Cardiovascular responses at the onset of passive leg cycle exercise in paraplegics with spinal cord injury

Muraki, Satoshi; Ehara, Yoshito; Yamasaki, Masahiro

doi:10.1007/s004210050042

Cited by 31 publications

(17 citation statements)

References 12 publications

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“…(Muraki et al . ) and more recently Ballaz et al . () reported that passive cycle exercise enhances both cardiac output and blood flow, but Ter Woerds et al .…”

Section: Discussionmentioning

confidence: 83%

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Passive leg movement‐induced hyperaemia with a spinal cord lesion: evidence of preserved vascular function

et al. 2013

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A spinal cord injury (SCI) clearly results in greater cardiovascular risk, however, accompanying changes in peripheral vascular structure below the lesion, mean the real impact of a SCI on vascular function is unclear. Therefore, utilizing passive leg movement-induced (PLM) hyperemia, an index of nitric oxide (NO)-dependent vascular function, and the central hemodynamic response to this intervention, we studied 8 individuals with a SCI, and 8 age-matched controls (CTRL). Specifically, we assessed heart rate (HR), stroke volume (SV), cardiac output (CO), mean arterial pressure (MAP), leg blood flow (LBF), and thigh composition. In CTRL, passive movement, transiently decreased MAP, and increased HR and CO from baseline by 2.5±1 mmHg, 7±2 bpm, and 0.5±0.1 l/min respectively. In SCI, HR and CO responses were unidentifiable. LBF increased to a greater extent in CTRL (515±41 Δml/min) compared to SCI, (126±25 Δml/min) (p<0.05). There was a strong relationship between ΔLBF and thigh muscle volume (r = 0.95). After normalizing ΔLBF for this strong relationship (ΔLBF/muscle volume), there was evidence of preserved vascular function in SCI (CTRL: 120±9; SCI 104±11 ml/min/l). A comparison of ΔLBF in the passively moved and stationary leg, to partition the contribution of the blood flow response, implied that 35% of the hyperemia resulted from cardioacceleration in the CTRL, whereas all the hyperemia appeared peripheral in origin in the SCI. Thus, utilizing PLM-induced hyperemia as marker of vascular function, it is evident that peripheral vascular impairment is not an obligatory accompaniment to a SCI.

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“…(Muraki et al . ) and more recently Ballaz et al . () reported that passive cycle exercise enhances both cardiac output and blood flow, but Ter Woerds et al .…”

Section: Discussionmentioning

confidence: 83%

“…Passive movement studies examining subjects with a SCI have yielded conflicting results, with some studies revealing significant cardiac output and peripheral blood flow responses (Muraki et al . , Ballaz et al . ), while others have reported no LBF response in this population (Ter Woerds et al .…”

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confidence: 99%

Passive leg movement‐induced hyperaemia with a spinal cord lesion: evidence of preserved vascular function

et al. 2013

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“…One is to improve orthostatic hypotension, which is common in patients with spinal cord or traumatic brain injury. Venous return and, hence, cardiac output increase during passive leg cycle exercise in healthy and in subjects with spinal cord injuries [14]. Similar effects are observed with functional electrical stimulation to induce leg cycling [15].…”

Section: Discussionmentioning

confidence: 95%

Early Poststroke Rehabilitation Using a Robotic Tilt-Table Stepper and Functional Electrical Stimulation

Кузнецов

Rybalko

Даминов

et al. 2013

Stroke Research and Treatment

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Background. Stroke frequently leaves survivors with hemiparesis. To prevent persistent deficits, rehabilitation may be more effective if started early. Early training is often limited because of orthostatic reactions. Tilt-table stepping robots and functional electrical stimulation (FES) may prevent these reactions. Objective. This controlled convenience sample study compares safety and feasibility of robotic tilt-table training plus FES (ROBO-FES) and robotic tilt-table training (ROBO) against tilt-table training alone (control). A preliminary assessment of efficacy is performed. Methods. Hemiparetic ischemic stroke survivors (age 58.3 ± 1.2 years, 4.6 ± 1.2 days after stroke) were assigned to 30 days of ROBO-FES (n = 38), ROBO (n = 35), or control (n = 31) in addition to conventional physical therapy. Impedance cardiography and transcranial doppler sonography were performed before, during, and after training. Hemiparesis was assessed using the British Medical Research Council (MRC) strength scale. Results. No serious adverse events occurred; 8 patients in the tilt-table group prematurely quit the study because of orthostatic reactions. Blood pressure and CBFV dipped <10% during robot training. In 52% of controls mean arterial pressure decreased by ≥20%. ROBO-FES increased leg strength by 1.97 ± 0.88 points, ROBO by 1.50 ± 0.85 more than control (1.03 ± 0.61, P < 0.05). CBFV increased in both robotic groups more than in controls (P < 0.05). Conclusions. Robotic tilt-table exercise with or without FES is safe and may be more effective in improving leg strength and cerebral blood flow than tilt table alone.

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“…In the exercising limbs, blood flow is primarily enhanced by vasodilation and venous ''muscle pump'' activity. Previous studies have suggested that the mechanical lengthening and shortening of the muscles during passive leg cycling promotes circulation within the lower limbs of both persons with paraplegia Muraki et al 1996Muraki et al , 2000 and able-bodied individuals (Nakazono and Miyamoto 1985;Nobrega et al 1994), with positive health benefits to the former.…”

Section: Passive Leg Cyclingmentioning

confidence: 99%

Muscle oxygenation during prolonged electrical stimulation-evoked cycling in paraplegics

Muraki

Fornusek

Raymond

et al. 2007

Appl. Physiol. Nutr. Metab.

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This study investigated cardiorespiratory responses and muscle oxygenation during prolonged electrical stimulation (ES)-evoked leg cycling in individuals with paraplegia (PARA). Four PARA and 6 able-bodied (AB) persons participated in this study. Subjects performed 10 min of passive cycling and 40 min of active cycling (PARA, ES cycling; AB, voluntary cycling) at workloads selected to elicit an equivalent oxygen uptake between groups. Cycling power output, cardiorespiratory responses, mechanical efficiency, and quadriceps muscle oxygenation (measured with near-infrared spectroscopy) were measured over the duration of the exercise. Oxygen uptake was similar in both groups during active cycling (PARA, 737+/-177 mL.min(-1); AB, 840+/-90 mL.min(-1)). The cycling power output for PARA individuals commenced at 8.8 W, but varied considerably over 40 min. PARA individuals demonstrated markedly lower gross mechanical efficiency (approximately 1.3%) during ES cycling compared with AB individuals performing voluntary exercise (approximately 12.6%). During ES cycling, muscle oxygen saturation (SO2) decreased to approximately 72+/-19%, whereas SO2 during volitional cycling was unaltered from resting levels. Muscle oxygenated haemoglobin initially decreased (-23%) during ES cycling, but returned to resting levels after 10 min. Deoxygenated haemoglobin initially rose during the first 5 min of ES cycling, and remained elevated by 28% thereafter. Upon cessation of ES cycling, lower-limb muscle oxygenation increased (+93%), suggesting reactive hyperaemia in PARA individuals after such exercise. During ES cycling, muscle oxygenation followed a different pattern to that observed in AB individuals performing voluntary cycling at an equivalent VO2. Equilibrium between oxygen demand and oxygen delivery was reached during prolonged ES cycling, despite the lack of neural adjustments of leg vasculature in the paralyzed lower limbs.

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Cardiovascular responses at the onset of passive leg cycle exercise in paraplegics with spinal cord injury

Cited by 31 publications

References 12 publications

Passive leg movement‐induced hyperaemia with a spinal cord lesion: evidence of preserved vascular function

Passive leg movement‐induced hyperaemia with a spinal cord lesion: evidence of preserved vascular function

Early Poststroke Rehabilitation Using a Robotic Tilt-Table Stepper and Functional Electrical Stimulation

Muscle oxygenation during prolonged electrical stimulation-evoked cycling in paraplegics

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