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Spinal cord injury (SCI) is characterized by autonomic cardiovascular dysfunction that may contribute to the three‐ to fourfold greater risk of heart disease and stroke compared to non‐injured individuals. While exercise training elicits beneficial changes in autonomic function and vascular structure in healthy individuals, it is unclear if similar adaptations occur in individuals with SCI. Adults with chronic SCI (>1 year post injury) were randomized to 12 weeks of supervised upper‐body rowing exercise (UBROW; 3×/week; n = 8), adhering to current exercise guidelines, or control (CON; n = 9). Autonomic cardiovascular control was assessed by heart rate variability (HRV; electrocardiography) and blood pressure responses to a sit‐up test (finger plethysmography). Brachial (peripheral) and carotid (central) artery diameter and wall thickness (near‐ and far‐wall carotid intima–media‐thickness) were measured using high‐resolution ultrasound. All measurements were conducted at baseline, after 6 and 12 weeks. There was no effect of UBROW on time and frequency domain HRV or blood pressure responses to the sit‐up test (group‐by‐time interactions: P ≥ 0.28; effect sizes: ηp2 ≤ 0.11). For UBROW, brachial artery diameter increased from 4.80 ± 0.72 mm at baseline to 5.08 ± 0.91 mm after 12 weeks (P < 0.05, ηp2 = 0.27). Carotid artery dimensions did not change, and there were no correlations between changes (baseline–12 weeks) in brachial artery diameter and changes in HRV outcomes (r ≤ 0.40, P ≥ 0.14). While upper‐body rowing exercise enlarged brachial artery diameter, carotid artery dimensions and autonomic cardiovascular control did not change, suggesting local vascular remodelling, but no systemic vascular adaptations, in response to a supervised 12‐week exercise intervention in spinal cord‐injured humans. What is the central question of this study? What are the effects of volitional upper‐body rowing exercise on autonomic cardiovascular control and vascular structure in individuals with chronic SCI? What is the main findings and its importance? This study demonstrates that 12 weeks of volitional upper‐body rowing exercise results in localized enlargement of the brachial artery diameter with no influence on carotid artery dimensions (diameter and wall thickness) or autonomic vascular control. These findings provide novel evidence of local (and not systemic) vascular adaptations in response to exercise training in individuals with SCI.

In this study, we tested the hypotheses that unaccustomed eccentric exercise (ECC) would reduce the elastic modulus and dynamic stiffness of the upper trapezius muscle and that these changes would correlate with increases in muscle thickness, reflecting muscle edema. Shear wave elastography was used to measure elastic modulus, dynamic stiffness was assessed using myotonometry, and muscle thickness was measured using ultrasonography. All measurements were performed at four locations over the upper trapezius before and 24 h after a single bout of ECC. Fourteen healthy participants (11 males and 3 females; 23.2 ± 3.0 years; height 175.1 ± 10.4 cm; body mass 73.8 ± 11.3 kg) took part in the study. Overall, ECC resulted in decreased elastic modulus (from 45.8 ± 1.6 to 39.4 ± 1.2 kPa, p < 0.01) and dynamic muscle stiffness (from 369.0 ± 7.3 to 302.6 ± 6.0 N/m, p < 0.01). Additionally, ECC resulted in increased muscle thickness (from 6.9 ± 0.4 to 7.3 ± 0.4 mm, p < 0.01). Spatial changes (across the four locations) were found for elastic modulus, stiffness and thickness. No significant correlations were found between changes in measures of muscle stiffness, or between changes in stiffness and changes in thickness. In conclusion, the present pilot study showed that ECC altered biomechanical muscle properties, reflected by decreased elastic modulus and dynamic muscle stiffness 24 h after ECC.

IntroductionCardiovascular and metabolic diseases are a growing concern for individuals with spinal cord injury (SCI). Physical inactivity contributes to cardiometabolic morbidity and mortality in the SCI population. However, previous studies have shown mixed results regarding the effects of exercise on cardiometabolic risk factors in individuals with SCI. This discrepancy could be influenced by insufficient exercise stimuli. Recent guidelines recommend 30 min of moderate-to-vigorous intensity aerobic exercise, three times per week, for improvement in cardiometabolic health in individuals with SCI. However, to date, no studies have implemented an exercise intervention matching the new recommendations to examine the effects on cardiometabolic risk factors. Therefore, the primary objective of this study is to determine the effects of 12 weeks of wheelchair user-modified upper-body rowing exercise on both traditional (constituents of the metabolic syndrome) and novel (eg, vascular structure and function) cardiometabolic risk factors in manual wheelchair users with SCI.Methods and analysisA randomised controlled trial will compare 12 weeks of upper-body rowing exercise, 30 min three times per week, with a control group continuing their normal lifestyle. Outcome measurements will be performed immediately before (baseline), after 6 weeks (halfway), 12 weeks of training (post) and 6 months after the termination of the intervention period (follow-up). Outcomes will include inflammatory (eg, C reactive protein) and metabolic biomarkers determined from venous blood (with serum fasting insulin as primary outcome), body composition, arterial blood pressure, cardiorespiratory fitness level, brachial artery vascular structure and function and autonomic nervous system function.Ethics and disseminationThis trial is reported to the Danish Data Protection Agency (J.nr. 2019-899/10-0406) and approved by the Committees on Health Research Ethics in The North Denmark Region on 12 December 2019 (J.nr. N-20190053). The principal investigator will collect written informed consent from all participants prior to inclusion. Irrespective of study outcomes, the results will be submitted to peer-reviewed scientific journals for publication.Trial registration numberNCT04390087.

Unlike earlier short-duration lunar missions, current exploration-class missions include extended periods of microgravity exposure prior to lunar surface operations. Current exercise systems on the International Space Station are bulky and power-intensive, limiting their applicability for deep space missions. The European Enhanced Exploration Exercise Device (E4D) addresses these constraints by combining aerobic and resistive exercises in a compact, multifunctional device. This study compared kinematics and perceived exertion between exercises performed on E4D’s unpowered mode and conventional gym equipment. Fourteen participants performed rowing, seated row, deadlifts, and bench press under both conditions while wearing a sensor-based motion capture system. Differences in joint angles, angular velocities, and perceived exertion were observed, likely influenced by variations in ergonomics, force production mechanics, and load distribution. Whilst differences were significant, full-body aerobic and resistive exercises were possible using a single device without a motor to generate resistance, relevant for missions with volume and power constraints.

Study designExploratory clinical investigation.ObjectivesTo assess the feasibility, acceptability, and preliminary efficacy of upper-body rowing exercise adapted to wheelchair users with spinal cord injury (SCI).SettingUniversity exercise laboratory.MethodsEight individuals with SCI exercised on a rowing ergometer modified for wheelchair users (REMW), three times weekly, for up to 30 min per session. Participants completed feasibility and acceptability questionnaire (1–5 Likert scale), and the Wheelchair Users Shoulder Pain Index (WUSPI) before and after six weeks of exercise. Average power output (POAVG), distance rowed, percent peak heart rate (%HRpeak), and rating of perceived exertion (RPE) (6–20 scale) were monitored throughout the 18 exercise sessions and analyzed to evaluate preliminary efficacy of the exercise modality.ResultsAll eight participants completed the study (97% adherence). Participants rated the exercise high on the feasibility and acceptability scale; median (interquartile range) = 5.0 (4.0–5.0), where higher numbers indicated greater feasibility. Shoulder pain was reduced by 21% yet not significantly different from baseline (p = 0.899). Physiological measures (%HRpeak = 80–83%; RPE = 15.0–16.0) indicated a high cardiovascular training load. From week 1 to week 6, POAVG and distance rowed increased by 37 and 36%, respectively (both p ≤ 0.001).ConclusionsData from six weeks of exercise on the REMW suggests that upper-body rowing is a feasible and acceptable exercise modality for wheelchair users with SCI. Session data on %HRpeak, RPE, and shoulder pain indicate that REMW evoked moderate to vigorous intensity exercise without exacerbation of shoulder pain. Future research is required to quantify potential training-induced changes in cardiorespiratory fitness.

Background Multidisciplinary lifestyle interventions for children with obesity in Denmark often include recommendations regarding physical activity, but no structured exercise program. We hypothesized that adding high-intensity interval training (HIIT) to a multidisciplinary lifestyle intervention would improve BMI z-score (primary outcome), waist circumference, blood pressure, and health-related quality of life (HRQOL). Methods This randomized controlled trial included 173 children and adolescents with obesity. Participants were allocated to 12-months lifestyle intervention ( N  = 83), or 12-month lifestyle intervention accompanied by a 12-week HIIT program ( N  = 90). HIIT consisted of three weekly sessions and included activities eliciting intensities >85% of maximal heart rate. Results Attendance rate for the 3-months HIIT intervention was 68.0 ± 23.2%. Dropout was lower in HIIT compared to control at three months (7.8% vs. 20.5%) and 12 months (26.5% vs 48.2%). Changes in BMI z-score did not differ between HIIT and control at 3 months (Mean Difference (MD): 0.01, 95% confidence interval (CI): −0.09; 0.12, P  = 0.82) or 12 months (MD: 0.06, CI: −0.07;0.19, P  = 0.34). Across randomization, BMI z-score was reduced by 0.11 (CI: 0.17; 0.06, P  < 0.01) at 3 months and 0.20 (CI: 0.26;0.14, P < 0.01) at 12 months. At 3 months, HIIT experienced a greater increase in HRQOL of 2.73 (CI: 0.01;5.44, P  = 0.05) in PedsQL Child total-score and 3.85 (CI: 0.96; 6.74, P < 0.01) in psychosocial health-score compared to control. At 12 months, PedsQL Child physical-score was reduced by 6.89 (CI: 10.97; 2.83, P  < 0.01) in HIIT compared to control. No group differences or changes over time were found for waist circumference or blood pressure. Conclusion Adding a 12-week HIIT program did not further augment the positive effects of a 12-month lifestyle intervention on BMI z-score. Adding HIIT improved HRQOL after 3 months, but reduced HRQOL at 12 months. Implementation of HIIT in community-based settings was feasible and showed positive effects on adherence to the lifestyle intervention.

Multidisciplinary lifestyle interventions for children with obesity in Denmark often include recommendations regarding physical activity, but no structured exercise program. We hypothesized that adding high-intensity interval training (HIIT) to a multidisciplinary lifestyle intervention would improve BMI z-score (primary outcome), waist circumference, blood pressure, and health-related quality of life (HRQOL). This randomized controlled trial included 173 children and adolescents with obesity. Participants were allocated to 12-months lifestyle intervention (N = 83), or 12-month lifestyle intervention accompanied by a 12-week HIIT program (N = 90). HIIT consisted of three weekly sessions and included activities eliciting intensities >85% of maximal heart rate. Attendance rate for the 3-months HIIT intervention was 68.0 ± 23.2%. Dropout was lower in HIIT compared to control at three months (7.8% vs. 20.5%) and 12 months (26.5% vs 48.2%). Changes in BMI z-score did not differ between HIIT and control at 3 months (Mean Difference (MD): 0.01, 95% confidence interval (CI): -0.09; 0.12, P = 0.82) or 12 months (MD: 0.06, CI: -0.07;0.19, P = 0.34). Across randomization, BMI z-score was reduced by 0.11 (CI: 0.17; 0.06, P < 0.01) at 3 months and 0.20 (CI: 0.26;0.14, P < 0.01) at 12 months. At 3 months, HIIT experienced a greater increase in HRQOL of 2.73 (CI: 0.01;5.44, P = 0.05) in PedsQL Child total-score and 3.85 (CI: 0.96; 6.74, P < 0.01) in psychosocial health-score compared to control. At 12 months, PedsQL Child physical-score was reduced by 6.89 (CI: 10.97; 2.83, P < 0.01) in HIIT compared to control. No group differences or changes over time were found for waist circumference or blood pressure. Adding a 12-week HIIT program did not further augment the positive effects of a 12-month lifestyle intervention on BMI z-score. Adding HIIT improved HRQOL after 3 months, but reduced HRQOL at 12 months. Implementation of HIIT in community-based settings was feasible and showed positive effects on adherence to the lifestyle intervention.

PurposeThis study assessed the effects of upper-body rowing exercise on cardiorespiratory fitness, traditional cardiometabolic risk factors, and vascular health in individuals with spinal cord injury (SCI).MethodsSeventeen male and female adults with chronic (> 1 yr) motor-complete and incomplete SCI (level of injury: C4-L3) were randomized to control (CON, n = 9) or exercise (UBROW, n = 8). Participants in UBROW performed 12-week, 3 weekly sessions of 30-min upper-body ergometer rowing exercise, complying with current exercise guidelines for SCI. Cardiorespiratory fitness (V˙O2peak), traditional risk factors (lipid profile, glycemic control) as well as inflammatory and vascular endothelium-derived biomarkers (derived from fasting blood samples) were measured before and after 6 (6W) and 12 weeks (12W). Brachial artery resting diameter and flow-mediated dilation (FMD) were determined by ultrasound as exploratory outcomes.ResultsUBROW increased V˙O2peak from baseline (15.1 ± 5.1 mL/kg/min; mean ± SD) to 6W (16.5 ± 5.3; P < 0.01) and 12W (17.5 ± 6.1; P < 0.01). UBROW increased resting brachial artery diameter from baseline (4.80 ± 0.72 mm) to 12W (5.08 ± 0.91; P < 0.01), with no changes at 6W (4.96 ± 0.91), and no changes in CON. There were no significant time-by-group interactions in traditional cardiometabolic blood biomarkers, or in unadjusted or baseline diameter corrected FMD. Explorative analyses revealed inverse correlations between changes (∆12W-baseline) in endothelin-1 and changes in resting diameter (r = − 0.56) and FMD% (r = − 0.60), both P < 0.05.ConclusionThese results demonstrate that 12 weeks of upper-body rowing complying with current exercise guidelines for SCI improves cardiorespiratory fitness and increases resting brachial artery diameter. In contrast, the exercise intervention had no or only modest effects on traditional cardiometabolic risk factors. The study was registered at Clinicaltrials.gov (N-20190053, May 15, 2020).