Energy Expenditure and Heart Rate Responses to Increased Loading in Individuals With Motor Complete Spinal Cord Injury Performing Body Weight–Supported Exercises

Objective: To assess the current evidence with regard to the effects of body weight–supported treadmill training (BWSTT) on cardiovascular and pulmonary function in people with spinal cord injury (SCI) with a focus on outcomes of heart rate (HR), blood pressure (BP), and respiratory parameters. Methods: A systematic literature search was conducted through MEDLINE/PubMed, the Cumulative Index to Nursing and Allied Health Literature, and Physiotherapy Evidence Database. Clinical trials involving adults with SCI and focusing on the effects of BWSTT on HR, BP, and respiratory measurements were included. The quality of included studies was assessed using the Downs and Black scale. The level of evidence of each study was identified using the Spinal Cord Injury Rehabilitation Evidence system. Results: Nine studies that met inclusion criteria were evaluated and included in this review. Overall, the quality index of all included studies was low. All studies scored less than 21 out of 28 on the Downs and Black scale. The level of evidence varied from level 2 to level 4. Level 4 evidence supports the use of BWSTT to decrease resting and exercise HR and improve heart rate variability. The use of BWSTT to improve respiratory parameters after SCI is supported by one study with level 2 evidence. The evidence that supports the use of BWSTT to improve resting BP is inconclusive. Conclusion: There has been low to moderate evidence to support the use of BWSTT in individuals with SCI to improve cardiovascular and pulmonary health. Future randomized controlled trials are needed to investigate the effect of BWSTT on cardiovascular and pulmonary function in people with SCI and compare BWSTT to other physical rehabilitation interventions.

Download Full-text

Effects of body weight-supported treadmill training on heart rate variability and blood pressure variability in individuals with spinal cord injury

Journal of Applied Physiology ◽

10.1152/japplphysiol.01004.2004 ◽

2005 ◽

Vol 98 (4) ◽

pp. 1519-1525 ◽

Cited By ~ 68

Author(s):

David S. Ditor ◽

Mark V. Kamath ◽

Maureen J. MacDonald ◽

Joanne Bugaresti ◽

Neil McCartney ◽

...

Keyword(s):

Blood Pressure ◽

Spinal Cord ◽

Heart Rate ◽

Spinal Cord Injury ◽

Body Weight ◽

Autonomic Regulation ◽

Treadmill Training ◽

Increased Risk ◽

Cord Injury ◽

Head Up Tilt

Individuals with spinal cord injury are prone to cardiovascular dysfunction and an increased risk of cardiovascular disease. Body weight-supported treadmill training (BWSTT) may enhance ambulation in individuals with incomplete spinal cord injury; however, its effects on cardiovascular regulation have not been investigated. The purpose of this study was to examine the effects of 6-mo of BWSTT on the autonomic regulation of heart rate (HR) and blood pressure (BP) in individuals with incomplete tetraplegia. Eight individuals [age 27.6 yr (SD 5.2)] with spinal cord injury [C4–C5; American Spinal Injury Association B-C; 9.6 yr (SD 7.5) postinjury] participated. Ten-minute HR and finger arterial pressure (Finapres) recordings were collected during 1) supine rest and 2) an orthostatic stress (60° head-up tilt) before and after 6 mo of BWSTT. Frequency domain measures of HR variability [low-frequency (LF) power, high-frequency (HF) power, and LF-to-HF ratio] and BP variability (systolic and diastolic LF power) were used as clinically valuable indexes of neurocardiac and neurovascular control, respectively. There was a significant reduction in HR [61.9 (SD 6.9) vs. 55.7 beats/min (SD 7.7); P = 0.05] and LF-to-HF ratio [1.23 (SD 0.47) vs. 0.99 (SD 0.40); P < 0.05] after BWSTT. There was a significant reduction in LF systolic BP [183.1 (SD 46.8) vs. 158.4 mmHg2 (SD 45.2); P < 0.01] but no change in BP. There were no significant effects of training on HR variability or BP variability during 60° head-up tilt. In conclusion, individuals with incomplete tetraplegia retain the ability to make positive changes in cardiovascular autonomic regulation with BWSTT without worsening orthostatic intolerance.

Download Full-text

The Effect of Body Weight-Supported Treadmill Training on Muscle Morphology in an Individual With Chronic, Motor- Complete Spinal Cord Injury: A Case Study

Journal of Spinal Cord Medicine ◽

10.1080/10790268.2006.11753860 ◽

2006 ◽

Vol 29 (2) ◽

pp. 167-171 ◽

Cited By ~ 21

Author(s):

Melanie M. Adams ◽

David S. Ditor ◽

Mark A. Tarnopolsky ◽

Stuart M. Phillips ◽

Neil McCartney ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Body Weight ◽

Treadmill Training ◽

Muscle Morphology ◽

Cord Injury ◽

Complete Spinal Cord Injury

Download Full-text

Cardiovascular and Metabolic Responses to Electrical Stimulation-Induced Leg Exercise in Spinal Cord Injury

Methods of Information in Medicine ◽

10.1055/s-0038-1636852 ◽

1997 ◽

Vol 36 (04/05) ◽

pp. 372-375 ◽

Cited By ~ 9

Author(s):

J. R. Sutton ◽

A. J. Thomas ◽

G. M. Davis

Keyword(s):

Spinal Cord ◽

Heart Rate ◽

Spinal Cord Injury ◽

Cardiac Output ◽

Electrical Stimulation ◽

Knee Flexion ◽

Flexion Extension ◽

Cord Injury ◽

Leg Exercise ◽

Leg Muscle

Abstract:Electrical stimulation-induced leg muscle contractions provide a useful model for examining the role of leg muscle neural afferents during low-intensity exercise in persons with spinal cord-injury and their able-bodied cohorts. Eight persons with paraplegia (SCI) and 8 non-disabled subjects (CONTROL) performed passive knee flexion/extension (PAS), electrical stimulation-induced knee flexion/extension (ES) and voluntary knee flexion/extension (VOL) on an isokinetic dynamometer. In CONTROLS, exercise heart rate was significantly increased during ES (94 ± 6 bpm) and VOL (85 ± 4 bpm) over PAS (69 ± 4 bpm), but no changes were observed in SCI individuals. Stroke volume was significantly augmented in SCI during ES (59 ± 5 ml) compared to PAS (46 ± 4 ml). The results of this study suggest that, in able-bodied humans, Group III and IV leg muscle afferents contribute to increased cardiac output during exercise primarily via augmented heart rate. In contrast, SCI achieve raised cardiac output during ES leg exercise via increased venous return in the absence of any change in heart rate.

Download Full-text