Effects of exercise on autonomic cardiovascular control in individuals with chronic, motor-complete spinal cord injury: an exploratory randomised clinical trial.

STUDY DESIGN: Secondary analysis of a clinical trial. OBJECTIVE: To assess the impact of 6 months of arm cycle ergometry training (ACET), or body weight-supported treadmill training (BWSTT), on autonomic cardiovascular responses to a laboratory sit-up test (SUT) in individuals with chronic (≥1-year post-injury) spinal cord injury (SCI). SETTING: Tertiary Rehabilitation Centre, Vancouver, Canada. METHODS: Sixteen individuals with motor-complete (American Spinal Injury Association Impairment Scale A-B) SCI between the fourth cervical and sixth thoracic spinal cord segments, aged 39 ± 11 years, were assessed. Participants were randomized to receive 72 sessions of moderate-to-vigorous intensity ACET (n = 8) or passive BWSTT (n = 8). Changes in mean arterial pressure (finger plethysmography), hemodynamics (Modelflow® method), and heart rate/heart rate variability (HR/HRV; electrocardiography) were measured in response to a  SUT before and after 6 months of exercise training. Spontaneous cardiovagal baroreflex sensitivity (cvBRS) was assessed using the sequence method. RESULTS: Neither ACET nor BWSTT impacted hemodynamic responses to SUT or the incidence of orthostatic hypotension (all P > 0.36). ACET increased HR (P < 0.01, ηp2 = 0.34) and high frequency (HF) power HRV responses (P < 0.01, ηp2 = 0.42) to SUT following 6 months of training while BWSTT did not. Consistent with this, cvBRS improved (P < 0.05, ηp2 = 0.16) only following ACET. Improvements in cvBRS were correlated with both the HR (r = 0.726, P < 0.0001) and HF power (r = -0.484, P < 0.01) responses to SUT. CONCLUSION: Six months of ACET, but not BWSTT, improved cardiovagal baroreflex control of HR but had no effect on BP responses to SUT in individuals with chronic, motor-complete SCI. SPONSORSHIP: Canadian Institutes of Health Research (CIHR) CLINICAL TRIAL REGISTRATION: NCT01718977.

Acute physiological responses to high-intensity interval exercise in patients with coronary artery disease.

PURPOSE: Time spent closer to maximal effort during exercise is a potent stimulus for cardiorespiratory adaptations. The primary purpose was to determine which high-intensity interval exercise (HIIE) protocol provided the greatest physiological stimulus by comparing time spent ≥ 90% peak oxygen consumption (V̇O2peak) and heart rate reserve (HRR) in patients with coronary artery disease (CAD) in response to 3 HIIE protocols and the exercise standard of care, moderate-intensity continuous exercise (MICE). A secondary purpose was to assess protocol preference. METHODS: Fifteen patients with CAD (6 females, 67 ± 6 years) underwent measurements of V̇O2 and heart rate during MICE and three HIIE protocols all performed on a treadmill. The HIIE protocols included one with long intervals (4 × 4-min), short intervals (10 × 1-min), and an adapted version of the 4 × 4 [Toronto Rehabilitation Institute Protocol, (TRIP)]. Time spent ≥ 90% V̇O2peak and HRR were compared. RESULTS: Time spent ≥ 90% V̇O2peak was higher during 4 × 4 (6.3 ± 8.4 min) vs. MICE (1.7 ± 3.9 min; P = 0.001), while time spent ≥ 90% HRR was higher during 4 × 4 (6.0 ± 5.3 min) vs. MICE (0.1 ± 0.2 min; P < 0.001) and 10 × 1 (0.7 ± 0.8 min; P = 0.016). TRIP had similar responses as 10 × 1 and MICE. The 10 × 1 was the most preferred protocol and the 4 × 4 was the least preferred protocol. CONCLUSION: Longer intervals (4 × 4) provided the greatest physiological stimulus compared to the exercise standard of care and shorter intervals. However, this protocol was least preferred which may impact exercise adherence. Although the physiological stimulus is important to maximize training adaptations, exercise preferences and attitudes should be considered.

Cardiac Remodeling in Elite Aquatic Sport Athletes.

OBJECTIVE: To characterize and compare the sport-specific cardiac structure of elite swimmers (SW), water polo players (WP), and artistic swimmers (AS). DESIGN: A cross-sectional assessment of elite aquatic athletes' hearts. SETTING: The athletes' village at the 2019 FINA World Championships. PARTICIPANTS: Ninety athletes from swimming (SW) (20 M/17 F), water polo (WP) (21 M/9 F), and artistic swimming (AS) (23 F). ASSESSMENT AND MAIN OUTCOME MEASURES: An echocardiographic assessment of cardiac structure was performed on noncompetition days. RESULTS: Male SW displayed primarily eccentric volume-driven remodeling, whereas male WP had a greater incidence of pressure-driven concentric geometry (SW = 5%, WP = 25%) with elevated relative wall-thickness (RWT) (SW = 0.35 ± 0.04, WP = 0.44 ± 0.08, P < 0.001). Female SW and WP hearts were similar with primarily eccentric-remodeling, but SW and WP had greater concentricity index than artistic swimmers (SW = 6.74 ± 1.45 g/(mL)2/3, WP = 6.80 ± 1.24 g/(mL)2/3, AS = 5.52 ± 1.08 g/(mL)2/3, P = 0.007). AS had normal geometry, but with increased posterior-wall specific RWT (SW = 0.32 ± 0.05, AS = 0.42 ± 0.11, P = 0.004) and greater left atrial area than SW (SW = 9.7 ± 0.9 cm2/m2, AS = 11.0 ± 1.1 cm2/m2, P = 0.003). All females had greater incidence of left ventricular (LV) posterior/septal wall-thickness ≥11 mm than typically reported (SW = 24%, WP = 11%, AS = 17%). CONCLUSIONS: Male athletes presented classic sport-specific differentiation, with SW demonstrating primarily volume-driven eccentric remodelling, and WP with greater concentric geometry indicative of pressure-driven remodeling. Female SW and WP did not display this divergence, likely because of sex-differences in adaptation. AS had unique LV-specific adaptations suggesting elevated pressure under low-volume conditions. The overall incidence of elevated wall-thickness in female athletes may point to an aquatic specific pressure-stress.

Cardiac remodeling in middle-aged endurance athletes: relation between signal-averaged electrocardiogram and LV mass.

The relationship between structural and electrical remodeling in the heart, particularly after long-standing endurance training, remains unclear. Signal-averaged electrocardiogram (SAECG) may provide a more sensitive method to evaluate cardiac remodeling than a 12-lead electrocardiogram (ECG). Accurate measures of electrical function (SAECG filtered QRS duration (fQRSd) and late potentials (LP) and left-ventricular (LV) mass (cardiac magnetic resonance, CMR) can allow an assessment of structural remodeling and QRS prolongation. Endurance athletes (45-65 yr old, >10 yr of endurance sport), screened to exclude cardiac disease, had standardized 12-lead ECG, SAECG, resting echocardiogram (ECHO), and CMR performed. SAECG fQRSd was correlated with QRS duration on the 12-lead ECG, and ECHO and CMR-derived LV mass. Participants (n = 82, 67% male, mean age: 54 ± 6 yr, mean V̇o2max: 50 ± 7 mL/kg/min) had a CMR-derived LV mass of 118 ± 28 g/m2 and a fQRSd of 112 ± 8 ms (46% had abnormal fQRSd (>114 ms), and 51% met clinical threshold for abnormal SAECG). fQRSd was positively correlated with the 12-lead ECG QRS duration (r = 0.83), ECHO-derived LV mass (r = 0.60), CMR-derived LV mass (r = 0.58) and LV end-diastolic volume (r = 0.63, P < 0.001 for all). fQRSd had higher correlations with ECHO and CMR-derived LV mass than 12-lead ECG (P < 0.0008 and P < 0.0005, respectively). In conclusion, in a healthy cohort of middle-aged endurance athletes, the SAECG is often abnormal by conventional criteria, and is correlated with structural remodeling, but CMR evaluation does not indicate pathologic structural remodeling. SAECG fQRSd is superior to the 12-lead ECG for the electrocardiographic evaluation of LV mass.NEW & NOTEWORTHY Study findings indicate that a positive correlation exists between electrical (SAECG fQRSd) and structural indices (LV mass) in middle-aged endurance athletes with normal physiological LV adaptation, in the absence of known cardiac pathology. SAECG fQRSd may also provide an alternative, superior method for identifying increased LV mass compared to other 12-lead ECG criteria.

Examining the relationship between arterial stiffness and swim-training volume in elite aquatic athletes.

PURPOSE: Factors such as prone body position, hydrostatic pressure, and intermittent breath-holding subject aquatic athletes to unique physical and environmental stressors during swimming exercise. The relationship between exposure to aquatic exercise and both arterial stiffness and wave reflection properties is not well-understood. This study assessed central artery stiffness and wave reflection properties in elite pool-swimmers (SW), long-distance open-water swimmers (OW), and water polo players (WP) to examine the relationship between these variables and aquatic exercise. METHODS: Athletes competing in SW, OW and WP events at the FINA World Championships were recruited. Carotid-femoral pulse wave velocity, and pulse wave analysis were used to quantify arterial stiffness, and central wave reflection properties. RESULTS: Athletes undertook differing amounts of weekly swimming distance in training according to their discipline (SW: 40.2 ± 21.1 km, OW: 59.7 ± 28.4 km, WP: 11.4 ± 6.3 km; all p < 0.05). Pulse wave velocity (Males [SW: 6.0 ± 0.6 m/s, OW: 6.5 ± 0.8 m/s, WP: 6.7 ± 0.9 m/s], Females [SW: 5.4 ± 0.6 m/s, OW: 5.3 ± 0.5 m/s, WP: 5.2 ± 0.8 m/s; p = 0.4]) was similar across disciplines for females but was greater in male WP compared to male SW (p = 0.005). Augmentation index (Males [SW: - 3.4 ± 11%, OW: - 9.6 ± 6.4%, WP: 1.7 ± 10.9%], Females [SW: 3.5 ± 13.5%, OW: - 13.2 ± 10.7%, WP: - 2.8 ± 10.7%]) was lower in male OW compared to WP (p = 0.03), and higher in female SW compared to OW (p = 0.002). Augmentation index normalized to a heart rate of 75 bpm was inversely related to weekly swim distance in training (r = - 0.27, p = 0.004). CONCLUSIONS: This study provides evidence that the central vasculature of elite aquatic athletes differs by discipline, and this is associated with training load.

Associations between left ventricular structure and function with cardiorespiratory fitness and body composition in individuals with cervical and upper thoracic spinal cord injury.

STUDY DESIGN: Cross-sectional. OBJECTIVE: It is known that left ventricular mass (LVM) and cardiorespiratory fitness (CRF) are associated to fat-free mass (FFM).  It is unknown if these factors associated with left ventricular (LV) structure and function outcomes in individuals with spinal cord injury (SCI). SETTING: University-based laboratory.Vancouver, BC, Canada. METHODS: Thirty-two individuals (aged 40 ± 11 years) with chronic, motor-complete SCI between the fourth cervical and sixth thoracic levels were recruited. Echocardiographic LV parameters and body composition were assessed at rest, as per the recommended guidelines for each technique. CRF was assessed during an incremental arm-cycle exercise test until volitional fatigue. The appropriate bivariate correlation coefficients [i.e., Pearson's (r) and Spearman's rank (Rs)] tests were used for normal and non-normal distributed variables, respectively. RESULTS: LV structure and function parameters were not associated with the indexed peak oxygen consumption (V̇O2peak) [i.e., relative to body weight or FFM] (Rs values ranged from -0.168 to 0.134, all P values > 0.223). The association between peak oxygen pulse and the resting echocardiographic-obtained SV was medium sized (Rs = 0.331, P = 0.069). The LVM associations with FFM and fat mass (FM) were large and small (r = 0.614, P < 0.001 and r = 0.266, P = 0.141, respectively). Associations of absolute V̇O2peak were medium- positive with FFM (Rs = 0.414, P = 0.021) but negative with FM (Rs = -0.332, P = 0.068). CONCLUSION: LV parameters measured at rest are not associated with V̇O2peak in individuals with cervical and upper-thoracic SCI. Given the observed associations between LVM and V̇O2peak with FFM, future studies may consider utilizing FFM for indexing cardiovascular measures following SCI.

Construct validation of the leisure time physical activity questionnaire for people with SCI (LTPAQ-SCI).

STUDY DESIGN: Cross-sectional construct validation study. OBJECTIVES: To test the construct validity of the Leisure Time Physical Activity Questionnaire for People with Spinal Cord Injury (LTPAQ-SCI) by examining associations between the scale responses and cardiorespiratory fitness (CRF) in a sample of adults living with spinal cord injury (SCI). SETTING: Three university-based laboratories in Canada. METHODS: Participants were 39 adults (74% male; M age: 42 ± 11 years) with SCI who completed the LTPAQ-SCI and a graded exercise test to volitional exhaustion using an arm-crank ergometer. One-tailed Pearson's correlation coefficients were computed to examine the association between the LTPAQ-SCI measures of mild-, moderate-, heavy-intensity and total minutes per week of LTPA and CRF (peak volume of oxygen consumption [V̇O2peak] and peak power output [POpeak]). RESULTS: Minutes per week of mild-, moderate- and heavy-intensity LTPA and total LTPA were all positively correlated with V̇O2peak. The correlation between minutes per week of mild intensity LTPA and V̇O2peak was small-medium (r = 0.231, p = 0.079) while all other correlations were medium-large (rs ranged from 0.276 to 0.443, ps < 0.05). Correlations between the LTPAQ-SCI variables and POpeak were also positive but small (rs ranged from 0.087 to 0.193, ps > 0.05), except for a medium-sized correlation between heavy-intensity LTPA and POpeak (r = 0.294, p = 0.035). CONCLUSIONS: People with SCI who report higher levels of LTPA on the LTPAQ-SCI also demonstrate greater levels of CRF, with stronger associations between moderate- and heavy-intensity LTPA and CRF than between mild-intensity LTPA and CRF. These results provide further support for the construct validity of the LTPAQ-SCI as a measure of LTPA among people with SCI.

Acute Cardiometabolic and Perceptual Responses to Individual and Group-Based Body-Weight Resistance Exercise in Girls.

Girls' acute responses to group-based high-intensity interval exercise (HIIE) are not well characterized. PURPOSE: To compare acute responses to treadmill-based HIIE (TM) and body-weight resistance exercise circuit (CIRC) and to CIRC performed in a small-group setting (group CIRC). METHOD: Nineteen girls (9.1 [1.1] y) completed exercise testing on a TM to determine peak oxygen uptake, peak heart rate (HRpeak), and maximal aerobic speed. The TM involved eight 30-second sprints at 100% maximal aerobic speed. The CIRC consisted of 8 exercises of maximal repetitions performed for 30 seconds. Each exercise bout was followed by 30 seconds of active recovery. The blood lactate concentration was assessed preexercise and postexercise. The ratings of perceived exertion, affective valence, and enjoyment were recorded at preexercise, Intervals 3 and 6, and postexercise. RESULTS: The mean heart rate was higher during group CIRC (92% [7%] HRpeak) than CIRC (86% [7%] HRpeak) and TM (85% [4%] HRpeak) (ηp2 = .49). The mean oxygen uptake equaled 76% (11%) of the peak oxygen uptake for CIRC and did not differ from TM (d = 0.02). The CIRC elicited a greater postexercise blood lactate concentration versus TM (5.8 [1.7] vs 1.4 [0.4] mM, d = 3.61). The perceptual responses were similar among conditions (P > .05), and only the rating of perceived exertion increased during exercise (ηp2 = .78). CONCLUSION: Whether performed individually or in a small group, CIRC represents HIIE and may be a feasible alternative to running-based HIIE.

Spinal Cord Injury Impairs Cardiovascular Capacity in Elite Wheelchair Rugby Athletes.

OBJECTIVE: To examine differences in heart rate (HR) responses during international wheelchair rugby competition between athletes with and without a cervical spinal cord injury (SCI) and across standardized sport classifications. DESIGN: Observational study. SETTING: The 2015 Parapan American Games wheelchair rugby competition. PARTICIPANTS: Forty-three male athletes (31 ± 8 years) with a cervical SCI (n = 32) or tetraequivalent impairment (non-SCI, n = 11). MAIN OUTCOME MEASURES: Average and peak HR (HRavg and HRpeak, respectively). To characterize HR responses in accordance with an athletes' International Wheelchair Rugby Federation (IWRF) classification, we separated athletes into 3 groups: group I (IWRF classification 0.5-1.5, n = 15); group II (IWRF classification 2.0, n = 15); and group III (IWRF classification 2.5-3.5, n = 13). RESULTS: Athletes with SCI had lower HRavg (111 ± 14 bpm vs 155 ± 13 bpm) and HRpeak (133 ± 12 bpm vs 178 ± 13 bpm) compared with non-SCI (both P < 0.001). Average HR was higher in group III than in I (136 ± 25 bpm vs 115 ± 20 bpm, P = 0.045); however, SCI athletes showed no difference in HRavg or HRpeak between groups. Within group III, SCI athletes had lower HRavg (115 ± 6 bpm vs 160 ± 8 bpm) and HRpeak (135 ± 11 bpm vs 183 ± 11 bpm) than non-SCI athletes (both P < 0.001). CONCLUSIONS: This study is the first to demonstrate attenuated HR responses during competition in SCI compared with non-SCI athletes, likely due to injury to spinal autonomic pathways. Among athletes with SCI, IWRF classification was not related to differences in HR. Specific assessment of autonomic function after SCI may be able to predict HR during competition and consideration of autonomic impairments may improve the classification process.

Cardiometabolic and Perceptual Responses to Body-Weight Resistance High-Intensity Interval Exercise in Boys.

The majority of studies examining children's responses to high-intensity interval exercise primarily utilized running; however, this modality does not require/include other important aspects of physical activity including muscular fitness. PURPOSE: To compare acute responses between a body weight resistance exercise circuit (CIRC) and treadmill-based (TM) high-intensity interval exercise. METHOD: A total of 17 boys (age = 9.7 [1.3] y) completed a graded exercise test to determine peak heart rate, peak oxygen uptake (VO2peak), and maximal aerobic speed. Sessions were randomized and counterbalanced. CIRC required 2 sets of 30-second maximal repetitions of 4 exercises. TM included eight 30-second bouts of running at 100% maximal aerobic speed. Both included 30-second active recovery between bouts. Blood lactate concentration was measured preexercise and postexercise. Rating of perceived exertion, affective valence, and enjoyment were recorded preexercise, after intervals 3 and 6, and postexercise. RESULTS: Participants attained 88% (5%) peak heart rate and 74% (9%) VO2peak for CIRC and 89% (4%) peak heart rate and 81% (6%) VO2peak for TM, with a significant difference in percentage of VO2peak (P = .003) between protocols. Postexercise blood lactate concentration was higher following CIRC (5.0 [0.7] mM) versus TM (2.0 [0.3] mM) (P < .001). Rating of perceived exertion, affective valence, and enjoyment responses did not differ between protocols (P > .05). CONCLUSION: HR responses were near maximal during CIRC, supporting that this body-weight circuit is representative of high-intensity interval exercise.

Pulmonary hemodynamic and right ventricular responses to brief and prolonged exercise in middle-aged endurance athletes.

Right ventricular (RV) function is closely coupled to pulmonary arterial (PA) hemodynamics and is believed to decline with prolonged exercise. A linear pressure-flow relationship is thought to exist between PA pressures and increasing exercise intensity in athletes, yet a paucity of directly measured pulmonary hemodynamic data exists supporting this contention. We sought to describe the PA pressure, PA wedge pressure (PAWP), and RV functional responses to brief and prolonged exercise in endurance-trained athletes. Twenty-one healthy athletes (54 ± 5 yr) underwent right heart catheterization to assess pulmonary hemodynamics during graded, submaximal exercise. Measurements were made at rest and during three stages of steady-state, semiupright cycle ergometry at heart rates of 100 beats/min (EX1), 130 beats/min (EX2), and 150 beats/min (EX3). Five athletes completed an additional 34 min at 130 beats/min for a total exercise time of 60 min [prolonged exercise (PLG)]. PA pressures and PAWP increased significantly at EX1 without a further rise at EX2, EX3, or PLG. PAWP adjusted for absolute work rate demonstrated a significant decline as exercise intensity increased from EX1 to EX2. The resistance compliance time constant decreased at EX1 without further changes at EX2, EX3, and prolonged exercise. RV function did not decline during PLG. After an initial rise in PA pressure and PAWP during early, nonsteady-state exercise, values remained constant despite increases in exercise intensity and duration. These data indicate that in healthy, middle-aged endurance-trained athletes, the PA and pulmonary venous/left atrial compartments rapidly accommodate high conduit flows produced during intensive and prolonged exercise while maintaining RV function. NEW & NOTEWORTHY The right ventricular (RV)-pulmonary arterial (PA) circulatory unit has not been well studied during prolonged exercise, and this study provides an ecological approach that reflects a typical bout of endurance training integrating a transition from rest to exercise with successive increases in intensity, progressing to steady-state, sustained exercise. We demonstrated a remarkably constant response of the PA and PA wedge pressure during incremental, steady-state exercise and that no changes occur in pulmonary pressures throughout prolonged exercise, concomitant to a preservation of RV performance.

Associations between arterial stiffness and blood pressure fluctuations after spinal cord injury.

STUDY DESIGN: Cross-sectional. OBJECTIVE: To examine the relationship between arterial stiffness and daily fluctuations in blood pressure (BP) owing to hypotensive events and autonomic dysreflexia (AD) in individuals with a T6 and above spinal cord injury (SCI). SETTING: University-based laboratory in Vancouver, BC, Canada. METHODS: Twenty-six individuals (73% male; 43 (11) years) with a chronic (> 1 year post SCI), traumatic, motor-complete SCI with a neurological level of injury of C4-T6 participated in this study. Arterial stiffness was assessed using carotid-to-femoral pulse wave velocity (cfPWV). BP was measured over a 24-hr period using ambulatory BP monitoring. AD was defined as an increase in systolic BP > 20 mmHg above baseline BP. Hypotensive events were defined as a decrease in systolic BP ≥ 20 mmHg and/or diastolic BP ≥ 10 mmHg below baseline. The severity and frequency of these events were quantified and Pearson and Spearman's correlations between them and cfPWV were performed. RESULTS: AD severity and frequency were not were correlated with cfPWV. For hypotensive events, both the frequency (r = 0.412, P = 0.04) and severity (Δsystolic BP; r = -0.425, P = 0.03) of these events were correlated with cfPWV. The combined total of AD and hypotensive events (9 (5) events/day) was also correlated with cfPWV (r = 0.480, P = 0.01). CONCLUSIONS: Hypotensive events, and the combined frequency of both hypo- and hypertensive events within a 24-hr period are associated with increased arterial stiffness in individuals with T6 and above SCI, suggesting BP instability may play a role in arterial stiffening post SCI.

Assessing Ventilatory Threshold in Individuals With Motor-Complete Spinal Cord Injury.

OBJECTIVE: To assess the feasibility of measuring ventilatory threshold (VT) in higher-level motor-complete spinal cord injury (SCI) using 4 different analysis methods based on noninvasive gas exchange. DESIGN: Observational. SETTING: Laboratory testing. PARTICIPANTS: Individuals with C4-T6 motor-complete SCI (16 paraplegia, 22 tetraplegia; American Spinal Injury Association Impairment Scale A/B; 42±10 years old). INTERVENTIONS: Not applicable. MAIN OUTCOME: VT from a graded arm cycling test to volitional exhaustion using 4 methods: ventilatory equivalents, excess CO2, V-slope, and combined method. RESULTS: VT could be identified in all individuals with paraplegia, but in only 68% of individuals with tetraplegia. Individuals without observable VT completed the graded exercise test with lower ventilatory rate, peak power output, and peak oxygen consumption (Vo2peak) (all P<.05), compared to those with a detectable VT. Bland-Altman plots indicate minimal bias between methods (range: 0.01-0.03 L/min), with 95% limits of agreement of the difference within 0.25 L/min. Absolute V.o2 at VT with individual methods were all correlated to peak power output (r>0.74; P<.01) and Vo2peak (r>0.91; P<.01), with negligible differences between methods. CONCLUSIONS: The assessment of VT is a feasible alternative to peak exercise testing for aerobic fitness in individuals with higher-level, motor-complete SCI, although care should be taken when interpreting VT in individuals with tetraplegia who have lower cardiorespiratory fitness and lower peak power outputs.

A walking disaster: a case of incomplete spinal cord injury with symptomatic orthostatic hypotension.

Eight months post-injury, an ambulatory 58-year-old male with an incomplete spinal cord injury experienced syncope and a 52-mmHg drop in his systolic blood pressure during a tilt-table assessment. This case study highlights the necessity to examine autonomic function in all cases of spinal cord injury, regardless of injury severity.

Reliability of the sit-up test in individuals with spinal cord injury.

OBJECTIVE: To determine the day-to-day reliability of blood pressure responses during a sit-up test in individuals with a traumatic spinal cord injury (SCI). DESIGN: Within-subject, repeated measures design. SETTING: Community outpatient assessments at a research laboratory at the University of British Columbia. PARTICIPANTS: Five men and three women with traumatic SCI (age: 31 ± 6 years; C4-T11; American Spinal Injury Association Impairment Scale A-B; 1-17 years post-injury). OUTCOME MEASURE: Maximum change in systolic (ΔSBP) and diastolic (ΔDBP) blood pressure upon passively moving from a supine to seated position. RESULTS: The average values for ΔSBP were -11 ± 13 mmHg (range -38 to 3 mmHg) for visit 1, and -12 ± 8 mmHg (range -26 to -1 mmHg) for visit 2. The average values for ΔDBP were -9 ± 8 mmHg (range -21 to 0 mmHg) for visit 1, and -13 ± 8 mmHg (range -29 to -3 mmHg) for visit 2. The ΔSBP demonstrated substantial reliability with an intraclass correlation coefficient of 0.79 (P = 0.006; 95% CI 0.250-0.953), while the ΔDBP demonstrated almost perfect reliability with an intraclass correlation coefficient of 0.92 (P < 0.001; 95% CI 0.645-0.983). The smallest detectable differences in ΔSBP and ΔDBP were 7 mmHg and 6 mmHg, respectively. CONCLUSION: Blood pressure responses to the sit-up test are reliable in individuals with SCI, which supports its implementation as a practical bedside assessment for orthostatic hypotension in this at risk population.

Passive hind-limb cycling improves cardiac function and reduces cardiovascular disease risk in experimental spinal cord injury.

Spinal cord injury (SCI) causes altered autonomic control and severe physical deconditioning that converge to drive maladaptive cardiac remodelling. We used a clinically relevant experimental model to investigate the cardio-metabolic responses to SCI and to establish whether passive hind-limb cycling elicits a cardio-protective effect. Initially, 21 male Wistar rats were evenly assigned to three groups: uninjured control (CON), T3 complete SCI (SCI) or T3 complete SCI plus passive hind-limb cycling (SCI-EX; 2 × 30 min day(-1), 5 days week(-1) for 4 weeks beginning 6 days post-SCI). On day 32, cardio-metabolic function was assessed using in vivo echocardiography, ex vivo working heart assessments, cardiac histology/molecular biology and blood lipid profiles. Twelve additional rats (n = 6 SCI and n = 6 SCI-EX) underwent in vivo echocardiography and basal haemodynamic assessments pre-SCI and at days 7, 14 and 32 post-SCI to track temporal cardiovascular changes. Compared with CON, SCI exhibited a rapid and sustained reduction in left ventricular dimensions and function that ultimately manifested as reduced contractility, increased myocardial collagen deposition and an up-regulation of transforming growth factor beta-1 (TGFß1) and mothers against decapentaplegic homolog 3 (Smad3) mRNA. For SCI-EX, the initial reduction in left ventricular dimensions and function at day 7 post-SCI was completely reversed by day 32 post-SCI, and there were no differences in myocardial contractility between SCI-EX and CON. Collagen deposition was similar between SCI-EX and CON. TGFß1 and Smad3 were down-regulated in SCI-EX. Blood lipid profiles were improved in SCI-EX versus SCI. We provide compelling novel evidence that passive hind-limb cycling prevents cardiac dysfunction and reduces cardiovascular disease risk in experimental SCI.

Physical exercise improves arterial stiffness after spinal cord injury.

OBJECTIVE/BACKGROUND: Aortic pulse wave velocity (PWV), the gold-standard assessment of central arterial stiffness, has prognostic value for cardiovascular disease risk in able-bodied individuals. The aim of this study was to compare aortic PWV in athletes and non-athletes with spinal cord injury (SCI). DESIGN: Cross-sectional comparison. METHODS: Aortic PWV was assessed in 20 individuals with motor-complete, chronic SCI (C2-T5; 18 ± 8 years post-injury) using applanation tonometry at the carotid and femoral arterial sites. Ten elite hand-cyclists were matched for sex to 10 non-athletes; age and time since injury were comparable between the groups. Heart rate and discrete brachial blood pressure measurements were collected throughout testing. OUTCOME MEASURES: Aortic PWV, blood pressure, heart rate. RESULTS: Aortic PWV was significantly lower in athletes vs. non-athletes (6.9 ± 1.0 vs. 8.7 ± 2.5 m/second, P = 0.044). There were no significant between-group differences in resting supine mean arterial blood pressure (91 ± 19 vs. 81 ± 10 mmHg) and heart rate (60 ± 10 vs. 58 ± 6 b.p.m.). CONCLUSION: Athletes with SCI exhibited improved central arterial stiffness compared to non-athletes, which is in agreement with the previous able-bodied literature. This finding implies that chronic exercise training may improve arterial health and potentially lower cardiovascular disease risk in the SCI population.

Exercise systolic blood pressures are unaffected by time of day in healthy young adults.

Blood pressure (BP) assessment during exercise testing has the capacity to identify exaggerated exercise BP (EEBP). BP has a circadian rhythm; therefore, exercise BPs may change throughout the day complicating EEBP identification. The purpose of this study was to determine the effect of time of day on exercise BP in healthy young adults. Thirty-one participants [48% female; 23(4) years] completed a modified Bruce treadmill protocol in the morning (M), afternoon (A), and evening (E). Submaximal (stage 4) and peak (highest value) systolic BP (SBP) were determined and ΔSBP was calculated (peak SBP-pre-exercise SBP). Repeated-measures tests were used to compare SBP data. EEBP was defined as a submaximal SBP ≥ 170 mmHg. Chronotype was assessed using the Morning-Eveningness Questionnaire (MEQ) and Pearson correlations were used to determine the relationship between MEQ score and ΔSBP during all tests. Significance was set at P < 0.05. Submaximal SBP (M:159(25); A:156(16); E:162(24) mmHg; P = 0.295), peak SBP (M:177(32); A:184(25); E:185(26) mmHg; P = 0.087) and ΔSBP (M:62(29); A:67(23); 65(20) mmHg; P = 0.546) were similar across time points. Eight participants had an EEBP on at least two tests. MEQ scores were correlated with ΔSBP during the A test (r = 0.357, P = 0.049) and E test (r = 0.363, P = 0.045). In conclusion, time of day had no effect on SBP responses to exercise, but our correlational analysis suggests changes in SBP may differ between chronotypes depending on the time of day of exercise. Given the clinical value of EEBP, it is notable that 26% of our healthy young sample had EEBP.

The Role of Exercise Blood Pressure in Hypertension: Measurement, Mechanisms and Management.

ABSTRACT: Hypertension affects one in three adults globally and is the leading modifiable risk factor for cardiovascular disease. While blood pressure measurements at rest are fundamental to the detection and management of hypertension, abnormal blood pressure responses to exercise, namely an exaggerated exercise blood pressure (EEBP), can provide additional independent information about current and future hypertension risk. This paper summarizes a symposium entitled: "The Role of Exercise BP in Hypertension: Measurement, Mechanisms and Management" included at the 2023 American College of Sports Medicine annual meeting, which presented a timely discussion about the clinical utility of EEBP. Here we will summarize the evidence presented by the speakers including considerations for blood pressure measurement during exercise, an overview of EEBP thresholds and discussion about the value of EEBP during submaximal exercise for the identification and management of hypertension, a summary of the potential physiological mechanisms underpinning an EEBP, and a review of exercise prescription guidelines based on new and emerging evidence as they relate to the American College of Sports Medicine's exercise recommendations for hypertension. We conclude by highlighting areas for future research with the overarching goal of improving the measurement and management of hypertension.