Hodgkiss Daniel D, Balthazaar Shane J T, Gee Cameron M, Chiou Shin-Yi, Lucas Samuel J E, Nightingale Tom E
School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, UK.
International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC, Canada.
Sports Med Open. 2025 Nov 6;11(1):125. doi: 10.1186/s40798-025-00909-7.
Spinal cord injury (SCI) affects motor and autonomic functions that reduce exercise capacity. Specifically, the loss of sympathetic drive following SCI at or above the sixth thoracic segment (≥ T6) can impair cardiovascular responses to exercise. This systematic scoping review aimed to identify ergogenic strategies that may augment the cardiovascular system and acutely enhance exercise performance in individuals with SCI.
A systematic literature search was conducted using electronic databases (Medline, Embase, Web of Science) from inception to 1st April 2025. Studies were included if they met the following eligibility criteria: (1) human participants (aged ≥ 16 years); (2) any acquired SCI (traumatic, infection, cancer); (3) any sample size but must be > 80% SCI; (4) acute, single, volitional exercise sessions with cross-over design (i.e., ergogenic strategy and control sessions); (5) report a measurable exercise performance outcome, and (6) the strategy used to enhance performance must have a theoretical effect on the cardiovascular system. Data were extracted from eligible studies and charted. Hedges' g summary effect sizes were calculated to quantify the magnitude of effects across strategies.
A total of 7266 possible articles were identified. Following a full-text review, 32 articles were included. Findings were reported by strategy, defined as either mechanical (e.g., abdominal binders, lower-body compression, passive leg exercise and supine posture) or neuromodulatory [e.g., autonomic dysreflexia (AD), functional electrical stimulation (FES), pharmaceuticals/supplements/stimulants, and spinal cord stimulation (SCS)]. The neuromodulatory strategies appeared more robust at augmenting cardiovascular and performance outcomes, particularly AD, FES, and SCS.
We examined methods to improve acute exercise performance by augmenting the cardiovascular system in individuals with SCI. The large heterogeneity across methodologies and outcome measures made it challenging to draw conclusions regarding the underlying physiological mechanisms. Consequently, providing definitive recommendations on the best strategies to enhance performance was not possible based on current literature. Future research should be conducted across all ergogenic strategies, with a careful focus on females, trained and untrained participants, and individuals who are more likely to benefit from improvements in cardiovascular output (i.e., SCI ≥ T6). Registration This review was pre-registered on the Open Science Framework ( https://osf.io/w7apu/ ).
脊髓损伤（SCI）会影响运动和自主神经功能，从而降低运动能力。具体而言，第六胸段及以上（≥T6）的脊髓损伤后交感神经驱动丧失会损害运动时的心血管反应。本系统综述旨在确定可能增强心血管系统并急性改善脊髓损伤患者运动表现的促力策略。
使用电子数据库（Medline、Embase、Web of Science）进行系统文献检索，检索时间范围从数据库建立至2025年4月1日。符合以下纳入标准的研究被纳入：（1）人类参与者（年龄≥16岁）；（2）任何后天性脊髓损伤（创伤性、感染性、癌性）；（3）任何样本量，但脊髓损伤患者比例必须>80%；（4）采用交叉设计的急性、单次、自愿运动试验（即促力策略试验和对照试验）；（5）报告可测量的运动表现结果；（6）用于提高表现的策略必须对心血管系统有理论上的影响。从符合条件的研究中提取数据并制表。计算Hedges' g汇总效应量以量化各策略的效应大小。
共识别出7266篇可能的文章。经过全文审查，纳入了32篇文章。研究结果按策略报告，策略分为机械性策略（如腹部捆绑、下肢加压、被动腿部运动和仰卧姿势）或神经调节策略[如自主神经反射异常（AD）、功能性电刺激（FES）、药物/补充剂/兴奋剂和脊髓刺激（SCS）]。神经调节策略在增强心血管和运动表现结果方面似乎更有效，尤其是AD、FES和SCS。
我们研究了通过增强脊髓损伤患者的心血管系统来改善急性运动表现的方法。方法和结果测量的巨大异质性使得就潜在生理机制得出结论具有挑战性。因此，根据当前文献无法就提高表现的最佳策略提供明确建议。未来的研究应涵盖所有促力策略，尤其要关注女性、受过训练和未受过训练的参与者，以及更可能从心输出量改善中受益的个体（即脊髓损伤≥T6者）。注册情况：本综述已在开放科学框架（https://osf.io/w7apu/）上预先注册。
