Exercise Improves Cardiorespiratory Fitness, but Not Arterial Health, after Spinal Cord Injury: The CHOICES Trial

Abstract

Data availability statement:The CHOICES trial protocol and statistical analysis plan have been published. The datasets that were collected and analyzed for the purpose of this trial are available with de-identified participants data from the corresponding author upon reasonable request, subject to a standard data-sharing agreement.

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

“… Ordonez et al (2013) and Rosety-Rodriguez et al (2014) , as well as Nightingale et al (2017b , 2018) reported different outcome measures from the same group of participants; the results from these corresponding studies by the same authors were combined and reported as a single study. Since the purpose of this review was to determine the effects of ACE in chronic SCI, studies comparing ACE with a different type of intervention [e.g., whole-body exercise ( Alrashidi et al, 2021 ), strength training ( Jacobs, 2009 ), functional electrical stimulation ( Farkas et al, 2021 )] or comparing SCI with non-injured adults ( El-Sayed and Younesian, 2005 ; Horiuchi and Okita, 2017 ) were treated as pre-post studies without a control group and only data from the ACE group were extracted. Three RCTs, one non-RCT, and thirteen pre-post studies were identified.…”

“…Exercise intensity was commonly prescribed based on a percentage of peak oxygen consumption (V̇O 2peak ) (5/17), peak heart rate (for level of injury below T6; 3/17) or peak heart rate reserve (for level of injury above T6; 3/17), or using ratings of perceived exertion (e.g., Borg CR10 scale or Borg RPE 6-20 scale; 3/17). In addition, exercise intensity in each study was defined as either light, moderate, moderate-to-vigorous, or vigorous-intensity based on the classification of the American College of Sport Medicine ( Mitchell et al, 2019 ; American College of Sports, 2021 ) ( Table 3 ); one study used light-intensity ( Brizuela et al, 2020 ), three studies employed moderate-intensity ( McLean and Skinner, 1995 ; Dyson-Hudson et al, 2007 ; Farkas et al, 2021 ), nine applied moderate-to-vigorous-intensity ( Davis et al, 1987 ; DiCarlo, 1988 ; El-Sayed and Younesian, 2005 ; Ordonez et al, 2013 ; Horiuchi and Okita, 2017 ; Nightingale et al, 2017b ; Graham et al, 2019 ; Williams et al, 2020 ; Alrashidi et al, 2021 ), and four trained at vigorous-intensity ( Silva et al, 1998 ; Jacobs, 2009 ; Harnish et al, 2017 ; Bresnahan et al, 2019 ). Arm cranking speed was between 50 and 60 revolutions per minute.…”

“…Fifteen studies reported outcomes of cardiorespiratory fitness using graded cardiopulmonary exercise testing, performed on an arm-crank ergometer to volitional exhaustion to identify peak oxygen consumption (V̇O 2peak ) and peak power output ( Davis et al, 1987 , 1991 ; DiCarlo, 1988 ; McLean and Skinner, 1995 ; El-Sayed and Younesian, 2005 ; Jacobs, 2009 ; Ordonez et al, 2013 ; Harnish et al, 2017 ; Horiuchi and Okita, 2017 ; Nightingale et al, 2017b ; Bresnahan et al, 2019 ; Graham et al, 2019 ; Williams et al, 2020 ; Alrashidi et al, 2021 ; Farkas et al, 2021 ). Two studies used spirometry to assess pulmonary function and measured forced vital capacity (FVC) and maximum voluntary ventilation (MVV) ( Silva et al, 1998 ; Brizuela et al, 2020 ).…”

“…Of the two studies using spirometry, one reported no change in FVC and increased MVV after the intervention ( Brizuela et al, 2020 ), whereas the other study reported increased FVC but no change in MVV between pre- and post-intervention values ( Silva et al, 1998 ). Twelve studies reported the outcome of peak power output obtained from the graded cardiopulmonary exercise testing ( DiCarlo, 1988 ; McLean and Skinner, 1995 ; El-Sayed and Younesian, 2005 ; Jacobs, 2009 ; Harnish et al, 2017 ; Horiuchi and Okita, 2017 ; Nightingale et al, 2017b ; Bresnahan et al, 2019 ; Graham et al, 2019 ; Brizuela et al, 2020 ; Williams et al, 2020 ; Alrashidi et al, 2021 ). Of the twelve studies, ten reported a statistically significant increase in peak power after the ACE intervention ( g = 0.05–5.91; large [≥0.8]: 3/10; medium [≥0.5]: 4/10; small [≥0.2]: 1/10; <0.2 or uncalculatable: 2/10) ( DiCarlo, 1988 ; McLean and Skinner, 1995 ; El-Sayed and Younesian, 2005 ; Jacobs, 2009 ; Harnish et al, 2017 ; Horiuchi and Okita, 2017 ; Nightingale et al, 2017b ; Bresnahan et al, 2019 ; Brizuela et al, 2020 ; Williams et al, 2020 ); two reported no change in peak power ( Graham et al, 2019 ; Alrashidi et al, 2021 ).…”

“…There were nine included studies reporting outcomes relating to CVD risk factors ( Davis et al, 1987 ; El-Sayed and Younesian, 2005 ; Harnish et al, 2017 ; Horiuchi and Okita, 2017 ; Nightingale et al, 2017b ; Bresnahan et al, 2019 ; Graham et al, 2019 ; Alrashidi et al, 2021 ; Farkas et al, 2021 ).…”