Accidental boosting in an individual with tetraplegia – considerations for the interpretation of cardiopulmonary exercise testing

Abstract

Context

Autonomic dysreflexia (AD), characterized by a transient increase in systolic blood pressure (BP), is experienced by individuals with spinal cord injury (SCI) and can be purposefully induced (‘boosting’) to counteract autonomic dysfunction that impairs cardiovascular responses to exercise. Herein, we demonstrate the impact of unintentional boosting observed during cardiopulmonary exercise testing (CPET) in an inactive male with SCI (C5, motor-complete).

Findings

On two separate occasions the individual performed a standard arm-crank CPET (1-min stages, 7W increase in resistance) following by a longer CPET (4-min stages, 12W increase in resistance), both to volitional exhaustion. The second CPET was performed to confirm the accuracy of exercise intensity prescription and verify peak exercise parameters. Immediately following the second CPET on the initial visit, the individual reported symptoms of AD, verified as a 58mmHg increase in systolic BP from baseline. Relative to the first CPET, performed only 35 min earlier, there were pronounced differences in peak exercise responses. In comparison to the longer CPET performed on the second visit without a concomitant episode of AD (thereby controlling for the type of CPET protocol administered), peak exercise outcomes were considerably elevated: power output (Δ19W), oxygen uptake (Δ3.61 ml·kg·⁻¹min⁻¹), ventilation (Δ11.4 L ·min⁻¹) and heart rate (Δ9 b·min⁻¹).

Conclusion/Clinical Relevance

This case raises important considerations around the nuances of CPET in this population. In individuals susceptible to BP instability, the physiologically boosted state may explain a significant proportion of the variance in peak aerobic capacity and should be closely monitored before and after clinical CPET.

Keywords:

• Ergogenic aids
• Physical therapy/Rehabilitation
• Blood pressure
• Exercise
• Spinal cord injury

Acknowledgements

The authors would like to thank the individual for his participation in this case report. The authors also recognize the work of other scientists that could not be cited in this brief report due to reference limitations.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Disclaimer statements

Contributors None.

Conflict of interest Dr Krassioukov has previously collaborated with the International Paralympic Committee (IPC) as a consultant. The other authors do not declare any conflicts of interest.

Additional information

Funding

This study was funded by the PRAXIS Spinal Cord Institute (formerly Rick Hansen Institute; grant number 2015-31; Principal Investigator Dr. Krassioukov). Dr Nightingale was a recipient of a 2018/2020 Michael Smith Foundation for Health Research/International Collaboration on repair Discoveries Research Trainee Award (#17767). Mr Shane Balthazaar is a recipient of the Robert H.N Ho Scholarship and the UBC President’s Academic Excellence Award. The equipment used for this case-report was supported by a Canada Foundation for Innovation/B.C. Knowledge Development Fund grant (#35869) to Dr Krassioukov.