Effects of Perceptually Regulated Exercise Training on Cardiorespiratory Fitness and Peak Power Output in Adults With Spinal Cord Injury: A Systematic Review and Meta-analysis

Published:April 05, 2022DOI:



      To analyze and summarize the effect of regulating exercise training interventions with subjective measures of intensity on cardiorespiratory fitness, measured by peak oxygen uptake (V̇O2peak) and peak power output (POpeak) in adults with spinal cord injury (SCI).

      Data Sources

      Four databases (MEDLINE, Embase, PsycINFO, SPORTDiscus) were searched from inception up until September 1, 2020, and updated November 18, 2021.

      Study Selection

      Searches combined keywords relating to the topics: SCI, subjective measures of exercise intensity, and exercise.

      Data Extraction

      Two reviewers independently conducted eligibility screening, data extraction, and assessed the risk of bias. Nine studies were included in the systematic review and meta-analysis, resulting in the inclusion of data from 95 adults with SCI representing both sexes and a diverse range of age, time since injury, lesion level, and lesion completeness classifications.

      Data Synthesis

      Data were extracted and added to summary tables with 3 outcomes: V̇O2peak, POpeak, and Other. Mean and SD values for V̇O2peak and POpeak were extracted from pre- and post-perceptually regulated exercise training.


      All studies used ratings of perceived exertion scale to prescribe exercise intensity. Seven of 8 studies concluded an improvement in V̇O2peak, and 5 studies of 7 concluded an improvement in POpeak. In the outcome Other, 5 studies concluded an improvement, and 3 studies concluded no change. There was evidence for an improvement in cardiorespiratory fitness, measured by V̇O2peak and POpeak after perceptually regulated exercise training in adults with SCI (Grading of Recommendations, Assessment, Development, and Evaluation ratings: Low) (mean difference [MD], 2.92mL/kg/min; 95% confidence interval [CI], 1.30-4.54; P=.0004 and MD, 9.8W; 95% CI, 5.5-14.3; P<.0001, respectively). This review provides critically appraised, cumulative evidence on the use of perceptually regulated exercise training in individuals with SCI.


      List of abbreviations:

      CI (confidence interval), CR10 (Category Ratio 10), GRADE (Grading of Recommendations, Assessment, Development, and Evaluation), MD (mean difference), POpeak (peak power output), RPE (rating of perceived exertion), RoB 2.0 (Risk of Bias 2.0), SCI (spinal cord injury), V̇O2peak (peak oxygen uptake)
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