Limits to Maximal Performance in Individuals with Spinal Cord Injury

Hopman, Maria T. E.; Dueck, C. A.; Monroe, M. B.; Philips, W. T.; Skinner, James S.

doi:10.1055/s-2007-971889

Cited by 70 publications

(54 citation statements)

References 16 publications

(33 reference statements)

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“…The outcome of the maximal exercise tests were expressed as peak levels of oxygen uptake and power output (instead of maximal levels), because some subjects may have been able to activate a larger muscle mass, either through activation of the lower limbs (eg in those with incomplete lesion), or without the restraints from overuse and fatigue of the upper extremities. 21,34,75 The large variability in results found in paraplegia may be attributed to differences in measurement protocol 20,23,74 and study population. 3 Because of lack of homogeneity, no consistent conclusions on the influence of a particular protocol can be drawn.…”

Section: Discussionmentioning

confidence: 99%

“…Secondly, peak heart rate is not a valid measure of physical capacity in SCI, and is not sensitive to change during training. 1,34,75 Reasons for this may be that upper body exercise is limited by local fatigue and overuse (rather than cardiovascular strain), and that peak heart rate varies too much in persons with a tetraplegia. 20,21,24,71 Overall, a positive selection is shown which will bias the results.…”

Section: Limitationsmentioning

confidence: 99%

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Physical capacity in wheelchair-dependent persons with a spinal cord injury: a critical review of the literature

et al. 2006

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Study design: Review of publications. Objective: To assess the level of physical capacity (peak oxygen uptake, peak power output, muscle strength of the upper extremity and respiratory function) in wheelchair-dependent persons with a spinal cord injury (SCI). Setting: Erasmus MC, University Medical Centre Rotterdam, The Netherlands. Methods: Pubmed (Medline) search of publications from 1980 onwards. Studies were systematically assessed. Weighted means were calculated for baseline values. Results: In tetraplegia, the weighted mean for peak oxygen uptake was 0.89 l/min for the wheelchair exercise test (WCE) and 0.87 l/min for arm-cranking or hand-cycling (ACE). The peak power output was 26 W (WCE) and 40 W (ACE). In paraplegia, the peak oxygen uptake was 2.10 l/min (WCE) and 1.51 l/min (ACE), whereas the peak power output was 74 W (ACE) and 85 W (WCE). In paraplegia, muscle strength of the upper extremity and respiratory function were comparable to that in the able-bodied population. In tetraplegia muscle strength varied greatly, and respiratory function was reduced to 55-59% of the predicted values for an age-, gender-and height-matched able-bodied population. Conclusions: Physical capacity is reduced and varies in SCI. The variation between results is caused by population and methodological differences. Standardized measurement of physical capacity is needed to further develop comparative values for clinical practice and rehabilitation research.

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Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

Physical capacity in wheelchair-dependent persons with a spinal cord injury: a critical review of the literature

et al. 2006

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“…The median sample size of included studies was 13 (range: 21 Did not use abdominal binder in study Hoit, 2002 22 Two subjects only Hopman, 1998 23 Stockings and abdominal binder combined variable Hopman, 1998 24 Stockings and abdominal binder combined variable Kline, 1981 25 Didactic comment on AB use for hypotension Kirby, 1966 26 Did not measure in sitting/no corset Koulouris, 1989 27 Normal subjects only MacLean, 1989 28 Not SCI subjects Sataloff, 1984 29 Single case study Smit, 2004 18 Not SCI subjects & no respiratory parameters Urmey, 1986 16 Investigated mechanics of breathing rather than volumetric data with AB Van Lieshout,1991 30 Single case study…”

Section: Sample Size and Clinical Presentationmentioning

confidence: 99%

Abdominal binder use in people with spinal cord injuries: a systematic review and meta-analysis

et al. 2008

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Study design: Systematic review and meta-analysis. Objectives: To review the evidence for the use of an abdominal binder on breathing, speech and cardiovascular function in people who have suffered a spinal cord injury (SCI). Setting: Brisbane, Australia. Methods: A search of multiple databases (Medline, Cinahl, Cochrane, Embase, PEDro) was undertaken accompanied by the reference list evaluation of each relevant publication identified. Methodological quality of studies identified was assessed using the PEDro scale. The size of effect of an abdominal binder on outcomes was also calculated where sufficient data were reported. Further descriptive analysis was performed. Results: Eleven studies met the review inclusion criteria and employed either crossover or within subject designs. Comparison of studies involving elastic and non-elastic binders was performed. A PEDro mean score of 4.3 out of 8 (range: 3-6) was found. Meta-analysis indicated that the use of abdominal binders improved vital capacity (VC) by (weighted mean difference (95% confidence interval (CI)) 0.32 (0.09, 0.55) litres, decreased functional residual capacity (FRC) by 0.41 (0.14, 0.67) litres, but did not significantly influence total lung capacity (TLC). Conclusions: This review found some evidence that the use of an abdominal binder improves VC, but decreases FRC when assuming the sitting or tilted position in people who have suffered SCI. Overall, the quality of the studies was poor. Available evidence is not yet sufficient to either support or discourage the use of an abdominal binder in this patient population. Further studies utilizing more methodologically rigorous designs are required.

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“…It has been shown in able-bodied persons that VO 2 max in two arm-cranking corresponds to 55% VO 2 max of two leg VO 2 max. 15 Individuals with SCI have a limitation in VO 2 peak compared to able-bodied persons, which is rather due to the small active muscle mass 16 than the limitation of the cardiovascular 17 or the cardiopulmonary system 18 depending upon the level of lesion. 19 The corresponding impaired work capacity of SCI individuals compared to able-bodied persons can be attributed to the smaller active muscle mass available for physical performance.…”

Section: Muscle Mass Involved In Exercisementioning

confidence: 99%

Optimal exercise intensities for fat metabolism in handbike cycling and cycling

2004

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Study design: Energy expenditure (EE) and fat oxidation in handbike cycling compared to cycling in order to determine the intensity that elicits maximal fat oxidation in handbike cycling. Objective: To establish the exercise intensity with the highest fat oxidation rate in handbike cycling compared with cycling (control group) in order to give training recommendations for spinal cord-injured (SCI) athletes performing handbike cycling. Setting: Institute of Sports Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland. Methods: Eight endurance-trained handbike cyclists (VO 2 peak handbike cycling 37.577.8 ml/kg/ min) and eight endurance trained cyclists (VO 2 peak cycling 62.574.5 ml/kg/min) performed three 20-min exercise blocks at 55, 65 and 75% VO 2 peak in handbike cycling on a treadmill or in cycling on a cycling ergometer, respectively, in order to find the intensity with the absolutely highest fat oxidation. Results: The contribution of fat to total EE was highest (39.1716.3% EE) at 55% VO 2 peak in handbike cycling compared to cycling, where highest contribution of fat to EE (50.8713.8%) was found at 75% VO 2 peak. In handbike cycling, the highest absolute fat oxidation (0.2870.10 g/min) was found at 55% VO 2 peak compared to cycling, where highest fat oxidation (0.6770.20 g/min) was found at 75% VO 2 peak. Conclusion: Well-trained handbike cyclists have their highest fat oxidation at 55% VO 2 peak handbike cycling compared to well-trained cyclists at 75% VO 2 peak cycling . Handbike cyclists should perform endurance exercise training at 55% VO 2 peak handbike cycling , whereas well-trained cyclists should be able to exercise at 75% VO 2 peak cycling . For training recommendations, the heart rate at 55% VO 2 peak handbike cycling lies at 13576 bpm in handbike cycling in SCI compared to 147714 bpm at 75% VO 2 peak cycling in well-trained cyclists. We presume that the reduced muscle mass involved in exercise during handbike cycling is the most important factor for impaired fat oxidation compared to cycling. But also other factors as fitness level and haemodynamic differences should be considered. Our results are only applicable to well-trained handbike cyclists with SCI and not for the general SCI population.

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Limits to Maximal Performance in Individuals with Spinal Cord Injury

Cited by 70 publications

References 16 publications

Physical capacity in wheelchair-dependent persons with a spinal cord injury: a critical review of the literature

Physical capacity in wheelchair-dependent persons with a spinal cord injury: a critical review of the literature

Abdominal binder use in people with spinal cord injuries: a systematic review and meta-analysis

Optimal exercise intensities for fat metabolism in handbike cycling and cycling

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