Accidental boosting in an individual with tetraplegia - considerations for the interpretation of cardiopulmonary exercise testing.
J Spinal Cord Med
; 45(6): 969-974, 2022 Nov.
Article
em En
| MEDLINE
| ID: mdl-33513073
ABSTRACT
CONTEXT Autonomic dysreflexia (AD), characterized by a transient increase in systolic blood pressure (BP), is experienced by individuals with spinal cord injury (SCI) and can be purposefully induced ('boosting') to counteract autonomic dysfunction that impairs cardiovascular responses to exercise. Herein, we demonstrate the impact of unintentional boosting observed during cardiopulmonary exercise testing (CPET) in an inactive male with SCI (C5, motor-complete). FINDINGS:
On two separate occasions the individual performed a standard arm-crank CPET (1-min stages, 7W increase in resistance) following by a longer CPET (4-min stages, 12W increase in resistance), both to volitional exhaustion. The second CPET was performed to confirm the accuracy of exercise intensity prescription and verify peak exercise parameters. Immediately following the second CPET on the initial visit, the individual reported symptoms of AD, verified as a 58mmHg increase in systolic BP from baseline. Relative to the first CPET, performed only 35 min earlier, there were pronounced differences in peak exercise responses. In comparison to the longer CPET performed on the second visit without a concomitant episode of AD (thereby controlling for the type of CPET protocol administered), peak exercise outcomes were considerably elevated power output (Δ19W), oxygen uptake (Δ3.61â ml·â kg·-1min-1), ventilation (Δ11.4 Lâ ·min-1) and heart rate (Δ9 b·min-1). CONCLUSION/CLINICAL RELEVANCE This case raises important considerations around the nuances of CPET in this population. In individuals susceptible to BP instability, the physiologically boosted state may explain a significant proportion of the variance in peak aerobic capacity and should be closely monitored before and after clinical CPET.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Traumatismos da Medula Espinal
/
Disreflexia Autonômica
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
/
Guideline
Limite:
Humans
/
Male
Idioma:
En
Revista:
J Spinal Cord Med
Assunto da revista:
NEUROLOGIA
/
REABILITACAO
Ano de publicação:
2022
Tipo de documento:
Article
País de afiliação:
Reino Unido