Cardiovascular Responses and Postexercise Hypotension After Arm Cycling Exercise in Subjects With Spinal Cord Injury

Claydon, Victoria E.; Hol, Adrienne T.; Eng, Janice J.; Krassioukov, Andrei V.

doi:10.1016/j.apmr.2006.05.011

Cited by 94 publications

(56 citation statements)

References 52 publications

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“…Considering heart rate reserve in subjects with SCI is important because those with high injury levels in particular tend to have slightly lower resting heart rates and markedly lower peak heart rates. 8,11 By normalizing HRR for differences in HRrest and HRpeak (Figure 1), the effects of differences in heart rate reserve were removed. After normalizing for heart rate reserve, HRR actually declined more rapidly in subjects with tetraplegia ( Figure 3).…”

Section: Discussionmentioning

confidence: 99%

“…HRR has the potential to better characterize the degree of autonomic imbalance in SCI, and several groups have recently used HRR for this purpose. [9][10][11] Previous studies on HRR have generally compared only heart rate at a given point in recovery (for example, 1 or 2 min) between patients with favorable and poor outcomes. Some investigators have theorized that the transition processes from sympathetic control of heart rate at peak exercise to vagally mediated heart rate at rest are reflected in the shape of the HRR curve, providing additional insight into autonomic balance.…”

Section: Introductionmentioning

confidence: 99%

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Post-exercise heart rate recovery in individuals with spinal cord injury

et al. 2010

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Study design: Prospective comparison of spinal cord injured (SCI) subjects and ambulatory subjects. Objectives: To determine the effects of the presence and level of SCI on heart rate recovery (HRR). Setting: Outpatient SCI center. Methods: HRR was determined in 63 SCI subjects (26 with tetraplegia, 22 with high-level paraplegia, 15 with low-level paraplegia) and 26 ambulatory subjects. To adjust for differences in heart rate reserve between groups (HRpeak minus HRrest), HRR was also 'normalized' to a range of 1 at peak heart rate and to 0 at 8 min, and the shapes of HRR curves were compared. Results: Although absolute HRR was similar between high-and low-level paraplegia, it was significantly more rapid in participants with paraplegia at 2, 5 and 8 min after exercise than in those with tetraplegia (39±14 vs 29±14 b.p.m., Po0.05; 51±14 vs 33±16 b.p.m., Po0.01 and 52±16 vs 36 ± 17 b.p.m., Po0.01, respectively). HRR among ambulatory subjects was more rapid than among those with tetraplegia at all time points in recovery. However, when normalized for heart rate reserve, HRR was significantly more rapid in tetraplegic subjects (Po0.001 vs paraplegia and ambulatory subjects). Conclusion: In SCI, HRR is strongly associated with the peak exercise level and peak heart rate achieved during exercise testing.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Post-exercise heart rate recovery in individuals with spinal cord injury

et al. 2010

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“…SCI volunteers underwent the ASIA assessment of neurological level and severity of injury to motor and sensory pathways (39). Injury to descending (sympathetic) autonomic pathways was assessed from sympathetic skin responses (SSR), as described previously (8,10). ASIA examinations and SSR were obtained on the same morning as data for the present study.…”

Section: Methodsmentioning

confidence: 99%

Clinical correlates of frequency analyses of cardiovascular control after spinal cord injury

Claydon

Krassioukov²

2008

American Journal of Physiology-Heart and Circulatory Physiology

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Claydon VE, Krassioukov AV. Clinical correlates of frequency analyses of cardiovascular control after spinal cord injury. Am J Physiol Heart Circ Physiol 294: H668 -H678, 2008. First published November 16, 2007 doi:10.1152/ajpheart.00869.2007.-Spinal cord injury (SCI) has profound effects on cardiovascular autonomic function due to injury to descending autonomic pathways, and cardiovascular diseases are the leading causes of morbidity and mortality after SCI. Evaluation of cardiovascular autonomic dysfunction after SCI and appraisal of simple noninvasive autonomic assessments that are clinically meaningful would be useful to SCI clinicians and researchers. We aimed to assess supine and upright cardiovascular autonomic function from frequency analyses of heart rate and blood pressure variability (HRV and BPV) after SCI. We studied 26 subjects with chronic cervical or thoracic SCI and 17 able-bodied controls. We continuously recorded R-R interval (RRI, by ECG) and beat-to-beat blood pressure (by Finometer) in supine and seated positions. Cardiovascular control was assessed from spectral analysis of RRI and blood pressure time series. Cardiac baroreflex control was assessed from cross-spectral analyses of low-frequency spectra. Supine and upright low-frequency HRV and BPV were reduced in cervical SCI subjects, as were total BPV and HRV. Supine high-frequency HRV was reduced in thoracic SCI subjects. Cardiac baroreflex delay was increased in cervical SCI subjects. Supine frequency domain indexes were correlated with sympathetic skin responses, orthostatic cardiovascular responses, and plasma catecholamine levels. SCI results in reduced sympathetic drive to the heart and vasculature and increased baroreflex delay in cervical SCI subjects and reduced cardiac vagal tone in thoracic SCI subjects. Frequency analyses of autonomic function are related to clinical measures of autonomic control after SCI and provide useful noninvasive clinical tools with which to assess autonomic completeness of injury following SCI. baroreceptor reflex; autonomic nervous system; spectral analysis SPINAL CORD INJURY (SCI) is associated with abnormal cardiovascular control that is related to the level and severity of injury to descending autonomic (sympathetic) pathways (10,15,35). The leading cause of morbidity and mortality in SCI individuals is cardiovascular disease (16,45). This most commonly manifests as neurogenic shock (in acute SCI) (35); supine hypotension (35); orthostatic hypotension (marked decreases in blood pressure in the upright position) (10, 11); autonomic dysreflexia (profound and life-threatening blood pressure increases following afferent stimulation below the lesion) (35); ECG abnormalities and arrhythmia (38), particularly during autonomic dysreflexia (9, 14); and abnormal cardiovascular responses to exercise (8).The severe impact of cardiovascular dysfunction on quality of life after SCI has prompted the search for simple physiological bedside assessments of autonomic function that can easily be performed in the clin...

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“…A reference of able-bodied individuals was not included. 13 Dela et al demonstrated a significant decrease in BP in six individuals with tetraplegia during electrically induced exercise, while individuals with paraplegia demonstrated a non-significant decrease and able-bodied controls showed no change. 14 The aim of the current study was to describe the differences in the BP response between able-bodied individuals and individuals with cervical SCI following a graded exercise test.…”

Section: Introductionmentioning

confidence: 99%

“…9,12 There are limited reports in the literature on the blood pressure (BP) response to peak voluntary exercise in individuals with tetraplegia. 13,14 Claydon et al reported transient post-exercise hypotension in individuals with cervical SCI, but not in those with thoracic SCI. A reference of able-bodied individuals was not included.…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular response to peak voluntary exercise in males with cervical spinal cord injury

Machač

Radvanský

Kolář

et al. 2015

The Journal of Spinal Cord Medicine

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Context/Objective: Traumatic damage to the cervical spinal cord is usually associated with a disruption of the autonomic nervous system (ANS) and impaired cardiovascular control both during and following exercise. The magnitude of the cardiovascular dysfunction remains unclear. The aim of the current study was to compare cardiovascular responses to peak voluntary exercise in individuals with tetraplegia and able-bodied participants. Design: A case-control study. Subjects: Twenty males with cervical spinal cord injury (SCI) as the Tetra group and 27 able-bodied males as the Control group were included in the study. Outcome Measures: Blood pressure (BP) response one minute after the peak exercise, peak heart rate (HR peak ), and peak oxygen consumption (VO 2peak ) on an arm crank ergometer were measured. In the second part of the study, 17 individuals of the Control group completed the Tetra group's workload protocol with the same parameters recorded. Results: There was no increase in BP in response to the exercise in the Tetra group. Able-bodied individuals exhibited significantly increased post-exercise systolic BP after the maximal graded exercise test (123±16%) and after completion of the Tetra group's workload protocol (114±11%) as compared to pre-exercise. The Tetra group VO 2peak was 59% and the HR peak was 73% of the Control group VO 2peak and HR peak , respectively. Conclusions: BP did not increase following maximal arm crank exercise in males with a cervical SCI unlike the increases observed in the Control group. Some males in the Tetra group appeared to be at risk of severe hypotension following high intensity exercise, which can limit the ability to progressive increase and maintain high intensity exercise.

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Cardiovascular Responses and Postexercise Hypotension After Arm Cycling Exercise in Subjects With Spinal Cord Injury

Cited by 94 publications

References 52 publications

Post-exercise heart rate recovery in individuals with spinal cord injury

Post-exercise heart rate recovery in individuals with spinal cord injury

Clinical correlates of frequency analyses of cardiovascular control after spinal cord injury

Cardiovascular response to peak voluntary exercise in males with cervical spinal cord injury

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