Ventilatory Support to Improve Exercise Training in High Level Spinal Cord Injury

总结 有规律的有氧运动和足够的强度可以改善整体健康，但每天 能量消耗在SCI患者中较低，尤其是在那些具有高度损伤的患者中。我们有 开发了功能性电刺激行训练（FESRT）， 和电控腿部锻炼，增加活跃的肌肉， 大肌肉群运动。尽管有提高有氧能力的潜力， 高级别病变（C4至T2）对获得更高的工作能力仍有障碍 他们有最大的肺肌肉去神经支配，我们的初步工作表明， 限制了FESRT可以达到的有氧能力。外部支持可以 提高运动训练的能力，从而增强对慢性运动的适应能力， 高级SCI。运动训练期间的无创通气（NIV）已被证明 改善那些呼吸类似受限的人的运动能力。所以我们 假设在FESRT期间使用NIV将减少运动的限制， 增加高水平SCI的有氧能力。我们的目标是确定 有氧能力的改善及其与最大心输出量增加的关系， 与FESRT+假NIV相比，FESRT+NIV治疗4个月后的动静脉血氧差异。 我们有机会获得一个大的（N>70）和独特的人口与SCI的人谁已经 参加FESRT至少6个月。大约一半的人在C4和T2之间有SCI。30 患有高水平SCI的个人，接受至少6个月的FES行培训， 随机分配至（继续）FESRT 4个月，采用NIV或假NIV。前后 训练时，我们将评估最大有氧能力、通气量、心输出量和动静脉 氧差根据我们目前的数据，我们假设只有那些随机分配到 NIV将经历有氧能力的进一步增加，这些增加将与 增加心输出量和动静脉氧差。探索性/发展性 研究项目将确定这一做法的可行性和有效性，并将 为更大规模的对照试验打下基础

Summary 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. We 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 exercise train and hence enhance the adaptations to chronic exercise in high level SCI. Non invasive ventilation (NIV) during exercise training has been shown to improve gains in exercise capacity in those with similarly restrictive breathing. Therefore, we hypothesize that the use of NIV during FESRT will reduce ventilatory limits to exercise, leading to increased aerobic capacity in high level SCI. Our aims are to determine the magnitude of improvement in aerobic capacity and its relationship to increases in maximal cardiac output and arterio venous oxygen difference after 4 months of FESRT+NIV compared to FESRT+shamNIV. We 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. 30 individuals with high level SCI who have FES row trained for at least 6 months will be randomized to (continued) FESRT for 4 months with either NIV or sham NIV. Before and after training, we will assess maximal aerobic capacity, ventilation, cardiac output, and arterio venous oxygen difference. Based on our current data, we hypothesize that only those randomized to NIV will experience further increases in aerobic capacity and that these increases will relate to increased cardiac output and arterio venous oxygen difference. 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.