Rethinking aerobic exercise intensity prescription in adults with spinal cord injury: time to end the use of “moderate to vigorous” intensity?

Spinal Cord ◽

10.1038/s41393-021-00733-2 ◽

2021 ◽

Author(s):

Michael J. Hutchinson ◽

Victoria L. Goosey-Tolfrey

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Aerobic Exercise ◽

Exercise Intensity ◽

Perceived Exertion ◽

Lactate Concentration ◽

Blood Lactate Concentration ◽

Step Test ◽

Large Variability ◽

Cord Injury

Abstract Study design Cohort study. Objectives To investigate and critique different methods for aerobic exercise intensity prescription in adults with spinal cord injury (SCI). Setting University laboratory in Loughborough, UK. Methods Trained athletes were split into those with paraplegia (PARA; n = 47), tetraplegia (TETRA; n = 20) or alternate health condition (NON-SCI; n = 67). Participants completed a submaximal step test with 3 min stages, followed by graded exercise test to exhaustion. Handcycling, arm crank ergometry or wheelchair propulsion were performed depending on the sport of the participant. Oxygen uptake (V̇O2), heart rate (HR), blood lactate concentration ([BLa]) and ratings of perceived exertion (RPE) on Borg’s RPE scale were measured throughout. Lactate thresholds were identified according to log-V̇O2 plotted against log-[BLa] (LT1) and 1.5 mmol L−1 greater than LT1 (LT2). These were used to demarcate moderate (<LT1), heavy (>LT1, < LT2) and severe (>LT2) exercise intensity domains. Results Associations between percentage of peak V̇O2 (%V̇O2peak) and HR (%HRpeak) with RPE differed between PARA and TETRA. At LT1 and LT2, %V̇O2peak and %HRpeak were significantly greater in TETRA compared to PARA and NON-SCI (P < 0.05). The variation in %V̇O2peak and %HRpeak at lactate thresholds resulted in large variability in the domain distribution at fixed %V̇O2peak and %HRpeak. Conclusions Fixed %V̇O2peak and %HRpeak should not be used for aerobic exercise intensity prescription in adults with SCI as the method does not lead to uniform exercise intensity domain distribution.

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The Impact of Sub-maximal Exercise on Neuropathic Pain, Inflammation, and Affect Among Adults With Spinal Cord Injury: A Pilot Study

Frontiers in Rehabilitation Sciences ◽

10.3389/fresc.2021.700780 ◽

2021 ◽

Vol 2 ◽

Author(s):

Kendra R. Todd ◽

Jan W. Van Der Scheer ◽

Jeremy J. Walsh ◽

Garett S. Jackson ◽

Gabriel U. Dix ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Neuropathic Pain ◽

Aerobic Exercise ◽

Perceived Exertion ◽

Maximal Exercise ◽

Well Being ◽

Post Exercise ◽

Cord Injury ◽

The Impact

Introduction: Persons with spinal cord injury (SCI) often report high levels of neuropathic pain (NP) and poor well-being, which may result from increased inflammation. This study examined the impact of sub-maximal aerobic exercise on NP, inflammation and psychological affect among adults with SCI.Methods: Eight active adults with tetraplegia (n-4, AIS A-C) and paraplegia (n = 4, AIS A-C) performed 30-min of arm-crank aerobic exercise and reported their ratings of perceived exertion (RPE) each minute. Measures of NP, affect, and inflammatory cytokines (IL-6, IL-10, IL-1ra, TNF-α) were taken pre-(T0), immediately post-(T1), and 90-min post-exercise (T2).Results: NP decreased between T0 and T1 for tetraplegics (−60%, d = 0.47; CI = −0.32, 2.02) and paraplegics (−16%, d = 0.15; CI = −0.30, 0.90). Correlations between change in cytokines and change in NP were medium-to large for tetraplegics (rs ranged from −0.820 to 0.965) and paraplegics (rs ranged from −0.598 to 0.833). However, the pattern of correlations between change in cytokines and affect was inconsistent between groups. Lower baseline levels of IL-1ra predicted greater decreases in NP immediately post-exercise (r = 0.83, p = 0.01).Conclusion: Sub-maximal exercise can positively impact NP for some persons with SCI. Further experimental research should identify the optimal exercise intensity to reduce NP for persons with SCI, in addition to understanding biomarkers which may predict changes in NP.Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT03955523.

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Comparison of two Borg exertion scales for monitoring exercise intensity in able-bodied participants, and those with paraplegia and tetraplegia

Spinal Cord ◽

10.1038/s41393-021-00642-4 ◽

2021 ◽

Author(s):

Michael J. Hutchinson ◽

Ingrid Kouwijzer ◽

Sonja de Groot ◽

Victoria L. Goosey-Tolfrey

Keyword(s):

Blood Lactate ◽

Exercise Intensity ◽

Goodness Of Fit ◽

Perceived Exertion ◽

Strong Association ◽

Lactate Concentration ◽

Blood Lactate Concentration ◽

Quadratic Model ◽

Upper Body Exercise ◽

Cord Injury

Abstract Study design Cross-sectional cohort study. Objectives To compare ratings of perceived exertion (RPE) on Borg’s 6–20 RPE scale and Category Ratio 10 (CR10) in able-bodied (AB) participants during upper and lower body exercise, and recreationally active participants with paraplegia (PARA) and athletes with tetraplegia (TETRA) during upper body exercise only. Setting University and rehabilitation centre-based laboratories in UK and Netherlands. Methods Twenty-four participants were equally split between AB, PARA, and TETRA. AB performed maximal tests using cycle (AB-CYC) and handcycle (AB-HC) ergometry. PARA and TETRA performed maximal handcycle and wheelchair propulsion tests, respectively. Oxygen uptake (V̇O2) and blood lactate concentration were monitored throughout. RPE was rated each stage on Borg’s RPE scale and CR10. Thresholds were identified according to log-V̇O2 plotted against log-blood lactate (LT1), and 1.5 mmol L−1 greater than LT1 (LT2). Results RPE from both scales were best fit against each other using a quadratic model, with high goodness of fit between scales that was independent of exercise mode and participant group (range R2: 0.965–0.970, P < 0.005). Though percentage peak V̇O2 was significantly greater in TETRA (P < 0.005), there was no difference in RPE at LT1 or LT2 between groups on Borg’s RPE scale or CR10. Conclusion Strong association between Borg’s RPE scale and CR10 suggests they can be used interchangeably. RPE at lactate thresholds were independent of mode of exercise and level of spinal cord injury. However, inter-individual variation precludes from making firm recommendations about using RPE for prescribing homogenous exercise intensity.

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Cardiorespiratory Responses to 10 Weeks of Exoskeleton-Assisted Overground Walking Training inChronic Nonambulatory Patients with Spinal Cord Injury

Sensors ◽

10.3390/s21155022 ◽

2021 ◽

Vol 21 (15) ◽

pp. 5022

Author(s):

Jae Hyeon Park ◽

Hyeon Seong Kim ◽

Seong Ho Jang ◽

Dong Jin Hyun ◽

Sang In Park ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Oxygen Consumption ◽

Exercise Intensity ◽

Moderate Physical Activity ◽

Intensity Level ◽

Cardiorespiratory System ◽

Cardiorespiratory Responses ◽

Cord Injury ◽

Walking Efficiency

Exercise intensity of exoskeleton-assisted walking in patients with spinal cord injury (SCI) has been reported as moderate. However, the cardiorespiratory responses to long-term exoskeleton-assisted walking have not been sufficiently investigated. We investigated the cardiorespiratory responses to 10 weeks of exoskeleton-assisted walking training in patients with SCI. Chronic nonambulatory patients with SCI were recruited from an outpatient clinic. Walking training with an exoskeleton was conducted three times per week for 10 weeks. Oxygen consumption and heart rate (HR) were measured during a 6-min walking test at pre-, mid-, and post-training. Exercise intensity was determined according to the metabolic equivalent of tasks (METs) for SCI and HR relative to the HR reserve (%HRR). Walking efficiency was calculated as oxygen consumption divided by walking speed. The exercise intensity according to the METs (both peak and average) corresponded to moderate physical activity and did not change after training. The %HRR demonstrated a moderate (peak %HRR) and light (average %HRR) exercise intensity level, and the average %HRR significantly decreased at post-training compared with mid-training (31.6 ± 8.9% to 24.3 ± 7.3%, p = 0.013). Walking efficiency progressively improved after training. Walking with an exoskeleton for 10 weeks may affect the cardiorespiratory system in chronic patients with SCI.

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Relationship between wheelchair skills scores and peak aerobic exercise capacity of manual wheelchair users with spinal cord injury: a cross-sectional study

Disability and Rehabilitation ◽

10.1080/09638288.2018.1493545 ◽

2018 ◽

Vol 42 (1) ◽

pp. 114-121

Author(s):

R. Lee Kirby ◽

Sonja de Groot ◽

Rachel E. Cowan

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Aerobic Exercise ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Wheelchair Users ◽

Manual Wheelchair ◽

Cord Injury ◽

Aerobic Exercise Capacity

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Development of a Rehabilitation Game for Individuals With Spinal Cord Injury Using a User-Centered Design Process

2018 Design of Medical Devices Conference ◽

10.1115/dmd2018-6932 ◽

2018 ◽

Author(s):

Stuart R. Fairhurst ◽

Logan C. McCool ◽

Kristin M. Scheel ◽

Crystal L. Stien ◽

Charlotte M. Brenteson ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Video Game ◽

Perceived Exertion ◽

Interactive Video ◽

Spinal Cord Injuries ◽

Lower Limbs ◽

User Centered Design ◽

Cord Injury ◽

Interactive Video Game

The use of video games during exercise, exergaming, has been shown to increase energy expenditure without increasing perceived exertion [1]. This suggests that exergaming may be an effective way to engage a patient during rehabilitation and increase adherence to a rehabilitation regime. Existing exergame systems are designed with able bodied users in mind and often combine hand controlled game play while using lower limbs for aerobic exertion, making current systems inaccessible to individuals with spinal cord injuries and others without lower limb function. Our earlier work on increasing exercise accessibility includes developing an ergometer for supine use for patients who have recently had a flap procedure [2]. The goal of the present project was to create an engaging, interactive video game designed for use during arm ergometry by individuals with spinal cord injury (SCI) in either the supine or seated position.

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