Effects of perceptually regulated exercise training on cardiorespiratory fitness and peak power output in adults with spinal cord injury: a systematic review and meta-analysis

Objective

To analyze and summarize the effect of regulating exercise training interventions with subjective measures of intensity on cardiorespiratory fitness, measured by peak oxygen uptake (V̇O_2peak), and peak power output (PO_peak) in adults with spinal cord injury (SCI).

Data Sources

Four databases (Medline, Embase, PsycINFO, and SPORTDiscus) were searched from inception up until September 1, 2020, and updated November 18, 2021.

Study Selection

Searches combined keywords relating to the topics: SCI, subjective measures of exercise intensity, and exercise.

Data Extraction

Two reviewers independently conducted eligibility screening, data extraction and assessed the risk of bias. Nine studies were included in the systematic review and meta-analysis, resulting in the inclusion of data from 95 adults with SCI representing both sexes and a diverse range of age, time since injury, lesion level and lesion completeness classifications.

Data Synthesis

Data were extracted and added to summary tables with three outcomes: V̇O_2peak, PO_peak, and Other. Mean and SD values for V̇O_2peak and PO_peak were extracted from pre and post perceptually regulated exercise training.

Conclusion

All studies used ratings of perceived exertion scale to prescribe exercise intensity. Seven studies out of eight studies concluded an improvement in V̇O_2peak and five studies out of seven concluded an improvement in PO_peak. In the outcome ‘Other’, five studies concluded an improvement, and three studies concluded no change. There was evidence for an improvement in cardiorespiratory fitness, measured by V̇O_2peak, and PO_peak after perceptually regulated exercise training in adults with SCI (GRADE ratings: ‘Low’) (MD: 2.92ml/kg/min; 95%CI: 1.30, 4.54; P =0.0004 and MD: 9.8W; 95%CI: 5.5, 14.3; P <0.0001, respectively). This review provides critically appraised, cumulative evidence on the use of perceptually regulated exercise training in individuals with SCI.

Registration

The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) network (CRD42020210552).