scholarly journals Exercise-induced diaphragm fatigue in a Paralympic champion rower with spinal cord injury

2018 ◽  
Vol 124 (3) ◽  
pp. 805-811 ◽  
Author(s):  
Nicholas B. Tiller ◽  
Thomas R. Aggar ◽  
Christopher R. West ◽  
Lee M. Romer
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Pulmonary Ventilation ◽  
Time Trial ◽  
Upper Body ◽  
Upper Body Exercise ◽  
Transdiaphragmatic Pressure ◽  
Cord Injury ◽  
Exercise Induced ◽  
Diaphragm Fatigue

The aim of this case report was to determine whether maximal upper body exercise was sufficient to induce diaphragm fatigue in a Paralympic champion adaptive rower with low-lesion spinal cord injury (SCI). An elite arms-only oarsman (age: 28 yr; stature: 1.89 m; and mass: 90.4 kg) with motor-complete SCI (T12) performed a 1,000-m time trial on an adapted rowing ergometer. Exercise measurements comprised pulmonary ventilation and gas exchange, diaphragm EMG-derived indexes of neural respiratory drive, and intrathoracic pressure-derived indexes of respiratory mechanics. Diaphragm fatigue was assessed by measuring pre- to postexercise changes in the twitch transdiaphragmatic pressure (Pdi,tw) response to anterolateral magnetic stimulation of the phrenic nerves. The time trial (248 ± 25 W, 3.9 min) elicited a peak O2 uptake of 3.46 l/min and a peak pulmonary ventilation of 150 l/min (57% MVV). Breath-to-stroke ratio was 1:1 during the initial 400 m and 2:1 thereafter. The ratio of inspiratory transdiaphragmatic pressure to diaphragm EMG (neuromuscular efficiency) fell from rest to 600 m (16.0 vs. 3.0). Potentiated Pdi,tw was substantially reduced (−33%) at 15–20 min postexercise, with only partial recovery (−12%) at 30–35 min. This is the first report of exercise-induced diaphragm fatigue in SCI. The decrease in diaphragm neuromuscular efficiency during exercise suggests that the fatigue was partly due to factors independent of ventilation (e.g., posture and locomotion). NEW & NOTEWORTHY This case report provides the first objective evidence of exercise-induced diaphragm fatigue in spinal cord injury (SCI) and, for that matter, in any population undertaking upper body exercise. Our data support the notion that high levels of exercise hyperpnea and factors other than ventilation (e.g., posture and locomotion) are responsible for the fatigue noted after upper body exercise. The findings extend our understanding of the limits of physiological function in SCI.

Upper-Body Exercise Improves Indices of Physical and Psychological Functioning in Persons With Spinal Cord Injury

2017 ◽  
Vol 98 (10) ◽  
pp. e18
Author(s):  
James Bilzon ◽  
Peter Rouse ◽  
Jean-Philippe Walhin ◽  
Dylan Thompson ◽  
Tom Nightingale
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Psychological Functioning ◽  
Upper Body ◽  
Upper Body Exercise ◽  
Cord Injury

scholarly journals No effect of arm-crank exercise on diaphragmatic fatigue or ventilatory constraint in Paralympic athletes with cervical spinal cord injury

2010 ◽  
Vol 109 (2) ◽  
pp. 358-366 ◽  
Author(s):  
Bryan J. Taylor ◽  
Christopher R. West ◽  
Lee M. Romer
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cervical Spinal Cord ◽  
Work Of Breathing ◽  
Cervical Spinal Cord Injury ◽  
Flow Volume ◽  
Transdiaphragmatic Pressure ◽  
Cord Injury ◽  
Diaphragmatic Fatigue ◽  
Exercise Induced

Cervical spinal cord injury (CSCI) results in a decrease in the capacity of the lungs and chest wall for pressure, volume, and airflow generation. We asked whether such impairments might increase the potential for exercise-induced diaphragmatic fatigue and mechanical ventilatory constraint in this population. Seven Paralympic wheelchair rugby players (mean ± SD peak oxygen uptake = 16.9 ± 4.9 ml·kg−1·min−1) with traumatic CSCI (C5–C7) performed arm-crank exercise to the limit of tolerance at 90% of their predetermined peak work rate. Diaphragm function was assessed before and 15 and 30 min after exercise by measuring the twitch transdiaphragmatic pressure (Pdi,tw) response to bilateral anterolateral magnetic stimulation of the phrenic nerves. Ventilatory constraint was assessed by measuring the tidal flow volume responses to exercise in relation to the maximal flow volume envelope. Pdi,tw was not different from baseline at any time after exercise (unpotentiated Pdi,tw = 19.3 ± 5.6 cmH2O at baseline, 19.8 ± 5.0 cmH2O at 15 min after exercise, and 19.4 ± 5.7 cmH2O at 30 min after exercise; P = 0.16). During exercise, there was a sudden, sustained rise in operating lung volumes and an eightfold increase in the work of breathing. However, only two subjects showed expiratory flow limitation, and there was substantial capacity to increase both flow and volume (<50% of maximal breathing reserve). In conclusion, highly trained athletes with CSCI do not develop exercise-induced diaphragmatic fatigue and rarely reach mechanical ventilatory constraint.

scholarly journals The effects of upper body exercise on the physical capacity of people with a spinal cord injury: a systematic review

2007 ◽  
Vol 21 (4) ◽  
pp. 315-330 ◽  
Author(s):  
Linda Valent ◽  
Annet Dallmeijer ◽  
Han Houdijk ◽  
Eelkje Talsma ◽  
Luc van der Woude
Keyword(s):  
Systematic Review ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Physical Capacity ◽  
Upper Body ◽  
Upper Body Exercise ◽  
Cord Injury

VO2 Off-Kinetics Following Exhaustive Upper Body Exercise Test in Spinal Cord Injury

2017 ◽  
Vol 49 (5S) ◽  
pp. 629-630
Author(s):  
Donal Murray ◽  
Rachel E. Cowan ◽  
Suzanne L. Groah ◽  
Inger H. Liungberg ◽  
Amanda K. Rounds ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Exercise Test ◽  
Upper Body ◽  
Upper Body Exercise ◽  
Cord Injury

scholarly journals Recovery Off-Kinetics Following Exhaustive Upper Body Exercise in Spinal Cord Injury

2020 ◽  
Vol 26 (4) ◽  
pp. 304-313
Author(s):  
Donal Murray ◽  
Lisa M.K. Chin ◽  
Rachel E. Cowan ◽  
Suzanne L. Groah ◽  
Randall E. Keyser
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Vigorous Physical Activity ◽  
Exponential Model ◽  
Cardiopulmonary Exercise Test ◽  
Lactate Clearance ◽  
Upper Body ◽  
Control Group ◽  
Upper Body Exercise ◽  
Cord Injury

Background: People with spinal cord injury (SCI) present with impaired autonomic control when the lesion is above T6. This could lead to delayed cardiorespiratory recovery following vigorous physical activity. Objectives: To characterize and compare gas exchange off-kinetics following exhaustive exercise in individuals with SCI and an apparently healthy control group. Methods: Participants were 19 individuals with SCI who presented with the inability to voluntarily lift their legs against gravity (age, 44.6 ± 14.2 years; AIS A, n = 5; AIS B, n = 7; AIS C, n = 7; paraplegia, n = 14; tetraplegia, n = 5) and 10 healthy comparisons (COM; age, 30.5 ± 5.3 years). All participants performed an arm ergometer cardiopulmonary exercise test (aCPET) to volitional exhaustion followed by a 10-minute passive recovery. O2 uptake (V̇o2) and CO2 output (V̇co2) off-kinetics was examined using a mono-exponential model in which tau off (τoff) and mean response time (MRT) were determined. The off-kinetics transition constant (Ktoff) was calculated as ΔV̇o2/MRT. Student t tests were used to compare SCI versus COM group means. Results: COM had a significantly higher relative peak V̇o2 compared to SCI (1.70 ± 0.55 L/min vs 1.19 ± 0.51 L/min, p = .019). No difference was observed for τoff between the groups, however Ktoff for both V̇o2 and V̇co2 was significantly lower in the SCI compared to the COM group. Conclusion: A reduced Ktoff during recovery may suggest inefficiencies in replenishing muscle ATP stores and lactate clearance in these participants with SCI. These findings may contribute to the observed lower cardiorespiratory fitness and greater fatigability typically reported in individuals with SCI.

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