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Submaximal measures of cardiovascular fitness in individuals with spinal cord injury Hol, Adrienne Theresa

Abstract

Background: The prevalence of cardiovascular disease in individuals with spinal cord injury (SCI) is as high as or greater than in the general population, yet assessment of cardiovascular fitness rarely occurs in individuals with SCI. Purpose: 1) To review current literature and develop guidelines to assist clinicians in choosing appropriate submaximal tests for the evaluation of cardiovascular fitness in individuals with SCI; 2) to design a submaximal single-stage arm ergometer test (SSSAET) for use in individuals with SCI; and 3) to determine the test-retest reliability and criterion validity of this exercise test. Methods: A systematic review of the literature was done to identify and evaluate arm exercise tests that submaximally measure cardiovascular fitness in individuals with SCI. To evaluate the SSSAET, 30 subjects with SCI were assessed using the American Spinal Injury Association (ASIA) scale, isometric strength testing, a physical activity questionnaire, the SSSAET, and a VO₂peak test. Test-retest reliability of the SSSAET was determined by having subjects complete the SSSAET on two days, separated by one week. Criterion validity was determined by comparing the results from the SSSAET with the VO₂peak test. Results: The literature review identified six submaximal arm exercise tests for measuring cardiovascular fitness in individuals with SCI, but all tests featured limitations that prevented widespread clinical use. Test-retest reliability of the SSSAET was excellent (ICC=0.81-0.90). As well, correlations between VO₂peak and outcomes of the SSSAET ranged from r=0.63- 0.92, indicating good to excellent criterion validity. Conclusions: Clinical recommendations were provided for the existing arm exercise test protocols. Testing showed that the SSSAET has acceptable test-retest reliability and criterion validity, however further research is necessary before the SSSAET will be ready for implementation as a clinical tool to assess baseline and changes in cardiovascular fitness in individuals with SCI.

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