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High-intensity, whole-body exercise improves blood pressure control in individuals with spinal cord injury: A prospective randomized controlled trial.

ABSTRACT: Blood pressure regulation following spinal cord injury (SCI) is often compromised due to impaired vascular sympathetic control, leading to increased reliance on cardiovagal baroreflex sensitivity to maintain pressure. Whole-body exercise improves cardiovagal baroreflex sensitivity in uninjured individuals, though has not been explored in those with SCI. Our objective was to determine changes in cardiovagal baroreflex sensitivity following 6 months of high-intensity, whole-body exercise in individuals with SCI compared to lower-intensity, arms only exercise, or waitlist. This randomized controlled trial recruited individuals with SCI aged 18-40 years old. Sixty-one individuals were randomized, with 38 completing at least one cardiovagal baroreflex sensitivity assessment. Whole-body exercise was performed with hybrid functional electrical stimulation rowing prescribed as two to three times per week, for 30-60 minutes with a target heart rate of >75% of maximum. The arms only exercise group performed upper body rowing exercise with the same prescription as whole-body exercise. Waitlist controls were not enrolled in any explicit training regimen. After 6 months, those in arms only exercise or waitlist crossed over to whole-body exercise. Cardiovagal baroreflex sensitivity was assessed via the neck suction technique at baseline and at three-month intervals thereafter. Intention to treat analysis with a structured equation model demonstrated no significant effect of waitlist control or arms only exercise on cardiovagal baroreflex sensitivity. Whole-body exercise significantly improved cardiovagal baroreflex sensitivity at 6 months for those initially randomized (p = 0.03), as well as those who crossed over from arms only exercise or waitlist control (p = 0.03 for each). However, amount of exercise performed and aerobic gains (VO2max) each poorly correlated with increases in cardiovagal baroreflex sensitivity (R2<0.15). In post-hoc analyses, individuals with paraplegia made significantly greater gains in baroreflex sensitivity compared to those with tetraplegia (p = 0.02), though gains within this group were again poorly correlated to gains in aerobic capacity. Clinicaltrials.gov number NCT02139436.

SUBMITTER: Solinsky R

PROVIDER: S-EPMC7932070 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:High-intensity stepping practice may be a critical component to improve gait following motor incomplete spinal cord injury (iSCI). However, such practice is discouraged by traditional theories of rehabilitation that suggest high-intensity locomotor exercise degrades gait performance. Accordingly, such training is thought to reinforce abnormal movement patterns, although evidence to support this notion is limited.The purposes of this study were: (1) to evaluate the effects of short-term manipulations in locomotor intensity on gait performance in people with iSCI and (2) to evaluate potential detrimental effects of high-intensity locomotor training on walking performance.A single-day, repeated-measures, pretraining-posttraining study design was used.Nineteen individuals with chronic iSCI performed a graded-intensity locomotor exercise task with simultaneous collection of lower extremity kinematic and electromyographic data. Measures of interest were compared across intensity levels of 33%, 67%, and 100% of peak gait speed. A subset of 9 individuals participated in 12 weeks of high-intensity locomotor training. Similar measurements were collected and compared between pretraining and posttraining evaluations.The results indicate that short-term increases in intensity led to significant improvements in muscle activity, spatiotemporal metrics, and joint excursions, with selected improvements in measures of locomotor coordination. High-intensity locomotor training led to significant increases in peak gait speed (0.64-0.80 m/s), and spatiotemporal and kinematic metrics indicate a trend for improved coordination.Measures of gait performance were assessed during treadmill ambulation and not compared with a control group. Generalizability of these results to overground ambulation is unknown.High-intensity locomotor exercise and training does not degrade, but rather improves, locomotor function and quality in individuals with iSCI, which contrasts with traditional theories of motor dysfunction following neurologic injury.

Project description:BackgroundThe number of exercise trials examining cardiometabolic outcomes in spinal cord injury (SCI) is low, and prescribed exercise is often inconvenient for individuals with SCI to perform within their community. Individuals with SCI experience a myriad of barriers to exercise participation, which can include a lack of time, accessible or usable equipment and facilities, and transportation. Thus, it is imperative to identify effective modes of exercise that provide the greatest overall health benefits but do not require a significant time commitment. Low-volume high intensity interval training (HIIT) has demonstrated the same improvements in cardiometabolic health as moderate intensity exercise training (MIT), despite only requiring 20% of the total time commitment in adults without disabilities and more recently in individuals with SCI.ObjectivesThe primary purpose of this study is to integrate a 16 week home-based telehealth HIIT arm crank exercise training program in individuals with SCI and assess changes in cardiometabolic health.MethodsMen and women between the ages of 19 and 60 with a confirmed diagnosis of SCI between C7 and T12 will be recruited for this study. Participants will be randomized to 16 weeks of telehealth HIIT exercise two days per week or a no-exercise control group. Aerobic capacity, muscular strength, blood lipids, glucose tolerance, resting energy expenditure, blood pressure, and body composition will be assessed at baseline and 16 weeks post-training.DiscussionInactivity associated with SCI leads to chronic cardiometabolic health conditions. The majority of exercise interventions to date show that exercise is capable of increasing physical function, aerobic capacity, and muscle mass, and strength. Additionally, we have recently shown the ability of HIIT to improve blood lipid and glucose concentrations. Advances in telehealth exercise approaches have improved the capability to prescribe home-based exercise programs. Therefore, we hypothesize that the utilization of a home-based telehealth HIIT program will improve cardiometabolic health markers, yield high adherence (> 75%), and will be more enjoyable in individuals with SCI.Trial registrationTelehealth High-Intensity Interval Exercise and Cardiometabolic Health in Spinal Cord Injury NCT04940598.

Project description:IntroductionThe prevalence of cardiometabolic disease following spinal cord injury is known to be high. However, it is unknown whether engaging in high-intensity exercise, which is advocated by recent guidelines, is beneficial or feasible for these individuals.ObjectiveTo assess the effects of high-intensity, whole-body exercise on the prevalence of cardiometabolic disease in individuals with spinal cord injury.DesignCombination of a randomized controlled trial and an open label intervention study of functional electrical stimulation legs plus arms rowing.SettingOutpatient academic rehabilitation hospital.ParticipantsForty individuals with spinal cord injury, with American Spinal Injury Association (ASIA) impairments scales A-D and neurological levels of injury C1-T12.InterventionSix months of high-intensity, hybrid-functional electrical stimulation rowing.Main outcome measuresChange in VO2max , serum lipids, and insulin resistance, prevalence of cardiometabolic disease.ResultsIndividuals averaged 42.1 ± 22.0 minutes of hybrid-functional electrical stimulation rowing a week over an average of 1.69 sessions per week over the 6 months of intervention. This amounted to an average of 170.9 ± 100 km rowed, at a mean heart rate of 82.7% of individualized maximum. Only one of 40 individuals met current exercise guidelines for the full 6 months. VO2max increased significantly (P < .001), yet prevalence of cardiometabolic disease did not change significantly (decrease from 22.5% to 20%, P = .70). Hemoglobin A1c did decrease significantly over this time (P = .01), although serum lipids and fasting glucose/insulin levels were unchanged. In exploratory subanalyses assessing individuals injured ≤12 months, those with more chronic injuries decreased their triglyceride-to-high-density lipoprotein (HDL) ratio (P = .04), a marker of cardiac mortality. Stratifying by neurological level of injury, individuals with paraplegia had worsened low-density lipoprotein (LDL) level (P = .02) and total cholesterol-to-HDL ratio (P = .04) over the 6-month intervention.ConclusionsSustained high-intensity exercise with hybrid functional electrical stimulation rowing does not decrease the prevalence of cardiometabolic disease after spinal cord injury.

Project description:BackgroundPressure ulcers (PUs) on the buttocks are among the most common secondary complications in individuals with chronic spinal cord injury (SCI). PUs can result from sitting for extended periods, disuse atrophy, increased sitting pressure and reduced circulation. Compared with usual care, activation of paralysed muscles using electrical stimulation (ES) has been shown to markedly increase paralysed muscle mass, improve circulation of skin and muscle and improve sitting pressure distribution. ES might therefore be a useful method to reduce PU incidence.MethodsA multicentre randomized controlled trial (SCI PREVOLT) will be conducted with an economic and process evaluation alongside. One hundred participants with a SCI in the chronic phase and a minimal incidence of 1 PU in the last 5 years will be recruited from rehabilitation centres across the Netherlands. Participants will be stratified by centre and age and randomized to the intervention or control group. The intervention group will use ES at least 1 h/day during at least 4 times a week for 1 year next to usual care. The control group will only receive usual care. The primary outcome is the incidence of PUs, measured by a blinded person assessing the presence or absence of a PU on the buttocks on a photo made by the participant or his/her caregiver. The incidence of a PU will be evaluated every 2 weeks. Secondary outcomes include interface pressure distribution, blood flow in the profunda femoris artery, muscle thickness of the hamstrings and gluteal muscles and questionnaires about different dimensions of life, e.g. participation and quality of life. Secondary outcomes will be measured at baseline and 3, 6, 9 and 12 months after randomization.DiscussionThis study will assess if electrical stimulation is a (cost-)effective method to prevent PUs and reduce the risk factors of getting PUs. If ES is effective and cost-effective compared with usual care, ES could be implemented in daily treatment of individuals with a SCI.Trial registrationNetherlands Trials Register NTR NL9469 . Registered on 26 May 2021.

Project description:BACKGROUND:Metabolic syndrome (MetS) is a cluster of metabolic abnormalities that increases the cardiovascular risk. Regular physical exercise can promote benefits, but the MetS individuals are demotivated to perform it. Thus, new possibilities are important as an alternative intervention. The whole-body vibration can be considered an exercise modality and would be a safe and low-cost strategy to improve functional parameters of individuals in different clinical conditions. The aim of this exploratory study was to assess effects of whole-body vibration on functional parameters of MetS individuals. The hypothesis of this work was that the whole-body vibration could improve the functionality of MetS individuals. METHODS:Twenty-two individuals performed the intervention. The vibration frequency varied from 5 to 14?Hz and the peak-to-peak displacements, from 2.5 to 7.5?mm. Each session consisted of one minute-bout of working time followed by a one minute-bout of passive rest in each peak-to-peak displacement for three-times. The whole-body vibration protocol was applied twice per week for 5?weeks. Data from the trunk flexion, gait speed, sit-to-stand test and handgrip strength were collected. Physiological parameters (blood pressure and heart rate) were also evaluated. The Wilcoxon Rank test and Student t-test were used. RESULTS:No significant changes (p?>?0.05) were observed in physiological parameters (arterial blood pressure and heart rate). Significant improvements were found in trunk flexion (p?= 0.01), gait speed (p?= 0.02), sit-to-stand test (p?= 0.005) and handgrip strength (p?= 0.04) after the whole-body vibration. CONCLUSIONS:In conclusion, whole-body vibration may induce biological responses that improve functional parameters in participants with MetS without interfering in physiological parameters, comparing before and after a 5-week whole-body vibration protocol. TRIAL REGISTRATION:Register in the Registro Brasileiro de Ensaios Clínicos (ReBEC) with the number RBR 2bghmh (June 6th, 2016) and UTN: U1111-1181-1177. (virgula).

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High-intensity, whole-body exercise improves blood pressure control in individuals with spinal cord injury: A prospective randomized controlled trial.

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