Assessment of Exercise Stroke Volume and Its Prediction From Oxygen Pulse in Paralympic Athletes With Locomotor Impairments: Cardiac Long-Term Adaptations Are Possible

Peak V̇O2 during handcycling in spinal cord injured athletes: incremental versus verification testing

The present study aimed to compare peak oxygen uptake (V̇O2peak), peak heart rate (HRpeak), and peak O2pulse during an incremental and a verification test performed on the same day in hand-cyclists with spinal cord injury (SCI). Eight competitive SCI hand-cyclists (age: 23 ± 2.7 years; V̇O2peak: 36.3 ± 14.0 mL.kg-1.min-1) performed a maximal incremental handcycling test and a verification test to exhaustion at 100% of the peak speed on an oversized treadmill. The V̇O2peak, HRpeak, and peak O2pulse (i.e., VO2/HR) were compared between incremental and verification tests. Absolute and relative V̇O2peak obtained in the verification test (2.51 ± 0.96 L.min-1; 36.3 ± 14.0 mL.kg.min-1) were significantly higher than values obtained in the incremental test (2.24 ± 0.79 L.min-1; 33.5 ± 12.9 mL.kg.min-1; P < 0.05). The mean differences (95% CL) of absolute and relative V̇O2peak between tests were 8.2% (3.3%-13.2%) and 10.9% (4.3%-18.1%), respectively. There was no difference in HR peak (incremental: 169 ± 24 bpm; verification 167 ± 25 bpm; P = 0.130). Peak O2pulse from the verification test (14.6 ± 4.7 mL.beat-1) was higher than incremental test (13.0 ± 3.8 mL.beat-1; P = 0.007). In conclusion, the verification test elicited greater V̇O2peak and O2pulse than a two-phase incremental test despite the similar HRpeak. This indicates that for this progressive protocol lasting ≥25 min, the verification phase adds value to determining V̇O2peak in SCI athletes.

The Effects of a 6-Week Plyometric and Sprint Interval Training Intervention on Soccer Player's Physical Performance

Despite the well-documented benefits of sprint interval training (SIT) and plyometric training (PT) in improving the physical fitness of soccer players, it remains unclear which of these training methods is superior for enhancing players' aerobic and anaerobic performance. Therefore, this study aimed to compare the effects of SIT and PT on physical performance measures of male soccer players. Thirty male soccer players were randomly assigned to PT (n = 10), SIT (n = 10), and an active control group (CON, n = 10). Before and after the training period, participants underwent a battery of tests consisting of vertical jump, Wingate, linear sprint with and without ball dribbling, change of direction, ball kick, and the Yo-Yo intermittent recovery level 1 (Yo-Yo IR1) tests. Both groups exhibited similar improvements in maximal kicking distance (PT, effect size [ES] = 0.68; SIT, ES = 0.92) and measures of aerobic fitness including maximum oxygen uptake (PT, ES = 1.24; SIT, ES = 1.26) and first (PT, ES = 0.85; SIT, ES = 1.08) and second (PT, ES = 0.86; SIT, ES = 0.98) ventilatory thresholds. However, PT intervention resulted in greater changes in vertical jump (ES = 1.72 vs. 0.82, p = 0.001), anaerobic power (peak power, ES = 1.62 vs. 0.97, p = 0.009; mean power, ES = 1.15 vs. 1.20, p = 0.05), linear speed (20-m, ES = -1.58 vs. -0.98, p = 0.038; 20-m with ball, ES = -0.93 vs. 0.71, p = 0.038), and change of direction ability (ES = -2.56 vs. -2.71, p = 0.046) than SIT. In conclusion, both PT and SIT demonstrated effectiveness in enhancing aerobic performance among male soccer players. However, PT yielded superior improvements in anaerobic power, vertical jump, linear speed, and change of direction performance compared to SIT. These findings suggest that PT may offer additional benefits beyond aerobic conditioning.

Chlorella Supplementation Reduces Blood Lactate Concentration and Increases O2 Pulse during Submaximal and Maximal Cycling in Young Healthy Adults

Chlorella supplementation is reported to improve V˙O2max following extended supplementation periods (~3 weeks). However, there is little research on its impact over submaximal exercise intensities and following shorter supplementation regimens. This study aimed to investigate the efficacy of 6 g/day 2-day chlorella supplementation on exercise performance in healthy young adults. Twenty young healthy adults (Males = 16, Females = 4) (Age 22 ± 6 years, V˙O2max 42.7 ± 9.6 mL/(kg·min)) were recruited for this double-blinded, randomised cross-over study. Participants ingested 6 g/day of chlorella or a placebo for 2 days, with a one-week washout period between trials. Exercise testing consisted of a 20 min submaximal cycle at 40% of their work rate max (WRmax) (watts), followed by an incremental V˙O2max test. Lactate (mmol/L), heart rate (b/min), oxygen consumption (mL/(kg·min)), O2 pulse (mL/beat), respiratory exchange ratio (RER), and WRmax were compared across conditions. Following chlorella supplementation, blood lactate levels were significantly lower (p < 0.05) during submaximal exercise (3.05 ± 0.92 mmol/L vs. 2.67 ± 0.79 mmol/L) and following V˙O2max tests (12.79 ± 2.61 mmol/L vs. 11.56 ± 3.43 mmol/L). The O2 pulse was significantly higher (p < 0.05) following chlorella supplementation during submaximal (12.6 ± 3.5 mL/beat vs. 13.1 ± 3.5 mL/beat) and maximal exercise intensity (16.7 ± 4.6 mL/beat vs. 17.2 ± 4.5 mL/beat). No differences existed between conditions for oxygen consumption, RER, V˙O2max, or WRmax. A total of 2 days of 6 g/day chlorella supplementation appears to lower the blood lactate response and increase O2 pulse during both submaximal and maximal intensity exercise but did not lead to any improvements in V˙O2max.

The Effects of Incorporating Dry-land Short Intervals to Long Aerobic-dominant In-Water Swimming Training on Physiological Parameters, Hormonal Factors, and Performance: A Randomized-Controlled Intervention Study

This study investigated the impact of a 4-week dry-land short sprint interval program (sSIT) on a swim ergometer, when incorporated into long aerobic-dominant in-water swimming training, on the physiological parameters, hormonal factors, and swimming performance of well-trained swimmers. Sixteen participants (age = 25 ± 6 years, height = 183 ± 6 cm, weight 78 ± 6 kg, body fat = 10.6 ± 3.1%) were randomized to either a long aerobic-dominant in-pool training plus three sessions/week of sSIT or a control group (CON) who didn't engage in SIT. sSIT consisted of 3 sets of 10 × 4 s, 10 × 6 s, and 10 × 8 s all-out sprints interspersed by 15, 60, and 40 s recovery between each sprint, respectively. Pre- and post-training assessments included peak oxygen uptake (V̇O2peak), O2pulse (V̇O2/HR), ventilation at V̇O2peak (V̇E@V̇O2peak), peak and average power output, and freestyle swim performance at 50, 100, and 200-m distances, stroke rate, as well as testosterone and cortisol. sSIT resulted in significant improvements in V̇O2peak (5.8%), O2pulse (4.7%), V̇E@V̇O2peak (7.1%), peak and average power output (6.7% and 13.8%, respectively), total testosterone (20%), testosterone to cortisol ratio (16.1%), and 50, 100, and 200-m freestyle swimming performance (-2.2%, -1.2%, and -1.1%, respectively). Furthermore, the observed alterations in the physiological, biochemical, and performance adaptations were significantly more substantial in the sSIT group than the CON group (p ≤ 0.05), demonstrating no modifications during the 4-week long aerobic-dominant in-water swimming without sSIT. The current research effectively established that supplementing standard long aerobic-dominant in-water swim training with three weekly dry-land sSIT sessions triggers adaptive mechanisms that foster enhancements in the aerobic and anaerobic capacity and swimming performance in well-trained swimmers.

The Prevalence of Cardiovascular Diseases in Paralympic Athletes

Paralympic participants represent a special subset of athletes. Although sudden cardiac death in this group is a rare event, it should be underlined that, in particular, Paralympians with movement restrictions have a higher prevalence of coronary heart disease. Numerous reports have focused on comparing athletes with spinal cord injury (SCI) and the ones with non-spinal cord injury-NSCI. The first group is more prone to develop arrhythmias, arterial hypertension, hyperlipidaemia including atrial fibrillation and atrial flutter, and this group potentially may have a higher risk of cardiovascular mortality. In ECGs of the disabled athletes with SCI, we more often find changes typically established as consequences of exercise training, such as T-wave inversions. The potential differences in the cardiovascular status of disabled athletes may depend not only on the class of impairment, but also on the discipline of sport and environmental conditions, which makes the analysis relatively complex. The paper analyses up-to-date articles discussing the cardiovascular problems in disabled athletes, pointing to scarce data in several fields of interest. Previous studies on the frequency of abnormalities of the cardiovascular system in Paralympic athletes highlighted the need to intensify preventive cardiology care for this group of athletes, and some activities could be proposed for sportsmen and sportswomen in this group, including more frequent screening ECG, application of 24 h ECG Holter monitoring, echocardiography and cardiological care. Due to the relatively few data available and existing discrepancies in this area, further research is necessary.

Comparison of echocardiographic parameters of amputee football players with active football players and sedentary individuals

BACKGROUND

The purpose of this study is to compare the echocardiographic (ECHO) parameters of amputee football players (AF) with those of athletes without a disability (football players) (FP), and sedentary individuals (SI).

METHODS

A total of 37 male participants (nAF = 12, nFP = 12, nSI = 13) were included in the study. All participants underwent a transthoracic echocardiographic examination. Aortic diameter in systole (ADs), aortic diameter in diastole (ADd), isovolumic contraction time (IVCT), isovolumic relaxation time (IVRT), left ventricular ejection fraction (LVEF), early (E) and late (A) wave velocities, myocardial systolic (S), early diastolic (E'), and late diastolic (A') myocardial rates, interventricular septal thickness (IVS), left ventricular end-diastolic diameter (LVDd) and left ventricular end-systole diameter (LVDs), left ventricular posterior wall thickness (LVPWd), left atrial diameter (LAD), and ascending aortic diameter (AAD) were measured.

RESULTS

LVDd, E' were lower in AF than in FP. In contrast, LVDs, LVPWd, and A wave were higher in AF than in FP. When AF and SI groups were compared, ADs, LVPWd, A wave, IVRT, and S wave were higher in AF than in SI. ANOVA test showed a statistically significant difference between groups in LVPWd, A-wave, and E' wave. TTE data indicate that some parameters in AF differ from those observed in healthy individuals. The smaller LVEED diameter and higher PWT were found in AF.

CONCLUSIONS

Although within normal limits, some ECHO parameters in the AF group differed from those without disability. Future studies should further investigate these differences using different and detailed measurement methods.

Effects of a paddling-based high-intensity interval training prescribed using anaerobic speed reserve on sprint kayak performance

The aim of this study was to investigate physiological and performance adaptations to high-intensity interval training (HIIT) prescribed as a proportion of anaerobic speed reserve (ASR) compared to HIIT prescribed using maximal aerobic speed (MAS). Twenty-four highly trained sprint kayak athletes were randomly allocated to one of three 4-weak conditions (N = 8) (ASR-HIIT) two sets of 6 × 60 s intervals at ∆%20ASR (MAS-HIIT) six 2 min paddling intervals at 100% maximal aerobic speed (MAS); or controls (CON) who performed six sessions/week of 1-h traditional endurance paddling at 70%-80% maximum HR. A graded exercise test was performed on a kayak ergometer to determine peak oxygen uptake (V̇O_2peak), MAS, V̇O₂/HR, and ventilatory threshold. Also, participants completed four consecutive upper-body wingate tests to asses peak and average power output. Significant increases in V̇O_2peak (ASR-HIIT = 6.9%, MAS-HIIT = 4.8%), MAS (ASR-HIIT = 7.2%, MAS-HIIT = 4.8%), ASR (ASR-HIIT = -25.1%, MAS-HIIT = -15.9%), upper-body Wingate peak power output and average power output (p < 0.05 for both HIIT groups) were seen compared with pre-training. Also, ASR-HIIT resulted in a significant decrease in 500-m - 1.9 % , and 1,000 - m   - 1.5 % paddling time. Lower coefficient of variation values were observed for the percent changes of the aforementioned factors in response to ASR-HIIT compared to MAS-HIIT. Overall, a short period of ASR-HIIT improves 500-m and 1,000-m paddling performances in highly trained sprint kayak athletes. Importantly, inter-subject variability (CV) of physiological adaptations to ASR-HIIT was lower than MAS-HIIT. Individualized prescription of HIIT using ASR ensures similar physiological demands across individuals and potentially facilitates similar degrees of physiological adaptation.

Accidental boosting in an individual with tetraplegia - considerations for the interpretation of cardiopulmonary exercise testing

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 (Δ3.61 ml·kg·^-1min^-1), ventilation (Δ11.4 L ·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.

How does cervical spinal cord injury impact the cardiopulmonary response to exercise?

We compared cardiopulmonary responses to arm-ergometry in individuals with cervical spinal cord injury (C-SCI) and able-bodied controls. We hypothesized that individuals with C-SCI would have higher respiratory frequency (f_b) but lower tidal volume (VT) at a given work rate and dynamically hyperinflate during exercise, whereas able-bodied individuals would not. Participants completed pulmonary function testing, an arm-ergometry test to exhaustion, and a sub-maximal exercise test consisting of four-minute stages at 20, 40, 60, and 80% peak work rate. Able-bodied individuals completed a further sub-maximal test with absolute work rate matched to C-SCI. During work rate matched sub-maximal exercise, C-SCI had smaller VT (main effect p < 0.001) compensated by an increased f_b (main effect p = 0.009). C-SCI had increased end-expiratory lung volume at 80% peak work rate vs. rest (p < 0.003), whereas able-bodied did not. In conclusion, during arm-ergometry, individuals with C-SCI exhibit altered ventilatory patterns characterized by reduced VT, higher f_b, and dynamic hyperinflation that may contribute to the observed reduced aerobic exercise capacity.

Aerobic fitness is a potential crucial factor in protecting paralympic athletes with locomotor impairments from atherosclerotic cardiovascular risk

Purpose

To test the hypothesis that aerobic fitness is inversely related to the risk of atherosclerotic cardiovascular disease (ACVD) in athletes with locomotor impairments deriving from health conditions, such as spinal cord injury (SCI), lower limb amputation, cerebral palsy, poliomyelitis, and other health conditions different from the previous ones.

Methods

A total of 68 male athletes who competed in either summer or winter Paralympic games were divided in two health conditions groups (35 with SCI, mean age 37.2 ± 8.0 years, and 33 with different health conditions, mean age 37.8 ± 9.9 years) and in four sport type groups (skill, power, intermittent—mixed metabolism—and endurance). They were evaluated through anthropometric and blood pressure measurements, laboratory blood tests, and graded cardiopulmonary maximal arm cranking exercise test, with oxygen uptake peak (VO2peak) measurement. Cardiovascular risk profile was assessed in each athlete.

Results

The prevalence of ACVD-risk factors in the overall population was 20.6% for hypertension; 47% and 55.9% for high values of total and LDL cholesterol, respectively; 22.1% for reduce glucose tolerance; and 8.8% for obesity. No difference was found between athletes with and without SCI, while the prevalence of obesity was significantly higher in those practicing skill sports (22.7%, p = 0.035), which was the sport type group with Paralympic athletes with the lowest VO2peak (22.5 ± 5.70 ml kg−1 min−1). VO2peak was lower in athletes with SCI than those with different health conditions (28.6 ± 10.0 vs 33.6 ± 8.9 ml kg−1 min−1p = 0.03), and in those with 3–4 risk factors (19.09 ± 5.34 ml kg−1 min−1) than those with 2 risk factors (27.1 ± 5.50 ml kg−1 min−1), 1 risk factor (31.6 ± 8.55 ml kg−1 min−1), or none (36.4 ± 8.76 ml kg−1 min−1) (p < 0.001).

Conclusions

The present study suggests that having higher VO2peak seems to offer greater protection against ACVD in individuals with a locomotor impairment. Prescribing physical exercise at an intensity similar to that of endurance and intermittent sports should become a fundamental tool to promote health among people with a locomotor impairment.

Effects of a Tailored Physical Activity Intervention on Cardiovascular Structure and Function in Individuals With Spinal Cord Injury

Background

Spinal cord injury (SCI) leads to a loss of descending motor and sympathetic control below the level of injury (LOI), which ultimately results in chronically altered cardiovascular function and remodeling. While supervised, laboratory-based exercise training can generate cardiovascular adaptations in people with SCI, it is unknown whether behavioral community-based interventions effectively generate such adaptations for individuals with SCI.

Objective

Examine the effects of a tailored behavioral physical activity (PA) intervention on cardiac and vascular structure and function in individuals with SCI.

Methods

In this randomized controlled trial, 32 participants with SCI (18-65 years, SCI >1 year) were assigned to PA (8-week behavioral intervention) or control (CON) groups. At baseline and postintervention, measures of resting left ventricular (LV) structure and function, carotid intima-media thickness and pulse-wave velocity were assessed with ultrasound and tonometry.

Results

Twenty-eight participants completed the study (n = 14/group). Across the full study cohort there were no significant changes in indices of LV or vascular structure and function, despite notable improvements in peak power and oxygen uptake in the PA group. However, in a subanalysis for LOI, individuals in the PA group with LOIs below T6 had evidence of altered LV geometry (ie, increased LV internal diameter, reduced sphericity index and relative wall thickness; group × time P < 0.05 for all), which was not seen in individuals with higher LOIs at or above T6.

Conclusion

An 8-week behavioral PA intervention appears to promote adaptations in cardiac geometry more readily in individuals with lower level SCI than those with higher-level SCI.

Comparison of Physiological and Biomechanical Responses to Flat and Uphill Cross-Country Sit-Skiing in Able-Bodied Athletes

PURPOSE

To compare peak work rate (WRpeak) and associated physiological and biomechanical performance-determining variables between flat and uphill cross-country (XC) sit-skiing.

METHODS

Fifteen able-bodied male XC skiers completed 2 test sessions, each comprising four 4-minute submaximal stages, followed by an incremental test to exhaustion and a verification test in a sit-ski on a roller-ski treadmill. The test sessions were counterbalanced by the incline, being either 0.5% (FLAT) or 5% (UPHILL). The authors compared WRpeak and peak oxygen uptake, as well as physiological variables, rating of perceived exertion, gross efficiency, and cycle characteristics at identical submaximal work rate, between FLAT and UPHILL.

RESULTS

In UPHILL, WRpeak was 35% higher compared to FLAT (P < .001), despite no difference in peak oxygen uptake (P = .9). The higher WRpeak in UPHILL was achieved through more work per cycle, which was enabled by the twice as long poling time, compared to FLAT (P < .001). Submaximal gross efficiency was 0.5 to 2 percentage points lower in FLAT compared to UPHILL (P < .001), with an increasing difference as work rate increased (P < .001). Neither cycle rate nor work per cycle differed between inclines when compared at identical submaximal work rate (P > .16).

CONCLUSIONS

The longer poling times utilized in uphill XC sit-skiing enable more work per cycle and better gross efficiency, thereby allowing skiers to achieve a higher WRpeak compared to flat XC sit-skiing. However, the similar values of peak oxygen uptake between inclines indicate that XC sit-skiers can tax their cardiorespiratory capacity similarly in both conditions.

Comparison between the 10- and the 30-s-long Wingate Anaerobic Test in summer Paralympic athletes with a lower limb impairment

Background

The 30-s-long Wingate Anaerobic Test (WAnT_30s) has some limitations in high-level athletes. A shorter version might be helpful for both clinical applications and performance assessment. The comparison between the traditional WAnT_30s and a shorter version has never been carried out yet in Paralympic athletes.

Aim

To assess if a 10-s-long Wingate Anaerobic Test (WAnT_10s) could be used to accurately assess and predict the anaerobic components of physical fitness as an alternative to the traditional WAnT_30s in male Paralympic athletes.

Methods

Forty-four trained male Paralympic Athletes grouped by severity of locomotor impairment completed the WAnT_30s and the WAnT_10s with an arm cranking ergometer. Differences between mean and peak power achieved throughout both WAnTs were analysed using a mixed-design analysis of variance and predictivity was assessed by stepwise linear regression analysis.

Results

In the whole sample, peak power values were similar (P > 0.005) in the two tests and the WAnT_10s mean power was significantly higher than that in the WAnT_30s (P < 0.005). Finally, the mean power measured during WAnT_30s showed high level of predictability from mean power measured during WAnT_10s and the Functional class (adjusted R2 = 0.906; P < 0.001).

Conclusion

The WAnT_10s is accurate to assess peak power, is definitively appropriate to evaluate the alactic anaerobic metabolism and seems able to predict the mean power as traditionally evaluated through a WAnT_30s in male Paralympic Athletes. Thus, it can be used to assess the anaerobic components of physical fitness in this athletic population.

Effect of Carbohydrate-Electrolyte Solution Including Bicarbonate Ion Ad Libitum Ingestion on Urine Bicarbonate Retention during Mountain Trekking: A Randomized, Controlled Pilot Study

We investigated whether bicarbonate ion (HCO₃⁻) in a carbohydrate-electrolyte solution (CE+HCO₃) ingested during climbing to 3000 m on Mount Fuji could increase urine HCO₃⁻ retention. This study was a randomized, controlled pilot study. Sixteen healthy lowlander adults were divided into two groups (six males and two females for each): a tap water (TW) group (0 kcal with no energy) and a CE+HCO3 group. The allocation to TW or CE+HCO3 was double blind. The CE solution contains 10 kcal energy, including Na⁺ (115 mg), K⁺ (78 mg), HCO₃⁻ (51 mg) per 100 mL. After collecting baseline urine and measuring body weight, participants started climbing while energy expenditure (EE) and heart rate (HR) were recorded every min with a portable calorimeter. After reaching a hut at approximately 3000 m, we collected urine and measured body weight again. The HCO₃⁻ balance during climbing, measured by subtracting the amount of urine excreted from the amount of fluid ingested, was −0.37 ± 0.77 mmol in the CE+HCO3, which was significantly higher than in the TW (−2.23 ± 0.96 mmol, p < 0.001). These results indicate that CE containing HCO₃⁻ supplementation may increase the bicarbonate buffering system during mountain trekking up to ~3000 m, suggesting a useful solution, at least, in the population of the present study on Mount Fuji.

Physiologic and Clinical Features of the Paralympic Athlete's Heart

Importance

Paralympic medicine is a newly adopted term to describe the varied health care issues associated with athletes in the Paralympics. Scarce scientific data, however, are currently available describing the cardiac remodeling in Paralympic athletes.

Objective

To investigate the physiological and clinical characteristics of the Paralympic athlete's heart and derive the normative values.

Design, Setting, and Participants

This is a single-center study on a relatively large cohort of Paralympic athletes, conducted at the Italian Institute of Sport Medicine and Science. Paralympic athletes free of cardiac or systemic pathologic conditions other than their cause of disability were selected for participation in the Paralympic Games from January 2000 to June 2014. Athletes were arbitrarily classified for disability in 2 groups: those with spinal cord injuries (SCI) and those with non-SCI (NSCI). Data analysis occurred from March 2019 to June 2020.

Main Outcomes and Measures

The primary outcome was the difference in cardiac remodeling in Paralympic athletes according to disability type and sports discipline type. Athletes underwent cardiac evaluation, including 12-lead and exercise electrocardiograms, echocardiography, and cardiopulmonary exercise testing.

Results

Among 252 consecutive Paralympic athletes (median [interquartile range (IQR)] age, 34 [29-41] years; 188 men [74.6%]), 110 had SCI and 142 had NSCI. Those with SCI showed a higher prevalence of abnormal electrocardiogram findings than those with NSCI (13 of 110 [11.8%] vs 6 of 142 [4.2%]; P = .003), smaller left ventricular end-diastolic dimension (median [IQR], 48 [46-52] vs 51 [48-54] mm; P = .001) and left ventricular mass index (median [IQR], 80.6 [69-94] vs 91.3 [80-108] g/m2; P = .001), and lower peak oxygen uptake (VO2) (median [IQR], 27.1 [2-34] vs 38.5 [30-47] mL/min/kg; P = .001) in comparison with those with NSCI. Regarding sport discipline, endurance athletes had a larger left ventricular cavity (median [IQR], 52 [47-54] vs 49 [47-53] mm; P = .006) and higher peak VO2 (median [IQR], 46 [39-55] vs 30 [25-35] mL/min/kg; P = .001) than athletes in nonendurance sports.

Conclusions and Relevance

Cardiac remodeling in Paralympic athletes differed by disability and sport discipline. Having NSCI lesions and engaging in endurance sports were associated with the largest left ventricular cavity and left ventricular mass and highest VO2 peak. Having SCI lesions and engaging in nonendurance disciplines, on the contrary, were associated with the smallest left ventricular cavity and mass and lowest VO2 peak.

Diet in neurogenic bowel management: A viewpoint on spinal cord injury

The aim of this review is to offer dietary advice for individuals with spinal cord injury (SCI) and neurogenic bowel dysfunction. With this in mind, we consider health conditions that are dependent on the level of lesion including skeletal muscle atrophy, autonomic dysreflexia and neurogenic bladder. In addition, SCI is often associated with a sedentary lifestyle, which increases risk for osteoporosis and diseases associated with chronic low-grade inflammation, including cardiovascular and chronic kidney diseases. The Mediterranean diet, along with exercise and dietary supplements, has been suggested as an anti-inflammatory intervention in individuals with SCI. However, individuals with chronic SCI have a daily intake of whole fruit, vegetables and whole grains lower than the recommended dietary allowance for the general population. Some studies have reported an increase in neurogenic bowel dysfunction symptoms after high fiber intake; therefore, this finding could explain the low consumption of plant foods. Low consumption of fibre induces dysbiosis, which is associated with both endotoxemia and inflammation. Dysbiosis can be reduced by exercise and diet in individuals with SCI. Therefore, to summarize our viewpoint, we developed a Mediterranean diet-based diet and exercise pyramid to integrate nutritional recommendations and exercise guidelines. Nutritional guidelines come from previously suggested recommendations for military veterans with disabilities and individuals with SCI, chronic kidney diseases, chronic pain and irritable bowel syndrome. We also considered the recent exercise guidelines and position stands for adults with SCI to improve muscle strength, flexibility and cardiorespiratory fitness and to obtain cardiometabolic benefits. Finally, dietary advice for Paralympic athletes is suggested.