At-Home High-Intensity Interval Training for Individuals with Paraplegia Following Spinal Cord Injury: A Pilot Study

Objective

This pilot study aimed to assess the efficacy of a 16-week at-home high-intensity interval training (HIIT) program among individuals with spinal cord injury (SCI).

Methods

Eight individuals (age: 47±11 (SD) years, 3 females) with SCI below the sixth thoracic vertebrae participated in a 16-week at-home HIIT program using an arm ergometer. Participants completed baseline graded exercise tests to determine target heart rate zones. HIIT was prescribed thrice per week. Each training session consisted of six one-minute bouts with a target heart rate ~80% heart rate reserve (HRR), interspersed with two minutes of recovery at ~30% HRR. A portable heart rate monitor and phone application provided visual feedback during training and allowed for measurements of adherence and compliance. Graded exercise tests were completed after 8 and 16 weeks of HIIT. Surveys were administered to assess participation, self-efficacy, and satisfaction.

Results

Participants demonstrated a decrease in submaximal cardiac output (P=0.028) and an increase in exercise capacity (peak power output, P=0.027) following HIIT, indicative of improved exercise economy and maximal work capacity. An 87% adherence rate was achieved during the HIIT program. Participants reached a high intensity of 70% HRR or greater during ~80% of intervals. The recovery HRR target was reached during only ~35% of intervals. Self-reported metrics of satisfaction and self-efficacy with at-home HIIT scored moderate to high.

Conclusion

Participants demonstrated an improvement in exercise economy and maximal work capacity following at-home HIIT. Additionally, participant adherence, compliance, satisfaction, and self-efficacy metrics suggest that at-home HIIT was easily implemented and enjoyable.

Post-Exercise Arterial Stiffness Responses Are Similar After Acute Eccentric and Concentric Arm Cycling

Upper-body resistance exercise effectively increases muscular strength, but may concomitantly increase arterial stiffness. Eccentric exercise can lead to muscle soreness and arterial stiffness in untrained participants. However, it is unclear if upper-body eccentric exercise could reduce arterial stiffness in a single session for participants that have undergone progressive training. Our purpose was to compare acute responses to upper-body eccentric (novel, ECCarm) and concentric (traditional, CONarm) steady state arm cycling. We hypothesized that arm arterial stiffness would be reduced after both ECCarm and CONarm. Twenty-two young healthy individuals performed either ECCarm (n = 11) or CONarm (n = 11) at ~70% of peak heart rate for 20 min after a training period. Heart rate, central pulse wave velocity (cPWV), and peripheral pulse wave velocity (pPWV; i.e., arm arterial stiffness) were assessed before, 10 min, and 30 min after exercise. Heart rate was not elevated at 10 min post ECCarm, but was elevated at 10- and 30-min post CONarm (p < 0.01). After exercise, pPWV was decreased at 10 min post for both ECCarm (7.1 ± 0.3 vs. 6.5 ± 0.2 m/s) and CONarm (7.0 ± 0.2 vs. 6.5 ± 0.2 m/s; p < 0.05), while both groups returned to baseline values 30 min post. cPWV did not change in either group. Our results indicate that acute ECCarm provides a high-force, low energy cost form of resistance exercise that acutely reduces arm arterial stiffness. The reduction in pPWV and rapid heart rate recovery suggests that ECCarm is a safe form of exercise for overall and cardiovascular health.

Verification testing to confirm VO2max attainment in persons with spinal cord injury

Context/Objective: Maximal oxygen uptake (VO₂max) is a widely used measure of cardiorespiratory fitness, aerobic function, and overall health risk. Although VO₂max has been measured for almost 100 yr, no standardized criteria exist to verify VO₂max attainment. Studies document that incidence of 'true' VO₂max obtained from incremental exercise (INC) can be confirmed using a subsequent verification test (VER). In this study, we examined efficacy of VER in persons with spinal cord injury (SCI). Design: Repeated measures, within-subjects study. Setting: University laboratory in San Diego, CA. Participants: Ten individuals (age and injury duration = 33.3 ± 10.5 yr and 6.8 ± 6.2 yr) with SCI and 10 able-bodied (AB) individuals (age = 24.1 ± 7.4 yr). Interventions: Peak oxygen uptake (VO₂peak) was determined during INC on an arm ergometer followed by VER at 105 percent of peak power output (% PPO). Outcome Measures: Gas exchange data, heart rate (HR), and blood lactate concentration (BLa) were measured during exercise. Results: Across all participants, VO₂peak was highly related between protocols (ICC = 0.98) and the mean difference was equal to 0.08 ± 0.11 L/min. Compared to INC, VO₂peak from VER was not different in SCI (1.30 ± 0.45 L/min vs. 1.31 ± 0.43 L/min) but higher in AB (1.63 ± 0.40 L/min vs. 1.76 ± 0.40 L/min). Conclusion: Data show similar VO₂peak between incremental and verification tests in SCI, suggesting that VER confirms VO₂max attainment. However, in AB participants completing arm ergometry, VER is essential to validate appearance of 'true' VO₂peak.

Peak power output in handcycling of individuals with a chronic spinal cord injury: predictive modeling, validation and reference values

Purpose: To develop and validate predictive models for peak power output to provide guidelines for individualized handcycling graded exercise test protocols for people with spinal cord injury (SCI); and to define reference values.Materials and methods: Power output was measured in 128 handcyclists with SCI during a synchronous handcycling exercise test. Eighty percent of the data was used to develop four linear regression models: two theoretical and two statistical models with peak power output (in W and W/kg) as dependent variable. The other 20% of the data was used to determine agreement between predicted versus measured power output. Reference values were based on percentiles for the whole group.Results: Lesion level, handcycling training hours and sex or body mass index were significant determinants of peak power output. Theoretical models (R² = 42%) were superior to statistical models (R²=39% for power output in W, R² = 30% for power output in W/kg). The intraclass correlation coefficients varied between 0.35 and 0.60, depending on the model. Absolute agreement was low.Conclusions: Both models and reference values provide insight in physical capacity of people with SCI in handcycling. However, due to the large part of unexplained variance and low absolute agreement, they should be used with caution. Implications for rehabilitationIndividualization of the graded exercise test protocol is very important to attain the true peak physical capacity in individuals with spinal cord injury.The main determinants to predict peak power output during a handcycling graded exercise test for individuals with a spinal cord injury are lesion level, handcycling training hours and sex or body mass index.The predictive models for peak power output should be used with caution and should not replace a graded exercise test.

Interval training elicits higher enjoyment versus moderate exercise in persons with spinal cord injury

BACKGROUND

High intensity interval training (HIIT) is a robust and time-efficient approach to improve multiple health indices including maximal oxygen uptake (VO2max). Despite the intense nature of HIIT, data in untrained adults report greater enjoyment of HIIT versus continuous exercise (CEX). However, this has yet to be investigated in persons with spinal cord injury (SCI).

OBJECTIVE

To examine differences in enjoyment in response to CEX and HIIT in persons with SCI.

DESIGN

Repeated measures, within-subjects design.

SETTING

University laboratory in San Diego, CA.

PARTICIPANTS

Nine habitually active men and women (age = 33.3 ± 10.5 years) with chronic SCI.

INTERVENTION

Participants performed progressive arm ergometry to volitional exhaustion to determine VO2peak. During subsequent sessions, they completed CEX, sprint interval training (SIT), or HIIT in randomized order.

OUTCOME MEASURES

Physical activity enjoyment (PACES), affect, rating of perceived exertion (RPE), VO2, and blood lactate concentration (BLa) were measured.

RESULTS

Despite a higher VO2, RPE, and BLa consequent with HIIT and SIT (P < 0.05), PACES was significantly higher (P = 0.03) in response to HIIT (107.4 ± 13.4) and SIT (103.7 ± 12.5) compared to CEX (81.6 ± 25.4). Fifty-five percent of participants preferred HIIT and 45% preferred SIT, with none identifying CEX as their preferred exercise mode.

CONCLUSION

Compared to CEX, brief sessions of submaximal or supramaximal interval training elicit higher enjoyment despite higher metabolic strain. The long-term efficacy and feasibility of HIIT in this population should be explored considering that it is not viewed as more aversive than CEX.