Intensity of physical activity as a percentage of peak oxygen uptake, heart rate and Borg RPE in motor-complete para- and tetraplegia

English version

Autoři: Tobias Holmlund ^aff001; Elin Ekblom-Bak ^aff003; Erika Franzén ^aff004; Claes Hultling ^aff001; Kerstin Wahman ^aff001
Působiště autorů: Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden ^aff001; Rehab Station Stockholm/Spinalis R&D Unit, Solna, Sweden ^aff002; Åstrand Laboratory of Work Physiology, The Swedish School of Sport and Health Sciences, Stockholm, Sweden ^aff003; Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden ^aff004; Allied Health Professionals Function, Function Area Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden ^aff005; Spinals Foundation–R&D Unit, Stockholm, Sweden ^aff006
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0222542

Souhrn

Objective

The aims were to describe VO_2peak, explore the potential influence of anthropometrics, demographics and level of physical activity within each cohort; b) to define common, standardized activities as percentages of VO_2peak and categorize these as light, moderate and vigorous intensity levels according to present classification systems, and c) to explore how clinically accessible methods such as heart-rate monitoring and Borg rating of perceived exertion (RPE) correlate or can describe light, moderate and vigorous intensity levels.

Design

Cross sectional.

Setting

Rehabilitation facility and laboratory environment.

Subjects

Sixty-three individuals, thirty-seven (10 women) with motor-complete paraplegia (MCP), T7-T12, and twenty-six (7 women) with motor-complete tetraplegia (MCT), C5-C8.

Interventions

VO_2peak was obtained during a graded peak test until exhaustion, and oxygen uptake during eleven different activities was assessed and categorized using indirect calorimetry.

Main outcome measures

VO_2peak, Absolute and relative oxygen consumption, Borg RPE.

Results

Absolute VO_2peak was significantly higher in men than in women for both groups, with fairly small differences in relative VO_2peak. For MCP sex, weight and time spent in vigorous-intensity activity explained 63% of VO_2peak variance. For MCT sex and time in vigorous-intensity activity explained 55% of the variance. Moderate intensity corresponds to 61–72% HR_peak and RPE 10–13 for MCP vs. 71–79% HR_peak, RPE 13–14 for MCT.

Conclusion

Using current classification systems, eleven commonly performed activities were categorized in relative intensity terms, (light, moderate and vigorous) based on percent of VO_2peak, HR_peak and Borg RPE. This categorization enables clinicians to better guide persons with SCI to meet required physical activity levels.

Klíčová slova:

Physical activity – Exercise – Anthropometry – Heart rate – Spinal cord injury – Wheelchairs – Oxygen consumption – Paraplegia

Zdroje

1. Flank P, Wahman K, Levi R, Fahlstrom M. Prevalence of risk factors for cardiovascular disease stratified by body mass index categories in patients with wheelchair-dependent paraplegia after spinal cord injury. J Rehabil Med. 2012;44(5):440–3. doi: 10.2340/16501977-0964 22549653.

2. Wahman K, Nash MS, Lewis JE, Seiger A, Levi R. Increased cardiovascular disease risk in Swedish persons with paraplegia: The Stockholm spinal cord injury study. J Rehabil Med. 2010;42(5):489–92. doi: 10.2340/16501977-0541 20544162.

3. Manns PJ, McCubbin JA, Williams DP. Fitness, inflammation, and the metabolic syndrome in men with paraplegia. Archives of physical medicine and rehabilitation. 2005;86(6):1176–81. doi: 10.1016/j.apmr.2004.11.020 15954057.

4. Liang H, Tomey K, Chen D, Savar NL, Rimmer JH, Braunschweig CL. Objective measures of neighborhood environment and self-reported physical activity in spinal cord injured men. Archives of physical medicine and rehabilitation. 2008;89(8):1468–73. Epub 2008/08/05. doi: 10.1016/j.apmr.2008.01.017 18674982.

5. de Groot S, Dallmeijer AJ, Post MW, Angenot EL, van den Berg-Emons RJ, van der Woude LH. Prospective analysis of lipid profiles in persons with a spinal cord injury during and 1 year after inpatient rehabilitation. Archives of physical medicine and rehabilitation. 2008;89(3):531–7. Epub 2008/02/26. doi: 10.1016/j.apmr.2007.11.023 18295633.

6. Hetz SP, Latimer AE, Buchholz AC, Martin Ginis KA. Increased participation in activities of daily living is associated with lower cholesterol levels in people with spinal cord injury. Archives of physical medicine and rehabilitation. 2009;90(10):1755–9. Epub 2009/10/06. doi: 10.1016/j.apmr.2009.04.021 19801067.

7. Buchholz AC, McGillivray CF, Pencharz PB. Physical activity levels are low in free-living adults with chronic paraplegia. Obes Res. 2003;11(4):563–70. doi: 10.1038/oby.2003.79 12690086.

8. Rocchi M, Routhier F, Latimer-Cheung AE, Ginis KAM, Noreau L, Sweet SN. Are adults with spinal cord injury meeting the spinal cord injury-specific physical activity guidelines? A look at a sample from a Canadian province. Spinal cord. 2017;55(5):454–9. Epub 2017/02/01. doi: 10.1038/sc.2016.181 28139660.

9. Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Medicine and science in sports and exercise. 2011;43(7):1334–59. doi: 10.1249/MSS.0b013e318213fefb 21694556.

10. Borg G. Perceived exertion as an indicator of somatic stress. Scand J Rehabil Med. 1970;2(2):92–8. Epub 1970/01/01. 5523831.

11. Currie KD, West CR, Hubli M, Gee CM, Krassioukov AV. Peak heart rates and sympathetic function in tetraplegic nonathletes and athletes. Medicine and science in sports and exercise. 2015;47(6):1259–64. doi: 10.1249/MSS.0000000000000514 25211366.

12. Jacobs KA, Burns P, Kressler J, Nash MS. Heavy reliance on carbohydrate across a wide range of exercise intensities during voluntary arm ergometry in persons with paraplegia. J Spinal Cord Med. 2013;36(5):427–35. doi: 10.1179/2045772313Y.0000000123 23941790; PubMed Central PMCID: PMC3739892.

13. Qi L, Ferguson-Pell M, Salimi Z, Haennel R, Ramadi A. Wheelchair users' perceived exertion during typical mobility activities. Spinal cord. 2015;53(9):687–91. Epub 2015/03/18. doi: 10.1038/sc.2015.30 25777329.

14. Au JS, Totosy DEZJO, Macdonald MJ. Modeling Perceived Exertion during Graded Arm Cycling Exercise in Spinal Cord Injury. Medicine and science in sports and exercise. 2017;49(6):1190–6. Epub 2017/01/13. doi: 10.1249/MSS.0000000000001203 28079704.

15. Koopman AD, Eken MM, van Bezeij T, Valent LJ, Houdijk H. Does clinical rehabilitation impose sufficient cardiorespiratory strain to improve aerobic fitness? J Rehabil Med. 2013;45(1):92–8. Epub 2012/10/26. doi: 10.2340/16501977-1072 23096222.

16. Collins EG, Gater D, Kiratli J, Butler J, Hanson K, Langbein WE. Energy cost of physical activities in persons with spinal cord injury. Medicine and science in sports and exercise. 2010;42(4):691–700. Epub 2009/12/03. doi: 10.1249/MSS.0b013e3181bb902f 19952846.

17. Penn RD. Intrathecal baclofen for severe spasticity. Ann N Y Acad Sci. 1988;153:157–66.

18. Teasell RW, Arnold JM, Krassioukov A, Delaney GA. Cardiovascular consequences of loss of supraspinal control of the sympathetic nervous system after spinal cord injury. Archives of physical medicine and rehabilitation. 2000;81(4):506–16. doi: 10.1053/mr.2000.3848 10768544.

19. Krassioukov A. Autonomic function following cervical spinal cord injury. Respir Physiol Neurobiol. 2009;169(2):157–64. Epub 2009/08/18. doi: 10.1016/j.resp.2009.08.003 19682607.

20. Holmlund T, Ekblom-Bak E, Franzen E, Hultling C, Wahman K. Energy expenditure after spinal cord injury in people with motor-complete tetraplegia or motor-complete paraplegia. Spinal cord. 2017. Epub 2017/12/15. doi: 10.1038/s41393-017-0024-4 29238094.

21. Holmlund T, Ekblom-Bak E, Franzen E, Hultling C, Wikmar LN, Wahman K. Energy expenditure in people with motor-complete paraplegia. Spinal cord. 2017. doi: 10.1038/sc.2017.27 28374809.

22. Jacobs PL, Nash MS, Rusinowski JW. Circuit training provides cardiorespiratory and strength benefits in persons with paraplegia. Medicine and science in sports and exercise. 2001;33(5):711–7. Epub 2001/04/27. doi: 10.1097/00005768-200105000-00005 11323537.

23. Leicht CA, Tolfrey K, Lenton JP, Bishop NC, Goosey-Tolfrey VL. The verification phase and reliability of physiological parameters in peak testing of elite wheelchair athletes. Eur J Appl Physiol. 2013;113(2):337–45. Epub 2012/06/22. doi: 10.1007/s00421-012-2441-6 22718268.

24. Sperlich PF, Holmberg HC, Reed JL, Zinner C, Mester J, Sperlich B. Individual versus Standardized Running Protocols in the Determination of VO2max. Journal of sports science & medicine. 2015;14(2):386–93. Epub 2015/05/20. 25983589; PubMed Central PMCID: PMC4424469.

25. Beltz NM, Gibson AL, Janot JM, Kravitz L, Mermier CM, Dalleck LC. Graded Exercise Testing Protocols for the Determination of VO2max: Historical Perspectives, Progress, and Future Considerations. Journal of sports medicine (Hindawi Publishing Corporation). 2016;2016:3968393. Epub 2017/01/25. doi: 10.1155/2016/3968393 28116349; PubMed Central PMCID: PMC5221270.

26. Flank P, Fahlstrom M, Bostrom C, Lewis JE, Levi R, Wahman K. Self-reported physical activity and risk markers for cardiovascular disease after spinal cord injury. J Rehabil Med. 2014;46(9):886–90. doi: 10.2340/16501977-1857 25211062.

27. Martin Ginis KA, van der Scheer JW, Latimer-Cheung AE, Barrow A, Bourne C, Carruthers P, et al. Evidence-based scientific exercise guidelines for adults with spinal cord injury: an update and a new guideline. Spinal cord. 2017. Epub 2017/10/27. doi: 10.1038/s41393-017-0017-3 29070812.

28. Pescatello LS, Arena R, Riebe D, Thompson PD, American College of Sports M, Lippincott W, et al. ACSM's guidelines for exercise testing and prescription. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2014.

29. FYSS 2017: fysisk aktivitet i sjukdomsprevention och sjukdomsbehandling. Stockholm: Läkartidningen förlag AB; 2016.

30. Evans JD. Straightforward statistics for the behavioral sciences. Pacific Grove: Brooks/Cole Pub. Co.; 1996.

31. Bhambhani YN, Holland LJ, Eriksson P, Steadward RD. Physiological responses during wheelchair racing in quadriplegics and paraplegics. Paraplegia. 1994;32(4):253–60. Epub 1994/04/01. doi: 10.1038/sc.1994.45 8022635.

32. Haisma JA, van der Woude LHV, Stam HJ, Bergen MP, Sluis TAR, Bussmann JBJ. Physical capacity in wheelchair-dependent persons with a spinal cord injury: a critical review of the literature. Spinal cord. 2006;44(11):642–52. doi: 10.1038/sj.sc.3101915 WOS:000241884700001. 16534502

33. Garstang SV, Miller-Smith SA. Autonomic nervous system dysfunction after spinal cord injury. Physical medicine and rehabilitation clinics of North America. 2007;18(2):275–96, vi-vii. doi: 10.1016/j.pmr.2007.02.003 17543773.

34. Jacobs PL, Nash MS, Klose KJ, Guest RS, Needham-Shropshire BM, Green BA. Evaluation of a training program for persons with SCI paraplegia using the Parastep 1 ambulation system: part 2. Effects on physiological responses to peak arm ergometry. Archives of physical medicine and rehabilitation. 1997;78(8):794–8. Epub 1997/08/01. doi: 10.1016/s0003-9993(97)90189-1 9344295.

35. Hooker SP, Greenwood JD, Hatae DT, Husson RP, Matthiesen TL, Waters AR. Oxygen uptake and heart rate relationship in persons with spinal cord injury. Medicine and science in sports and exercise. 1993;25(10):1115–9. Epub 1993/10/01. 8231755.

36. Torhaug T, Brurok B, Hoff J, Helgerud J, Leivseth G. Arm Crank and Wheelchair Ergometry Produce Similar Peak Oxygen Uptake but Different Work Economy Values in Individuals with Spinal Cord Injury. Biomed Res Int. 2016;2016:5481843. doi: 10.1155/2016/5481843 27144169; PubMed Central PMCID: PMC4842047.

37. Price MJ, Campbell IG. Determination of peak oxygen uptake during upper body exercise. Ergonomics. 1997;40(4):491–9. Epub 1997/04/01. doi: 10.1080/001401397188116 9140208.

38. Goosey-Tolfrey VL, Paulson TA, Tolfrey K, Eston RG. Prediction of peak oxygen uptake from differentiated ratings of perceived exertion during wheelchair propulsion in trained wheelchair sportspersons. Eur J Appl Physiol. 2014;114(6):1251–8. doi: 10.1007/s00421-014-2850-9 24610244.

39. Baumgart JK, Brurok B, Sandbakk O. Peak oxygen uptake in Paralympic sitting sports: A systematic literature review, meta- and pooled-data analysis. PloS one. 2018;13(2):e0192903. doi: 10.1371/journal.pone.0192903 29474386; PubMed Central PMCID: PMC5825058.

40. Hayes AM, Myers JN, Ho M, Lee MY, Perkash I, Kiratli BJ. Heart rate as a predictor of energy expenditure in people with spinal cord injury. Journal of rehabilitation research and development. 2005;42(5):617–23. doi: 10.1682/jrrd.2004.12.0150 WOS:000237069100007. 16586187

41. Martel G, Noreau L, Jobin J. Physiological responses to maximal exercise on arm cranking and wheelchair ergometer with paraplegics. Paraplegia. 1991;29(7):447–56. Epub 1991/09/01. doi: 10.1038/sc.1991.61 1784511.

42. Arabi H, Vandewalle H, Pitor P, de Lattre J, Monod H. Relationship between maximal oxygen uptake on different ergometers, lean arm volume and strength in paraplegic subjects. European journal of applied physiology and occupational physiology. 1997;76(2):122–7. Epub 1997/01/01. doi: 10.1007/s004210050223 9272769.

43. Glaser RM, Sawka MN, Brune MF, Wilde SW. Physiological responses to maximal effort wheelchair and arm crank ergometry. Journal of applied physiology: respiratory, environmental and exercise physiology. 1980;48(6):1060–4. Epub 1980/06/01. doi: 10.1152/jappl.1980.48.6.1060 7380703.

44. Mossberg K, Willman C, Topor MA, Crook H, Patak S. Comparison of asynchronous versus synchronous arm crank ergometry. Spinal cord. 1999;37(8):569–74. doi: 10.1038/sj.sc.3100875 10455533.

45. The World Health Organization 'Global Strategy on Diet, Physical Activity and Health' initiative. Diabetes Obes Metab. 2003;5(6):468–9. WOS:000186415900015.

46. Kressler J C,. R E,. Ginnity K,. Nash M S,. Subjective measures of exercise intensity to gauge substrate partitioning in persons with paraplegia. Top Spinal Cord Inj Rehabil. 2012;18(3):205–11. Epub 2013/03/06. doi: 10.1310/sci1803-205 23459243; PubMed Central PMCID: PMC3584778.

47. Paulson TA, Bishop NC, Leicht CA, Goosey-Tolfrey VL. Perceived exertion as a tool to self-regulate exercise in individuals with tetraplegia. Eur J Appl Physiol. 2013;113(1):201–9. Epub 2012/05/31. doi: 10.1007/s00421-012-2426-5 22644568.

48. Lewis JE, Nash MS, Hamm LF, Martins SC, Groah SL. The relationship between perceived exertion and physiologic indicators of stress during graded arm exercise in persons with spinal cord injuries. Archives of physical medicine and rehabilitation. 2007;88(9):1205–11. Epub 2007/09/11. doi: 10.1016/j.apmr.2007.05.016 17826469.

49. Janssen TW, van Oers CA, Veeger HE, Hollander AP, van der Woude LH, Rozendal RH. Relationship between physical strain during standardised ADL tasks and physical capacity in men with spinal cord injuries. Paraplegia. 1994;32(12):844–59. Epub 1994/12/01. doi: 10.1038/sc.1994.131 7708424.

50. van der Scheer JW, Martin Ginis KA, Ditor DS, Goosey-Tolfrey VL, Hicks AL, West CR, et al. Effects of exercise on fitness and health of adults with spinal cord injury: A systematic review. Neurology. 2017;89(7):736–45. Epub 2017/07/25. doi: 10.1212/WNL.0000000000004224 28733344.

51. Schmid A, Huonker M, Barturen JM, Stahl F, Schmidt-Trucksass A, Konig D, et al. Catecholamines, heart rate, and oxygen uptake during exercise in persons with spinal cord injury. J Appl Physiol (1985). 1998;85(2):635–41. doi: 10.1152/jappl.1998.85.2.635 9688742.