Acute Effect of Ventilatory Support During Exercise in Spinal Cord Injury
| Status: | Completed |
|---|---|
| Conditions: | Hospital, Hospital, Orthopedic |
| Therapuetic Areas: | Orthopedics / Podiatry, Other |
| Healthy: | No |
| Age Range: | 18 - 60 |
| Updated: | 2/23/2019 |
| Start Date: | June 14, 2017 |
| End Date: | October 15, 2018 |
The investigators have an existing exercise program (N>70) with a unique population of
individuals with spinal cord injury (SCI) who have been enrolled in Functional Electrical
Stimulation - Rowing Training (FES-RT) for at least 6 months. Previous data in the laboratory
from this exercise platform has recently showed that respiratory restriction in SCI reduces
inspiratory capacity in direct relation to lesion level, and those with high level injuries
have the greatest compromise. As a result, the increase in ventilatory requirements with FES
training results in an imbalance between ventilatory capacity and greater whole body skeletal
muscle demand after FES rowing training. Hence, external ventilatory support could improve
the ability to exercise train and hence enhance the adaptations to chronic exercise in high
level SCI. If our hypothesis is correct, this indicates that maximal aerobic capacity in
these individuals exceeds maximal voluntary ventilation. It will be important to determine
however the consistency of this response and at what level of injury it is not observed. In
parallel of the study # NCT02865343, the investigators will recruit here a population of
subjects who have completed six months of FES-row exercise training across a range of SCI
level (C5-T12). Hence, the investigators will be able to determine the consistency of the
effect and the dependence of the effect on SCI level. Some of them with level >T3 may also
enroll in training effect study with NIV or sham NIV (NCT02865343))
individuals with spinal cord injury (SCI) who have been enrolled in Functional Electrical
Stimulation - Rowing Training (FES-RT) for at least 6 months. Previous data in the laboratory
from this exercise platform has recently showed that respiratory restriction in SCI reduces
inspiratory capacity in direct relation to lesion level, and those with high level injuries
have the greatest compromise. As a result, the increase in ventilatory requirements with FES
training results in an imbalance between ventilatory capacity and greater whole body skeletal
muscle demand after FES rowing training. Hence, external ventilatory support could improve
the ability to exercise train and hence enhance the adaptations to chronic exercise in high
level SCI. If our hypothesis is correct, this indicates that maximal aerobic capacity in
these individuals exceeds maximal voluntary ventilation. It will be important to determine
however the consistency of this response and at what level of injury it is not observed. In
parallel of the study # NCT02865343, the investigators will recruit here a population of
subjects who have completed six months of FES-row exercise training across a range of SCI
level (C5-T12). Hence, the investigators will be able to determine the consistency of the
effect and the dependence of the effect on SCI level. Some of them with level >T3 may also
enroll in training effect study with NIV or sham NIV (NCT02865343))
Regular aerobic exercise with sufficient intensity can improve overall health, however daily
energy expenditure is low in those with SCI, especially in those with high level lesions. The
investigators have developed Functional Electrical Stimulation Row Training (FESRT) that
couples volitional arm and electrically controlled leg exercise, increasing the active muscle
and resulting in benefits of large muscle mass exercise. Despite the potential for enhancing
aerobic capacity, those with high level lesions (C4 to T2) have a remaining obstacle to
attaining higher work capacities. They have the greatest pulmonary muscle denervation and our
preliminary work suggests this limits the aerobic capacity that can be achieved with FESRT.
External ventilatory support could improve the ability to reach higher level of peak
ventilation and hence enhance the ability to exercise in high level SCI. Therefore, the
investigators hypothesize that the use of NIV during FESRT will reduce ventilatory limits to
exercise, leading to increased aerobic capacity in high level SCI. The aims are to examine
the acute effect of NIV on FES-row VO2max in subjects with both high and low level SCI. The
investigators have access to a large (N>70) and unique population of individuals with SCI who
have been enrolled in FESRT for at least 6 months. Roughly half have SCI between C4 and T2
and half with lower injury levels (
to determine maximal aerobic capacity and ventilation. Both FES-VO2max Row tests will be
performed at least 48-hours apart. Both tests will be performed with the NIV set-up but with
and without use of the NIV support in a random order. The level of inspiratory pressure will
be individually set during a familiarization test. The investigators will assess maximal
aerobic capacity, minute ventilation, tidal volume and cardiac output during FES-rowing.
Based on current data, it is hypothesized that only those with higher level of injury (> T3)
will experience further increases in aerobic capacity when using the NIV support. This
exploratory/developmental research project will determine feasibility and effectiveness of
this approach to exercise and will lay the groundwork for a larger, controlled trial.
energy expenditure is low in those with SCI, especially in those with high level lesions. The
investigators have developed Functional Electrical Stimulation Row Training (FESRT) that
couples volitional arm and electrically controlled leg exercise, increasing the active muscle
and resulting in benefits of large muscle mass exercise. Despite the potential for enhancing
aerobic capacity, those with high level lesions (C4 to T2) have a remaining obstacle to
attaining higher work capacities. They have the greatest pulmonary muscle denervation and our
preliminary work suggests this limits the aerobic capacity that can be achieved with FESRT.
External ventilatory support could improve the ability to reach higher level of peak
ventilation and hence enhance the ability to exercise in high level SCI. Therefore, the
investigators hypothesize that the use of NIV during FESRT will reduce ventilatory limits to
exercise, leading to increased aerobic capacity in high level SCI. The aims are to examine
the acute effect of NIV on FES-row VO2max in subjects with both high and low level SCI. The
investigators have access to a large (N>70) and unique population of individuals with SCI who
have been enrolled in FESRT for at least 6 months. Roughly half have SCI between C4 and T2
and half with lower injury levels (
to determine maximal aerobic capacity and ventilation. Both FES-VO2max Row tests will be
performed at least 48-hours apart. Both tests will be performed with the NIV set-up but with
and without use of the NIV support in a random order. The level of inspiratory pressure will
be individually set during a familiarization test. The investigators will assess maximal
aerobic capacity, minute ventilation, tidal volume and cardiac output during FES-rowing.
Based on current data, it is hypothesized that only those with higher level of injury (> T3)
will experience further increases in aerobic capacity when using the NIV support. This
exploratory/developmental research project will determine feasibility and effectiveness of
this approach to exercise and will lay the groundwork for a larger, controlled trial.
Inclusion Criteria:
- Subjects aged 18 to 60
- Have had SCI (at neurological level C5-T12 with American Spinal Injury Association
grade A or B or C)
- Medically stable
- Have FES-row trained for >6 months
Exclusion Criteria:
- Hypertension(Blood pressure>140/90 mmHg)
- Significant arrhythmias
- Coronary disease
- Chronic respiratory disease
- Diabetes
- Renal disease
- Cancer
- Epilepsy
- Current use of cardioactive medications
- Current grade 2 or greater pressure ulcers at relevant contact sites
- Other neurological disease
- Peripheral nerve compression or rotator cuff tears that limit the ability to row
- History of bleeding disorder
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