Cardiovascular control, autonomic function, and elite endurance performance in spinal cord injury

West, Christopher R.; Gee, Cameron M.; Voss, Christine; Hubli, Michéle; Currie, Katharine D.; Schmid, Johannes; Krassioukov, Andrei V.

doi:10.1111/sms.12308

Cited by 48 publications

(60 citation statements)

References 34 publications

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“…In fact, these values are similar to those reported in the boosted state (Table 1). Similarly, our research on H1 hand cyclists competing at an international level in 2013 found resting SBP to be 112 ± 11 mmHg in the seated position [33]. Of particular note in the study by Blauwet et al is one athlete who competed following recording a pre-race BP of 176/97 mmHg.…”

Section: Boostingmentioning

confidence: 89%

“…Recent evidence suggests that the autonomic completeness of injury, assessed by sympathetic skin responses and orthostatic tolerance, can predict aerobic performance in elite athletes with SCI [3,33]. Presently, no studies that compare performance in the boosted and unboosted state have included an assessment of the integrity of spinal autonomic circuits outside of resting and exercise HR and BP measures.…”

Section: Autonomic Nervous System Assessmentmentioning

confidence: 94%

“…Given the dangers associated with episodic bouts of hypertension in this population [10], ethical considerations, and the potential for response bias for athletes' attitudes [15], conducting research on the effects of boosting is [33]. HR heart rate problematic.…”

Section: Boostingmentioning

confidence: 99%

“…3). It has been suggested that autonomic testing may assist in the classification of paralympic athletes with cervical and high thoracic SCI [6,72] owing to the competitive disadvantage individuals with an altered autonomic response to exercise experience, despite similar motor function [3,33]. Such classification may reduce the likelihood of one-sided competition and promote participation, a basic tenet of the IPC's Classification Code [68], and to achieve this goal of greater participation in disability sport, the impact of impairment (e.g., autonomic function) must be controlled for such that each class includes athletes with a comparable degree of limitation [73].…”

Section: Autonomic Nervous System Assessmentmentioning

confidence: 99%

“…Therefore, an individual with an autonomic complete SCI (absence of supraspinal control of spinal autonomic circuits) at or above these levels will have a greater degree of cardiovascular/autonomic dysfunction than an individual with an autonomic incomplete SCI (intact or partially intact spinal autonomic circuits) [6]. The evaluation of the completeness of an injury to autonomic spinal pathways is a challenging task and various methods have been proposed as indices that reflect this function including; exercise HR [33], BP variability and resting catecholamines [34], orthostatic tolerance [35], and the degree of preservation of sympathetic skin responses (SSRs) [36,37]. The assessment of SSRs, in which sweat responses to some form of electrical stimulation (i.e., median or tibial nerve) are recorded in the hands and feet, are a measure of sympathetic cholinergic sudomotor function that has been proposed as a surrogate for the assessment of the integrity of descending autonomic spinal pathways [37,38], and has been used in both patients [39] and athletes [3,33,36] with SCI.…”

Section: Autonomic Dysreflexiamentioning

confidence: 99%

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Boosting in Elite Athletes with Spinal Cord Injury: A Critical Review of Physiology and Testing Procedures

2015

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Many individuals with spinal cord injury (SCI) experience autonomic dysfunction, which can have major implications on heart rate and blood pressure responses to exercise, and consequently athletic performance. Athletic performance may be improved by the induction of autonomic dysreflexia ('boosting'), a dangerous and sometimes life-threatening condition. Here, we review the autonomic response to exercise in individuals with SCI and the current testing methods for boosting, and examine the potential for autonomic testing to be used in the classification of SCI athletes. Given the difficulties associated with researching the effects of boosting, only three studies have compared the physiological performance of elite athletes in the boosted and unboosted state. These studies found athletes had an improved performance of ~7 to 10% in the boosted state. Blood pressure, heart rate, oxygen consumption, and circulating catecholamines were also higher in the boosted state. Although 27.1% of athletes believe that boosting was common in their sport, no athlete has ever tested positive for boosting at an event sanctioned by the International Paralympic Committee. Athletes with SCI competing in sports that have a high cardiovascular demand/aerobic component may experience the greatest benefit of boosting. Boosting improves athletic performance even at blood pressure levels well below the current threshold for disqualification set by the International Paralympic Committee, a level at which individuals with SCI are putting their health and lives at serious risk.

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Section: Boostingmentioning

confidence: 89%

Section: Autonomic Nervous System Assessmentmentioning

confidence: 94%