Reliability and validity of subjective measures of aerobic intensity in adults with spinal cord injury: a systematic review

Objective: To systematically synthesize and appraise research regarding test-retest reliability or criterion validity of subjective measures for assessing aerobic exercise intensity in adults with spinal cord injury (SCI). Data Sources: Electronic databases (Pubmed, PsychINFO, SPORTDiscus, EMBASE and CINAHL) were searched from inception to 1-1-2016. Study Selection: Studies involving at least 50% of participants with SCI who performed an aerobic exercise test that included measurement of subjective and objective intensity based on test-retest reliability or criterion validity protocols. Data Extraction: Characteristics were extracted on study design, measures, participants, protocols, and results. Each study was evaluated for risk of bias based on strength of the study design and a quality checklist score (COnsensus-based Standards for the selection of health Measurement Instruments [COSMIN]). Data Synthesis: The seven eligible studies (one for reliability, six for validity) evaluated overall, peripheral and/or central ratings of perceived exertion on a 6-20 scale (RPE 6-20). No eligible studies were identified for other subjective intensity measures. The evidence for reliability and validity were synthesized separately for each measure, and assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Overall, very low GRADE confidence ratings were established for reliability and validity evidence generalizable to the entire population with SCI and various upper-body and lower-body modalities. There was low confidence for the evidence showing that overall RPE 6-20 has acceptable validity for adults with SCI and high fitness levels performing moderate to vigorous-intensity upper-body aerobic exercise. Conclusions: Health care professionals and scientists need to be aware of the very low to low confidence in the evidence, which currently prohibits a strong clinical recommendation for the use of subjective measures for assessing aerobic exercise intensity in adults with SCI. However, a tentative, conditional recommendation regarding overall RPE 6-20 seems applicable depending on participants’ fitness level as well as the exercise intensity and modality used

Bilateral scapular kinematics, asymmetries and shoulder pain in wheelchair athletes

Background Shoulder pain is the most common complaint for wheelchair athletes. Scapular orientation and dyskinesia are thought to be associated with shoulder pathology, yet no previous studies have examined the bilateral scapula kinematics of wheelchair athletes during propulsion. Research question To examine bilateral scapular kinematics of highly trained wheelchair rugby (WR) players and any associations with self-reported shoulder pain during everyday wheelchair propulsion. Methods Ten WR players (5 with shoulder pain, 5 without) performed 2 × 3-minute bouts of exercise in their everyday wheelchair on a wheelchair ergometer at two sub-maximal speeds (3 and 6 km∙h-1). During the final minute, 3D kinematic data were collected at 100 Hz to describe scapulothoracic motion relative to each propulsion cycle. Instantaneous asymmetries in scapular orientation between dominant and non-dominant sides were also reported. Differences in scapular kinematics and propulsion asymmetries were compared across shoulders symptomatic and asymptomatic of pain. Results An internally rotated, upwardly rotated and anteriorly tilted scapula was common during wheelchair propulsion and asymmetries ≤ 14° did exist, yet minimal changes were observed across speeds. Participants with bilateral shoulder pain displayed a less upwardly rotated scapula during propulsion, however large inter-individual variability in scapular kinematics was noted. Significance Scapular asymmetries are exhibited by wheelchair athletes during wheelchair propulsion, yet these were not exacerbated by increased speed and had limited associations to shoulder pain. This suggests that propulsion kinematics of highly trained athletes may not be the primary cause of pain experienced by this population

A comparison of static and dynamic cerebral autoregulation during mild whole-body cold stress in individuals with and without cervical spinal cord injury: a pilot study

Study design: Experimental study. Objectives: To characterize static and dynamic cerebral autoregulation (CA) of individuals with cervical spinal cord injury (SCI) compared to able-bodied controls in response to moderate increases in mean arterial pressure (MAP) caused by mild whole-body cold stress. Setting: Japan Methods: Five men with complete autonomic cervical SCI (sustained>5y) and six age-matched able-bodied men participated in hemodynamic, temperature, catecholamine and respiratory measurements for 60 min during three consecutive stages: baseline (10 min; 330C water through a thin-tubed whole-body suit), mild cold stress (20 min; 250C water) and post-cold recovery (30 min; 330C water). Static CA was determined as the ratio between mean changes in middle cerebral artery blood velocity and MAP, dynamic CA as transfer function coherence, gain and phase between spontaneous changes in MAP to middle cerebral artery blood velocity. Results: MAP increased in both groups during cold and post-cold recovery (mean differences: 5 to 10 mm Hg; main effect of time: p=0.001). Static CA was not different between the able-bodied vs the cervical SCI group (mean [95% CI] of between-group difference: -4 [-11 to 3] and -2 [-5 to 1] cm/s/mmHg for cold (p=0.22) and post-cold (p=0.24), respectively). At baseline, transfer function phase was shorter in the cervical SCI group (mean [95% CI] of between-group difference: 0.6 [0.2 to 1.0] rad; p=0.006), while between-group differences in changes in phase were not different in response to the cold stress (interaction term: p=0.06). Conclusions: This pilot study suggests that static CA is similar between individuals with cervical SCI and able-bodied controls in response to moderate increases in MAP, while dynamic CA may be impaired in cervical SCI due to disturbed sympathetic control

Development of scientific exercise guidelines for adults with spinal cord injury [infographic]

Development of scientific exercise guidelines for adults with spinal cord injury [infographic

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

Additional file 1 of Guiding organisational decision-making about COVID-19 asymptomatic testing in workplaces: mixed-method study to inform an ethical framework

Additional file 1. Questionnaire used in the case study consultation

Additional file 2 of Guiding organisational decision-making about COVID-19 asymptomatic testing in workplaces: mixed-method study to inform an ethical framework

Additional file 2. Interview guide used in the case study consultation

Additional file 3 of Guiding organisational decision-making about COVID-19 asymptomatic testing in workplaces: mixed-method study to inform an ethical framework

Additional file 3. Selection of supporting data from the survey and interviews that informed the framework