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Published on: December 10, 2020
Cardiovascular Stress During Inpatient Spinal Cord Injury Rehabilitation
Dominik Zbogar1, Janice J Eng1, Jeremy W Noble2
1Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada; International Collaboration on Repair Discoveries, Vancouver, BC, Canada; Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Objectives:
(1) To measure the amount of cardiovascular stress, self-reported physical activity, and accelerometry-measured physical activity by individuals with spinal cord injury (SCI) during physical therapy (PT) and occupational therapy (OT); and (2) to investigate the relations between these measures.
Design:
Observational study.
Setting:
Two inpatient SCI rehabilitation centers.
Participants:
Patients with SCI (N=87) were recruited from consecutive admissions to rehabilitation.
Interventions:
Not applicable.
Main Outcome Measures:
Heart rate was recorded by a Holter monitor, whereas physical activity was captured by self-report (Physical Activity Recall Assessment for People with SCI questionnaire) and real-time wrist accelerometry during a total of 334 PT and OT inpatient sessions. Differences between individuals with paraplegia and tetraplegia were assessed via Mann-Whitney U tests. Spearman correlations were used to explore the relation between measurements of physical activity and heart rate.
Results:
Time spent at a heart rate within a cardiovascular training zone (≥40% heart rate reserve) was low and did not exceed a median of 5 minutes. In contrast, individuals reported at least 60 minutes of higher-intensity time during therapy. There was a low but statistically significant correlation between all measures.
Conclusions:
The cardiovascular stress incurred by individuals with SCI during inpatient PT and OT sessions is low and not sufficient to obtain a cardiovascular training effect to optimize their neurologic, cardiovascular, or musculoskeletal health; this represents a lost opportunity to maximize rehabilitation. Self-reported minutes of higher-intensity physical activity do not reflect actual time spent at a higher intensity measured objectively via a heart rate monitor.
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