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Non-Invasive Ventilation Increases Peak Minute Ventilation and Vo2 Max During Whole Body Functional Electrical Stimulation Rowing in an Individual with C5 Spinal Cord Injury
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A2182 - Non-Invasive Ventilation Increases Peak Minute Ventilation and Vo2 Max During Whole Body Functional Electrical Stimulation Rowing in an Individual with C5 Spinal Cord Injury
Author Block: I. Vivodtzev, J. W. Morgan, J. A. Taylor; Physical Medicine and Rehabilitation, Cardiovascular Research Laboratory, Harvard Medical School, Cambridge, MA, United States.
High level spinal cord injury (SCI) results in profound limitations to respiratory function leading to lower exercise capacity. Therefore, when adding functional electrical stimulation (FES) of the paralyzed legs to produce higher exercise capacity (hybrid FES exercise), peak ventilation may be a key limitation to aerobic capacity. Based on prior research on individuals with respiratory restriction, we hypothesized that non-invasive ventilation (NIV) would improve the increases in aerobic capacity with FES-row training in individuals with high-level SCI. Our assumption was that the systemic adaptations to hybrid FES exercise training are delimited by the maximal ventilation that can be achieved. However, herein we present a case counter to our hypothesis that exemplifies the important determinant role of maximal ventilation for aerobic capacity during whole body hybrid FES exercise in those with high level injuries.
An 18-year-old male with C5 SCI (FVC = 4.01 L, 75% of predicted and FEV1 = 3.80 L, 82% of predicted) performed arms-only row training for 6 months prior to whole body FES-row training for 18 months. VEpeak and VO2max increased with arms only training, with the addition of the paralyzed legs with hybrid FES rowing, and with 6 months of hybrid FES row training. Thereafter, despite long term (+12 months), intense (> 80% max heart rate), frequent (>2x weekly) whole body (FES) exercise training, neither VO2max nor VE peak increased further (1.94 L/min and 66.0 L/min). Thus, it appeared that aerobic capacity increased up to ventilatory capacity. However, a single session of whole body FES-rowing with the addition of NIV (inspiratory/expiratory pressure = 23/5 cmH2O; increase in peak minute ventilation to 71 L/min) increased VO2max by 12% (2.23 L/min with NIV vs. 1.99 L/min with sham NIV).
This interesting case demonstrates that aerobic capacity increases with whole body exercise training in those with SCI are restricted by ventilatory capacity and that with ventilatory support the true increase in exercise capacity is realized. Hence, exercise with the combination of increased muscle mass with FES and increased ventilation with NIV may produce aerobic capacities not previously attainable for those with high-level SCI.
Author Block: I. Vivodtzev, J. W. Morgan, J. A. Taylor; Physical Medicine and Rehabilitation, Cardiovascular Research Laboratory, Harvard Medical School, Cambridge, MA, United States.
High level spinal cord injury (SCI) results in profound limitations to respiratory function leading to lower exercise capacity. Therefore, when adding functional electrical stimulation (FES) of the paralyzed legs to produce higher exercise capacity (hybrid FES exercise), peak ventilation may be a key limitation to aerobic capacity. Based on prior research on individuals with respiratory restriction, we hypothesized that non-invasive ventilation (NIV) would improve the increases in aerobic capacity with FES-row training in individuals with high-level SCI. Our assumption was that the systemic adaptations to hybrid FES exercise training are delimited by the maximal ventilation that can be achieved. However, herein we present a case counter to our hypothesis that exemplifies the important determinant role of maximal ventilation for aerobic capacity during whole body hybrid FES exercise in those with high level injuries.
An 18-year-old male with C5 SCI (FVC = 4.01 L, 75% of predicted and FEV1 = 3.80 L, 82% of predicted) performed arms-only row training for 6 months prior to whole body FES-row training for 18 months. VEpeak and VO2max increased with arms only training, with the addition of the paralyzed legs with hybrid FES rowing, and with 6 months of hybrid FES row training. Thereafter, despite long term (+12 months), intense (> 80% max heart rate), frequent (>2x weekly) whole body (FES) exercise training, neither VO2max nor VE peak increased further (1.94 L/min and 66.0 L/min). Thus, it appeared that aerobic capacity increased up to ventilatory capacity. However, a single session of whole body FES-rowing with the addition of NIV (inspiratory/expiratory pressure = 23/5 cmH2O; increase in peak minute ventilation to 71 L/min) increased VO2max by 12% (2.23 L/min with NIV vs. 1.99 L/min with sham NIV).
This interesting case demonstrates that aerobic capacity increases with whole body exercise training in those with SCI are restricted by ventilatory capacity and that with ventilatory support the true increase in exercise capacity is realized. Hence, exercise with the combination of increased muscle mass with FES and increased ventilation with NIV may produce aerobic capacities not previously attainable for those with high-level SCI.
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