Exercise Guidelines to Promote Cardiometabolic Health in Spinal Cord Injured Humans: Time to Raise the Intensity?

Abstract

Spinal cord injury (SCI) is a life-changing event that, as a result of paralysis, negatively influences habitual levels of physical activity and hence cardiometabolic health. Performing regular structured exercise therefore appears extremely important in persons with SCI. However, exercise options are mainly limited to the upper body, which involves a smaller activated muscle mass compared with the mainly leg-based activities commonly performed by nondisabled individuals. Current exercise guidelines for SCI focus predominantly on relative short durations of moderate-intensity aerobic upper-body exercise, yet contemporary evidence suggests this is not sufficient to induce meaningful improvements in risk factors for the prevention of cardiometabolic disease in this population. As such, these guidelines and their physiological basis require reappraisal. In this special communication, we propose that high-intensity interval training (HIIT) may be a viable alternative exercise strategy to promote vigorous-intensity exercise and prevent cardiometabolic disease in persons with SCI. Supplementing the limited data from SCI cohorts with consistent findings from studies in nondisabled populations, we present strong evidence to suggest that HIIT is superior to moderate-intensity aerobic exercise for improving cardiorespiratory fitness, insulin sensitivity, and vascular function. The potential application and safety of HIIT in this population is also discussed. We conclude that increasing exercise intensity could offer a simple, readily available, time-efficient solution to improve cardiometabolic health in persons with SCI. We call for high-quality randomized controlled trials to examine the efficacy and safety of HIIT in this population.

Hemodynamic and cardiorespiratory responses to various arm cycling regimens in men with spinal cord injury

“…In able-bodied adults, higher intensity exercise such as interval training leads to superior increases in VO 2 max than moderate exercise which is beneficial to overall health status. In fact, Nightingale et al [32] proposed that HIIT may be a viable alternative to MICE in persons with SCI to markedly improve fitness and health status. This is an important consideration since some data show that chronic MICE does not alter many outcomes related to cardiometabolic health in persons with SCI [33].…”

Time-efficient and computer-guided sprint interval exercise training for improving health in the workplace: a randomised mixed-methods feasibility study in office-based employees

“…The majority of this work has concentrated on cardiorespiratory exercise modalities in which the exercise bouts are applied in short intervals of (sub) maximal ('high-intensity interval training' [HIIT]) or supramaximal ('sprint interval training' [SIT]) intensity exercise bouts, interspersed with periods of lowintensity or resting recovery. There is now a convincing body of evidence demonstrating that, at least in the short-term, both HIIT and SIT are associated with very similar, and in some cases superior, cardiometabolic health benefits compared with currently recommended moderate-intensity continuous training (MICT [19][20][21]; ). However, multiple sprint repetitions combined with the need for recovery intervals mean that many HIIT and SIT protocols are not as time-efficient as often claimed, with most taking~22-40 min per training session [19].…”

Leisure time physical activity participation in individuals with spinal cord injury in Malaysia: barriers to exercise

“…Participation in LTPA among the population with SCI globally consistently has shown that no more than 52% [5][6][7][8][9] undertake such activities on a regular basis. Although LTPA is an important component for improving positive psychological well-being and quality of life among a population with chronic SCI [10], performing LTPA alone may not necessarily be sufficient to provide health benefits or raise cardiometabolic fitness [11]. In addition, activities of daily living among individuals with SCI who use wheelchairs, as opposed to the able-bodied, may not be adequate for producing intensities that are health beneficial [12,13], though some studies have reported otherwise [14,15].…”