Augmenting exercise capacity with noninvasive ventilation in high-level spinal cord injury
Augmenting exercise capacity with noninvasive ventilation in high-level spinal cord injury
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DOI：
10.1152/japplphysiol.01028.2017
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发表时间：
2018-05-01
影响因子：
3.3
通讯作者：
Vivodtzev, Isabelle
中科院分区：
文献类型：
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作者：
Morgan, James W.;Ferrazzani, Eric;Vivodtzev, Isabelle
高位脊髓损伤（SCI）导致受神经支配的骨骼肌质量非常有限，这严重降低了运动能力。我们最近的工作表明，当增加瘫痪腿的功能性电刺激（FES）（混合FES-运动）以产生更高的运动能力时，峰值通气量成为训练诱导的有氧能力改善的限制因素。我们的假设是，对运动训练的系统适应是由可以达到的最大通气量限定的。然而，在这里，我们提出了一个案例，显示急性增加有氧能力时，使用非侵入性呼吸支持（NIV）在FES划船试验中的个人谁曾在他的有氧能力高原18个月。一名18岁的C5脊髓损伤男性，仅用手臂划船训练6个月，随后用混合FES划船训练18个月。在仅手臂训练后，峰值每分钟通气量（（V）比dot（E）（峰值））和峰值耗氧量（（V）比doto（2 peak））增加，并在6个月的混合FES-行训练后进一步增加。尽管持续的密集和频繁的混合FES-行训练，在接下来的一年中，（V）超过点（E）（峰值）和（V）超过点（2 peak）都没有进一步增加（1.94和66.0 1/min）。然而，当该个体在添加NIV的情况下进行FES-划船（V）超过doto（2 p）（ak）测试时，（V）超过doto（Epeak）增加了5 1/min，导致（V）超过doto（2 pe）（ak）改善（2.23 1/min，+12%）。这个病例表明，无创通气可以克服高水平SCI通气的局限性，并在混合FES-运动期间将有氧能力提高到其他方法无法达到的水平。此外，它广泛地说明了肺功能在决定运动能力方面的重要作用。
High-level spinal cord injury (SCI) results in a very limited innervated skeletal muscle mass that strongly reduces exercise capacity. Our recent work showed that when adding functional electrical stimulation (FES) of the paralyzed legs (hybrid FES-exercise) to produce higher exercise capacity, peak ventilation became a limiting factor to training-induced improvement in aerobic capacity. Our assumption was that the systemic adaptations to exercise training are delimited by the maximal ventilation that can be achieved. However, herein, we present a case showing an acute increase in aerobic capacity when using noninvasive ventilatory support (NIV) during FES-rowing test in an individual who had previously experimented a plateau in his aerobic capacity for 18 mo. An 18-yr-old man with C5 SCI trained with arms-only rowing for 6 mo and subsequently trained with hybrid FES-rowing for 18 mo. Peak minute ventilation ((V) over dot(E)(peak)) and peak oxygen consumption ((V) over doto(2peak)) were increased after arms-only training and increased further with 6 mo of hybrid FES-row training. Despite continued intense and frequent, hybrid FES-row training, neither (V) over dot(E)(peak) nor (V) over doto(2peak) increased further over the next year (1.94 and 66.0 1/min). However, when this individual performed a FES-rowing (V) over doto(2p)(eak) test with the addition of NIV, (V) over dot(Epeak) increased by 5 1/min, resulting in an improved (V) over doto(2pe)(ak) (2.23 1/min, +12%). This case demonstrates that noninvasive ventilation can overcome limitations to ventilation in high-level SCI and improve aerobic capacity during hybrid FES-exercise to a level not otherwise achievable. In addition, it broadly illustrates the intimate role of pulmonary function in determining the capacity to perform exercise.