The Feasibility Of Arm Upper Limb Ergometer Cycling On The Exercise Stress Test Of Paraplegic Spinal Cord Injury Patients

Background:Spinal cord injury(SCI)patients need regular exercise to improve cardiopulmonary function,reduce the incidence of cardiovascular disease.But for the condition of their cardiopulmonary function,what exercise intensity is appropriate,is not clear.Objectives:To observe whether the upper limb ergometer cycling can be used in exercise stress test for spinal cord injury(SCI)patients,analyze cardiopulmonary function of those patients and find the suitable index of aerobic exercise.Methods:We recruited twenty patients with SCI and 20 healthy control.Under the monitoring of K4b2 type of cardiopulmonary measurement equipment,they performed active upper limb ergometer cycling.After 10 minutes’ rest,they started the upper limb ergometer cycling exercise with 50-60 round per minute.The resistance was 0 when started,and increased 10 watt in every 2 minutes until the patients reached the ending criterion.The parameters of cardiopulmonary system,Rating of Perceived Exertion、heart rate and blood pressure were monitored.Results:The two groups showed statistical significance on the heart rate,systolic and diastolic blood pressure in time effect(P<0.001).There are statistical significance in peak oxygen uptake(19.38±2.56,26.49±3.45ml/min/kg),Peak heart rate(143.35±20.01,170.95±1 1.93bmp),the heart rate during the anaerobic threshold(102.35± 12.16,120.25±10.07bmp),the maximum respiratory exchange rate(1.15±0.04,1.22±0.05)and exercise test duration(12.55±0.61,13.47± 1.13min)between the spinal cord group and control group(P<0.01);But there is no statistical significance in the Rating of Perceived Exertion during the anaerobic threshold between groups(P>0.05).The peak heart rate of the experimental group was 67%of the predicted value,The peak heart rate of the control group was 85%of the predicted value.Conclusions:Upper limb ergometer cycling is a feasible method for the application of the exercise stress test in spinal cord injury patients with paraplegia.The peak heart rate of the experimental group was 67%of the predicted value.Cardiopulmonary function is significantly decreased in SCI patients.Ratings of Perceived Exertion can be an useful parameter for intensity of aerobic exercise in patients with spinal cord injury.Background:Changes in body position and amount of exercise lead to increased metabolism and cardiopulmonary disease in patients with spinal cord injury(SCI).Aerobic exercise is one of the most effective rehabilitation training methods to improve cardiopulmonary disease and metabolic status.But,currently,the recommend use of wheelchair treadmill training and body-weight treadmill training after discharge are unsuited to practice for patients with SCI.So we need to design a kind of suitable aerobic exercise pattern for SCI patients training at home.Arm:Observation the changes of cardiopulmonary,exercise,and metabolism parameters in SCI patients with paraplegia,in order to prove the effectiveness and feasibility of Aerobic wheelchair exercises.And,investigation the more suitable aerobic exercise pattern for SCI patients with paraplegia.Methods:Screened and included 36 patients of SCI with paraplegia,and randomly divided into control group,upper limb ergometer cycling group and aerobic wheelchair exercise group.All patients underwent a 12 week exercise intervention after receiving a healthy diet education.The control group were treated with routine rehabilitation training,rehabilitation exercise 5 days a week,2 hours a day;the upper limb ergometer cycling group treated with intelligent active passive upper limb rehabilitation training device(MOTOmed)and routine rehabilitation,exercise intensity for maximum cardiopulmonary exercise test heart rate in 60-80%,5 days a week,1 times a day,each time 30min;aerobic wheelchair exercise group treated with routine rehabilitation,plus aerobic wheelchair exercise,the intensity and frequency same with the upper limb ergometer cycling group.The exercise ability,cardiorespiratory function,metabolic parameters,life satisfaction and emotional were evaluated before and after the 12 weeks treatment.Exercise capacity evaluated by cardiopulmonary exercise test,including peak oxygen uptake(peak oxygen,uptake,VO2peak),peak energy metabolic equivalent(metabolic equivalent of energy,METpeak),and the ability of daily life evaluated by the modified Barthel scale.The parameters of cardiopulmonary function:the forced expiratory volume in one Second(FEV1),the ratio of the forced expiratory volume with the expected value(FEV1%),and Forced Vital Capacity(FVC).The main metabolic parameters were observed in Fasting plasma glucose(FPG,mmol/1),total cholesterol(TC,mmol/1),triglycerid(TG,mmol/1),high density lipoprotein(mmol/1),low density lipoprotein(LDL mmol/1),and changes of body mass index(BMI).The quality of life assessment scale(WHOQOL-BREF)assessment of the patient’s life satisfaction;the self-rating Depression Scale(SDS)and self-rating Anxiety Scale SAS)to assess the emotional state of patients.Results:34 patients(11 cases in the control group,11 cases in upper limb ergometer cycling group,12 cases in aerobic wheelchair exercise group)successfully completed the study.Before treatment,there was no significant difference in age,sex,degree of injury,course of disease,BMI index and clinical data between the three groups(P>0.05).After 12 weeks of treatment,the scores of METpeak and MBI in the control group were significantly higher than those before treatment(P<0.01),and the changes of other indexes were not statistically significant.After treatment,the FVC,FEV1%,V02peak,METpeak,MBI score,HDL level,BMI score and life satisfaction in physical part was significantly improved in upper limb ergometer cycling group compared with before treatment(P<0.05),but only V02peawas higher than the control group(P<0.05).the parameters of FEV1,FVC,FEV1%,VO2peak,METpeak,MBI score,HDL level,BMI score and life satisfaction in physical and social relations parts in aerobic wheelchair exercise group in were significantly improved compared with before treatment(P<0.05),and the V02peak and life satisfaction were batter than the control group(P<0.05).Conclusion:The results of this study show that 12 weeks of exercise intervention can improve the exercise ability of SCI patients with paraplegic,meanwhile the effect of aerobic intervention is better than that of routine rehabilitation training.Aerobic exercise can also significantly improve the cardiopulmonary function,metabolism parameters and life satisfaction in SCI patients with paraplegia.It is worth popularizing.