Cardiovascular capacity in individuals with cervical spinal cord injury

Background: The prevalence of cardiovascular disease in individuals with cervical spinal cord injury (SCI) is high, yet research surrounding the improvement of cardiovascular fitness in this population is lacking. Purpose: 1) To systematically review the published literature to assess the effects of exercise modality, time since injury, injury severity, and training on VO₂peak values in individuals with cervical SCI; 2) to develop an aerobic exercise program to enhance aerobic capacity in a patient undergoing primary rehabilitation from a motor-complete C5/6 SCI. Methods: Part 1. A systematic review of the literature was undertaken to identify published studies measuring VO₂peak in individuals with cervical SCI. Scatterplots were generated to illustrate the effects of exercise modality, time since injury, and injury severity on VO₂peak. Effect sizes were calculated for the response to training on VO₂peak. Part 2. Using the American College of Sports Medicine (ACSM) guidelines, an aerobic exercise program was developed for individuals with cervical SCI. Activity stations were designed to challenge aerobic capacity while minimizing muscular fatigue. The program was trialed on one subject with a C5 AIS A SCI undergoing sub-acute rehabilitation from injury. Results: The literature review identified 40 studies reporting VO₂peak in individuals with cervical SCI. Scatterplots illustrated that VO₂peak was influenced by injury severity, but not exercise modality. Effect sizes for VO₂peak ranged from 0 to 21 (using pre-training standard deviations) in response to training. The case study of an individual with a C5 AIS A SCI showed that participation in the aerobic training program facilitated increased exercise tolerance, both in terms of exercise duration and exercise intensity. Measures of cardiovascular health, taken before and after training, showed increases in peak oxygen uptake and orthostatic tolerance over the 2 month course of the program. Conclusions: The systematic review provided further evidence that VO₂peak is related to injury severity. The training studies reviewed suggest that it is possible for individuals with tetraplegia to gain cardiovascular benefits from aerobic training. The subject in our case study exhibited several signs of improved exercise tolerance over the 2 month program, indicating potential cardiovascular improvement from the exercise training.Medicine, Faculty ofGraduat