Abstract
Study design:
Prospective comparison of spinal cord injured (SCI) subjects and ambulatory subjects.
Objectives:
To determine the effects of the presence and level of SCI on heart rate recovery (HRR).
Setting:
Outpatient SCI center.
Methods:
HRR was determined in 63 SCI subjects (26 with tetraplegia, 22 with high-level paraplegia, 15 with low-level paraplegia) and 26 ambulatory subjects. To adjust for differences in heart rate reserve between groups (HRpeak minus HRrest), HRR was also ‘normalized’ to a range of 1 at peak heart rate and to 0 at 8 min, and the shapes of HRR curves were compared.
Results:
Although absolute HRR was similar between high- and low-level paraplegia, it was significantly more rapid in participants with paraplegia at 2, 5 and 8 min after exercise than in those with tetraplegia (39±14 vs 29±14 b.p.m., P<0.05; 51±14 vs 33±16 b.p.m., P<0.01 and 52±16 vs 36±17 b.p.m., P<0.01, respectively). HRR among ambulatory subjects was more rapid than among those with tetraplegia at all time points in recovery. However, when normalized for heart rate reserve, HRR was significantly more rapid in tetraplegic subjects (P<0.001 vs paraplegia and ambulatory subjects).
Conclusion:
In SCI, HRR is strongly associated with the peak exercise level and peak heart rate achieved during exercise testing.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Teasell RW, Arnold JM, Krassioukov A, Delaney GA . Cardiovascular consequences of loss of supraspinal control of the sympathetic nervous system after spinal cord injury. Arch Phys Med Rehabil 2000; 81: 506–516.
Freeman JV, Dewey FE, Hadley DM, Myers J, Froelicher VF . Autonomic nervous system interaction with the cardiovascular system during exercise. Prog Cardiovasc Dis 2006; 48: 342–362.
Lahiri MK, Kannankeril PJ, Goldberger JJ . Assessment of autonomic function in cardiovascular disease: physiological basis and prognostic implications. J Am Coll Cardiol 2008; 51: 1723–1733.
Imai K, Sato H, Hori M, Kusuoka H, Ozaki H, Yokoyama H et al. Vagally mediated heart rate recovery after exercise is accelerated in athletes but blunted in patients with chronic heart failure. J Amer Coll Cardiol 1994; 24: 1529–1535.
Cole CR, Foody JM, Blackstone EH, Lauer MS . Heart rate recovery after submaximal exercise testing as a predictor of mortality in cardiovascularly healthy cohort. Ann Intern Med 2000; 132: 552–555.
Myers J, Tan SY, Abella J, Froelicher VF . Comparison of the chronotropic response to exercise and heart rate recovery in predicting cardiovascular mortality. Eur J Cardiovasc Prev Rehab 2007; 14: 215–221.
Karlsson AK . Autonomic dysfunction in spinal cord injury: clinical presentation of symptoms and signs. Prog Brain Res 2006; 152: 1–8.
Myers J, Lee M, Kiratli J . Cardiovascular disease in spinal cord injury: an overview of prevalence, risk, evaluation, and management. Am J Phys Med Rehabil 2007; 86: 142–152.
Takahashi M, Matsukawa K, Nakamoto T, Tsuchimochi H, Sakaguchi A, Kawaguchi K et al. Control of heart rate variability by cardiac parasympathetic nerve activity during voluntary static exercise in humans with tetraplegia. J Appl Physiol 2007; 103: 1669–1677.
Sedlock DA, Schneider DA, Gass E, Gass G . Excess post-exercise oxygen consumption in spinal cord-injured men. Eur J Appl Physiol 2004; 93: 231–236.
Clayton VE, Hol AT, Eng JJ, Krassioukov AV . Cardiovascular responses and postexercise hypotension after arm cycling exercise in subjects with spinal cord injury. Arch Phys Med Rehabil 2006; 87: 1106–1114.
Hadley DM, Freeman JV, Dewey FE, Engel G, Myers JN, Froelicher VF . Prediction of cardiovascular death from heart rate recovery slope. Med Sci Sports Exerc 2008; 40: 1072–1079.
Myers J, Hadley D, Oswald U, Brunner K, Kottman W, Dubach P . Effects of exercise training on heart rate recovery in patients with chronic heart failure. Am Heart J 2007; 153: 1056–1063.
Gorelik DD, Hadley D, Myers J, Froelicher VF . Is there a better way to predict death using heart rate recovery? Clin Cardiol 2006; 29: 399–404.
Desai M, De la Pena-Almaguer E, Mannting F . Abnormal heart rate recovery after exercise as a reflection of an abnormal chronotropic response. Am J Cardiol 2001; 87: 1164–1169.
Myers J, Do D, Herbert W, Ribisl P, Froelicher VF . A nomogram to predict exercise capacity from a specific activity questionnaire and clinical data. Am J Cardiol 1994; 73: 591–596.
Rosenwinkel ET, Bloomfield DM, Arwady MA, Goldsmith RL . Exercise and autonomic function in health and cardiovascular disease. Cardiol Clin 2001; 19: 369–387.
Garstang SV, Miller-Smith SA . Autonomic nervous system dysfunction after spinal cord injury. Phys Med Rehabil Clin N Am 2007; 18: 275–296.
Duran FS, Lugo L, Ramirez L, Eusse E . Effects of an exercise program on the rehabilitation of patients with spinal cord injury. Arch Phys Med Rehabil 2001; 82: 1348–1354.
Acknowledgements
This study was funded by the VA Rehabilitation Research and Development Service: Grant nos. B2549R and B3122R.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Myers, J., Hsu, L., Hadley, D. et al. Post-exercise heart rate recovery in individuals with spinal cord injury. Spinal Cord 48, 639–644 (2010). https://doi.org/10.1038/sc.2009.196
Received:
Revised:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/sc.2009.196
Keywords
This article is cited by
-
Association of serum myokines and aerobic exercise training in patients with spinal cord injury: an observational study
BMC Neurology (2016)
-
Cardiovascular autonomic control in paraplegic and quadriplegic
Clinical Autonomic Research (2016)
