Abstract
Objective
To evaluate the effects of pressure threshold respiratory training (RT) on heart rate
variability and baroreflex sensitivity in persons with chronic spinal cord injury
(SCI).
Design
Before-after intervention case-controlled clinical study.
Setting
SCI research center and outpatient rehabilitation unit.
Participants
Participants (N=44) consisted of persons with chronic SCI ranging from C2 to T11 who
participated in RT (n=24), and untrained control subjects with chronic SCI ranging
from C2 to T9 (n=20).
Interventions
A total of 21±2 RT sessions performed 5 days a week during a 4-week period using a
combination of pressure threshold inspiratory and expiratory devices.
Main Outcome Measures
Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and beat-to-beat arterial blood pressure and heart rate changes during the 5-second-long
maximum expiratory pressure maneuver (5s MEP) and the sit-up orthostatic stress test,
acquired before and after the RT program.
Results
In contrast to the untrained controls, individuals in the RT group experienced significantly
increased FVC and FEV1 (both P<.01) in association with improved quality of sleep, cough, and speech. Sympathetically
(phase II) and parasympathetically (phase IV) mediated baroreflex sensitivity both
significantly (P<.05) increased during the 5s MEP. During the orthostatic stress test, improved autonomic
control over heart rate was associated with significantly increased sympathetic and
parasympathetic modulation (low- and high-frequency change: P<.01 and P<.05, respectively).
Conclusions
Inspiratory-expiratory pressure threshold RT is a promising technique to positively
affect both respiratory and cardiovascular dysregulation observed in persons with
chronic SCI.
Keywords
List of abbreviations:
AIS (American Spinal Injury Association Impairment Scale), BS (baroreflex sensitivity), FEV1 (forced expiratory volume in 1 second), 5s MEP (5-second maximum expiratory pressure maneuver), FVC (forced vital capacity), HF (high frequency), HRV (heart rate variability), LF (low frequency), RRI (R-R interval), RT (respiratory training), SBP (systolic blood pressure), SCI (spinal cord injury)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 09, 2017
Footnotes
Supported by the Leona M. and Harry B. Helmsley Charitable Trust; Kentucky Spinal Cord and Head Injury Research Trust (grant no. 9-10A); Christopher and Dana Reeve Foundation (grant no. OA2-0802); Craig H. Neilsen Foundation (grant no. 1000056824); U.S. Department of Education and Department of Health and Human Services (grant no. H133N110007); and National Institutes of Health (grant nos. R01HL103750, P30GM103507).
Clinical Trial Registration No.: NCT02396823.
Disclosures: none.
Identification
Copyright
© 2017 by the American Congress of Rehabilitation Medicine
