Ashley E A, Laskin J J, Olenik L M, Burnham R, Steadward R D, Cumming D C, Wheeler G D
Institute of Physiology, University of Glasgow, Scotland.
Paraplegia. 1993 Sep;31(9):593-605. doi: 10.1038/sc.1993.95.
The purpose of the investigation was to examine the safety and efficacy of functional electrical stimulation (FES)-assisted hydraulic resistance training in improving cardiovascular fitness in persons with spinal cord injuries. The cardiopulmonary responses of 10 high spinal cord injured (SCI) and five able bodied (AB) subjects were assessed during three bouts of FES-assisted leg extension exercise. The protocol involved three 30-minute tests: (1) unloaded leg extension, (2) hydraulically-resisted leg extension (loaded), and (3) a reproduction of the unloaded and loaded protocols to measure cardiac output (Q). Pre-measurements were made of body mass, mean limb weight, maximal force output and maximal oxygen uptake (incremental arm ergometry). Oxygen uptake (VO2), minute ventilation (Ve), respiratory exchange ratio (RER), heart rate (HR), blood pressure (BP) were recorded before, during and after tests. There was a significant difference in VO2 max between SCI and AB subjects. Cardiac output significantly increased between the loaded and unloaded tests. The significant increases from rest to unloaded and loaded exercise pointed to the potential value of adding resistance to a leg extension training regime. Heart rate and BP of the participants with SCI consistently demonstrated a response suggestive of autonomic dysreflexia. Upon stimulation an immediate increase in (predominantly systolic) BP was observed, followed by a fall in HR. On cessation of stimulation HR exhibited a substantial rebound effect and BP returned to normal levels. This response was highly reproducible and suggests caution be exercised in the use of FES for people with SCI with lesion levels above the major splanchnic outflow (T6).
本研究的目的是检验功能性电刺激（FES）辅助液压阻力训练对改善脊髓损伤患者心血管健康状况的安全性和有效性。在三轮FES辅助的腿部伸展运动中，对10名高位脊髓损伤（SCI）患者和5名健全（AB）受试者的心肺反应进行了评估。该方案包括三项30分钟的测试：（1）无负荷腿部伸展，（2）液压阻力腿部伸展（有负荷），以及（3）重复无负荷和有负荷方案以测量心输出量（Q）。预先测量了体重、平均肢体重量、最大力量输出和最大摄氧量（递增式手臂测力计测试）。在测试前、测试期间和测试后记录摄氧量（VO2）、分钟通气量（Ve）、呼吸交换率（RER）、心率（HR）、血压（BP）。SCI患者和AB受试者之间的最大摄氧量存在显著差异。有负荷测试和无负荷测试之间的心输出量显著增加。从休息到无负荷和有负荷运动的显著增加表明在腿部伸展训练方案中增加阻力具有潜在价值。SCI患者的心率和血压始终表现出提示自主神经反射异常的反应。刺激后立即观察到（主要是收缩压）血压升高，随后心率下降。停止刺激后，心率出现大幅反弹效应，血压恢复到正常水平。这种反应具有高度可重复性，提示对于脊髓损伤水平在主要内脏神经传出部位（T6）以上的SCI患者，在使用FES时应谨慎。
