Hettinga Dries M, Andrews Brian J
School of Health Sciences and Social Care, Brunel University, London, UK.
Sports Med. 2008;38(10):825-38. doi: 10.2165/00007256-200838100-00003.
A lesion in the spinal cord leads in most cases to a significant reduction in active muscle mass, whereby the paralysed muscles cannot contribute to oxygen consumption (VO2) during exercise. Consequently, persons with spinal cord injury (SCI) can only achieve high VO2 values by excessively stressing the upper body musculature, which might increase the risk of musculoskeletal overuse injury. Alternatively, the muscle mass involved may be increased by using functional electrical stimulation (FES). FES-assisted cycling, FES-cycling combined with arm cranking (FES-hybrid exercise) and FES-rowing have all been suggested as candidates for cardiovascular training in SCI. In this article, we review the levels of VO2 (peak [VO2peak] and sub-peak [VO2sub-peak]) that have been reported for SCI subjects using these FES exercise modalities. A systematic literature search in MEDLINE, EMBASE, AMED, CINAHL, SportDiscus and the authors' own files revealed 35 studies that reported on 499 observations of VO2 levels achieved during FES-exercise in SCI. The results show that VO2peak during FES-rowing (1.98 L/min, n = 17; 24.1 mL/kg/min, n = 11) and FES-hybrid exercise (1.78 L/min, n = 67; 26.5 mL/kg/min, n = 35) is considerably higher than during FES-cycling (1.05 L/min, n = 264; 14.3 mL/kg/min, n = 171). VO2sub-peak values during FES-hybrid exercise were higher than during FES-cycling. FES-exercise training can produce large increases in VO2peak; the included studies report average increases of +11% after FES-rowing training, +12% after FES-hybrid exercise training and +28% after FES-cycling training. This review shows that VO2 during FES-rowing or FES-hybrid exercise is considerably higher than during FES-cycling. These observations are confirmed by a limited number of direct comparisons; larger studies to test the differences in effectiveness of the various types of FES-exercise as cardiovascular exercise are needed. The results to date suggest that FES-rowing and FES-hybrid are more suited for high-intensity, high-volume exercise training than FES-cycling. In able-bodied people, such exercise programmes have shown to result in superior health and fitness benefits. Future research should examine whether similar high-intensity and high-volume exercise programmes also give persons with SCI superior fitness and health benefits. This kind of research is very timely given the high incidence of physical inactivity-related health conditions in the aging SCI population.
脊髓损伤在大多数情况下会导致主动肌质量显著减少，致使瘫痪的肌肉在运动过程中无法参与耗氧量（VO2）的消耗。因此，脊髓损伤（SCI）患者只能通过过度加重上身肌肉的负担来实现较高的VO2值，这可能会增加肌肉骨骼过度使用损伤的风险。或者，可以通过使用功能性电刺激（FES）来增加受累肌肉的质量。FES辅助骑行、FES骑行与手臂曲柄运动相结合（FES混合运动）以及FES划船都被认为是SCI患者心血管训练的备选方式。在本文中，我们回顾了使用这些FES运动方式的SCI受试者所报告的VO2水平（峰值[VO2peak]和次峰值[VO2sub-peak]）。在MEDLINE、EMBASE、AMED、CINAHL、SportDiscus以及作者自己的资料库中进行的系统文献检索显示，有35项研究报告了499例在SCI患者FES运动期间所达到的VO2水平的观察结果。结果表明，FES划船（1.98升/分钟，n = 17；24.1毫升/千克/分钟，n = 11）和FES混合运动（1.78升/分钟，n = 67；26.5毫升/千克/分钟，n = 35）期间的VO2peak显著高于FES骑行（1.05升/分钟，n = 264；14.3毫升/千克/分钟，n = 171）。FES混合运动期间的VO2sub-peak值高于FES骑行。FES运动训练可使VO2peak大幅增加；纳入研究报告称，FES划船训练后平均增加11%，FES混合运动训练后增加12%，FES骑行训练后增加28%。本综述表明，FES划船或FES混合运动期间的VO2显著高于FES骑行。这些观察结果得到了有限数量直接比较的证实；需要开展更大规模的研究来测试各种类型FES运动作为心血管运动的有效性差异。迄今为止的结果表明，与FES骑行相比，FES划船和FES混合运动更适合高强度、大容量的运动训练。在身体健全的人中，此类运动计划已显示出能带来更好的健康和健身益处。未来的研究应探讨类似的高强度、大容量运动计划是否也能给SCI患者带来更好的健身和健康益处。鉴于老年SCI人群中与身体活动不足相关的健康状况发生率较高，这种研究非常及时。
