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A Model for Incorporating A Clinically-Feasible Exercise Test in Paraplegic Annual Reviews: A Tool for Stratified Cardiopulmonary Stress Performance Classification and Monitoring

Sylvie Coupaud, Alan N McLean, Stanley J Grant, Helen R Berry and David B Allan

Objectives: (i) To identify and characterize an exercise test for use in routine spinal cord injury clinical review, and (ii) to describe levels of, and factors affecting, cardiopulmonary stress performance during exercise in the chronic paraplegic population in Scotland, UK.

Design: Cross-sectional study.

Setting: Queen Elizabeth National Spinal Injuries Unit (Glasgow, Scotland).

Patients: 48 subjects with chronic paraplegia resulting from spinal cord injury at neurological levels T2-L2.

Methods: Peak oxygen uptake, peak power output, gas exchange threshold and peak heart rate were determined from an incremental arm-cranking exercise test. Using a general linear model, the effects of gender, high (injury level above T6) versus low paraplegia, time since injury, body mass and age on peak oxygen uptake and peak power output were investigated.

Results: All 48 subjects completed the arm-cranking exercise test, which was shown to be practical for fitness screening in paraplegia. Men (n=38) had a peak oxygen uptake of 1.302 ± 0.326 l.min-1 (mean ± SD) and peak power output of 81.6 ± 23.2W, which was significantly higher than for women (n=10), at 0.832 ± 0.277 l.min-1 and 50.1 ± 27.8 W, respectively. There was large intersubject variability in cardiopulmonary performance during arm-cranking exercise testing, but the overall mean for the Scottish population was lower than reference values from other countries.

Conclusions: Arm-cranking exercise tests are feasible in the clinical environment. The motivation for their implementation is threefold: (i) to determine cardiopulmonary stress performance of individual paraplegic patients, (ii)