RESISTIVE RESPIRATORY TRAINING IMPROVES BLOOD PRESSURE REGULATION IN INDIVIDUALS WITH CHRONIC SPINAL CORD INJURY

Arch Phys Med Rehabil, 2016 · DOI: 10.1016/j.apmr.2015.11.018 · Published: June 1, 2016

Spinal Cord Injury Pulmonology Neurology

Simple Explanation

This study looked at how a type of breathing exercise called Resistive Respiratory Motor Training (RMT) affects blood pressure in people with chronic spinal cord injuries (SCI). Many people with SCI have problems with low blood pressure when they sit up (orthostatic hypotension or OH). The researchers had people with SCI do RMT exercises for about a month and then measured their blood pressure, heart rate, and breathing during a sit-up test. They compared the results to before the training and also to healthy people. The study found that RMT helped improve blood pressure control in many people with SCI, reducing the severity of OH. It seemed to work by improving breathing capacity, autonomic nervous system function, and the coordination between breathing and heart function.

Study Duration

One-month period

Participants

11 individuals with chronic C3-T2 SCI and 10 healthy controls

Evidence Level

Before-after intervention case-controlled clinical study

Key Findings

1
Completion of RMT intervention abolished OH in 7 out of 11 individuals.
2
FVC, low-frequency component of power spectral density (LF PSD) of BP and HR oscillations, baroreflex effectiveness and cross correlations between BP, HR, and respiratory rate during orthostatic challenge were significantly improved, approaching levels observed in NI individuals.
3
These findings indicate increased sympathetic activation and baroreflex effectiveness in association with improved respiratory-cardiovascular interactions in response to the sudden decrease in BP.

Research Summary

The study investigated the effects of resistive respiratory motor training (RMT) on pulmonary function and cardiovascular responses in individuals with chronic spinal cord injury (SCI) who experience orthostatic hypotension (OH). The results showed that RMT improved respiratory capacity, autonomic activation, and cardiorespiratory coupling, suggesting it could be an effective therapy for managing OH after SCI. The study also highlights the importance of a 15-minute observation period during sit-up orthostatic stress tests for individuals with SCI to accurately diagnose OH.

Practical Implications

Clinical Management of OH

Resistive respiratory training can be considered as a potential efficacious therapy for managing orthostatic hypotension after spinal cord injury.

Improved Rehabilitation Outcomes

RMT may shorten the time between injury and the initial steps leading to eventual resumption of a more stable lifestyle.

Understanding Autonomic Dysfunction

Findings provide insight into the mechanisms of benefits, which can be associated with awakened autonomic networks, harnessing respiratory pump, and improved cardiovascular baroreflex function.

Study Limitations

1
Severity of injury to the spinal autonomic pathways was not assessed.
2
Study was limited by group heterogeneity and relatively small sample size.
3
Impact of combinatory effects of neurological, pulmonary and cardiovascular factors was not elucidated.

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