Post-processing Peak Oxygen Uptake Data Obtained During Cardiopulmonary Exercise Testing in Individuals With Spinal Cord Injury: A Scoping Review and Analysis of Different Post-processing Strategies

Alrashidi, Abdullah; Nightingale, Tom E.; Bhangu, Gurjeet S; Bissonnette-Blais, Virgile; Krassioukov, Andrei V.

doi:10.1016/j.apmr.2022.11.015

Cited by 5 publications

(2 citation statements)

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“…Additionally, studies typically failed to utilise the training principle of progression, which during prolonged exercise interventions is essential for preventing a plateau in training adaptations and perhaps particularly important in this population for supporting the transition from an inactive lifestyle to higher levels of activity, and ultimately achieving greater CRF benefits [ 24 ]. On the whole, the reporting of O 2peak attainment criteria was poor, with only 24% of the included exercise interventions using at least 2 criterion methods for identifying when an individual had reached peak capacity, as recently recommended by Alrashidi and colleagues [ 159 ]. At least 2 methods [e.g., RPE ≥17, respiratory exchange ratio (RER) ≥1.1, plateau in oxygen uptake] should be adopted for confirming the attainment of a true O 2peak to prevent magnitudes of change in CRF from being inflated or underestimated.…”

Section: Discussionmentioning

confidence: 99%

Exercise and aerobic capacity in individuals with spinal cord injury: A systematic review with meta-analysis and meta-regression

Hodgkiss,

Bhangu,

Lunny

et al. 2023

PLoS Med

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Background A low level of cardiorespiratory fitness [CRF; defined as peak oxygen uptake (V˙O2peak) or peak power output (PPO)] is a widely reported consequence of spinal cord injury (SCI) and a major risk factor associated with chronic disease. However, CRF can be modified by exercise. This systematic review with meta-analysis and meta-regression aimed to assess whether certain SCI characteristics and/or specific exercise considerations are moderators of changes in CRF. Methods and findings Databases (MEDLINE, EMBASE, CENTRAL, and Web of Science) were searched from inception to March 2023. A primary meta-analysis was conducted including randomised controlled trials (RCTs; exercise interventions lasting >2 weeks relative to control groups). A secondary meta-analysis pooled independent exercise interventions >2 weeks from longitudinal pre-post and RCT studies to explore whether subgroup differences in injury characteristics and/or exercise intervention parameters explained CRF changes. Further analyses included cohort, cross-sectional, and observational study designs. Outcome measures of interest were absolute (AV˙O2peak) or relative V˙O2peak (RV˙O2peak), and/or PPO. Bias/quality was assessed via The Cochrane Risk of Bias 2 and the National Institute of Health Quality Assessment Tools. Certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Random effects models were used in all meta-analyses and meta-regressions. Of 21,020 identified records, 120 studies comprising 29 RCTs, 67 pre-post studies, 11 cohort, 7 cross-sectional, and 6 observational studies were included. The primary meta-analysis revealed significant improvements in AV˙O2peak [0.16 (0.07, 0.25) L/min], RV˙O2peak [2.9 (1.8, 3.9) mL/kg/min], and PPO [9 (5, 14) W] with exercise, relative to controls (p < 0.001). Ninety-six studies (117 independent exercise interventions comprising 1,331 adults with SCI) were included in the secondary, pooled meta-analysis which demonstrated significant increases in AV˙O2peak [0.22 (0.17, 0.26) L/min], RV˙O2peak [2.8 (2.2, 3.3) mL/kg/min], and PPO [11 (9, 13) W] (p < 0.001) following exercise interventions. There were subgroup differences for RV˙O2peak based on exercise modality (p = 0.002) and intervention length (p = 0.01), but there were no differences for AV˙O2peak. There were subgroup differences (p ≤ 0.018) for PPO based on time since injury, neurological level of injury, exercise modality, and frequency. The meta-regression found that studies with a higher mean age of participants were associated with smaller changes in AV˙O2peak and RV˙O2peak (p < 0.10). GRADE indicated a moderate level of certainty in the estimated effect for RV˙O2peak, but low levels for AV˙O2peak and PPO. This review may be limited by the small number of RCTs, which prevented a subgroup analysis within this specific study design. Conclusions Our primary meta-analysis confirms that performing exercise >2 weeks results in significant improvements to AV˙O2peak, RV˙O2peak, and PPO in individuals with SCI. The pooled meta-analysis subgroup comparisons identified that exercise interventions lasting up to 12 weeks yield the greatest change in RV˙O2peak. Upper-body aerobic exercise and resistance training also appear the most effective at improving RV˙O2peak and PPO. Furthermore, acutely injured, individuals with paraplegia, exercising for ≥3 sessions/week will likely experience the greatest change in PPO. Ageing seemingly diminishes the adaptive CRF responses to exercise training in individuals with SCI. Registration PROSPERO: CRD42018104342

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Section: Discussionmentioning

confidence: 99%

Exercise and aerobic capacity in individuals with spinal cord injury: A systematic review with meta-analysis and meta-regression

Hodgkiss,

Bhangu,

Lunny

et al. 2023

PLoS Med

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“…Attainment of VȮ 2peak required meeting two of the following three criteria: (1) plateau in VȮ 2 , (2) respiratory exchange ratio (RER) ≥ 1.15, and (3) RPE ≥ 19. 31 Ventilatory thresholds (V T ) were identi ed using a variety of strategies and via an online application tool. 32,33 All thresholds were agreed upon by two independent raters and enabled the identi cation of a workload corresponding to either V T2 (prescribed for ESCS P1 and TSCS P1) or the midpoint between V T1 and V T2 (prescribed for ESCS P2 and TSCS P2).…”

Section: Study Design and Assessmentsmentioning

confidence: 99%

Ergogenic effects of spinal cord stimulation on exercise performance following spinal cord injury

Hodgkiss,

Williams,

Shackleton

et al. 2024

Preprint

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Importance: Cervical or upper-thoracic spinal cord injury (SCI, ≥T6) often leads to low resting blood pressure and impaired cardiovascular responses to acute exercise due to disrupted supraspinal sympathetic drive. Epidural (invasive, ESCS) and transcutaneous spinal cord stimulation (non-invasive, TSCS) have been used to target sympathetic circuits and modulate cardiovascular responses, yet their impact on submaximal upper-body exercise performance in individuals with SCI is unknown. Objective To compare the effects of cardiovascular-optimised ESCS and TSCS versus sham ESCS and TSCS on modulating cardiovascular responses and improving submaximal upper-body exercise performance in individuals with SCI. Design: Double-blinded, randomised comparison trial. Setting: Research center. Participants: Seven males with a chronic, motor-complete SCI between C6-T4, underwent a mapping session to identify cardiovascular responses to spinal cord stimulation. Subsequently, four participants (two ESCS and two TSCS) completed submaximal exercise testing. Exposures: Stimulation parameters (waveform, frequency, intensity, epidural electrode array configuration, specific transcutaneous electrode locations in the lumbosacral region) were optimized to elevate cardiovascular responses (CV-SCS). A sham condition (SHAM-SCS) served as a comparison. Participants performed arm-crank exercise to fatigue at a fixed workload corresponding to above ventilatory threshold, on separate days, with CV-SCS or SHAM-SCS. Main Outcomes and Measures: The primary outcome was time to fatigue during submaximal exercise. Heart rate and gas exchange variables were recorded throughout exercise and used to calculate oxygen pulse (a surrogate for stroke volume, SV). Blood pressure (BP) was monitored before exercise (pre-post applying stimulation). Rating of perceived exertion (RPE) was recorded every 5-min. Results CV-SCS increased resting BP, left ventricular cardiac contractility and total peripheral resistance. CV-SCS increased time to fatigue with ESCS and TSCS, relative to SHAM-SCS. Relative to baseline, change in systolic BP at rest was greater with CV-SCS versus SHAM-SCS. Peak oxygen pulse during exercise was greater with CV-SCS relative to SHAM-SCS. Furthermore, RPE tended to be lower with CV-SCS than SHAM-SCS during exercise. Conclusions and Relevance: Comparable improvements in time to fatigue with ESCS and TSCS suggest that both approaches could be promising ergogenic aids to support exercise performance or rehabilitation, along with reducing fatigue during activities of daily living in individuals with SCI.

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Consensus-Based Recommendations for Designing, Delivering, Evaluating, and Reporting Exercise Intervention Research Involving People Living With a Spinal Cord Injury

Ponzano,

Nash,

Bilzon

et al. 2024

Archives of Physical Medicine and Rehabilitation

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Post-processing Peak Oxygen Uptake Data Obtained During Cardiopulmonary Exercise Testing in Individuals With Spinal Cord Injury: A Scoping Review and Analysis of Different Post-processing Strategies

Cited by 5 publications

References 231 publications

Exercise and aerobic capacity in individuals with spinal cord injury: A systematic review with meta-analysis and meta-regression

Exercise and aerobic capacity in individuals with spinal cord injury: A systematic review with meta-analysis and meta-regression

Ergogenic effects of spinal cord stimulation on exercise performance following spinal cord injury

Consensus-Based Recommendations for Designing, Delivering, Evaluating, and Reporting Exercise Intervention Research Involving People Living With a Spinal Cord Injury

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