Effects of Arm-Crank Exercise on Fitness and Health in Adults With Chronic Spinal Cord Injury: A Systematic Review

Chiou, Shin Yi; Clarke, Emma; Lam, Chi Hin; Harvey, T. L.; Nightingale, Tom E.

doi:10.3389/fphys.2022.831372

Cited by 16 publications

(9 citation statements)

References 78 publications

(239 reference statements)

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“…This review revealed there were no significant subgroup differences between exercise modalities in AV ̇O2peak or RV ̇O2peak, indicating that improvements can be gained from any form of exercise intervention. The change in RV ̇O2peak in the current review (21%) is equivalent to the average 21% improvement reported in a recent systematic review on the effects of ACE in chronic SCI [107]. Whilst the current review did not exclusively investigate ACE, it is evident that aerobic, volitional upper-body Several studies directly compared the effects of specific exercise modalities on the change in CRF [54,76,114].…”

Section: Exercise Modalitymentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

“…Despite a number of recent reviews summarising the effects of specific exercise modalities on the change in CRF following SCI, including aerobic ACE [107], FES-cycling [39], and aerobic plus muscle strength training (mixed multimodal) interventions [108], this meta-analysis is the first to directly compare the effects of a wide range of exercise modalities on the change in CRF in individuals with SCI. This review revealed there were no significant subgroup differences between exercise modalities in AV ̇O2peak or RV ̇O2peak, indicating that improvements can be gained from any form of exercise intervention.…”

Section: Exercise Modalitymentioning

confidence: 99%

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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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Section: Exercise Modalitymentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Section: Exercise Modalitymentioning

confidence: 99%

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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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“…[3][4][5] Accordingly, moderate-tovigorous-intensity aerobic exercise is highly encouraged in individuals with SCI to help reduce the risk of CVD. 6 Upper-body aerobic exercise, such as arm-cycle ergometer training (ACET), is the most common modality to improve cardiometabolic health in this population; 7,8 however, some studies have shown that passive lower limb exercise such as body-weight-supported treadmill training (BWSTT) are well tolerated and have the potential to improve cardiovascular function in individuals with SCI. [9][10][11] While there is some evidence that BWSTT can improve resting cardiovascular function in SCI, little is known about the effects of BWSTT, or indeed ACET, on cardiac autonomic responses to physiological stressors such as an orthostatic challenge.…”

Section: Introductionmentioning

confidence: 99%

Effects of exercise on autonomic cardiovascular control in individuals with chronic, motor-complete spinal cord injury: an exploratory randomised clinical trial

Dorey¹,

Nightingale

Alrashidi³

et al. 2023

Preprint

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Study Design: Secondary analysis of a clinical trial. Objective: To assess the impact of 6 months of arm-cycle ergometer training (ACET), or body weight supported treadmill training (BWSTT), on autonomic cardiovascular responses to a laboratory sit-up test (SUT) in individuals with chronic (≥1-year post-injury) spinal cord injury (SCI). Setting: Canada. Methods: Sixteen individuals with motor-complete (American Spinal Injury Association Impairment Scale A-B) SCI between the fourth cervical and sixth thoracic spinal cord segments, aged 39±11 years, were assessed. Participants were randomized to receive 72 sessions of moderate-to-vigorous intensity ACET (n=8) or passive BWSTT (n=8). Changes in mean arterial pressure (MAP; finger plethysmography), hemodynamics (Modelflow® method), and heart rate/heart rate variability (HR/HRV; electrocardiography) were measured in response to SUT before and after 6 months of exercise training. Spontaneous cardiovagal baroreflex sensitivity (cvBRS) was assessed using the sequence method. Results: Neither ACET nor BWSTT impacted hemodynamic responses to SUT or the incidence of orthostatic hypotension (all P>0.36). ACET led to increased HR and high frequency (HF) power HRV responses (interaction effects, both P<0.01) to SUT following 6 months of training compared to BWSTT. Consistent with this, cvBRS improved (P<0.05) following ACET but not BWSTT. At the group level, improvements in cvBRS were highly correlated with both the HR (r=0.726, P<0.0001) and HF power (R=-0.484, P<0.01) responses to SUT. Conclusion: Six months of exercise training had no effect on BP responses to SUT in individuals with SCI. However, ACET, but not BWSTT, improved cardiovagal baroreflex control of HR in individuals with chronic, motor-complete SCI, suggesting benefits of volitional upper-body exercise. Clinical Trial Registration: NCT01718977

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“…Arm cycling exercise is a form of volitional exercise commonly used by individuals with SCI for cardiorespiratory fitness 27 . The exercise is simple and can be performed outside a clinical setting by individuals without supervision from professionals, positing an opportunity to overcome the barriers of current approaches for trunk rehabilitation.…”

Section: Introductionmentioning

confidence: 99%

Home-based arm cycling exercise improves trunk control in persons with incomplete spinal cord injury: an observational study

van Helden,

Alexander,

Cabral

et al. 2023

Sci Rep

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Arm cycling is used for cardiorespiratory rehabilitation but its therapeutic effects on the neural control of the trunk after spinal cord injury (SCI) remain unclear. We investigated the effects of single session of arm cycling on corticospinal excitability, and the feasibility of home-based arm cycling exercise training on volitional control of the erector spinae (ES) in individuals with incomplete SCI. Using transcranial magnetic stimulation, we assessed motor evoked potentials (MEPs) in the ES before and after 30 min of arm cycling in 15 individuals with SCI and 15 able-bodied controls (Experiment 1). Both groups showed increased ES MEP size after the arm cycling. The participants with SCI subsequently underwent a 6-week home-based arm cycling exercise training (Experiment 2). MEP amplitudes and activity of the ES, and movements of the trunk during reaching, self-initiated rapid shoulder flexion, and predicted external perturbation tasks were measured. After the training, individuals with SCI reached further and improved trajectory of the trunk during the rapid shoulder flexion task, accompanied by increased ES activity and MEP amplitudes. Exercise adherence was excellent. We demonstrate preserved corticospinal drive after a single arm cycling session and the effects of home-based arm cycling exercise training on trunk function in individuals with SCI.

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Effects of Arm-Crank Exercise on Fitness and Health in Adults With Chronic Spinal Cord Injury: A Systematic Review

Cited by 16 publications

References 78 publications

The effect of exercise on 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

Effects of exercise on autonomic cardiovascular control in individuals with chronic, motor-complete spinal cord injury: an exploratory randomised clinical trial

Home-based arm cycling exercise improves trunk control in persons with incomplete spinal cord injury: an observational study

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