Perspective: does laboratory-based maximal incremental exercise testing elicit maximum physiological responses in highly-trained athletes with cervical spinal cord injury?

The physiological assessment of highly-trained athletes is a cornerstone of many scientific support programs. In the present article, we provide original data followed by our perspective on the topic of laboratory-based incremental exercise testing in elite athletes with cervical spinal cord injury. We retrospectively reviewed our data on Great Britain Wheelchair Rugby athletes collected during the last two Paralympic cycles. We extracted and compared peak cardiometabolic (heart rate and blood lactate) responses between a standard laboratory-based incremental exercise test on a treadmill and two different maximal field tests (4 min and 40 min maximal push). In the nine athletes studied, both field tests elicited higher peak responses than the laboratory-based test. The present data imply that laboratory-based incremental protocols preclude the attainment of true peak cardiometabolic responses. This may be due to the different locomotor patterns required to sustain wheelchair propulsion during treadmill exercise or that maximal incremental treadmill protocols only require individuals to exercise at or near maximal exhaustion for a relatively short period of time. We acknowledge that both field- and laboratory-based testing have respective merits and pitfalls and suggest that the choice of test be dictated by the question at hand: if true peak responses are required then field-based testing is warranted, whereas laboratory-based testing may be more appropriate for obtaining cardiometabolic responses across a range of standardised exercise intensities

Effects of exercise on fitness and health of adults with spinal cord injury: a systematic review

Objective: To synthesize and appraise research testing the effects of exercise interventions on fitness, cardiometabolic health and bone health among adults with spinal cord injury (SCI). Methods: Electronic databases were searched (1980-2016). Included studies: employed exercise interventions for a period ≥2 weeks; involved adults with acute or chronic SCI; and measured fitness (cardiorespiratory fitness, power output and/or muscle strength), cardiometabolic health (body composition and/or cardiovascular risk factors), and/or bone health outcomes. Evidence was synthesized and appraised using GRADE. Results: 211 studies met the inclusion criteria (22 acute, 189 chronic). For chronic SCI, GRADE confidence ratings were moderate to high for evidence showing exercise can improve all of the reviewed outcomes except bone health. For acute SCI, GRADE ratings were very low for all outcomes. For chronic SCI, there was low-to-moderate confidence in the evidence showing that 2-3 sessions/week of upper-body aerobic exercise at a moderate-to-vigorous intensity for 20-40 min, plus upper-body strength exercise (3 sets of 10 repetitions at 50-80% 1RM for all large muscle groups) can improve cardiorespiratory fitness, power output and muscle strength. For chronic SCI, there was low-to-moderate confidence in the evidence showing that 3-5 sessions per week of upper-body aerobic exercise at a moderate-to-vigorous intensity for 20-44 min can improve cardiorespiratory fitness, muscle strength, body composition, and cardiovascular risk. Conclusions: Exercise improves fitness and cardiometabolic health of adults with chronic SCI. The evidence on effective exercise types, frequencies, intensities and durations should be used to formulate exercise guidelines for adults with SCI

Transforming research systems for meaningful engagement: a reflexive thematic analysis of spinal cord injury researchers’ barriers and facilitators to using the integrated knowledge translation guiding principles

To develop an in-depth understanding of spinal cord injury (SCI) researchers’ barriers and facilitators to deciding to use 1) a partnered approach to research and, 2) systematically developed principles for guiding Integrated Knowledge Translation (IKT) in spinal cord injury research (IKT Guiding Principles). Qualitative interview study with North American SCI researchers who were interested in using a partnered research approach. The research was conducted using an IKT approach, and interview data were analyzed using reflexive thematic analysis. Thirteen SCI researchers whose research focused on prevention, clinical, rehabilitation, and/or community SCI research were interviewed. Three themes were co-constructed with partners: 1) the principles are necessary but not sufficient for the implementation of a partnered approach to research; 2) relational capacity building is needed; and 3) institutional transformation is needed to value, resource, and support meaningful engagement. Supporting change that enables SCI researchers to adopt and implement the IKT Guiding Principles will require transformation at the individual (theme 1), relational (theme 2), and institutional levels (theme 3). Findings provide clear, practical, and tangible actions to promote change that can support meaningful engagement in the SCI Research System. Providing researchers with clear, procedural information and strategies to use each of the Integrated Knowledge Translation Guiding Principles in practice can support the implementation of the principles and partnered research in rehabilitation-based research.Fostering and evaluating resources and initiatives that help researchers network, build connections, and receive mentorship could help spinal cord injury researchers partner more effectively.Academic, research, and funding systems must ensure their practices, structures, culture, and processes enable, value, resource, support, and/or incentivize partnered research to ensure the research being conducted is relevant and useful in addressing the needs and priorities of research users. Providing researchers with clear, procedural information and strategies to use each of the Integrated Knowledge Translation Guiding Principles in practice can support the implementation of the principles and partnered research in rehabilitation-based research. Fostering and evaluating resources and initiatives that help researchers network, build connections, and receive mentorship could help spinal cord injury researchers partner more effectively. Academic, research, and funding systems must ensure their practices, structures, culture, and processes enable, value, resource, support, and/or incentivize partnered research to ensure the research being conducted is relevant and useful in addressing the needs and priorities of research users.</p

Response to correspondence from the ESSA Statement authors

Response to correspondence from the ESSA Statement author