Cardiorespiratory Fitness and Training in Quadriplegics and Paraplegics

Summary

With the growing interest in exercise and sport and the significance of cardiovascular disease in the spinal cord injured population, the role of endurance training in improving cardiovascular health is of particular interest. Ordinary daily activities of those with spinal cord injury are usually not adequate to maintain cardiovascular fitness, and lack of participation in a regular activity programme may result in a debilitative cycle. As this occurs, there is a reduction in functional work capacity which may limit independence, and the reduction in cardiovascular fitness may increase the risk for cardiovascular disease. Work capacity in those with spinal cord injury is limited by loss of functional muscle mass and sympathetic control. Sympathetic nervous system impairment limits control of regional blood flow and cardiac output, and maximum heart rate following cervical lesions may be reduced to 110 to 130 beats/min. However, endurance training in quadriplegics and paraplegics can elicit improvements in exercise performance similar to those observed in able-bodied individuals. Review of 13 cardiorespiratory training studies involving spinal cord injured subjects revealed average improvements of 20% in V̇O2 max and 40% in physical work capacity after 4 to 20 weeks of training. Based upon the positive results of these studies, the general endurance training guidelines for the normal population appear to also be appropriate for the spinal cord injured population. These guidelines can be followed during participation in a number of different activities and sports including wheelchair pushing, arm crank ergometry, aerobic swimming, ambulation training, canoeing and wheelchair basketball. There is no evidence that intense training and competition is harmful, but special areas of risk as a result of impairments in sensation, cardiovascular function, autonomic function and temperature regulation must be considered. The long term benefits of endurance training in those with spinal cord injury has not been adequately studied, but there is suggestion that similar physiological and psychological changes may occur as in able-bodied individuals.

This is a preview of subscription content, access via your institution.

References

  1. Aloia JF, Cohn SH, Ostuni JA, Cane R, Ellis K. Prevention of involutional bone loss by exercise. Annals of Internal Medicine 89: 356–358, 1978

    PubMed  CAS  Google Scholar 

  2. American. College of Sports Medicine. The recommended quality and quantity of exercise for developing and maintaining fitness in healthy adults. Medicine and Science in Sports 10: vii–x, 1978

    Google Scholar 

  3. Andersen EC, Kasch FW. Maximum oxygen uptake of trained paraplegics during arm ergometry and tethered swimming. (Abstract.) Medicine and Science in Sports and Exercise 16: 148, 1984

    Article  Google Scholar 

  4. Åstrand I, Guharay A, Wahren J. Circulatory responses to arm exercise with different arm positions. Journal of Applied Physiology 25: 528–532, 1968

    PubMed  Google Scholar 

  5. Åstrand PO, Rodahl K. Textbook of work physiology: physiological bases of exercise, 2nd ed., McGraw-Hill, New York, 1977

    Google Scholar 

  6. Åstrand PO, Saltin B. Maximal oxygen uptake and heart rate in various types of muscular activity. Journal of Applied Physiology 16: 977–981, 1961

    PubMed  Google Scholar 

  7. Auchinachie JA, Burke EJ, Loftin JM, Hayden R. Energy cost of wheelchair basketball. (Abstract.) Medicine and Science in Sports and Exercise 15: 181, 1983

    Article  Google Scholar 

  8. Bar-Or O, Inbar O, Spira R. Physiological effects of a sports rehabilitation program on cerebral palsied and post-poliomyelitic adolescents. Medicine and Science in Sports 8: 157–161, 1976

    PubMed  CAS  Google Scholar 

  9. Bar-Or O, Zwiren LD. Maximal oxygen consumption test during arm exercise-reliability and validity. Journal of Applied Physiology 38: 424–426, 1975

    PubMed  CAS  Google Scholar 

  10. Bar SA, Glaser RM. Physiological responses to wheelchair and bicycle activity. (Abstract.) Federation Proceedings 36: 580, 1977

    Google Scholar 

  11. Bevegard S, Freyschuss U, Strandell T. Circulatory adaptation to arm and leg exercise in supine and sitting position. Journal of Applied Physiology 21: 37–46, 1966

    PubMed  CAS  Google Scholar 

  12. Bexton RS, Milne JR, Cory-Pearce R, English TAH, Camm AJ. Effect of beta blockade on exercise response after cardiac transplantation. British Heart Journal 49: 584–588, 1983

    PubMed  CAS  Article  Google Scholar 

  13. Bidart Y, Maury M. The circulatory behaviour in complete chronic paraplegia. Paraplegia 11: 1–24, 1973

    PubMed  CAS  Article  Google Scholar 

  14. Bleasdale N. Swimming and the paraplegic. Paraplegia 13: 124–127, 1975

    PubMed  CAS  Article  Google Scholar 

  15. Blocker WP, Merrill JM, Krebs MA, Cardus DP, Ostermann HJ. An electrocardiographic survey of patients with chronic spinal cord injury. American Corrective Therapy Journal 37: 101–104, 1983

    PubMed  CAS  Google Scholar 

  16. Boldin EM, Lundegren HL. Comparative aerobic training effects of arm versus wheelchair ergometry. (Abstract.) Medicine and Science in Sports and Exercise 17: 288–289, 1985

    Article  Google Scholar 

  17. Brattgard S, Grimby G, Hook O. Energy expenditure and heart rate in driving a wheel-chair ergometer. Scandinavian Journal of Rehabilitation Medicine 2: 143–148, 1970

    PubMed  CAS  Google Scholar 

  18. British Sports Association for the Disabled. Water Sports for the Disabled, 2nd ed., EP Publishing Limited, West Yorkshire, 1983

  19. Brooks GA, Fahey TD. Exercise physiology: human bioenergetics and its applications, John Wiley & Sons, New York, 1984

    Google Scholar 

  20. Burke EJ, Auchinachie JA, Hayden R, Loftin JM. Energy cost of wheelchair basketball. Physician and Sportsmedicine 13(3): 99–105, 1985

    Google Scholar 

  21. Cameron BJ, Ward GR, Wicks JR. Relationship of type of training to maximum oxygen uptake and upper limb strength in male paraplegic athletes. (Abstract.) Medicine and Science in Sports 9: 58, 1977

    Google Scholar 

  22. Chambers RS, Nelson AG, Fisher AG. Prediction of upper extremity VO2 max through submaximal arm cranking tests. (Abstract.) Medicine and Science in Sports and Exercise 17: 230, 1985

    Article  Google Scholar 

  23. Clarke KS. Caloric costs of activity in paraplegic persons. Archives of Physical Medicine and Rehabilitation 47: 427–435, 1966

    PubMed  CAS  Google Scholar 

  24. Clausen JP. Effect of physical training on cardiovascular adjustments to exercise in man. Physiological Reviews 57: 779–815, 1977

    PubMed  CAS  Google Scholar 

  25. Clausen JP, Klausen K, Rasmussen B, Trap-Jensen J. Central and peripheral circulatory changes after training of the arms or legs. American Journal of Physiology 225: 675–682, 1973

    PubMed  CAS  Google Scholar 

  26. Clausen JP, Trap-Jensen J, Lassen NA. The effects of training on the heart rate during arm and leg exercise. Scandinavian Journal of Clinical and Laboratory Investigation 26: 295–301, 1970

    PubMed  CAS  Article  Google Scholar 

  27. Clinkingbeard JR, Gersten JW, Hoehn D. Energy cost of ambulation in the traumatic paraplegic. American Journal of Physical Medicine 43: 157–165, 1964

    PubMed  CAS  Google Scholar 

  28. Corcoran PJ, Goldman RF, Hoerner EF, Kling C, Knuttgen HG, et al. Sports medicine and the physiology of wheelchair marathon racing. Orthopedic Clinics of North America 11: 697–716, 1980

    PubMed  CAS  Google Scholar 

  29. Coutts KD, Prediction of oxygen uptake from power output in tetraplegics and paraplegics during wheelchair ergometry. (Abstract.) Medicine and Science in Sports and Exercise 15: 181, 1983

    Article  Google Scholar 

  30. Coutts KD, Rhodes EC, McKenzie DC. Maximal exercise responses of tetraplegics and paraplegics. Journal of Applied Physiology 55: 479–482, 1983

    PubMed  CAS  Google Scholar 

  31. Coutts KD, Rhodes EC, McKenzie DC. Submaximal exercise responses of tetraplegics and paraplegics. Journal of Applied Physiology 59: 237–241, 1985

    PubMed  CAS  Google Scholar 

  32. Croucher N. Outdoor activities. Physiotherapy 64: 294–295, 1978

    Google Scholar 

  33. Curtis KA, Dillon DA. Survey of wheelchair athletic injuries: common patterns and prevention. Paraplegia 23: 170–175, 1985

    PubMed  CAS  Article  Google Scholar 

  34. Dalton RB. Effects of exercise and vitamin B12 supplementation on the depression scale scores of a wheelchair confined population. Doctoral dissertation, University of Missouri-Columbia, 1980. Dissertation Abstracts International 41: 4063-B, 1981

  35. Davies CTM, Sargeant AJ. Physiological responses to standardized arm work. Ergonomics 17: 41–49, 1974

    PubMed  Article  Google Scholar 

  36. Davis GM, Kofsky PR, Kelsey JC, Shephard RJ. Cardiorespiratory fitness and muscular strength of wheelchair users. Canadian Medical Association Journal 125: 1317–1323, 1981

    PubMed  CAS  Google Scholar 

  37. Davis GM, Shephard RJ, Ward GR. Alterations of dynamic strength following forearm crank training of disabled subjects. (Abstract.) Medicine and Science in Sports and Exercise 16: 147, 1984

    Article  Google Scholar 

  38. De Boer LB, Kallal JE, Longo MR. Upper extremity prone position exercise as aerobic capacity indicator. Archives of Physical Medicine and Rehabilitation 63: 467–471, 1982

    PubMed  Google Scholar 

  39. Dehn MM, Bruce R. Longitudinal variations in maximal oxygen intake with age and activity. Journal of Applied Physiology 33: 805–807, 1972

    PubMed  CAS  Google Scholar 

  40. Deitrick JE, Whedon D, Shorr E. Effects of immobilization upon various metabolic and physiologic functions of normal men. American Journal of Medicine 4: 3–36, 1948

    PubMed  CAS  Article  Google Scholar 

  41. DiCarlo SE. Improved cardiopulmonary status after a two-month program of graded arm exercise in a patient with C6 quadri-plegia. Physical Therapy 62: 456–459, 1982

    PubMed  CAS  Google Scholar 

  42. DiCarlo SE, Supp MD, Taylor HC. Effect of arm ergometry training on physical work capacity of individuals with spinal cord injuries. Physical Therapy 63: 1104–1107, 1983

    PubMed  CAS  Google Scholar 

  43. DiRocco P, Hashimoto A, Daskalovic I, Langbein E. Cardiopulmonary responses during arm work on land and in a water environment of nonambulatory, spinal cord impaired individuals. Paraplegia 23: 90–99, 1985

    PubMed  CAS  Article  Google Scholar 

  44. Dreisinger TE, Dalton RB, Whiting RB. Maximal wheelchair exercise: comparison of ablebodied and wheelchair bound. (Abstract.) Medicine and Science in Sports and Exercise 16: 147, 1984

    Article  Google Scholar 

  45. Dreisinger TE, Londeree BR. Wheelchair exercise: a review. Paraplegia 20: 20–34, 1982

    PubMed  CAS  Article  Google Scholar 

  46. Dreisinger TE, Londeree BR, Craig HW, Whiting RB, Dalton RB. Wheelchair ergometric training in the handicapped. (Abstract.) Medicine and Science in Sports and Exercise 11: 112–113, 1979

    Google Scholar 

  47. Ekblom B, Lundberg A. Effect of physical training on adolescents with severe motor handicaps. Acta Paediatrica Scandinavica 57: 17–23, 1968

    PubMed  CAS  Article  Google Scholar 

  48. Ernes C. Physical work capacity of wheelchair athletes. Research Quarterly 48: 209–212, 1977

    Google Scholar 

  49. Engel P, Hildebrandt G. Long term spiroergometric studies of paraplegics during the clinical period of rehabilitation. Paraplegia 11: 105–110, 1973

    PubMed  CAS  Article  Google Scholar 

  50. Figoni SF. Spinal cord injury and maximal aerobic power. American Corrective Therapy Journal 38: 44–50, 1984

    PubMed  CAS  Google Scholar 

  51. Fisher SV, Gullickson G. Energy cost of ambulation in health and disability: a literature review. Archives of Physical Medicine and Rehabilitation 59: 124–133, 1978

    PubMed  CAS  Google Scholar 

  52. Franklin BA. Exercise testing, training and arm ergometry. Sports Medicine 2: 100–119, 1985

    PubMed  CAS  Article  Google Scholar 

  53. Freedman S. Sustained maximum voluntary ventilation. Respiratory Physiology 8: 230–244, 1970

    CAS  Article  Google Scholar 

  54. Freyschuss U, Knutsson E. Cardiovascular control in man with transverse cervical cord lesions. Life Sciences 8: 421–424, 1969

    PubMed  CAS  Article  Google Scholar 

  55. Froelicher VF, Brown P. Exercise and coronary heart disease. Journal of Cardiac Rehabilitation 1: 277–288, 1981

    Google Scholar 

  56. Fugl-Meyer AR. Effects of respiratory muscle paralysis in tetraplegic and paraplegic patients. Scandinavian Journal of Rehabilitation Medicine 3: 141–150, 1971

    PubMed  CAS  Google Scholar 

  57. Gandee R, Winningham M, Deitchman R, Narraway A. The aerobic capacity of an elite wheelchair marathon racer. (Abstract.) Medicine and Science in Sports and Exercise 12: 142, 1980

    Google Scholar 

  58. Gandevia B, Hugh-Jones P. Terminology for measurements of ventilatory capacity. Thorax 12: 290–293, 1957

    PubMed  CAS  Article  Google Scholar 

  59. Gass GC, Camp EM. Physiological characteristics of trained Australian paraplegic and tetraplegic subjects. Medicine and Science in Sports 11: 256–259, 1979

    PubMed  CAS  Google Scholar 

  60. Gass GC, Camp EM. The maximum physiological responses during incremental wheelchair and arm cranking exercise in male paraplegics. Medicine and Science in Sports and Exercise 16: 355–359, 1984

    PubMed  CAS  Google Scholar 

  61. Gass GC, Camp EM, Davis HA, Eager D, Grout L. The effect of prolonged exercise on spinally injured subjects. Medicine and Science in Sports and Exercise 13: 277–283, 1981

    PubMed  CAS  Google Scholar 

  62. Gass GC, Watson J, Camp EM, Court HJ, McPherson LM, et al. The effects of physical training on high level spinal lesion patients. Scandinavian Journal of Rehabilitation Medicine 12: 61–65, 1980

    PubMed  CAS  Google Scholar 

  63. Geis GC. A therapeutic aquatics program for quadnplegia patients. American Corrective Therapy Journal 29: 155–157, 1975

    PubMed  CAS  Google Scholar 

  64. Glaser RM, Edwards M, Barr SA, Wilson GH. Energy cost and cardiorespiratory response to wheelchair ambulation and walking. (Abstract.) Federation Proceedings 34: 461, 1975

    Google Scholar 

  65. Glaser RM, Foley DM, Laubach LL, Sawka MN, Suryaprasad AG. An exercise test to evaluate fitness for wheelchair activity. Paraplegia 16: 341–349, 1978–1979

    PubMed  CAS  Article  Google Scholar 

  66. Glaser RM, Laubach LL, Foley DM, Barr SA, Suryaprasad AG, et al. An interval training program for wheelchair users. (Abstract.) Medicine and Science in Sports 10: 54, 1978

    Google Scholar 

  67. Glaser RM, Sawka MN, Brune MF, Wilde SW. Physiological responses to maximal effort wheelchair and arm crank ergometry. Journal of Applied Physiology 48: 1060–1064, 1980a

    PubMed  CAS  Google Scholar 

  68. Glaser RM, Sawka MN, Durbin RJ, Foley DM, Suryaprasad AG. Exercise program for wheelchair activity. American Journal of Physical Medicine 60: 67–75, 1981

    PubMed  CAS  Google Scholar 

  69. Glaser RM, Sawka MN, Young RE, Suryaprasad AG. Applied physiology for wheelchair design. Journal of Applied Physiology 48: 41–44, 1980b

    PubMed  CAS  Google Scholar 

  70. Glaser RM, Young RE, Suryaprasad AG. Reducing energy cost and cardiopulmonary stresses during wheelchair activity. (Abstract.) Federation Proceedings 36: 580, 1977

    Google Scholar 

  71. Goldberg G, Shephard RJ. Personality profiles of disabled individuals in relation to physical activity patterns. Journal of Sports Medicine 22: 477–484, 1982

    CAS  Google Scholar 

  72. Gollnick PD, Armstrong RB, Saubert CW, Piehl K, Saltin B. Enzyme activity and fiber composition in skeletal muscle of untrained and trained men. Journal of Applied Physiology 33: 312–319, 1972

    PubMed  CAS  Google Scholar 

  73. Gordon EE. Energy costs of activities in health and disease. Archives of Internal Medicine 101: 702–713, 1958

    PubMed  CAS  Article  Google Scholar 

  74. Gordon EE, Vanderwalde H. Energy requirements in paraplegic ambulation. Archives of Physical Medicine and Rehabilitation 37: 276–285, 1956

    PubMed  CAS  Google Scholar 

  75. Gordon SK, Scalise A, Felton RM, Jones C, Gordon G. UechiRyu karate in spinal cord injury rehabilitation: the Sepulveda experience. American Corrective Therapy Journal 34: 166–168, 1980

    PubMed  CAS  Google Scholar 

  76. Graveline DE, Balke B, McKenzie RE, Hartman B. Psychobiologic effects of water-immersion-induced hypodynamics. Aerospace Medicine 32: 387–400, 1961

    PubMed  CAS  Google Scholar 

  77. Greenway RM, Houser HB, Lindan O, Weir DR. Long-term changes in gross body composition of paraplegic and quadriplegic patients. Paraplegia 7: 301–318, 1970

    PubMed  CAS  Article  Google Scholar 

  78. Gross D, Ladd HW, Riley EJ, Macklem PT, Grassino A. The effect of training on strength and endurance of the diaphragm in quadriplegia. American Journal of Medicine 68: 27–35, 1980

    PubMed  CAS  Article  Google Scholar 

  79. Heigenhauser GF, Ruff GL, Miller B, Faulkner JA. Cardiovascular response of paraplegics during graded arm ergometry. (Abstract.) Medicine and Science in Sports 8: 68, 1976

    Google Scholar 

  80. Hildebrandt G, Voigt ED, Bahn D, Berendes B, Kroger J. Energy costs of propelling wheelchair at various speeds: cardiac response and effect on steering accuracy. Archives of Physical Medicine and Rehabilitation 51: 131–136, 1970

    PubMed  CAS  Google Scholar 

  81. Hjeltnes N. Oxygen uptake and cardiac output in graded arm exercise in paraplegics with low level spinal lesions. Scandinavian Journal of Rehabilitation Medicine 9: 107–113, 1977

    PubMed  CAS  Google Scholar 

  82. Hjeltnes N. Capacity for physical work and training after spinal injuries and strokes. Scandinavian Journal of Social Medicine (Suppl. 29): 245–251, 1982

    PubMed  CAS  Google Scholar 

  83. Hjeltnes N, Vokac Z. Circulatory strain in everyday life of paraplegics. Scandinavian Journal of Rehabilitation Medicine 11: 67–73, 1979

    PubMed  CAS  Google Scholar 

  84. Hullemann KD, List M, Matthes D, Wiese G, Zika D. Spiroergometric and telemetric investigations during the XXI International Stoke Mandeville Games 1972 in Heidelberg. Paraplegia 13: 109–123, 1975

    PubMed  CAS  Article  Google Scholar 

  85. Jackson RW, Davis GM. The value of sports and recreation for the physically disabled. Orthopedic Clinics of North America 14: 301–315, 1983

    PubMed  CAS  Google Scholar 

  86. Jackson RW, Fredrickson A. Sports for the physically disabled. American Journal of Sports Medicine 7: 293–296, 1979

    PubMed  CAS  Article  Google Scholar 

  87. Jochheim KA, Strohkendl H. The value of particular sports of the wheelchair-disabled in maintaining health of the paraplegic. Paraplegia 11: 173–178, 1973

    PubMed  CAS  Article  Google Scholar 

  88. Johnson SP, Franklin BA, Wrisley D, Rubenfire M, MacRitchie M, et al. Deficient aerobic arm capacity in early paraplegia: implications for arm endurance training. (Abstract.) Medicine and Science in Sports and Exercise 16: 148, 1984

    Article  Google Scholar 

  89. Keens TG, Krastins IRB, Wannamaker EM, Levison H, Crozier DN, et al. Ventilatory muscle endurance training in normal subjects and patients with cystic fibrosis. American Review of Respiratory Disease 116: 853–860, 1977

    PubMed  CAS  Google Scholar 

  90. King H, Taylor R, Zimmet P, Pargeter K, Raper LR, et al. Noninsulin-dependent diabetes in a newly independent Pacific nation: the Republic of Kiribati. Diabetes Care 7: 409–415, 1984

    PubMed  CAS  Article  Google Scholar 

  91. Knutsson E, Lewenhaupt-Olsson E, Thorsen M. Physical work capacity and physical conditioning in paraplegic patients. Paraplegia 11: 205–216, 1973

    PubMed  CAS  Article  Google Scholar 

  92. Kofsky PR, Davis GM, Shephard RJ, Jackson RW, Keene GCR. Field testing: assessment of physical fitness of disabled adults. European Journal of Applied Physiology 51: 109–120, 1983

    CAS  Article  Google Scholar 

  93. Kokkola K, Moller K, Lehtonen T. Pulmonary function in tetraplegic and paraplegic patients. Annals of Clinical Research 7: 76–79, 1975

    PubMed  CAS  Google Scholar 

  94. Kottke TE, Caspersen CJ, Hill CS. Exercise in the management and rehabilitation of selected chronic diseases. Preventive Medicine 13: 47–65, 1984

    PubMed  CAS  Article  Google Scholar 

  95. LaPorte RE, Brenes G, Dearwater S, Murphy MA, Cauley JA, et al. HDL cholesterol across a spectrum of physical activity from quadriplegia to marathon running. Lancet 1: 1212–1213, 1983

    PubMed  CAS  Article  Google Scholar 

  96. Le CT, Price M. Survival from spinal cord injury. Journal of Chronic Diseases 35: 487–492, 1982

    PubMed  CAS  Article  Google Scholar 

  97. Leith DE, Bradley M. Ventilatory muscle strength and endurance training. Journal of Applied Physiology 41: 508–516, 1976

    PubMed  CAS  Google Scholar 

  98. Leon AS, Blackburn H. The relationship of physical activity to coronary heart disease and life expectancy. Annals New York Academy of Sciences 301: 561–578, 1977

    CAS  Article  Google Scholar 

  99. Lundberg A. Wheelchair driving: evaluation of a new training outfit. Scandinavian Journal of Rehabilitation Medicine 12: 67–72, 1980

    PubMed  CAS  Google Scholar 

  100. Madorsky JGB, Curtis KA. Wheelchair sports medicine. American Journal of Sports Medicine 12: 128–132, 1984

    PubMed  CAS  Article  Google Scholar 

  101. Madorsky JGB, Kiley DP. Wheelchair mountaineering. Archives of Physical Medicine and Rehabilitation 65: 490–492, 1984

    PubMed  CAS  Google Scholar 

  102. Madorsky JGB, Madorsky A. Wheelchair racing: an important modality in acute rehabilitation after paraplegia. Archives of Physical Medicine and Rehabilitation 64: 186–187, 1983

    PubMed  CAS  Google Scholar 

  103. Magel JR, McArdle WD, Toner M, Delio DJ. Metabolic and cardiovascular adjustment to arm training. Journal of Applied Physiology 45: 75–79, 1978

    PubMed  CAS  Google Scholar 

  104. Marincek CRT, Valencic V. Arm cycloergometry and kinetics of oxygen consumption in paraplegics. Paraplegia 15: 178–185, 1977–1978

    Article  Google Scholar 

  105. Mathias CJ, Christensen NJ, Corbett JL, Frankel HL, Goodwin TJ, et al. Plasma catecholamines, plasma renin activity and plasma aldosterone in tetraplegic man, horizontal and tilted. Clinical Science and Molecular Medicine 49: 291–299, 1975

    PubMed  CAS  Google Scholar 

  106. Mathias CJ, Christensen NJ, Corbett JL, Frankel HL, Spalding JMK. Plasma catecholamines during paroxysmal neurogenic hypertension in quadriplegic man. Circulation Research 39: 204–208, 1976

    PubMed  CAS  Article  Google Scholar 

  107. McConnell TJ, Beutel-Horvat TA, Golding LA, Horvat MA. A comparison of wheelchair treadmill ergometry and arm crank ergometry in measuring maximum performance capabilities of male paraplegics. (Abstract.) Medicine and Science in Sports and Exercise 16: 147, 1984

    Article  Google Scholar 

  108. Merkel KD, Miller NE, Merritt JL. Energy expenditure in patients with low-, mid-, or high-thoracic paraplegia using Scott-Craig knee-ankle-foot orthoses. Mayo Clinic Proceedings 60: 165–168, 1985

    PubMed  CAS  Google Scholar 

  109. Miles DS, Sawka MN, Wilde SW, Durbin RJ, Gotshall RW, et al. Pulmonary function changes in wheelchair athletes subsequent to exercise training. Ergonomics 25: 239–246, 1982

    PubMed  CAS  Article  Google Scholar 

  110. Millar AL, Ward GR. Physiological monitoring during intensive training of Canadian national track wheelchair athletes. (Abstract.) Medicine and Science in Sports and Exercise 15: 181–182, 1983

    Article  Google Scholar 

  111. Miller PB, Johnson RL, Lamb LE. Effects of moderate physical exercise during 4 weeks of bed rest on circulatory functions in man. Aerospace Medicine 36: 1077–1082, 1965

    PubMed  CAS  Google Scholar 

  112. Mollinger LA, Spurr GB, El Ghatit AZ, Barboriak JJ, Rooney CB, et al. Daily expenditure and basal metabolic rates of patients with spinal cord injury. Archives of Physical Medicine and Rehabilitation 66: 420–426, 1985

    PubMed  CAS  Google Scholar 

  113. Nagle FJ, Richie JP, Giese MD. VO2 max responses in separate and combined arm and leg air-braked ergometer exercise. Medicine and Science in Sports and Exercise 16: 563–566, 1984

    PubMed  CAS  Google Scholar 

  114. Nakamura Y. Working ability of the paraplegics. Paraplegia 11: 182–193, 1973

    PubMed  CAS  Article  Google Scholar 

  115. Nilsen R, Nygaard P, Bjorholt PG. Complications that may occur in those with spinal cord injuries who participate in sport. Paraplegia 23: 152–158, 1985

    PubMed  CAS  Article  Google Scholar 

  116. Nilsson S, Staff PH, Pruett EDR. Physical work capacity and the effect of training on subjects with long-standing paraplegia. Scandinavian Journal of Rehabilitation Medicine 7: 51–56, 1975

    PubMed  CAS  Google Scholar 

  117. Ornstein LJ, Skrinar GS, Garrett GG. Physiological effects of swimming training in physically disabled individuals. (Abstract.) Medicine and Science in Sports and Exercise 15: 110, 1983

    Article  Google Scholar 

  118. Pachalski A, Mekarski T. Effect of swimming on increasing of cardiorespiratory capacity in paraplegics. Paraplegia 18: 190–196, 1980

    PubMed  CAS  Article  Google Scholar 

  119. Petrofsky JS, Phillips CA. Active physical therapy: a modern approach to rehabilitation therapy. Journal of Neurological and Orthopaedic Surgery 4: 165–173, 1983

    Google Scholar 

  120. Petrofsky JS, Phillips CA. The use of functional electrical stimulation for rehabilitation of spinal cord injured patients. Central Nervous System Trauma 1: 57–74, 1984

    PubMed  CAS  Google Scholar 

  121. Phillips CA, Petrofsky JS, Hendershot DM, Strafford D. Functional electrical exercise: a comprehensive approach for physical conditioning of the spinal cord injured patient. Orthopedics 7: 1112–1123, 1984

    Google Scholar 

  122. Pimentai NA, Sawka MN, Billings DS, Trad LA. Physiological responses to prolonged upper-body exercise. Medicine and Science in Sports and Exercise 16: 360–365, 1984

    Google Scholar 

  123. Pollock ML, Miller HS, Linnerud AC, Laughridge E, Coleman E, et al. Arm pedaling as an endurance training regimen for the disabled. Archives of Physical Medicine and Rehabilitation 55: 418–424, 1974

    PubMed  CAS  Google Scholar 

  124. Pollock ML, Wilmore JH, Fox SM. Exercise in health and disease: evaluation and prescription for prevention and rehabilitation, W.B. Saunders Company, Philadelphia, 1984

    Google Scholar 

  125. Rhodes EC, McKenzie DC, Coutts KD, Rogers AR. A field test for the prediction of aerobic capacity in male paraplegics and quadriplegics. Canadian Journal of Applied Sport Sciences 6: 182–186, 1981

    CAS  Google Scholar 

  126. Roberts K. Sport for the disabled. Physiotherapy 60: 271–274, 1974

    PubMed  CAS  Google Scholar 

  127. Rowell LB. Human cardiovascular adjustments to exercise and thermal stress. Physiological Reviews 54: 75–159, 1974

    PubMed  CAS  Google Scholar 

  128. Saltin B, Blomqvist G, Mitchell JH. Responses to exercise after bed rest and after training: a longitudinal study of adaptive changes in oxygen transport and body composition. Circulation 38(Suppl. 7): 1–78, 1968

    Google Scholar 

  129. Sawka MN, Glaser RM, Laubach LL, Al-Samkari O, Suryaprasad AG. Wheelchair exercise performance of the young, middleaged, and elderly. Journal of Applied Physiology 50: 824–828, 1981

    PubMed  CAS  Google Scholar 

  130. Sawka MN, Glaser RM, Wilde SW, von Luhrte TC. Metabolic and circulatory responses to wheelchair and arm crank exercise. Journal of Applied Physiology 49: 784–788, 1980

    PubMed  CAS  Google Scholar 

  131. Secher NH, Ruberg-Larsen N, Binkhorst RA, Bonde-Petersen F. Maximal oxygen uptake during arm cranking and combined arm plus leg exercise. Journal of Applied Physiology 36: 515–518, 1974

    PubMed  CAS  Google Scholar 

  132. Sedlock DA, Fitzgerald PI, Knowlton RG, Schneider DA. The transfer of the cardiovascular effects of arm crank training to submaximal wheelchair ergometry. (Abstract.) Medicine and Science in Sports and Exercise 15: 182, 1983

    Article  Google Scholar 

  133. Shephard RJ. The maximum sustained voluntary ventilation in exercise. Clinical Science 32: 167–176, 1967

    PubMed  CAS  Google Scholar 

  134. Skrinar GS, Evans WJ, Ornstein LJ, Brown DA. Glycogen utilization in wheelchair-dependent athletes. International Journal of Sports Medicine 3: 215–219, 1982

    PubMed  CAS  Article  Google Scholar 

  135. Smith PA, Glaser RM, Petrofsky JS, Underwood PD, Smith GB, et al. Arm crank vs handrim wheelchair propulsion: metabolic and cardiopulmonary responses. Archives of Physical Medicine and Rehabilitation 64: 249–254, 1983

    PubMed  CAS  Google Scholar 

  136. Spencer WA, Vallbona C, Carter RE. Physiologic concepts of immobilization. Archives of Physical Medicine and Rehabilitation 46: 89–100, 1965

    PubMed  CAS  Google Scholar 

  137. Stoboy H, Rich BW, Lee M. Workload and energy expenditure during wheelchair propelling. Paraplegia 8: 223–230, 1971

    PubMed  CAS  Article  Google Scholar 

  138. Strayer JR, Glaser RM, May KP. Metabolic responses to voluntary arm and electrically stimulated leg exercise in spinal cord injured individuals. (Abstract.) Federation Proceedings 44: 1369, 1985

    Google Scholar 

  139. Taylor AW, McDonnell E, Royer D, Loiselle R, Lush N, et al. Skeletal muscle analysis of wheelchair athletes. Paraplegia 17: 456–460, 1979

    Article  Google Scholar 

  140. Van Loan M, McCluer S, Loftin JM, Boileau RA. Comparison of maximal physiological responses to arm exercise among ablebodied, paraplegics and quadriplegics. (Abstract.) Medicine and Science in Sports and Exercise 17: 250, 1985

    Article  Google Scholar 

  141. Vander LB, Franklin BA, Wrisley D, Rubenfire M. Cardiorespiratory responses to arm and leg ergometry: assessment of relative arm fitness in women. (Abstract.) Medicine and Science in Sports and Exercise 15: 124, 1983

    Article  Google Scholar 

  142. Vander LB, Franklin BA, Wrisley D, Rubenfire M. Cardiorespiratory responses to arm and leg ergometry in women. Physician and Sportsmedicine 12(5): 101–106, 1984

    Google Scholar 

  143. Voigt ED, Bahn D. Metabolism and pulse rate in physically handicapped when propelling a wheelchair up an incline. Scandinavian Journal of Rehabilitation Medicine 1: 101–106, 1969

    PubMed  CAS  Google Scholar 

  144. Walker GM. Riding for the disabled. Physiotherapy 64: 297, 1978

    PubMed  CAS  Google Scholar 

  145. Washburn RA, Seals DR. Peak oxygen uptake during arm cranking for men and women. Journal of Applied Physiology 56: 954–957, 1984

    PubMed  CAS  Google Scholar 

  146. Weiss M, Beck J. Sport as part of therapy and rehabilitation of paraplegics. Paraplegia 11: 166–172, 1973

    PubMed  CAS  Article  Google Scholar 

  147. Whiting RB, Dreisinger TE, Dalton RB, Londeree BR. Improved physical fitness and work capacity in quadriplegics by wheelchair exercise. Journal of Cardiac Rehabilitation 3: 251–255, 1983

    Google Scholar 

  148. Wicks JR, Lymburner K, Dinsdale SM, Jones NL. The use of multistage exercise testing with wheelchair ergometry and arm cranking in subjects with spinal cord lesions. Paraplegia 15: 252–261, 1977-1978

    Article  Google Scholar 

  149. Wicks JR, Oldridge NB, Cameron BJ, Jones NL. Arm cranking and wheelchair ergometry in elite spinal cord-injured athletes. Medicine and Science in Sports and Exercise 15: 224–231, 1983

    PubMed  CAS  Google Scholar 

  150. Wilde SW, Miles DS, Durbin RJ, Sawka MN. Suryaprasad AG, et al. Evaluation of myocardial performance during wheelchair ergometer exercise. American Journal of Physical Medicine 60: 277–291, 1981

    PubMed  CAS  Google Scholar 

  151. Wolf E, Magora A. Orthostatic and ergometric evaluation of cord-injured patients. Scandinavian Journal of Rehabilitation Medicine 8: 93–96, 1976

    Google Scholar 

  152. Woodburne RT. Essentials of human anatomy, 6th ed., Oxford University Press, New York, 1979

    Google Scholar 

  153. Wyndham CH. The role of physical activity in the prevention of ischaemic heart disease: a review. South African Medical Journal 56: 7–13, 1979

    PubMed  CAS  Google Scholar 

  154. Zwiren LD, Bar-Or O. Responses to exercise of paraplegics who differ in conditioning level. Medicine and Science in Sports 7: 94–98, 1975

    PubMed  CAS  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Dr Martin D. Hoffman.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Hoffman, M.D. Cardiorespiratory Fitness and Training in Quadriplegics and Paraplegics. Sports Medicine 3, 312–330 (1986). https://doi.org/10.2165/00007256-198603050-00002

Download citation

Keywords

  • Spinal Cord Injury
  • Endurance Training
  • Apply Physiology
  • Maximal Aerobic Power
  • Physical Work Capacity