Aerobic Training Effects of Electrically Induced Lower Extremity Exercises in Spinal Cord Injured People

Pollack, Susan F; Axen, Kenneth; Spielholz, Neil I.; Levin, Nathaniel M.; Haas, F.; Ragnarsson, Kristjan T.

doi:10.1016/s0003-9993(21)01690-7

Cited by 63 publications

(4 citation statements)

References 15 publications

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“…Leave-one-out analyses identified outliers for A O 2peak [ 42 , 61 , 93 ] ( S7 File ). A sensitivity analysis for risk of bias revealed no differences in the pooled effects for low and high risk of bias studies ( S7 File ).…”

Section: Resultsmentioning

confidence: 99%

“…Length of interventions ranged from 4 to 52 weeks, and while most studies reported a specific, predetermined intervention length, some reported a range [59][60][61], a total or targeted number of sessions [60,[62][63][64][65][66], or provided an average [65,67,68]. Exercise sessions were completed between 2 and 7 times per week.…”

Section: Exercise Intervention Characteristicsmentioning

confidence: 99%

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Exercise and aerobic capacity in individuals with spinal cord injury: A systematic review with meta-analysis and meta-regression

Hodgkiss,

Bhangu,

Lunny

et al. 2023

PLoS Med

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Background A low level of cardiorespiratory fitness [CRF; defined as peak oxygen uptake (V˙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 (AV˙O2peak) or relative V˙O2peak (RV˙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 AV˙O2peak [0.16 (0.07, 0.25) L/min], RV˙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 AV˙O2peak [0.22 (0.17, 0.26) L/min], RV˙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 RV˙O2peak based on exercise modality (p = 0.002) and intervention length (p = 0.01), but there were no differences for AV˙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 AV˙O2peak and RV˙O2peak (p < 0.10). GRADE indicated a moderate level of certainty in the estimated effect for RV˙O2peak, but low levels for AV˙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 AV˙O2peak, RV˙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 RV˙O2peak. Upper-body aerobic exercise and resistance training also appear the most effective at improving RV˙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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Section: Resultsmentioning

confidence: 99%

Section: Exercise Intervention Characteristicsmentioning

confidence: 99%

Exercise and aerobic capacity in individuals with spinal cord injury: A systematic review with meta-analysis and meta-regression

Hodgkiss,

Bhangu,

Lunny

et al. 2023

PLoS Med

View full text Add to dashboard Cite

show abstract

“…Length of interventions ranged from 4 to 52 weeks, and whilst most studies reported a specific, predetermined intervention length, some reported a range [50][51][52], a total or targeted number of sessions [51,[53][54][55][56][57], or provided an average [56,58,59]. Exercise sessions were completed between two to seven times per week.…”

Section: Exercise Intervention Characteristicsmentioning

confidence: 99%

The effect of exercise on aerobic capacity in individuals with spinal cord injury: A systematic review with meta-analysis and meta-regression

Hodgkiss

Bhangu

Lunny

et al. 2022

Preprint

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Background A low level of cardiorespiratory fitness [CRF; typically defined as peak oxygen uptake (VO2peak) or peak power output (PPO)] is a widely reported consequence of spinal cord injury (SCI). This systematic review with meta-analysis and meta-regression aimed to assess whether certain SCI characteristics and specific exercise considerations are moderators of changes in CRF. Methods Eligible studies included randomised controlled trials (RCTs) and pre-post studies that conducted an exercise intervention lasting >2 weeks. The outcome measures of interest were absolute (AVO2peak) or relative VO2peak (RVO2peak), and/or PPO. Four databases were searched up to July 2021. The Cochrane Risk of Bias 2 tool and the National Institute of Health Quality Assessment Tool were used to assess bias/quality. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Random effects meta-analyses and meta-regressions were conducted. Results Ninety studies (110 independent exercise interventions) with a total of 1,191 participants were included in our primary meta-analysis. There were significant improvements in AVO2peak [0.22 (0.17, 0.26) L/min, p<0.001)], RVO2peak [2.8 (2.2, 3.4) mL/kg/min, p<0.001)], and PPO [11 (8, 13) W, p<0.001]. There were no subgroup differences in AVO2peak or RVO2peak. There were subgroup differences (p<0.008) for changes in PPO based on time since injury, neurological level of injury, exercise modality, relative exercise intensity, method of exercise intensity prescription, and frequency. The meta-regression found that increased age was associated with increases in AVO2peak and RVO2peak, and exercise intensity prescription and volume were associated with increases in PPO (p<0.05). GRADE assessments indicated a low level of certainty in the estimated effects due to study design, risk of bias, inconsistency, and imprecision. Conclusion The pooled analysis indicates that performing exercise >2 weeks results in significant improvements in AVO2peak, RVO2peak and PPO in individuals with SCI. Subgroup comparisons identify that upper-body aerobic exercise and resistance training appear the most effective at improving PPO. Furthermore, acutely-injured, individuals with paraplegia, exercising at a moderate-to-vigorous intensity, prescribed via a percentage of oxygen consumption or heart rate, for more than 3 sessions/week will likely experience the greatest change in PPO. Registration PROSPERO CRD42018104342

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“…30 Presently, electrical stimulation is used in various neuroprostheses to substitute for non-recovered motorsensory functioning, including the anterior sacral root stimulator for bladder dysfunction, 31 FES system for improving hand function in tetraplegics, 32 and FES cycling to improve cardiovascular function. 33…”

Section: I) Functional Electrical Stimulationmentioning

confidence: 99%

Recovery and Regeneration after Spinal Cord Injury: A Review and Summary of Recent Literature

Lim

Tow²

2007

Ann Acad Med Singap

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Introduction: Spinal cord injury (SCI) often results in significant neurologic dysfunction and disability. An annual incidence of 15 to 40 traumatic SCI cases per million population has been reported worldwide, and a conservative estimate for Singapore would be 23 cases per million. With continued improvements in medical care, an increasing prevalence of SCI patients is expected, with corresponding need for comprehensive rehabilitation services led by specialist rehabilitation physicians. Methods: A literature search, review, and summary of findings of recent studies relating to factors associated with recovery, as well as interventions for rehabilitation and promotion of healing of the injured spinal cord was performed. Conclusions: Many SCI patients show improvements in motoric and neurologic level, but those with complete injuries have poor chance of improving American Spinal Injury Association (ASIA) scores. SCI of violent aetiology tends to be more neurologic complete, and those without sacral sparing less likely to improve. Older patients generally do well in activities of daily living. Women have better motor score improvement, although men have better Functional Independence Measure (FIM) scores generally. Electrodiagnostic tests such as somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) can help with prognostication, as can imaging techniques such as magnetic resonance imaging (MRI). Immediate surgery for spinal decompression may improve recovery, but whether routine surgery after SCI improves function remains unclear, as does the timing. Methylprednisolone and similar agents appear to help limit secondary injury processes. Rehabilitation interventions such as functional electrical stimulation (FES) and body-weight supported treadmill ambulation training may be effective, as may neural-controlled prostheses and devices. Substances that promote repair and regeneration of the injured spinal cord such as GM-1, 4-AP, BDNG, GDNF, Nogo and MAG-inhibitors, have been studied. Transplanted tissues and cells, such as blood macrophages, bone marrow transplant with GM-CSF, olfactory ensheathing cells, fetal tissues, stem or progenitor cells, have been reported to produce neurological improvements. Key words: Prognosis, Regeneration, Rehabilitation, Spinal cord injuries

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Aerobic Training Effects of Electrically Induced Lower Extremity Exercises in Spinal Cord Injured People

Cited by 63 publications

References 15 publications

Exercise and aerobic capacity in individuals with spinal cord injury: A systematic review with meta-analysis and meta-regression

Exercise and aerobic capacity in individuals with spinal cord injury: A systematic review with meta-analysis and meta-regression

The effect of exercise on aerobic capacity in individuals with spinal cord injury: A systematic review with meta-analysis and meta-regression

Recovery and Regeneration after Spinal Cord Injury: A Review and Summary of Recent Literature

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