Sports Medicine

, Volume 45, Issue 8, pp 1133–1142 | Cite as

Boosting in Elite Athletes with Spinal Cord Injury: A Critical Review of Physiology and Testing Procedures

  • Cameron M. Gee
  • Christopher R. West
  • Andrei V. KrassioukovEmail author
Review Article


Many individuals with spinal cord injury (SCI) experience autonomic dysfunction, which can have major implications on heart rate and blood pressure responses to exercise, and consequently athletic performance. Athletic performance may be improved by the induction of autonomic dysreflexia (‘boosting’), a dangerous and sometimes life-threatening condition. Here, we review the autonomic response to exercise in individuals with SCI and the current testing methods for boosting, and examine the potential for autonomic testing to be used in the classification of SCI athletes. Given the difficulties associated with researching the effects of boosting, only three studies have compared the physiological performance of elite athletes in the boosted and unboosted state. These studies found athletes had an improved performance of ~7 to 10 % in the boosted state. Blood pressure, heart rate, oxygen consumption, and circulating catecholamines were also higher in the boosted state. Although 27.1 % of athletes believe that boosting was common in their sport, no athlete has ever tested positive for boosting at an event sanctioned by the International Paralympic Committee. Athletes with SCI competing in sports that have a high cardiovascular demand/aerobic component may experience the greatest benefit of boosting. Boosting improves athletic performance even at blood pressure levels well below the current threshold for disqualification set by the International Paralympic Committee, a level at which individuals with SCI are putting their health and lives at serious risk.


Spinal Cord Injury Elite Athlete Athletic Performance Sympathetic Skin Response Autonomic Dysreflexia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Research in the laboratory of Dr. Andrei Krassioukov is supported by a Craig H. Neilsen Foundation Quality of Life Grant. Dr. C. West is supported by fellowships from the Michael Smith Foundation for Health Research and the Craig H. Neilsen Foundation.

Conflict of interest

Cameron M. Gee, Christopher R. West, and Andrei V. Krassioukov declare that they have no conflict of interest.


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Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Cameron M. Gee
    • 1
  • Christopher R. West
    • 1
    • 2
  • Andrei V. Krassioukov
    • 1
    • 3
    • 4
    Email author
  1. 1.Faculty of MedicineInternational Collaboration on Repair Discoveries (ICORD-BSCC), University of British ColumbiaVancouverCanada
  2. 2.School of KinesiologyUniversity of British ColumbiaVancouverCanada
  3. 3.Division of Physical Medicine and Rehabilitation, Faculty of MedicineUniversity of British ColumbiaVancouverCanada
  4. 4.GF Strong Rehabilitation Centre, Vancouver Health AuthorityVancouverCanada

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