Abstract
Study design:
Randomized dual center controlled clinical trial.
Objective:
To determine and compare the cardiorespiratory impact of 3 months of aquatic and robotic therapy for individuals with chronic motor incomplete spinal cord injury (CMISCI).
Settings:
Two rehabilitation specialty hospitals.
Methods:
Thirty-one individuals with CMISCI with neurological level between C2-T12 at least 1 year post injury were randomized to either aquatic or robotic treadmill therapy for 36 sessions. Customized sessions lasted 40–45 min at 65–75% heart rate reserve intensity with peak oxygen consumption (peak VO2) measured during arm ergometry at baseline and post intervention. Additional peak robotic treadmill VO2 assessments were obtained before and after training for participants randomized to robotic intervention.
Results:
Peak VO2 measured with arm ergometry was not significantly different with either aquatic intervention (8.1%, p = 0.14, n = 15) or robotic intervention (−0.7%, p = 0.31, n = 17). Peak VO2 measured with robotic treadmill ergometry demonstrated a statistical improvement (14.7%, p = 0.03, n = 17, two-tailed t-test) across the robotic intervention. Comparison between the two interventions demonstrated a trend favoring aquatic therapy for improving arm ergometry peak VO2 (ANOVA, p = 0.063).
Conclusions:
Neither 3-month exercise interventions statistically improved arm cycle ergometry peak VO2, our cardiorespiratory surrogate marker, although percent improvement was greater in the aquatic exercise condition. Robotic ergometry peak VO2 did improve for the robotic intervention, confirming previous work. These results suggest that either intervention may hold utility in improving cardiorespiratory fitness in CMISCI, but peak VO2 measurement technique appears critical in detecting effects.
Sponsorship:
DOD CDMRP SCI Research Program Clinical Trial Award SC090147, FY 2009. This study is registered under ClinicalTrials.gov Identifier: NCT01407354.
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Acknowledgements
We acknowledge the clinical expertize of therapists: Sara Frye, Naomi Price-Miller, Jean McQuaid, Marni Kallins, Neshella Braga, Michelle Daniels, Rosalyn Lobo, R. Sandy Alexander, Lauren McCollough, Angela Pihera, Michelle Deyton, and Lisa Ruger. We also appreciate the work of research coordinators Gertrude Morrison and John Perreault.
Funding
This work was funded by the Department of Defense CDMRP Spinal Cord Injury Research Program Clinical Trial Award SC090147, FY 2009.
Author contributions
PHG was responsible for co-study design, co-submitting the application for funding, screening, and medical supervision of participants at one center, writing the initial draft of the manuscript, and submission of completed manuscript. WS was responsible for daily study execution, robotic treadmill training and collection of all VO2 data at one center, initial statistical evaluation of the collected data, and major editing of the manuscript. LVH was responsible for co-design of the robotic treadmill algorithm and training, regulatory management and daily oversight including robotic treadmill training and aquatic therapy, VO2 data collection, screening and recruitment of participants at the second center, and review of the manuscript. KT was responsible for co-study design, medical oversight at the second center, co-authorship of the original funding application, and review of the manuscript. WMS was responsible for statistical analysis of the overall study. PRG was responsible for co-study design, co-submitting the application for funding, daily oversight of the dual center study, the design of the aquatic intervention, direct supervision of the aquatic intervention at one center and indirect at second site, initial statistical assessment with WS, and critical partial writing and review of the manuscript.
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Gorman, P.H., Scott, W., VanHiel, L. et al. Comparison of peak oxygen consumption response to aquatic and robotic therapy in individuals with chronic motor incomplete spinal cord injury: a randomized controlled trial. Spinal Cord 57, 471–481 (2019). https://doi.org/10.1038/s41393-019-0239-7
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DOI: https://doi.org/10.1038/s41393-019-0239-7
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