The effect of lower body positive pressure on the exercise capacity of individuals with spinal cord injury

Effect of leg vascular occlusion on arm cycling peak oxygen uptake in spinal cord-injured individuals

“…Previous studies have used leg positive pressure to augment VO 2peak in SCI. Pitetti et al 8 found that a pulsating anti-gravity suit pressure of 50-75 mm Hg in combination with ACE and/or wheelchair propulsion in eight tetraplegic individuals resulted in a higher mean VO 2peak and arm work rate compared with arm exercise alone, in line with the findings for the SCI-high group in our study. Whereas Houtman et al 7 using a pulsating anti-gravity suit pressure in conjunction with ACE, assessing individuals with level of injury between L 1 and L 5 , found no significant difference in VO 2peak compared with ACE alone, similar to the findings for the SCI-low group in our study.…”

“…However, comparisons between studies should be made with caution because of methodological diversity and population heterogeneity, that is, lack of consistent determination criteria for VO 2peak and different levels of SCI. The criteria for VO 2peak in our study differ from those by Pitetti et al 8 and Houtman et al 7 Furthermore, creating group homogeneity according to level and completeness of SCI, age and gender is challenging, although important when assessing aerobic performance.…”

“…The inclusion criteria were chronic/stable neurological state (at least 12 months since injury), paraplegia (lesion level between T 1 and L 1 , where arm function is spared, but depending on the level of injury, the trunk, legs and pelvic organs may be involved) and tetraplegia (lesion level between C 4 and C 8 , impairment of function in the arms as well as in the trunk, legs and pelvic organs), 10 with lower motor neuron intact, ASIA Impairment Scale A and able to FES cycle for a minimum of1 min. Exclusion criteria were pacemakers, severe autonomic dysreflexia and decubitus in any area.…”

“…To determine VO 2peak , the following criteria had to be met: respiratory exchange ratio (R) X1.05, blood lactate level ([La À ] b ) X7 mmol and rating of perceived exertion (RPE) X15, BORG scale (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). 14 If these criteria were met, the average of the highest VO 2 within three consecutive 10-s measurements was used to calculate VO 2peak .…”

“…[7][8][9] Modalities applying compression, that is, anti-gravity suits (pressurized suits covering the lower extremities and the abdomen) with either pulsed or continuous pressure have been tested with conflicting results. 8,[10][11][12] Thus in the pursuit of a less resource-demanding training modality, applying leg vascular occlusion (LEVO) during ACE needs further assessment. As the rationale for applying LEVO during ACE is to facilitate venous return, effects will be addressed separately for SCI with level of injury above and below T 6 (SCI-high and SCI-low, respectively).…”