Report

Effects of hybrid and handcycle exercise on cardiovascular disease risk factors

Researching the effects of hybrid cycle and handcycle exercise on cardiovascular disease risk factors in persons with a spinal cord injury: A randomised controlled trial

Lead academic:
Professor Vicky Tolfrey
Additional academics:
Tom Paulson
Funder:
The Peter Harrison Foundation

Participation in regular exercise has been shown to promote a range of anti-inflammatory benefits in non-disabled individuals, including reduced visceral adiposity.

However, in SCI, the anti-inflammatory benefits of exercise may be lower due to lower-limb paralysis, and reliance on the relatively small muscle mass activated during upper-body activities such as handcycling. To date, no intervention studies have examined the effect of long-term upper-body exercise on chronic inflammation in persons with a SCI. The activation of the paralysed lower-limb musculature via functional electrical stimulation (FES)-evoked cycle training has previously been shown to significantly reduce plasma concentrations of the inflammatory mediators CRP, IL-6 and tumour necrosis factor-alpha. The performance of combined FES-evoked leg exercise and voluntary upper-body exercise (i.e. hybrid exercise) has the potential to augment the anti-inflammatory response even further, since a larger muscle mass is activated than during FES-evoked leg exercise or upper-body exercise alone.

Methods

Multicentre randomized controlled trial. Both the hybrid cycle group (n=9) and the handcycle group (n=10) trained twice a week for 16 weeks. Outcome measures obtained pre and post the programme were: metabolic syndrome components (waist circumference, systolic and diastolic blood pressure, high-density lipoprotein cholesterol, triglycerides and insulin resistance), inflammatory status (C-reactive protein (CRP), interleukin (IL)-6 and -10), and visceral adiposity (trunk and android fat)
 

Main findings and application

  • Significant reductions were found for waist circumference (p=0.001), diastolic blood pressure (p=0.03), insulin resistance (p=0.006), CRP (p = 0.05), IL-6 (p=0.04), IL-6/IL-10 ratio (p=0.03), and trunk (p=0.04) and android (p=0.02) fat percentage.
  • The 16-week exercise programme, using either a hybrid cycle or a handcycle, found similar beneficial effects on metabolic syndrome components, inflammatory status and visceral adiposity, indicating that there were no additional benefits of FES-induced leg exercise over handcycle exercise alone.
  • In conclusion, this study demonstrated that a 16-week exercise programme, using either a hybrid cycle or a handcycle had similar beneficial effects on several CVD risk factors, including metabolic syndrome components, inflammatory status and visceral adiposity, indicating that there were no notable benefits of the FES-induced leg exercise over handcycle training alone

Reference

Bakkum, A., Paulson, T., Bishop, N., Goosey-Tolfrey, V. et al. (2015). Effects of hybrid cycle and handcycle exercise on cardiovascular disease risk factors in people with spinal cord injury: A randomized controlled trial. Journal of Rehabilitation Medicine. 47(6): 523-530. DOI: