Original research| Volume 99, ISSUE 3, P423-432, March 2018

Effects of Respiratory Training on Heart Rate Variability and Baroreflex Sensitivity in Individuals With Chronic Spinal Cord Injury

Published:August 09, 2017DOI:



      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).


      Before-after intervention case-controlled clinical study.


      SCI research center and outpatient rehabilitation unit.


      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).


      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.


      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).


      Inspiratory-expiratory pressure threshold RT is a promising technique to positively affect both respiratory and cardiovascular dysregulation observed in persons with chronic SCI.


      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)
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