Augmenting exercise capacity with noninvasive ventilation in high-level spinal cord injury

James W. Morgan, Eric Ferrazzani, J. Andrew Taylor, Isabelle Vivodtzev
2018 Journal of applied physiology  
Morgan JW, Ferrazzani E, Taylor JA, Vivodtzev I. Augmenting exercise capacity with noninvasive ventilation in high-level spinal cord injury. High-level spinal cord injury (SCI) results in a very limited innervated skeletal muscle mass that strongly reduces exercise capacity. Our recent work showed that when adding functional electrical stimulation (FES) of the paralyzed legs (hybrid FES-exercise) to produce higher exercise capacity, peak ventilation became a limiting factor to training-induced
more » ... o training-induced improvement in aerobic capacity. Our assumption was that the systemic adaptations to exercise training are delimited by the maximal ventilation that can be achieved. However, herein, we present a case showing an acute increase in aerobic capacity when using noninvasive ventilatory support (NIV) during FES-rowing test in an individual who had previously experimented a plateau in his aerobic capacity for 18 mo. An 18-yr-old man with C5 SCI trained with arms-only rowing for 6 mo and subsequently trained with hybrid FES-rowing for 18 mo. Peak minute ventilation (V Epeak) and peak oxygen consumption (V O2peak) were increased after arms-only training and increased further with 6 mo of hybrid FES-row training. Despite continued intense and frequent, hybrid FES-row training, neither V Epeak nor V O2peak increased further over the next year (1.94 and 66.0 l/min). However, when this individual performed a FES-rowing V O2peak test with the addition of NIV, V Epeak increased by 5 l/min, resulting in an improved V O2peak (2.23 l/min, ϩ12%). This case demonstrates that noninvasive ventilation can overcome limitations to ventilation in high-level SCI and improve aerobic capacity during hybrid FES-exercise to a level not otherwise achievable. In addition, it broadly illustrates the intimate role of pulmonary function in determining the capacity to perform exercise. aerobic capacity; functional electrical stimulation; pulmonary limitation; spinal cord injury; ventilation Address for reprint requests and other correspondence: I. Vivodtzev,
doi:10.1152/japplphysiol.01028.2017 pmid:29494290 fatcat:r47mhgreajavjhy7c6mmoqkhyi