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Assessing Ventilatory Threshold in Individuals With Motor-Complete Spinal Cord Injury

      Highlights

      • Ventilatory threshold (VT) can be assessed in men with paraplegia with low fitness.
      • Patients with tetraplegia with low peak work capacity may not reach VT during peak fitness tests.
      • There are negligible differences between VT methods in individuals with spinal cord injury.

      Abstract

      Objective

      To assess the feasibility of measuring ventilatory threshold (VT) in higher-level motor-complete spinal cord injury (SCI) using 4 different analysis methods based on noninvasive gas exchange.

      Design

      Observational.

      Setting

      Laboratory testing.

      Participants

      Individuals with C4-T6 motor-complete SCI (16 paraplegia, 22 tetraplegia; American Spinal Injury Association Impairment Scale A/B; 42±10 years old).

      Interventions

      Not applicable.

      Main Outcome

      VT from a graded arm cycling test to volitional exhaustion using 4 methods: ventilatory equivalents, excess CO2, V-slope, and combined method.

      Results

      VT could be identified in all individuals with paraplegia, but in only 68% of individuals with tetraplegia. Individuals without observable VT completed the graded exercise test with lower ventilatory rate, peak power output, and peak oxygen consumption (Vo2peak) (all P<.05), compared to those with a detectable VT. Bland-Altman plots indicate minimal bias between methods (range: 0.01-0.03 L/min), with 95% limits of agreement of the difference within 0.25 L/min. Absolute V . o2 at VT with individual methods were all correlated to peak power output (r>0.74; P<.01) and Vo2peak (r>0.91; P<.01), with negligible differences between methods.

      Conclusions

      The assessment of VT is a feasible alternative to peak exercise testing for aerobic fitness in individuals with higher-level, motor-complete SCI, although care should be taken when interpreting VT in individuals with tetraplegia who have lower cardiorespiratory fitness and lower peak power outputs.

      Keywords

      List of abbreviations:

      LoA (limits of agreement), SCI (spinal cord injury), SEE (standard error of estimate), V.CO2 (carbon dioxide consumption per unit time), V.o2 (oxygen consumption per unit time), Vo2peak (peak oxygen consumption), VT (ventilatory threshold)
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