To compare some psychophysiological responses to arm exercise with those to leg exercise, an experiment was carried out on electronically braked bicycle ergometers, one being adapted for arm exercise. Eight healthy males took part in the experiment with stepwise increases in exercise intensity every 4 min: 40—70—100—150—200 W in cycling and 20—35—50—70—100 W in arm cranking. Towards the end of each 4 min period, ratings of perceived exertion were obtained on the RPE scale and on a new category ratio (CR) scale: heart rate (HR) and blood lactate accumulation (BL) were also measured.

Perceived exertion related to heart rate and blood lactate during arm and leg exercise.

Persons with spinal cord injury (SCI) exhibit deficits in volitional motor control and sensation that limit not only the performance of daily tasks but also the overall activity level of these persons. This population has been characterised as extremely sedentary with an increased incidence of secondary complications including diabetes mellitus, hypertension and atherogenic lipid profiles. As the daily lifestyle of the average person with SCI is without adequate stress for conditioning purposes, structured exercise activities must be added to the regular schedule if the individual is to reduce the likelihood of secondary complications and/or to enhance their physical capacity. The acute exercise responses and the capacity for exercise conditioning are directly related to the level and completeness of the spinal lesion. Appropriate exercise testing and training of persons with SCI should be based on the individual's exercise capacity as determined by accurate assessment of the spinal lesion. The standard means of classification of SCI is by application of the International Standards for Classification of Spinal Cord Injury, written by the Neurological Standards Committee of the American Spinal Injury Association. Individuals with complete spinal injuries at or above the fourth thoracic level generally exhibit dramatically diminished cardiac acceleration with maximal heart rates less than 130 beats/min. The work capacity of these persons will be limited by reductions in cardiac output and circulation to the exercising musculature. Persons with complete spinal lesions below the T(10) level will generally display injuries to the lower motor neurons within the lower extremities and, therefore, will not retain the capacity for neuromuscular activation by means of electrical stimulation. Persons with paraplegia also exhibit reduced exercise capacity and increased heart rate responses (compared with the non-disabled), which have been associated with circulatory limitations within the paralysed tissues. The recommendations for endurance and strength training in persons with SCI do not vary dramatically from the advice offered to the general population. Systems of functional electrical stimulation activate muscular contractions within the paralysed muscles of some persons with SCI. Coordinated patterns of stimulation allows purposeful exercise movements including recumbent cycling, rowing and upright ambulation. Exercise activity in persons with SCI is not without risks, with increased risks related to systemic dysfunction following the spinal injury. These individuals may exhibit an autonomic dysreflexia, significantly reduced bone density below the spinal lesion, joint contractures and/or thermal dysregulation. Persons with SCI can benefit greatly by participation in exercise activities, but those benefits can be enhanced and the relative risks may be reduced with accurate classification of the spinal injury.

https://www.exeter.ac.uk/media/universityofexeter/internationalexeter/documents/iss/LC_Jacobs_and_Nash_2004.pdf

Exercise recommendations for individuals with spinal cord injury.

The effects of exercise training on physical capacity, strength, body composition and functional performance among adults with spinal cord injury: a systematic review

/pdf/the-effects-of-exercise-training-on-physical-capacity-d5iwwe1xdr.pdf

The effects of exercise training on physical capacity, strength, body composition and functional performance among adults with spinal cord injury: a systematic review.

With the growing interest in exercise and sport and the significance of cardiovascular disease in the spinal cord injured population, the role of endurance training in improving cardiovascular health is of particular interest. Ordinary daily activities of those with spinal cord injury are usually not adequate to maintain cardiovascular fitness, and lack of participation in a regular activity programme may result in a debilitative cycle. As this occurs, there is a reduction in functional work capacity which may limit independence, and the reduction in cardiovascular fitness may increase the risk for cardiovascular disease. Work capacity in those with spinal cord injury is limited by loss of functional muscle mass and sympathetic control. Sympathetic nervous system impairment limits control of regional blood flow and cardiac output, and maximum heart rate following cervical lesions may be reduced to 110 to 130 beats/min. However, endurance training in quadriplegics and paraplegics can elicit improvements in exercise performance similar to those observed in able-bodied individuals. Review of 13 cardiorespiratory training studies involving spinal cord injured subjects revealed average improvements of 20% in VO2max and 40% in physical work capacity after 4 to 20 weeks of training. Based upon the positive results of these studies, the general endurance training guidelines for the normal population appear to also be appropriate for the spinal cord injured population. These guidelines can be followed during participation in a number of different activities and sports including wheelchair pushing, arm crank ergometry, aerobic swimming, ambulation training, canoeing and wheelchair basketball. There is no evidence that intense training and competition is harmful, but special areas of risk as a result of impairments in sensation, cardiovascular function, autonomic function and temperature regulation must be considered. The long term benefits of endurance training in those with spinal cord injury has not been adequately studied, but there is suggestion that similar physiological and psychological changes may occur as in able-bodied individuals.

Cardiorespiratory fitness and training in quadriplegics and paraplegics.

Effect of spinal cord injury on the heart and cardiovascular fitness.

The purpose of this study was to evaluate arm cycle ergometry as an aerobic training method in the rehabilitation of individuals with spinal cord injuries. Four male subjects with spinal cord injuries trained for five weeks with arm cycle ergometry. Training sessions were 30 minutes long three times a week at an intensity of 60 to 80 percent of maximal heart rate. Pretraining and posttraining maximal exercise testing consisting of noncontinuous, multistage graded arm ergometry was completed by each subject. Heart rates, oxygen consumption, and work loads were measured. Mean increases of 64.32 percent and 60.54 percent were found for posttraining maximal work loads and maximal oxygen consumption values, respectively. A paired t test (p less than .05) revealed that only the change in posttraining mean maximal oxygen consumption value to be statistically significant. That only this value was significant may be attributable to the small sample size and the large intersubject variability. Implications of these results for clinicians and the limitations of the study are discussed.

Michael D Supp

Papers

Effect of Arm Ergometry Training on Physical Work Capacity of Individuals with Spinal Cord Injuries