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Effects of exercise on autonomic cardiovascular control in individuals with chronic, motor-complete spinal cord injury: an exploratory randomised clinical trial

Spinal Cord volume 62, pages 597–604 (2024)Cite this article

Subjects

Abstract

Study Design

Secondary analysis of a clinical trial.

Objective

To assess the impact of 6 months of arm cycle ergometry training (ACET), or body weight-supported treadmill training (BWSTT), on autonomic cardiovascular responses to a laboratory sit-up test (SUT) in individuals with chronic (≥1-year post-injury) spinal cord injury (SCI).

Setting

Tertiary Rehabilitation Centre, Vancouver, Canada.

Methods

Sixteen individuals with motor-complete (American Spinal Injury Association Impairment Scale A-B) SCI between the fourth cervical and sixth thoracic spinal cord segments, aged 39 ± 11 years, were assessed. Participants were randomized to receive 72 sessions of moderate-to-vigorous intensity ACET (n = 8) or passive BWSTT (n = 8). Changes in mean arterial pressure (finger plethysmography), hemodynamics (Modelflow® method), and heart rate/heart rate variability (HR/HRV; electrocardiography) were measured in response to a  SUT before and after 6 months of exercise training. Spontaneous cardiovagal baroreflex sensitivity (cvBRS) was assessed using the sequence method.

Results

Neither ACET nor BWSTT impacted hemodynamic responses to SUT or the incidence of orthostatic hypotension (all P > 0.36). ACET increased HR (P < 0.01, ηp2 = 0.34) and high frequency (HF) power HRV responses (P < 0.01, ηp2 = 0.42) to SUT following 6 months of training while BWSTT did not. Consistent with this, cvBRS improved (P < 0.05, ηp2 = 0.16) only following ACET. Improvements in cvBRS were correlated with both the HR (r = 0.726, P < 0.0001) and HF power (r = −0.484, P < 0.01) responses to SUT.

Conclusion

Six months of ACET, but not BWSTT, improved cardiovagal baroreflex control of HR but had no effect on BP responses to SUT in individuals with chronic, motor-complete SCI.

Sponsorship

Canadian Institutes of Health Research (CIHR)

Clinical Trial Registration

NCT01718977

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Fig. 1: Hemodynamic responses to laboratory sit-up test following 6 months of exercise training.
Fig. 2: Heart rate and blood pressure variability responses to laboratory sit-up test following 6 months of exercise training.
Fig. 3: Spontaneous cardiovagal baroreflex sensitivity (cvBRS) following 6 months of exercise training.

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Data availability

The data supporting the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors would like to thank all participants for their commitment in this study and the assistance of numerous volunteers during exercise training sessions. We acknowledge the support of Dr. Leanne Ramer (Simon Fraser University) in helping with writing and submitting the trial protocol. We also appreciate the support of Dr. Robert Teasel (University of Western Ontario) as a chair of Data and Safety Monitoring Committee for the CHOICES trial. We also gratefully acknowledge the administrative support of study coordinators at ICORD/UBC: Andrea Ramirez, Dr. Cameron Gee, Marko Gavric and Martina Franz in helping with participants’ screening, assessments, and training.

Funding

This work was supported by the Canadian Institutes of Health Research (CIHR) project grant (TCA 118348), Canada Foundation for Innovation (CFI) and BC Knowledge Development Fund (BCKDF 35869) awarded to AVK. TWD was supported by a CIHR Doctoral Research Award (412708). TEN was funded by the Michael Smith Foundation for Health Research and International Collaboration on Repair Discoveries (ICORD) Research Trainee Award (17767). ST was supported by a UBC work learn position. AAA was supported for his PhD scholarship by King Fahad Medical City, Riyadh, Saudi Arabia. KDC was funded by a Postdoctoral Fellowship from the Heart and Stroke Foundation (17R26776) and Craig H. Neilson Foundation (281863). MH was funded by two fellowships from the Swiss National Science Foundation for Prospective Researchers (PBEZP3_145704 and P300P3_151153). SJTB was supported by the Robert H.N. Ho Scholarship. AVK holds an Endowed Chair in Spinal Cord Rehabilitation Research, Department of Medicine, UBC.

Author information

Author notes

  1. These authors contributed equally: Tristan W. Dorey, Tom E. Nightingale.

Authors and Affiliations

  1. Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

    Tristan W. Dorey

  2. School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK

    Tom E. Nightingale

  3. International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada

    Tom E. Nightingale, Abdullah A. Alrashidi, Stefan Thomas, Shane J. T. Balthazaar & Andrei V. Krassioukov

  4. Faculty of Medicine, Experimental Medicine, University of British Columbia, Vancouver, BC, Canada

    Abdullah A. Alrashidi & Shane J. T. Balthazaar

  5. King Fahad Medical City, Physical Therapy Department, Riyadh, Saudi Arabia

    Abdullah A. Alrashidi

  6. Department of Kinesiology, Michigan State University, East Lansing, MI, USA

    Katharine D. Currie

  7. Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland

    Michèle Hubli

  8. Division of Cardiology, University of British Columbia, Vancouver General & University of British Columbia Hospital Echocardiography Department, Vancouver, BC, Canada

    Shane J. T. Balthazaar

  9. Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

    Andrei V. Krassioukov

  10. GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC, Canada

    Andrei V. Krassioukov

Authors
  1. Tristan W. Dorey
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  2. Tom E. Nightingale
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  4. Stefan Thomas
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  6. Michèle Hubli
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  8. Andrei V. Krassioukov
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Contributions

TWD, TEN, and ST were responsible for data analysis and interpretation. TEN, AAA, KDC, MH, and SJTB were responsible for collection of the data and revising the manuscript for intellectual content. TWD and TEN prepared the figures and wrote the manuscript. AVK was responsible for study concept/design, managing data collection at the Vancouver center, and revising the manuscript for intellectual content. All authors approved the final version of this manuscript.

Corresponding author

Correspondence to Andrei V. Krassioukov.

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Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

We certify that all applicable and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research. Written informed consent was obtained from all participants. This study was performed in line with the principles of the Declaration of Helsinki. This study has received approval from the University of British Columbia Research Ethics Board; approval number H12-02945.

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Dorey, T.W., Nightingale, T.E., Alrashidi, A.A. et al. Effects of exercise on autonomic cardiovascular control in individuals with chronic, motor-complete spinal cord injury: an exploratory randomised clinical trial. Spinal Cord 62, 597–604 (2024). https://doi.org/10.1038/s41393-024-01019-z

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