High-intensity, whole-body exercise improves blood pressure control in individuals with spinal cord injury: A prospective randomized controlled trial.
High-intensity, whole-body exercise improves blood pressure control in individuals with spinal cord injury: A prospective randomized controlled trial.
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DOI：
10.1371/journal.pone.0247576
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Taylor JA
中科院分区：
文献类型：
--
作者：
Solinsky R;Draghici A;Hamner JW;Goldstein R;Taylor JA
脊髓损伤（SCI）后的血压调节通常由于血管交感神经控制受损而受损，导致增加对心迷走神经压力反射敏感性的依赖以维持压力。全身运动可以改善未受伤个体的心迷走神经压力感受性反射敏感性，但尚未在SCI患者中进行研究。我们的目的是确定SCI患者在进行6个月高强度全身运动后，与低强度仅手臂运动或候补运动相比，心迷走神经压力反射敏感性的变化。这项随机对照试验招募了18-40岁的SCI患者。61人被随机分组，其中38人完成至少一次心迷走神经压力反射敏感性评估。全身运动采用混合功能性电刺激划船，每周2 - 3次，持续30-60分钟，目标心率>最大心率的75%。手臂运动组进行上肢划船运动，运动处方与全身运动相同。候补对照组未参加任何明确的训练方案。6个月后，那些只锻炼手臂或等待名单的人转向全身锻炼。在基线和此后每隔三个月通过颈部抽吸技术评估迷走神经压力感受性反射敏感性。意向治疗分析与结构方程模型表明，没有显着影响候补名单控制或手臂只锻炼心迷走神经压力反射敏感性。对于最初随机分组的患者（p = 0.03），以及从仅运动组或等待名单对照组交叉的患者（p = 0.03），全身运动显著改善了6个月时的心迷走神经压力感受器反射敏感性。然而，运动量和有氧增益（VO 2 max）与心迷走神经压力反射敏感性的增加相关性很差（R2<0.15）。在事后分析中，与四肢瘫患者相比，截瘫患者的压力反射敏感性显著增加（p = 0.02），尽管该组内的增益与有氧能力的增益相关性很差。Clinicaltrials.gov编号NCT 02139436。
Blood pressure regulation following spinal cord injury (SCI) is often compromised due to impaired vascular sympathetic control, leading to increased reliance on cardiovagal baroreflex sensitivity to maintain pressure. Whole-body exercise improves cardiovagal baroreflex sensitivity in uninjured individuals, though has not been explored in those with SCI. Our objective was to determine changes in cardiovagal baroreflex sensitivity following 6 months of high-intensity, whole-body exercise in individuals with SCI compared to lower-intensity, arms only exercise, or waitlist. This randomized controlled trial recruited individuals with SCI aged 18–40 years old. Sixty-one individuals were randomized, with 38 completing at least one cardiovagal baroreflex sensitivity assessment. Whole-body exercise was performed with hybrid functional electrical stimulation rowing prescribed as two to three times per week, for 30–60 minutes with a target heart rate of >75% of maximum. The arms only exercise group performed upper body rowing exercise with the same prescription as whole-body exercise. Waitlist controls were not enrolled in any explicit training regimen. After 6 months, those in arms only exercise or waitlist crossed over to whole-body exercise. Cardiovagal baroreflex sensitivity was assessed via the neck suction technique at baseline and at three-month intervals thereafter. Intention to treat analysis with a structured equation model demonstrated no significant effect of waitlist control or arms only exercise on cardiovagal baroreflex sensitivity. Whole-body exercise significantly improved cardiovagal baroreflex sensitivity at 6 months for those initially randomized (p = 0.03), as well as those who crossed over from arms only exercise or waitlist control (p = 0.03 for each). However, amount of exercise performed and aerobic gains (VO2max) each poorly correlated with increases in cardiovagal baroreflex sensitivity (R2<0.15). In post-hoc analyses, individuals with paraplegia made significantly greater gains in baroreflex sensitivity compared to those with tetraplegia (p = 0.02), though gains within this group were again poorly correlated to gains in aerobic capacity. Clinicaltrials.gov number NCT02139436.