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Exercise Guidelines to Promote Cardiometabolic Health in Spinal Cord Injured Humans: Time to Raise the Intensity?

Tom E. Nightingale, Richard Metcalfe Orcid Logo, Niels B. Vollaard, James L. Bilzon

Archives of Physical Medicine and Rehabilitation, Volume: 98, Issue: 8, Pages: 1693 - 1704

Swansea University Author: Richard Metcalfe Orcid Logo

Abstract

Spinal cord injury (SCI) is a life-changing event that, as a result of paralysis, negatively influences habitual levels of physical activity and hence cardiometabolic health. Performing regular structured exercise therefore appears extremely important in persons with SCI. However, exercise options a...

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Published in: Archives of Physical Medicine and Rehabilitation
ISSN: 0003-9993
Published: 2017
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URI: https://cronfa.swan.ac.uk/Record/cronfa35660
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first_indexed 2017-09-26T18:57:54Z
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spelling 2020-11-24T21:32:03.0907786 v2 35660 2017-09-26 Exercise Guidelines to Promote Cardiometabolic Health in Spinal Cord Injured Humans: Time to Raise the Intensity? 9bb783273dd9d54a2f3f66f75c43abdf 0000-0003-0980-2977 Richard Metcalfe Richard Metcalfe true false 2017-09-26 STSC Spinal cord injury (SCI) is a life-changing event that, as a result of paralysis, negatively influences habitual levels of physical activity and hence cardiometabolic health. Performing regular structured exercise therefore appears extremely important in persons with SCI. However, exercise options are mainly limited to the upper body, which involves a smaller activated muscle mass compared with the mainly leg-based activities commonly performed by nondisabled individuals. Current exercise guidelines for SCI focus predominantly on relative short durations of moderate-intensity aerobic upper-body exercise, yet contemporary evidence suggests this is not sufficient to induce meaningful improvements in risk factors for the prevention of cardiometabolic disease in this population. As such, these guidelines and their physiological basis require reappraisal. In this special communication, we propose that high-intensity interval training (HIIT) may be a viable alternative exercise strategy to promote vigorous-intensity exercise and prevent cardiometabolic disease in persons with SCI. Supplementing the limited data from SCI cohorts with consistent findings from studies in nondisabled populations, we present strong evidence to suggest that HIIT is superior to moderate-intensity aerobic exercise for improving cardiorespiratory fitness, insulin sensitivity, and vascular function. The potential application and safety of HIIT in this population is also discussed. We conclude that increasing exercise intensity could offer a simple, readily available, time-efficient solution to improve cardiometabolic health in persons with SCI. We call for high-quality randomized controlled trials to examine the efficacy and safety of HIIT in this population. Journal Article Archives of Physical Medicine and Rehabilitation 98 8 1693 1704 0003-9993 Cardiorespiratory fitness; Cardiovascular diseases; Exercise; High-intensity interval training; Metabolic diseases; Rehabilitation; Spinal cord injuries 31 8 2017 2017-08-31 10.1016/j.apmr.2016.12.008 COLLEGE NANME Sport and Exercise Sciences COLLEGE CODE STSC Swansea University 2020-11-24T21:32:03.0907786 2017-09-26T13:31:10.5665458 Faculty of Science and Engineering School of Aerospace, Civil, Electrical, General and Mechanical Engineering - Sport and Exercise Sciences Tom E. Nightingale 1 Richard Metcalfe 0000-0003-0980-2977 2 Niels B. Vollaard 3 James L. Bilzon 4 0035660-29092017100712.pdf NightingaleHITandSCIAPMR.pdf 2017-09-29T10:07:12.8770000 Output 2514656 application/pdf Accepted Manuscript true 2018-01-13T00:00:00.0000000 false eng
title Exercise Guidelines to Promote Cardiometabolic Health in Spinal Cord Injured Humans: Time to Raise the Intensity?
spellingShingle Exercise Guidelines to Promote Cardiometabolic Health in Spinal Cord Injured Humans: Time to Raise the Intensity?
Richard Metcalfe
title_short Exercise Guidelines to Promote Cardiometabolic Health in Spinal Cord Injured Humans: Time to Raise the Intensity?
title_full Exercise Guidelines to Promote Cardiometabolic Health in Spinal Cord Injured Humans: Time to Raise the Intensity?
title_fullStr Exercise Guidelines to Promote Cardiometabolic Health in Spinal Cord Injured Humans: Time to Raise the Intensity?
title_full_unstemmed Exercise Guidelines to Promote Cardiometabolic Health in Spinal Cord Injured Humans: Time to Raise the Intensity?
title_sort Exercise Guidelines to Promote Cardiometabolic Health in Spinal Cord Injured Humans: Time to Raise the Intensity?
author_id_str_mv 9bb783273dd9d54a2f3f66f75c43abdf
author_id_fullname_str_mv 9bb783273dd9d54a2f3f66f75c43abdf_***_Richard Metcalfe
author Richard Metcalfe
author2 Tom E. Nightingale
Richard Metcalfe
Niels B. Vollaard
James L. Bilzon
format Journal article
container_title Archives of Physical Medicine and Rehabilitation
container_volume 98
container_issue 8
container_start_page 1693
publishDate 2017
institution Swansea University
issn 0003-9993
doi_str_mv 10.1016/j.apmr.2016.12.008
college_str Faculty of Science and Engineering
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hierarchy_top_title Faculty of Science and Engineering
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description Spinal cord injury (SCI) is a life-changing event that, as a result of paralysis, negatively influences habitual levels of physical activity and hence cardiometabolic health. Performing regular structured exercise therefore appears extremely important in persons with SCI. However, exercise options are mainly limited to the upper body, which involves a smaller activated muscle mass compared with the mainly leg-based activities commonly performed by nondisabled individuals. Current exercise guidelines for SCI focus predominantly on relative short durations of moderate-intensity aerobic upper-body exercise, yet contemporary evidence suggests this is not sufficient to induce meaningful improvements in risk factors for the prevention of cardiometabolic disease in this population. As such, these guidelines and their physiological basis require reappraisal. In this special communication, we propose that high-intensity interval training (HIIT) may be a viable alternative exercise strategy to promote vigorous-intensity exercise and prevent cardiometabolic disease in persons with SCI. Supplementing the limited data from SCI cohorts with consistent findings from studies in nondisabled populations, we present strong evidence to suggest that HIIT is superior to moderate-intensity aerobic exercise for improving cardiorespiratory fitness, insulin sensitivity, and vascular function. The potential application and safety of HIIT in this population is also discussed. We conclude that increasing exercise intensity could offer a simple, readily available, time-efficient solution to improve cardiometabolic health in persons with SCI. We call for high-quality randomized controlled trials to examine the efficacy and safety of HIIT in this population.
published_date 2017-08-31T03:44:25Z
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