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Autonomic Cardiovascular Control in Paralympic Athletes with Spinal Cord Injury

West, Christopher R.1; Wong, Shirley C.1; Krassioukov, Andrei V.1,2,3

Medicine & Science in Sports & Exercise: January 2014 - Volume 46 - Issue 1 - p 60–68
doi: 10.1249/MSS.0b013e31829e46f3
Basic Sciences

Introduction Disruption of autonomic control after spinal cord injury (SCI) results in life-threatening cardiovascular dysfunctions and impaired endurance performance; hence, an improved ability to recognize those at risk of autonomic disturbances is of critical clinical and sporting importance.

Purpose The objective of this study is to assess the effect of neurological level, along with motor, sensory, and autonomic completeness of injury, on cardiovascular control in Paralympic athletes with SCI.

Methods Fifty-two highly trained male Paralympic athletes (age, 34.8 ± 7.1 yr) from 14 countries with chronic SCI (C2–L2) completed three experimental trials. During trial 1, motor and sensory functions were assessed according to the American Spinal Injury Association Impairment Scale. During trial 2, autonomic function was assessed via sympathetic skin responses (SSR). During trial 3, cardiovascular control was assessed via the beat-by-beat blood pressure response to orthostatic challenge.

Results Athletes with cervical SCI exhibited the lowest seated blood pressure and the most severe orthostatic hypotension (P < 0.025). There were no differences in cardiovascular function between athletes with different American Spinal Injury Association Impairment Scale grades (P > 0.96). Conversely, those with the lowest SSR scores exhibited the lowest seated blood pressure and the most severe orthostatic hypotension (P < 0.002). Linear regression demonstrated that the combined model of neurological level and autonomic completeness of SCI explained the most variance in all blood pressure indices.

Conclusion We demonstrate for the first time that neurological level and SSR score provide the optimal combination of assessments to identify those at risk of abnormal cardiovascular control. We advocate the use of autonomic testing in the clinical and sporting classification of SCI athletes.

1International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, CANADA; 2Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, BC, CANADA; and 3GF Strong Rehabilitation Centre, Vancouver, BC, CANADA

Address for correspondence: Andrei V. Krassioukov, MD, PhD, FRCPC, International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Centre (BSCC), University of British Columbia, 818 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada; E-mail:

Submitted for publication January 2013.

Accepted for publication May 2013.

© 2014 American College of Sports Medicine