High-intensity, whole-body exercise improves blood pressure control in individuals with spinal cord injury: A prospective randomized controlled trial

PLOS ONE, 2021 · DOI: https://doi.org/10.1371/journal.pone.0247576 · Published: March 4, 2021

Spinal Cord Injury Cardiovascular Science Rehabilitation

Simple Explanation

Blood pressure regulation is often compromised following spinal cord injury (SCI), leading to increased reliance on cardiovagal baroreflex sensitivity. This study explores whether whole-body exercise can improve this sensitivity in individuals with SCI. The study compared the effects of high-intensity, whole-body exercise with functional electrical stimulation rowing to arms-only exercise and a waitlist control group over six months. Cardiovagal baroreflex sensitivity was assessed using the neck suction technique. Results showed that whole-body exercise significantly improved cardiovagal baroreflex sensitivity, particularly in individuals with paraplegia, but this improvement was not strongly correlated with gains in aerobic capacity.

Study Duration

6 Months

Participants

61 individuals with SCI aged 18–40 years old

Evidence Level

Level 1, Randomized Controlled Trial

Key Findings

1
Whole-body exercise significantly improved cardiovagal baroreflex sensitivity at 6 months for those initially randomized to it.
2
Individuals with paraplegia made significantly greater gains in baroreflex sensitivity compared to those with tetraplegia.
3
Improvements in cardiovagal baroreflex sensitivity were poorly correlated to aerobic gains following intense exercise training.

Research Summary

This study investigated the impact of high-intensity, whole-body exercise on blood pressure regulation in individuals with spinal cord injury (SCI). The results indicate that whole-body exercise, specifically hybrid functional electrical stimulation rowing, can significantly improve cardiovagal baroreflex sensitivity, a key indicator of blood pressure control, particularly in individuals with paraplegia. Unlike in uninjured populations, improvements in baroreflex sensitivity were not strongly linked to gains in aerobic capacity, suggesting different mechanisms may be at play in individuals with SCI.

Practical Implications

Rehabilitation Strategies

Whole-body exercise with hybrid-FES rowing can be implemented as a rehabilitation strategy to improve blood pressure regulation in individuals with SCI, especially those with paraplegia.

Cardiovascular Risk Reduction

Improving cardiovagal baroreflex sensitivity through exercise may help reduce the risk of cardiovascular disease, a leading cause of death in individuals with chronic SCI.

Personalized Exercise Programs

Exercise programs should be tailored to the individual's level of injury, considering that individuals with paraplegia may experience greater benefits in terms of baroreflex sensitivity.

Study Limitations

1
The study had a purposefully narrow inclusion criteria with respect to participant age and time since injury, limiting broad generalizability.
2
Many baroreflex testing sessions were unable to generate meaningful data due to the inability to maintain breath hold during the neck suction.
3
The study acknowledges potential imbalances in autonomic completeness among the sample groups, which could influence the interpretation of results.

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