocol administered), peak exercise outcomes were considerably elevated: power output (Δ19W), oxygen uptake (Δ3.61 ml· kg·-1min-1), ventilation (Δ11.4 L ·min-1) and heart rate (Δ9 b·min-1). CONCLUSION/CLINICAL RELEVANCE This case raises important considerations around the nuances of CPET in this population. In individuals susceptible to BP instability, the physiologically boosted state may explain a significant proportion of the variance in peak aerobic capacity and should be closely monitored before and after clinical CPET.
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Affiliation(s)
- Tom E. Nightingale
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK,International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, Canada,Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Gevorg Eginyan
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, Canada,School of Kinesiology, University of British Columbia, Vancouver, Canada
| | - Shane J. T. Balthazaar
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, Canada,Experimental Medicine Program, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Alison M. M. Williams
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, Canada,School of Kinesiology, University of British Columbia, Vancouver, Canada
| | - Tania Lam
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, Canada,School of Kinesiology, University of British Columbia, Vancouver, Canada
| | - Andrei V. Krassioukov
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, Canada,Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, Canada,G.F. Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, Canada,Correspondence to: Andrei V. Krassioukov, Division of Physical Medicine & Rehabilitation, Department of Medicine, International Collaboration on Repair Discoveries-Blusson Spinal Cord Centre, University of British Columbia, 818W 10th Ave, Vancouver, BCV5Z 1M9, Canada; Ph: + (604) 675-8819, +1 (604) 675-8820.
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6
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Antunes D, Borszcz FK, Nascimento EMF, Cavalheiro GP, Fischer G, Brickley G, de Lucas RD. Physiological and Perceptual Responses in Spinal Cord Injury Handcyclists During an Endurance Interval Training: The Role of Critical Speed. Am J Phys Med Rehabil 2022; 101:977-982. [PMID: 36104844 DOI: 10.1097/phm.0000000000001890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study sought to determine the physiological (oxygen uptake, heart rate, and blood lactate concentration) and perceptual (rating of perceived exertion) responses during an endurance interval training at the critical speed in elite handcyclists with spinal cord injury. DESIGN Eight handcyclists performed an incremental test, three tests to exhaustion at a constant speed to determine critical speed, and the endurance interval training. The endurance interval training consisted of 6 × 5 mins at the individualized critical speed, with passive recovery of 50 secs. All testing was performed using their own handcycles on an oversized motorized treadmill. Physiological and perceptual responses were assessed during the incremental and endurance interval training tests. RESULTS There was no significant difference in average oxygen uptake from the first to the sixth repetition. The mean ∆[La-]10_last between the 10th to the 30th minute of the exercise was -0.36 mmol·l-1, and no difference was detected from the first to the sixth repetition. The heart rate also remained stable during endurance interval training, whereas rating of perceived exertion increased significantly throughout the session. CONCLUSIONS Repetitions of 5 mins at the critical speed in elite handcyclists are associated with cardiorespiratory and lactate steady state, whereas the perceived exertion increased systematically.
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Affiliation(s)
- Diego Antunes
- From the Sports Center, Federal University of Santa Catarina, Physical Effort Laboratory, Florianopolis, Brazil (DA, FKB, EMFN, GPC, GF, RDdL); and Center for Sport and Exercise Science and Medicine, University of Brighton, Eastbourne, United Kingdom (GB)
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7
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Chiou SY, Clarke E, Lam C, Harvey T, Nightingale TE. Effects of Arm-Crank Exercise on Fitness and Health in Adults With Chronic Spinal Cord Injury: A Systematic Review. Front Physiol 2022; 13:831372. [PMID: 35392374 PMCID: PMC8982085 DOI: 10.3389/fphys.2022.831372] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/15/2022] [Indexed: 12/15/2022] Open
Abstract
Individuals with spinal cord injury (SCI) may benefit less from exercise training due to consequences of their injury, leading to lower cardiorespiratory fitness and higher risks of developing cardiovascular diseases. Arm-crank exercise (ACE) is the most common form of volitional aerobic exercise used by people with SCI outside a hospital. However, evidence regarding the specific effects of ACE alone on fitness and health in adults with SCI is currently lacking. Hence, this review aimed to determine the effects of ACE on cardiorespiratory fitness, body composition, cardiovascular disease (CVD) risk factors, motor function, health-related quality of life (QoL), and adverse events in adults with chronic SCI. Inclusion criteria were: inactive adults (≥18 years) with chronic SCI (>12 months post injury); used ACE alone as an intervention; measured at least one of the following outcomes; cardiorespiratory fitness, body composition, cardiovascular disease risk factors, motor function, health-related QoL, and adverse events. Evidence was synthesized and appraised using GRADE. Eighteen studies with a combined total of 235 participants having an injury between C4 to L3 were included. There was a moderate certainty of the body of evidence on ACE improving cardiorespiratory fitness. Exercise prescriptions from the included studies were 30-40 min of light to vigorous-intensity exercise, 3-5 times per week for 2-16 weeks. GRADE confidence ratings were very low for ACE improving body composition, CVD risks factors, motor function, or health-related QoL. No evidence suggests ACE increases the risk of developing shoulder pain or other injuries. Overall, this review recommends adults with chronic SCI should engage in regular ACE to improve cardiorespiratory fitness. More high-quality, larger-scale studies are needed to increase the level of evidence of ACE in improving cardiorespiratory fitness and to determine the effects of ACE on other outcomes. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/display_reco rd.php?ID=CRD42021221952], identifier [CRD42021221952].
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Affiliation(s)
- Shin Yi Chiou
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, United Kingdom
| | - Emma Clarke
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Chi Lam
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Tom Harvey
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Tom E. Nightingale
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- Centre for Trauma Sciences Research, University of Birmingham, Birmingham, United Kingdom
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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8
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Fossey MPM, Balthazaar SJT, Squair JW, Williams AM, Poormasjedi-Meibod MS, Nightingale TE, Erskine E, Hayes B, Ahmadian M, Jackson GS, Hunter DV, Currie KD, Tsang TSM, Walter M, Little JP, Ramer MS, Krassioukov AV, West CR. Spinal cord injury impairs cardiac function due to impaired bulbospinal sympathetic control. Nat Commun 2022; 13:1382. [PMID: 35296681 PMCID: PMC8927412 DOI: 10.1038/s41467-022-29066-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 02/20/2022] [Indexed: 02/08/2023] Open
Abstract
Spinal cord injury chronically alters cardiac structure and function and is associated with increased odds for cardiovascular disease. Here, we investigate the cardiac consequences of spinal cord injury on the acute-to-chronic continuum, and the contribution of altered bulbospinal sympathetic control to the decline in cardiac function following spinal cord injury. By combining experimental rat models of spinal cord injury with prospective clinical studies, we demonstrate that spinal cord injury causes a rapid and sustained reduction in left ventricular contractile function that precedes structural changes. In rodents, we experimentally demonstrate that this decline in left ventricular contractile function following spinal cord injury is underpinned by interrupted bulbospinal sympathetic control. In humans, we find that activation of the sympathetic circuitry below the level of spinal cord injury causes an immediate increase in systolic function. Our findings highlight the importance for early interventions to mitigate the cardiac functional decline following spinal cord injury. By combining experimental models with prospective clinical studies, the authors show that spinal cord injury causes a rapid reduction in cardiac function that precedes structural changes, and that the loss of descending sympathetic control is the major cause of reduced cardiac function following spinal cord injury.
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Affiliation(s)
- Mary P M Fossey
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.,Experimental Medicine, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Shane J T Balthazaar
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.,Experimental Medicine, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jordan W Squair
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Alexandra M Williams
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.,Department of Cellular and Physiological Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Tom E Nightingale
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.,School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.,Centre for Trauma Sciences Research, University of Birmingham, Edgabaston, Birmingham, UK
| | - Erin Erskine
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.,Department of Cellular and Physiological Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Brian Hayes
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Mehdi Ahmadian
- 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
| | - Garett S Jackson
- Faculty of Health and Social Development, University of British Columbia, Kelowna, BC, Canada
| | - Diana V Hunter
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Katharine D Currie
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Teresa S M Tsang
- Division of Cardiology, University of British Columbia, Vancouver General and University of British Columbia Hospital Echocardiography Department, Vancouver, BC, Canada
| | - Matthias Walter
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.,Department of Urology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jonathan P Little
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
| | - Matt S Ramer
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.,Department of Zoology, Faculty of Science, University of British Columbia, Vancouver, BC, Canada
| | - Andrei V Krassioukov
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada. .,Experimental Medicine, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada. .,Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada. .,GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC, Canada.
| | - Christopher R West
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada. .,Department of Cellular and Physiological Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
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9
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Lütolf R, Rosner J, Curt A, Hubli M. Identifying Discomplete Spinal Lesions: New Evidence from Pain-Autonomic Interaction in Spinal Cord Injury. J Neurotrauma 2021; 38:3456-3466. [PMID: 34806429 DOI: 10.1089/neu.2021.0280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The clinical evaluation of spinal afferents is an important diagnostic and prognostic marker for neurological and functional recovery after spinal cord injury (SCI). Particularly important regarding neuropathic pain following SCI is the function of the spinothalamic tract (STT) conveying nociceptive and temperature information. Here, we investigated the added value of neurophysiological methods revealing discomplete STT lesions; that is, residual axonal sparing in clinically complete STT lesions. Specifically, clinical pinprick testing and thermal thresholds were compared with objective contact heat-evoked potentials (CHEPs) and a novel measure of pain-autonomic interaction employing heat-induced sympathetic skin responses (SSR). The test stimuli (i.e., contact heat, pinprick) were applied below the lesion level in 32 subjects with thoracic SCI while corresponding heat-evoked responses (i.e., CHEPs and SSR) were recorded above the lesion (i.e., scalp and hand, respectively). Readouts of STT function were related to neuropathic pain characteristics. In subjects with abolished pinprick sensation, measures of thermosensation (10%), CHEPs (33%), and SSR (48%) revealed residual STT function. Importantly, SSRs can be used as an objective readout and when abolished, no other proxy indicated residual STT function. No relationship was found between STT function readouts and spontaneous neuropathic pain intensity and extent. However, subjects with clinically preserved STT function presented more often with allodynia (54%) than subjects with discomplete (13%) or complete STT lesions (18%). In individuals with absent pinprick sensation, discomplete STT lesions can be revealed employing pain-autonomic measures. The improved sensitivity to discerning STT lesion completeness might support the investigation of its association with neuropathic pain following SCI.
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Affiliation(s)
- Robin Lütolf
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jan Rosner
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Michèle Hubli
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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10
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Goodlin GT, Steinbeck L, Bergfeld D, Haselhorst A. Adaptive Cycling: Injuries and Health Concerns. Phys Med Rehabil Clin N Am 2021; 33:45-60. [PMID: 34799002 DOI: 10.1016/j.pmr.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Para-cycling has high rates of acute injuries. The underlying medical conditions of para-athletes predispose these cyclists to injury patterns and sequelae different from those of their able-bodied counterparts. Such injuries include an increased incidence of upper-extremity and soft tissue injuries, along with predisposition for respiratory, skin, genitourinary, and heat-related illnesses. There are no validated sideline assessment tools or return-to-play protocols for sports-related concussion in wheelchair user para-athletes or those with balance deficits. Para-cyclists may be at increased risk for relative energy deficiency in sport due to competitive pressure to maintain certain weights and increased incidence of low bone mineral density.
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Affiliation(s)
- Gabrielle T Goodlin
- Physical Medicine & Rehabilitation, Department of Neurology, The University of Texas at Austin, Dell Medical School, 1400 North IH-35, Suite 2.230, Austin, TX 78701, USA. https://twitter.com/gabi_goodlin
| | - Lindsey Steinbeck
- Physical Medicine & Rehabilitation, Department of Neurology, The University of Texas at Austin, Dell Medical School, 1400 North IH-35, Suite 2.230, Austin, TX 78701, USA
| | - Deborah Bergfeld
- Physical Medicine & Rehabilitation, Department of Neurology, The University of Texas at Austin, Dell Medical School, 1400 North IH-35, Suite 2.230, Austin, TX 78701, USA
| | - Alexandria Haselhorst
- Physical Medicine & Rehabilitation, Department of Neurology, The University of Texas at Austin, Dell Medical School, 1400 North IH-35, Suite 2.230, Austin, TX 78701, USA.
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11
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Gee CM, Lacroix MA, Stellingwerff T, Gavel EH, Logan-Sprenger HM, West CR. Physiological Considerations to Support Podium Performance in Para-Athletes. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:732342. [PMID: 36188768 PMCID: PMC9397986 DOI: 10.3389/fresc.2021.732342] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/27/2021] [Indexed: 11/13/2022]
Abstract
The twenty-first century has seen an increase in para-sport participation and the number of research publications on para-sport and the para-athlete. Unfortunately, the majority of publications are case reports/case series or study single impairment types in isolation. Indeed, an overview of how each International Paralympic Committee classifiable impairment type impact athlete physiology, health, and performance has not been forthcoming in the literature. This can make it challenging for practitioners to appropriately support para-athletes and implement evidence-based research in their daily practice. Moreover, the lack of a cohesive publication that reviews all classifiable impairment types through a physiological lens can make it challenging for researchers new to the field to gain an understanding of unique physiological challenges facing para-athletes and to appreciate the nuances of how various impairment types differentially impact para-athlete physiology. As such, the purpose of this review is to (1) summarize how International Paralympic Committee classifiable impairments alter the normal physiological responses to exercise; (2) provide an overview of "quick win" physiological interventions targeted toward specific para-athlete populations; (3) discuss unique practical considerations for the para-sport practitioner; (4) discuss research gaps and highlight areas for future research and innovation, and (5) provide suggestions for knowledge translation and knowledge sharing strategies to advance the field of para-sport research and its application by para-sport practitioners.
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Affiliation(s)
| | | | - Trent Stellingwerff
- Athletics Canada, Ottawa, ON, Canada
- Canadian Sport Institute-Pacific, Victoria, BC, Canada
| | - Erica H. Gavel
- Canadian Sport Institute-Ontario, Toronto, ON, Canada
- Faculty of Health Science, Ontario Tech University, Oshawa, ON, Canada
| | - Heather M. Logan-Sprenger
- Canadian Sport Institute-Ontario, Toronto, ON, Canada
- Faculty of Health Science, Ontario Tech University, Oshawa, ON, Canada
| | - Christopher R. West
- Canadian Sport Institute-Pacific, Victoria, BC, Canada
- Faculty of Medicine, International Collaboration on Repair Discoveries, Vancouver, BC, Canada
- Department of Cellular and Physiological Sciences, University of British Columbia, Kelowna, BC, Canada
- Centre for Chronic Disease Prevention and Management, University of British Columbia, Kelowna, BC, Canada
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12
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Gee CM, Lacroix MA, Pethick WA, Côté P, Stellingwerff T, West CR. Cardiovascular responses to heat acclimatisation in athletes with spinal cord injury. J Sci Med Sport 2021; 24:756-762. [DOI: 10.1016/j.jsams.2021.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 12/07/2020] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
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13
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Gee CM, Eves ND, Sheel AW, West CR. How does cervical spinal cord injury impact the cardiopulmonary response to exercise? Respir Physiol Neurobiol 2021; 293:103714. [PMID: 34118435 DOI: 10.1016/j.resp.2021.103714] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 05/26/2021] [Accepted: 06/07/2021] [Indexed: 11/26/2022]
Abstract
We compared cardiopulmonary responses to arm-ergometry in individuals with cervical spinal cord injury (C-SCI) and able-bodied controls. We hypothesized that individuals with C-SCI would have higher respiratory frequency (fb) but lower tidal volume (VT) at a given work rate and dynamically hyperinflate during exercise, whereas able-bodied individuals would not. Participants completed pulmonary function testing, an arm-ergometry test to exhaustion, and a sub-maximal exercise test consisting of four-minute stages at 20, 40, 60, and 80% peak work rate. Able-bodied individuals completed a further sub-maximal test with absolute work rate matched to C-SCI. During work rate matched sub-maximal exercise, C-SCI had smaller VT (main effect p < 0.001) compensated by an increased fb (main effect p = 0.009). C-SCI had increased end-expiratory lung volume at 80% peak work rate vs. rest (p < 0.003), whereas able-bodied did not. In conclusion, during arm-ergometry, individuals with C-SCI exhibit altered ventilatory patterns characterized by reduced VT, higher fb, and dynamic hyperinflation that may contribute to the observed reduced aerobic exercise capacity.
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Affiliation(s)
- C M Gee
- International Collaboration on Repair Discoveries, Vancouver, BC, V5Z 1M9, Canada; School of Kinesiology, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada; Canadian Sport Institute - Pacific, Victoria, BC, V9E 2C5, Canada
| | - N D Eves
- Centre for Heart Lung & Vascular Health, University of British Columbia, Kelowna, BC, V1V 1V7, Canada
| | - A W Sheel
- International Collaboration on Repair Discoveries, Vancouver, BC, V5Z 1M9, Canada; School of Kinesiology, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
| | - C R West
- International Collaboration on Repair Discoveries, Vancouver, BC, V5Z 1M9, Canada; Canadian Sport Institute - Pacific, Victoria, BC, V9E 2C5, Canada; Faculty of Medicine, University of British Columbia, Kelowna, BC, V1Y 1T3, Canada.
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14
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Muchaxo R, De Groot S, Kouwijzer I, Van Der Woude L, Janssen T, Nooijen CFJ. A Role for Trunk Function in Elite Recumbent Handcycling Performance? J Sports Sci 2021; 39:2312-2321. [PMID: 34078241 DOI: 10.1080/02640414.2021.1930684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Handcycling classification considers trunk function, but there is limited scientific evidence of trunk involvement in recumbent performance. This study investigated the association between trunk function and recumbent handcycling performance of athletes without upper-limb impairments (H3-H4 sport classes). The study was divided into two parts. First, 528 time-trial results from 81 handcyclists with spinal cord injury (SCI) were obtained between 2014 and 2020. Average time-trial velocity was used as performance measure and SCI level as trunk function determinant. Multilevel regression analysis was performed to analyse differences in performance among SCI groups while correcting for lesion completeness, sex, and age. Second, in 26 handcyclists, standardised trunk flexion strength was measured with a handheld dynamometer. Peak and mean power-output from a sprint test and time-trial average velocity were used as performance measures. Spearman correlations were conducted to investigate the association between trunk strength and performance. Results showed that the different SCI groups did not exhibit significant differences in performance. Furthermore, trunk flexion strength and performance exhibited non-significant weak to moderate correlations (for time-trial speed: rs = 0.36; p = 0.07). Results of both analyses suggest that trunk flexion strength does not seem to significantly impact recumbent handcycling performance in athletes without upper-limb impairments.
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Affiliation(s)
- Rafael Muchaxo
- Faculty of Behavioural and Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam Rehabilitation Research Center, Amsterdam, The Netherlands
| | - Sonja De Groot
- Faculty of Behavioural and Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam Rehabilitation Research Center, Amsterdam, The Netherlands.,Center for Adapted Sports Amsterdam, Amsterdam Institute of Sport Science, Amsterdam, The Netherlands
| | - Ingrid Kouwijzer
- Amsterdam Rehabilitation Research Center, Amsterdam, The Netherlands.,Research and Development, Heliomare Rehabilitation Center, Wijk Aan Zee, The Netherlands.,University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
| | - Lucas Van Der Woude
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, The Netherlands.,Loughborough University, School of Sports, Exercise & Health, Peter Harrison Centre of Disability Sport
| | - Thomas Janssen
- Faculty of Behavioural and Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam Rehabilitation Research Center, Amsterdam, The Netherlands.,Center for Adapted Sports Amsterdam, Amsterdam Institute of Sport Science, Amsterdam, The Netherlands
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15
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Commentary on "The First Global Physical Activity and Sedentary Behavior Guidelines for People Living With Disability". J Phys Act Health 2021; 18:348-349. [PMID: 33741746 DOI: 10.1123/jpah.2020-0871] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 01/08/2021] [Indexed: 11/18/2022]
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16
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Antunes D, Nascimento EMF, Brickley G, Fischer G, de Lucas RD. Determination of the speed-time relationship during handcycling in spinal cord injured athletes. Res Sports Med 2021; 30:256-263. [PMID: 33586547 DOI: 10.1080/15438627.2021.1888097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study aimed to determine the critical speed (CS) and the work above CS (D') from three mathematical models of para-athletes during a treadmill handcycling exercise. Nine hand-cyclists with spinal cord injuries performed a maximal incremental handcycling test and three tests to exhaustion at a constant speed to determine the speed-time relationship. The three tests to exhaustion were performed at intensities between 90% and 105% of peak speed derived from the incremental test. Then, the determination of CS and D' was modelled by linear and hyperbolic models. CS and D' did not present any significant differences among the three mathematical models. Low values in the standard error of estimate for CS were found for the three models (Linear: Distance-time: 1.7 ± 0.5%; Linear: Speed-1/time: 3.0 ± 1.9% and Hyperbolic: 1.2 ± 0.6%). Based on the simplicity to calculate, the CS modelled by linear-distance-time can be a practical method for handcyclist coaches.
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Affiliation(s)
- Diego Antunes
- Sports Center, Physical Effort Laboratory, Federal University of Santa Catarina, Florianopolis, Brazil
| | | | - Gary Brickley
- Center for Sport and Exercise Science and Medicine, University of Brighton, Eastbourne, UK
| | - Gabriela Fischer
- Sports Center, Physical Effort Laboratory, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Ricardo Dantas de Lucas
- Sports Center, Physical Effort Laboratory, Federal University of Santa Catarina, Florianopolis, Brazil
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17
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Liu S, Wang Y, Niebauer J. Effect of Exercise on Cardiovascular Function Following Spinal Cord Injury: A REVIEW. J Cardiopulm Rehabil Prev 2021; 41:13-18. [PMID: 32796491 DOI: 10.1097/hcr.0000000000000534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Spinal cord injury (SCI) is associated with a reduced level of physical activity, deterioration of patient body composition, metabolic profile, quality of life, and psychological functioning. As a result, risk of cardiovascular disease (CVD) increases and CVD-related death occurs at an earlier age than in individuals without SCI. Regular participation in exercise has been shown to exert beneficial effects also in patients with SCI. In this review, we analyze and discuss the effects of regular exercise training in SCI on cardiovascular function, autonomic function of the cardiovascular system, arterial stiffness, metabolism, inflammation, and gene expression.
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Affiliation(s)
- Shujia Liu
- Departments of Spine and Spinal Cord Surgery (Dr Liu) and Clinical Laboratory (Dr Wang), Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China; Faculty of Rehabilitation Medicine, Capital Medical University, Beijing, China (Drs Liu and Wang); Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, and Institute of Sports Medicine, Prevention and Rehabilitation, University Hospital Salzburg, Salzburg, Austria (Dr Niebauer)
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18
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Construct validation of the leisure time physical activity questionnaire for people with SCI (LTPAQ-SCI). Spinal Cord 2020; 59:311-318. [PMID: 33040086 DOI: 10.1038/s41393-020-00562-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/25/2020] [Accepted: 09/28/2020] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional construct validation study. OBJECTIVES To test the construct validity of the Leisure Time Physical Activity Questionnaire for People with Spinal Cord Injury (LTPAQ-SCI) by examining associations between the scale responses and cardiorespiratory fitness (CRF) in a sample of adults living with spinal cord injury (SCI). SETTING Three university-based laboratories in Canada. METHODS Participants were 39 adults (74% male; M age: 42 ± 11 years) with SCI who completed the LTPAQ-SCI and a graded exercise test to volitional exhaustion using an arm-crank ergometer. One-tailed Pearson's correlation coefficients were computed to examine the association between the LTPAQ-SCI measures of mild-, moderate-, heavy-intensity and total minutes per week of LTPA and CRF (peak volume of oxygen consumption [V̇O2peak] and peak power output [POpeak]). RESULTS Minutes per week of mild-, moderate- and heavy-intensity LTPA and total LTPA were all positively correlated with V̇O2peak. The correlation between minutes per week of mild intensity LTPA and V̇O2peak was small-medium (r = 0.231, p = 0.079) while all other correlations were medium-large (rs ranged from 0.276 to 0.443, ps < 0.05). Correlations between the LTPAQ-SCI variables and POpeak were also positive but small (rs ranged from 0.087 to 0.193, ps > 0.05), except for a medium-sized correlation between heavy-intensity LTPA and POpeak (r = 0.294, p = 0.035). CONCLUSIONS People with SCI who report higher levels of LTPA on the LTPAQ-SCI also demonstrate greater levels of CRF, with stronger associations between moderate- and heavy-intensity LTPA and CRF than between mild-intensity LTPA and CRF. These results provide further support for the construct validity of the LTPAQ-SCI as a measure of LTPA among people with SCI.
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19
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Stephenson BT, Stone B, Mason BS, Goosey‐Tolfrey VL. Physiology of handcycling: A current sports perspective. Scand J Med Sci Sports 2020; 31:4-20. [DOI: 10.1111/sms.13835] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/28/2020] [Accepted: 09/15/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Ben T. Stephenson
- Peter Harrison Centre for Disability Sport School of Sport, Exercise and Health Sciences Loughborough University Loughborough UK
- English Institute of Sport Performance Centre Loughborough University Loughborough UK
| | - Benjamin Stone
- Peter Harrison Centre for Disability Sport School of Sport, Exercise and Health Sciences Loughborough University Loughborough UK
| | - Barry S. Mason
- Peter Harrison Centre for Disability Sport School of Sport, Exercise and Health Sciences Loughborough University Loughborough UK
| | - Victoria L. Goosey‐Tolfrey
- Peter Harrison Centre for Disability Sport School of Sport, Exercise and Health Sciences Loughborough University Loughborough UK
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20
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Do Handcycling Time-Trial Velocities Achieved by Para-Cycling Athletes Vary Across Handcycling Classes? Adapt Phys Activ Q 2020; 37:461-480. [PMID: 33022652 DOI: 10.1123/apaq.2019-0143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 11/18/2022] Open
Abstract
The classification system for handcycling groups athletes into five hierarchical classes, based on how much their impairment affects performance. Athletes in class H5, with the least impairments, compete in a kneeling position, while athletes in classes H1 to H4 compete in a recumbent position. This study investigated the average time-trial velocity of athletes in different classes. A total of 1,807 results from 353 athletes who competed at 20 international competitions (2014-2018) were analyzed. Multilevel regression was performed to analyze differences in average velocities between adjacent pairs of classes, while correcting for gender, age, and event distance. The average velocity of adjacent classes was significantly different (p < .01), with higher classes being faster, except for H4 and H5. However, the effect size of the differences between H3 and H4 was smaller (d = 0.12). Hence, results indicated a need for research in evaluating and developing evidence-based classification in handcycling, yielding a class structure with meaningful performance differences between adjacent classes.
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21
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Stone B, Mason BS, Stephenson BT, Goosey-Tolfrey VL. Physiological responses during simulated 16 km recumbent handcycling time trial and determinants of performance in trained handcyclists. Eur J Appl Physiol 2020; 120:1621-1628. [PMID: 32435985 PMCID: PMC7295712 DOI: 10.1007/s00421-020-04390-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 05/06/2020] [Indexed: 11/28/2022]
Abstract
Purpose To characterise the physiological profiles of trained handcyclists, during recumbent handcycling, to describe the physiological responses during a 16 km time trial (TT) and to identify the determinants of this TT performance. Methods Eleven male handcyclists performed a sub-maximal and maximal incremental exercise test in their recumbent handbike, attached to a Cyclus II ergometer. A physiological profile, including peak aerobic power output (POPeak), peak rate of oxygen uptake (\documentclass[12pt]{minimal}
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\begin{document}$$\dot{V}$$\end{document}V˙O2Peak), aerobic lactate threshold (AeLT) and PO at 4 mmol L−1 (PO4), were determined. Participants also completed a 16 km simulated TT using the same experimental set-up. Determinants of TT performance were identified using stepwise multiple linear regression analysis. Results Mean values of POPeak = 252 ± 9 W, \documentclass[12pt]{minimal}
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\begin{document}$$\dot{V}$$\end{document}V˙O2Peak = 3.30 ± 0.36 L min−1 (47.0 ± 6.8 mL kg−1 min−1), AeLT = 87 ± 13 W and PO4 = 154 ± 14 W were recorded. The TT was completed in 29:21 ± 0:59 min:s at an intensity equivalent to 69 ± 4% POPeak and 87 ± 5% \documentclass[12pt]{minimal}
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\begin{document}$$\dot{V}$$\end{document}V˙O2Peak. POPeak (r = − 0.77, P = 0.006), PO4 (r = − 0.77, P = 0.006) and AeLT (r = − 0.68, P = 0.022) were significantly correlated with TT performance. PO4 and POPeak were identified as the best predictors of TT performance (r = 0.89, P < 0.001). Conclusion POPeak, PO4 and AeLT are important physiological TT performance determinants in trained handcyclists, differentiating between superior and inferior performance, whereas \documentclass[12pt]{minimal}
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\begin{document}$$\dot{V}$$\end{document}V˙O2peak was not. The TT took place at an intensity corresponding to 69% POPeak and 87% \documentclass[12pt]{minimal}
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\begin{document}$$\dot{V}$$\end{document}V˙O2peak.
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Affiliation(s)
- Benjamin Stone
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, NCSEM 1.26, Loughborough University Campus, Loughborough, LE11 3TU, UK
| | - Barry S Mason
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, NCSEM 1.26, Loughborough University Campus, Loughborough, LE11 3TU, UK
| | - Ben T Stephenson
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, NCSEM 1.26, Loughborough University Campus, Loughborough, LE11 3TU, UK.,English Institute of Sport, Performance Centre, Loughborough University, Loughborough, UK
| | - Vicky L Goosey-Tolfrey
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, NCSEM 1.26, Loughborough University Campus, Loughborough, LE11 3TU, UK.
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22
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Gee CM, Nightingale TE, West CR, Krassioukov AV. Infographic. Doping without drugs: how para-athletes may self-harm to boost performance. Br J Sports Med 2020; 55:937-938. [PMID: 32381500 DOI: 10.1136/bjsports-2020-101980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Cameron M Gee
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada.,School of Kinesiology, The University of British Columbia, Vancouver, BC, Canada
| | - Tom E Nightingale
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada.,Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, British Columbia, Canada.,School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Christopher R West
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada.,Canadian Sport Institute - Pacific, Victoria, British Columbia, Canada.,Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrei V Krassioukov
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada .,Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, British Columbia, Canada.,GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, British Columbia, Canada
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Abstract
OBJECTIVE To examine differences in heart rate (HR) responses during international wheelchair rugby competition between athletes with and without a cervical spinal cord injury (SCI) and across standardized sport classifications. DESIGN Observational study. SETTING The 2015 Parapan American Games wheelchair rugby competition. PARTICIPANTS Forty-three male athletes (31 ± 8 years) with a cervical SCI (n = 32) or tetraequivalent impairment (non-SCI, n = 11). MAIN OUTCOME MEASURES Average and peak HR (HRavg and HRpeak, respectively). To characterize HR responses in accordance with an athletes' International Wheelchair Rugby Federation (IWRF) classification, we separated athletes into 3 groups: group I (IWRF classification 0.5-1.5, n = 15); group II (IWRF classification 2.0, n = 15); and group III (IWRF classification 2.5-3.5, n = 13). RESULTS Athletes with SCI had lower HRavg (111 ± 14 bpm vs 155 ± 13 bpm) and HRpeak (133 ± 12 bpm vs 178 ± 13 bpm) compared with non-SCI (both P < 0.001). Average HR was higher in group III than in I (136 ± 25 bpm vs 115 ± 20 bpm, P = 0.045); however, SCI athletes showed no difference in HRavg or HRpeak between groups. Within group III, SCI athletes had lower HRavg (115 ± 6 bpm vs 160 ± 8 bpm) and HRpeak (135 ± 11 bpm vs 183 ± 11 bpm) than non-SCI athletes (both P < 0.001). CONCLUSIONS This study is the first to demonstrate attenuated HR responses during competition in SCI compared with non-SCI athletes, likely due to injury to spinal autonomic pathways. Among athletes with SCI, IWRF classification was not related to differences in HR. Specific assessment of autonomic function after SCI may be able to predict HR during competition and consideration of autonomic impairments may improve the classification process.
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Griggs KE, Stephenson BT, Price MJ, Goosey-Tolfrey VL. Heat-related issues and practical applications for Paralympic athletes at Tokyo 2020. Temperature (Austin) 2019; 7:37-57. [PMID: 32166104 PMCID: PMC7053936 DOI: 10.1080/23328940.2019.1617030] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/02/2019] [Accepted: 05/06/2019] [Indexed: 02/07/2023] Open
Abstract
International sporting competitions, including the Paralympic Games, are increasingly being held in hot and/or humid environmental conditions. Thus, a greater emphasis is being placed on preparing athletes for the potentially challenging environmental conditions of the host cities, such as the upcoming Games in Tokyo in 2020. However, evidence-based practices are limited for the impairment groups that are eligible to compete in Paralympic sport. This review aims to provide an overview of heat-related issues for Paralympic athletes alongside current recommendations to reduce thermal strain and technological advancements in the lead up to the Tokyo 2020 Paralympic Games. When competing in challenging environmental conditions, a number of factors may contribute to an athlete's predisposition to heightened thermal strain. These include the characteristics of the sport itself (type, intensity, duration, modality, and environmental conditions), the complexity and severity of the impairment and classification of the athlete. For heat vulnerable Paralympic athletes, strategies such as the implementation of cooling methods and heat acclimation can be used to combat the increase in heat strain. At an organizational level, regulations and specific heat policies should be considered for several Paralympic sports. Both the utilization of individual strategies and specific heat health policies should be employed to ensure that Paralympics athletes' health and sporting performance are not negatively affected during the competition in the heat at the Tokyo 2020 Paralympic Games.
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Affiliation(s)
- Katy E. Griggs
- Department of Engineering, School of Science and Technology, Nottingham Trent University, Nottingham, UK
| | - Ben T. Stephenson
- Loughborough Performance Centre, English Institute of Sport, Loughborough University, Loughborough, UK
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Michael J. Price
- School of Life Sciences, Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry, UK
| | - Victoria L. Goosey-Tolfrey
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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25
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Gee CM, Williams AM, Sheel AW, Eves ND, West CR. Respiratory muscle training in athletes with cervical spinal cord injury: effects on cardiopulmonary function and exercise capacity. J Physiol 2019; 597:3673-3685. [DOI: 10.1113/jp277943] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 05/20/2019] [Indexed: 01/22/2023] Open
Affiliation(s)
- Cameron M. Gee
- International Collaboration on Repair Discoveries Vancouver BC Canada
- School of KinesiologyUniversity of British Columbia Vancouver BC Canada
- Canadian Sport Institute – Pacific Victoria BC Canada
| | - Alexandra M. Williams
- International Collaboration on Repair Discoveries Vancouver BC Canada
- Faculty of MedicineUniversity of British Columbia Kelowna BC Canada
| | - A. William Sheel
- International Collaboration on Repair Discoveries Vancouver BC Canada
- School of KinesiologyUniversity of British Columbia Vancouver BC Canada
| | - Neil D. Eves
- Centre for Heart Lung & Vascular HealthSchool of Health & Exercise SciencesUniversity of British Columbia Kelowna BC Canada
| | - Christopher R. West
- International Collaboration on Repair Discoveries Vancouver BC Canada
- Canadian Sport Institute – Pacific Victoria BC Canada
- Faculty of MedicineUniversity of British Columbia Kelowna BC Canada
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26
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Hoekstra SP, Leicht CA, Kamijo YI, Kinoshita T, Stephenson BT, Goosey-Tolfrey VL, Bishop NC, Tajima F. The inflammatory response to a wheelchair half-marathon in people with a spinal cord injury - the role of autonomic function. J Sports Sci 2019; 37:1717-1724. [DOI: 10.1080/02640414.2019.1586296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Sven P. Hoekstra
- The Peter Harrison Centre for Disability Sport; School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, UK
| | - Christof A. Leicht
- The Peter Harrison Centre for Disability Sport; School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, UK
| | - Yoshi-Ichiro Kamijo
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
| | - Tokio Kinoshita
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
| | - Ben T. Stephenson
- The Peter Harrison Centre for Disability Sport; School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, UK
| | - Victoria L. Goosey-Tolfrey
- The Peter Harrison Centre for Disability Sport; School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, UK
| | - Nicolette C. Bishop
- The Peter Harrison Centre for Disability Sport; School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, UK
| | - Fumihiro Tajima
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
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27
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Cowley KC. A new conceptual framework for the integrated neural control of locomotor and sympathetic function: implications for exercise after spinal cord injury. Appl Physiol Nutr Metab 2019; 43:1140-1150. [PMID: 30071179 DOI: 10.1139/apnm-2018-0310] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
All mammals, including humans, are designed to produce sustained locomotor movements. Many higher centres are involved in movement, but ultimately these centres act upon a core "rhythm-generating" network within the brainstem-spinal cord. In addition, endurance-based locomotor exercise requires sympathetic neural support to maintain homeostasis and to provide needed metabolic resources. This review focuses on the roles and integration of these 2 neural systems. Part I reviews the cardiovascular, thermoregulatory, and metabolic functions under spinal sympathetic control as revealed by spinal cord injury at different levels. Part II examines the integration between brainstem-spinal sympathetic pathways and the neural circuitry producing motor rhythms. In particular, the rostroventral medulla (RVM) contains the neural circuitry that (i) integrates heart rate, contractility, and blood flow in response to postural changes; (ii) initiates and maintains cardiovascular adaptations for exercise; (iii) provides direct descending innervation to preganglionic neurons innervating the adrenal glands, white adipose tissue, and tissues responsible for cooling the body; (iv) integrates descending sympathetic drive for energy substrate mobilization (lipolysis); and (v) is the relay for descending locomotor commands arising from higher brain centres. A unifying conceptual framework is presented, in which the RVM serves as the final descending supraspinal "exercise integration centre" linking the descending locomotor command signal with the metabolic and homeostatic support needed to produce prolonged rhythmic activities. The role and rationale for an ascending sympathetic and locomotor drive from the lower to upper limbs within this framework is presented. Examples of new research directions based on this unifying framework are discussed.
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Affiliation(s)
- Kristine C Cowley
- Department of Physiology and Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0J9, Canada.,Department of Physiology and Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0J9, Canada
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28
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Gee CM, Lacroix MA, West CR. Effect of Unintentional Boosting on Exercise Performance in a Tetraplegic Athlete. Med Sci Sports Exerc 2018; 50:2398-2400. [PMID: 30102676 DOI: 10.1249/mss.0000000000001738] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Boosting is the induction of autonomic dysreflexia (AD) to reflexively activate otherwise dormant thoracolumbar sympathetic circuitry to "boost" the capacity of the cardiovascular system and enhance exercise performance. AD is a life-threatening condition unique to individuals with spinal cord injury (SCI) characterized by a sudden increase in sympathetic activity below the level of the SCI. Here we report on the temporal HR response to an episode of unintentional boosting during a validated field-based exercise performance test in an athlete with tetraplegia.An athlete with SCI (C6 motor-complete, sensory-incomplete) completed a 20 ×20 m repeated sprint field test on two consecutive days. During the 13th sprint on day 2, the athlete unintentionally boosted via bladder overdistension. Average HR when boosted (i.e., sprints 14-20) was considerably higher than before boosting (141 ± 4 vs 116 ± 7 bpm) and compared with corresponding sprints on day 1 (141 ± 4 bpm vs 120 ± 1 bpm). Average time to complete 20 m sprints when boosted was also faster than the corresponding sprints on day 1 (6.70 ± 0.05 s vs 6.87 ± 0.05 s).This case report highlights the immediate effect of boosting on HR and field-based exercise performance and supports the suggestion that exercise performance in athletes with SCI is limited by cardiovascular capacity.
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Affiliation(s)
- Cameron M Gee
- School of Kinesiology, University of British Columbia, Vancouver, BC, CANADA.,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, CANADA.,Canadian Sport Institute-Pacific, Victoria, BC, CANADA
| | | | - Christopher R West
- School of Kinesiology, University of British Columbia, Vancouver, BC, CANADA.,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, CANADA.,Canadian Sport Institute-Pacific, Victoria, BC, CANADA
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29
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Gollie JM. Fatigability during volitional walking in incomplete spinal cord injury: cardiorespiratory and motor performance considerations. Neural Regen Res 2018; 13:786-790. [PMID: 29862998 PMCID: PMC5998625 DOI: 10.4103/1673-5374.232461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2018] [Indexed: 02/06/2023] Open
Abstract
Fatigability describes the decline in force production (i.e., performance fatigability) and/or changes in sensations regulating performance (i.e., perceived fatigability) during whole-body activity and poses a major challenge to those living with spinal cord injuries (SCI). After SCI, the inability to overcome disruptions to metabolic homeostasis due to cardiorespiratory limitations and physical deconditioning may contribute to increased fatigability severity. The increased susceptibility to fatigability may have implications for motor control strategies and motor learning. Locomotor training approaches designed to reduce fatigability and enhance aerobic capacity in combination with motor learning may be advantageous for promoting functional recovery after SCI. Future research is required to advance the understanding of the relationship between fatigability, cardiorespiratory function and motor performance following SCI.
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Affiliation(s)
- Jared M. Gollie
- Muscle Morphology, Mechanics and Performance Laboratory, Clinical Research Center-Human Performance Research Unit, Veteran Affairs Medical Center Washington, DC, USA
- Department of Health, Human Function, and Rehabilitation Sciences, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
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30
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Baumgart JK, Brurok B, Sandbakk Ø. Peak oxygen uptake in Paralympic sitting sports: A systematic literature review, meta- and pooled-data analysis. PLoS One 2018; 13:e0192903. [PMID: 29474386 PMCID: PMC5825058 DOI: 10.1371/journal.pone.0192903] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 01/12/2018] [Indexed: 11/30/2022] Open
Abstract
Background Peak oxygen uptake (VO2peak) in Paralympic sitting sports athletes represents their maximal ability to deliver energy aerobically in an upper-body mode, with values being influenced by sex, disability-related physiological limitations, sport-specific demands, training status and how they are tested. Objectives To identify VO2peak values in Paralympic sitting sports, examine between-sports differences and within-sports variations in VO2peak and determine the influence of sex, age, body-mass, disability and test-mode on VO2peak. Design Systematic literature review and meta-analysis. Data sources PubMed, CINAHL, SPORTDiscusTM and EMBASE were systematically searched in October 2016 using relevant medical subject headings, keywords and a Boolean. Eligibility criteria Studies that assessed VO2peak values in sitting sports athletes with a disability in a laboratory setting were included. Data synthesis Data was extracted and pooled in the different sports disciplines, weighted by the Dersimonian and Laird random effects approach. Quality of the included studies was assessed with a modified version of the Downs and Black checklist by two independent reviewers. Meta-regression and pooled-data multiple regression analyses were performed to assess the influence of sex, age, body-mass, disability, test mode and study quality on VO2peak. Results Of 6542 retrieved articles, 57 studies reporting VO2peak values in 14 different sitting sports were included in this review. VO2peak values from 771 athletes were used in the data analysis, of which 30% participated in wheelchair basketball, 27% in wheelchair racing, 15% in wheelchair rugby and the remaining 28% in the 11 other disciplines. Fifty-six percent of the athletes had a spinal cord injury and 87% were men. Sports-discipline-averaged VO2peak values ranged from 2.9 L∙min-1 and 45.6 mL∙kg-1∙min-1 in Nordic sit skiing to 1.4 L∙min-1 and 17.3 mL∙kg-1∙min-1 in shooting and 1.3 L∙min-1 and 18.9 mL∙kg-1∙min-1 in wheelchair rugby. Large within-sports variation was found in sports with few included studies and corresponding low sample sizes. The meta-regression and pooled-data multiple regression analyses showed that being a man, having an amputation, not being tetraplegic, testing in a wheelchair ergometer and treadmill mode, were found to be favorable for high absolute and body-mass normalized VO2peak values. Furthermore, high body mass was favourable for high absolute VO2peak values and low body mass for high body-mass normalized VO2peak values. Conclusion The highest VO2peak values were found in Nordic sit skiing, an endurance sport with continuously high physical efforts, and the lowest values in shooting, a sport with low levels of displacement, and in wheelchair rugby where mainly athletes with tetraplegia compete. However, VO2peak values need to be interpreted carefully in sports-disciplines with few included studies and large within-sports variation. Future studies should include detailed information on training status, sex, age, test mode, as well as the type and extent of disability in order to more precisely evaluate the effect of these factors on VO2peak.
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Affiliation(s)
- Julia Kathrin Baumgart
- Centre for Elite Sports Research, Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
- * E-mail:
| | - Berit Brurok
- Centre for Elite Sports Research, Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Physical Medicine and Rehabilitation, St. Olav’s University Hospital, Trondheim, Norway
| | - Øyvind Sandbakk
- Centre for Elite Sports Research, Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
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31
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A 20×20m repeated sprint field test replicates the demands of wheelchair rugby. J Sci Med Sport 2018; 21:753-757. [PMID: 29373205 DOI: 10.1016/j.jsams.2017.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 12/05/2017] [Accepted: 12/08/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To assess the physiological responses to, and the agreement between, a 20×20m repeated sprint field test and wheelchair rugby game play, as well as the reliability of the test. DESIGN Cross-sectional and longitudinal. METHODS Heart rate (HR), blood lactate ([La-]B), and ratings of perceived exertion (RPE) were collected in nineteen elite wheelchair rugby athletes before, during, and after a 20×20m repeated sprint field test and game play. Times to complete 5, 10, and 20m during the field test were also collected. RESULTS Peak HR and peak [La-]B were positively correlated during the field test (r=0.470, p=0.043), as were peak HR and peak speed (r=0.493, p=0.031), and peak [La-]B and peak speed (r=0.559, p=0.013). During game play, peak [La-]B was correlated with peak RPE (rho=0.703, p=0.001). Intra-class correlations (ICCs) between the field test and game play were significant for peak HR (ICC=0.922, p<0.001) and peak [La-]B (ICC=0.845, p<0.001). Bland-Altman analysis revealed good agreement between HR and [La-]B obtained during the field test and game play and excellent between-day reliability of the 20×20m sprint test. CONCLUSIONS The physiological demands of a 20×20m repeated sprint field test are similar to those of elite wheelchair rugby game play and the test is highly reliable. This simple to implement field test may be useful as a component of team selection and in assessing the effectiveness of training interventions or monitoring athletes across training phases.
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32
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Abstract
Over the past 10 years, our team has attended numerous Paralympic games and International Paralympic Committee (IPC)-sanctioned events where we have accumulated the largest data set to date from elite athletes with spinal cord injury (SCI). This empirical evidence has allowed us to address critical questions related to health and athletic performance in these incredibly medically complex individuals. Namely, does autonomic function influence performance? Can we account for this with the present sport classification? How can we prevent the doping practice of self-inducing life-threatening episodes of hypertension to improve performance (termed "boosting")? How does extremely high participation in routine upper-body wheelchair exercise impact cardiovascular and cerebrovascular disease risk? Is it possible to improve the sport classification to level the playing field between athletes with and without autonomic dysfunction? Herein, we will narratively address these questions, and provide our perspective on future directions and recommendations moving forward. Our extensive clinical experience and comprehensive dataset suggest preserved autonomic function is critical for elite performance. We will explore how an easy-to-execute test may be able to predict which individuals are most likely to develop autonomic dysfunctions that may negatively affect their health and performance. We also will evaluate the possibility that a level playing field may be even more difficult to establish than once thought, considering the importance of not only voluntary movement to performance, but also autonomic function. Finally, we also will discuss new changes in screening guidelines at Rio to assess the occurrence of boosting, which is a banned practice by the IPC.
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Affiliation(s)
- Aaron A Phillips
- 1 International Collaboration on Repair Discoveries, University of British Columbia , Vancouver, British Columbia, Canada
| | - Jordan W Squair
- 1 International Collaboration on Repair Discoveries, University of British Columbia , Vancouver, British Columbia, Canada .,2 MD/PhD Training Program, University of British Columbia , Vancouver, British Columbia, Canada
| | - Andrei V Krassioukov
- 1 International Collaboration on Repair Discoveries, University of British Columbia , Vancouver, British Columbia, Canada .,3 Department of Medicine, University of British Columbia , Vancouver, British Columbia, Canada .,4 GF Strong Rehabilitation Centre, Vancouver Health Authority, University of British Columbia , Vancouver, British Columbia, Canada
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33
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Squair JW, Phillips AA, Currie KD, Gee C, Krassioukov AV. Autonomic testing for prediction of competition performance in Paralympic athletes. Scand J Med Sci Sports 2017; 28:311-318. [PMID: 28452146 DOI: 10.1111/sms.12900] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2017] [Indexed: 11/29/2022]
Abstract
While we now appreciate that autonomic dysfunction can impact wheelchair rugby performance, this is currently not being assessed during classification, largely due to lack of a standardized and evidence-based strategy to assess autonomic function. Our aim, therefore, was to establish the optimal autonomic testing protocol that best predicts cardiovascular capacity during competition by comprehensively examining autonomic function in elite wheelchair rugby athletes with cervical SCI and thereby enhance the standardized classification. Twenty-six individuals with cervical SCI (C4-C8; AIS A, B, C) participated in this study during the 2015 Parapan American Games in Toronto, Canada. Clinic autonomic testing included: sympathetic skin responses, baseline hemodynamics, orthostatic challenge test, and cold-pressor tests. Further, we completed standard motor/sensory assessments and obtained each participants' International Wheelchair Rugby Federation classification. These clinic metrics were correlated to in-competition heart rate monitoring obtained during competition. The current study provides novel evidence that the change in systolic blood pressure during an orthostatic challenge test predicts approximately 50% of the in-competition peak heart rate (P<.001). Conversely, International Wheelchair Rugby Federation classification was poorly associated with in-competition peak heart rate (R2 =.204; P<.05). Autonomic testing provides deep insight regarding preserved autonomic control after SCI that is associated with performance in elite wheelchair rugby athletes. As such, incorporating assessments of cardiovascular capacity in classification will help to ensure a level playing field and may obviate the need for practices such as boosting to gain an advantage due to poor cardiovascular control.
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Affiliation(s)
- J W Squair
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada.,MD/PhD Training Program, University of British Columbia, Vancouver, BC, Canada
| | - A A Phillips
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
| | - K D Currie
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
| | - C Gee
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
| | - A V Krassioukov
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada.,Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC, Canada.,GF Strong Rehabilitation Centre, Vancouver Health Authority, Vancouver, BC, Canada
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34
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Cruz S, Blauwet CA. Implications of altered autonomic control on sports performance in athletes with spinal cord injury. Auton Neurosci 2017; 209:100-104. [PMID: 28457670 DOI: 10.1016/j.autneu.2017.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 03/25/2017] [Accepted: 03/31/2017] [Indexed: 11/26/2022]
Abstract
It is well known that athletes with spinal cord injury (SCI) may experience altered autonomic physiology that impacts their exercise capacity and sports performance. This is particularly relevant given the ever-increasing number of individuals with SCI who are actively engaged in sports at all levels, from community-based adaptive sports to elite Paralympic competitions. As such, the purpose of this article is to review the present literature regarding the implications of altered autonomic control on the safety and performance of athletes with SCI. A particular emphasis will be placed on the autonomic aspects of cardiovascular and thermoregulatory control in the athlete population, as well as the implications of autonomic dysreflexia in enhancing sports performance. Further research is needed to understand the autonomic factors that influence athletes with SCI in order to ensure optimal and safe sports competition. Additionally, this information is crucially relevant to the coaches, sports administrators, and team medical staff who work closely with athletes with SCI.
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Affiliation(s)
- Sebastian Cruz
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Cheri A Blauwet
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA; Spaulding Rehabilitation Hospital/Brigham and Women's Hospital, Boston, MA, USA.
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35
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West CR, Leicht CA, Goosey-Tolfrey VL, Romer LM. Perspective: Does Laboratory-Based Maximal Incremental Exercise Testing Elicit Maximum Physiological Responses in Highly-Trained Athletes with Cervical Spinal Cord Injury? Front Physiol 2016; 6:419. [PMID: 26834642 PMCID: PMC4712301 DOI: 10.3389/fphys.2015.00419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 12/21/2015] [Indexed: 11/20/2022] Open
Abstract
The physiological assessment of highly-trained athletes is a cornerstone of many scientific support programs. In the present article, we provide original data followed by our perspective on the topic of laboratory-based incremental exercise testing in elite athletes with cervical spinal cord injury. We retrospectively reviewed our data on Great Britain Wheelchair Rugby athletes collected during the last two Paralympic cycles. We extracted and compared peak cardiometabolic (heart rate and blood lactate) responses between a standard laboratory-based incremental exercise test on a treadmill and two different maximal field tests (4 min and 40 min maximal push). In the nine athletes studied, both field tests elicited higher peak responses than the laboratory-based test. The present data imply that laboratory-based incremental protocols preclude the attainment of true peak cardiometabolic responses. This may be due to the different locomotor patterns required to sustain wheelchair propulsion during treadmill exercise or that maximal incremental treadmill protocols only require individuals to exercise at or near maximal exhaustion for a relatively short period of time. We acknowledge that both field- and laboratory-based testing have respective merits and pitfalls and suggest that the choice of test be dictated by the question at hand: if true peak responses are required then field-based testing is warranted, whereas laboratory-based testing may be more appropriate for obtaining cardiometabolic responses across a range of standardized exercise intensities.
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Affiliation(s)
- Christopher R West
- International Collaboration on Repair Discoveries, University of British ColumbiaVancouver, BC, Canada; School of Kinesiology, University of British ColumbiaVancouver, BC, Canada; Centre for Sports Medicine and Human Performance, Brunel University LondonLondon, UK
| | - Christof A Leicht
- School of Sport, Exercise and Health Sciences, The Peter Harrison Centre for Disability Sport, Loughborough University Loughborough, UK
| | - Victoria L Goosey-Tolfrey
- School of Sport, Exercise and Health Sciences, The Peter Harrison Centre for Disability Sport, Loughborough University Loughborough, UK
| | - Lee M Romer
- Centre for Sports Medicine and Human Performance, Brunel University London London, UK
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36
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West CR, Krassioukov AV. Autonomic cardiovascular control and sports classification in Paralympic athletes with spinal cord injury. Disabil Rehabil 2016; 39:127-134. [DOI: 10.3109/09638288.2015.1118161] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Christopher R. West
- 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
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC, Canada
- G. F. Strong Rehab Centre, Vancouver, BC, Canada
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