Evidence-based risk assessment and recommendations for physical activity clearance: stroke and spinal cord injury1This paper is one of a selection of papers published in this Special Issue, entitled Evidence-based risk assessment and recommendations for physical activity clearance, and has undergone the Journal’s usual peer review process.

2011 ◽  
Vol 36 (S1) ◽  
pp. S214-S231 ◽  
Author(s):  
E. Paul Zehr
Keyword(s):  
Physical Activity ◽  
Risk Assessment ◽  
Spinal Cord ◽  
Adverse Events ◽  
Functional Capacity ◽  
Autonomic Dysreflexia ◽  
Exercise Stress ◽  
Evidence Based ◽  
Exercise Participation ◽  
Cord Injury

Physical activity (PA) has potential benefits after stroke or spinal cord injury (SCI), especially in improving efficiency and functional capacity in activities of daily living. Currently, many who could benefit from PA may be routinely excluded from participation because of myths related to functional capacity and the concern for harm. The purpose of this review was to evaluate the literature for reports of adverse events during exercise after stroke or SCI, and to provide recommendations regarding exercise participation in supervised and unsupervised environments. Studies were evaluated for quality, and the summary level and quality of evidence were evaluated using the AGREE rubric, modified to address the main outcome measure of adverse events. Levels of exercise stress were evaluated for aerobic activities, using an established rubric. Included in the current analysis were 32 studies for stroke and 4 for SCI. In aggregate, this yielded a total of 730 experimental participants with stroke and 143 with SCI. It should be noted that almost all studies were not designed to examine naturally occurring adverse events from PA. Significant contraindications to unsupervised exercise include manifestation of autonomic dysreflexia in SCI and cardiovascular comorbidity after stroke. There are clear benefits of exercise training on physiological outcomes in stroke and SCI, but the relation between outcomes and safety remains unclear. However, taken on balance, the risk-to-benefit ratio favors the recommendation of exercise. This recommendation is based on studies in which participants were almost universally screened for participation in supervised environments. Thus, the grading of evidence for finding adverse events to support this conclusion is inadequate.

Evidence-based risk assessment and recommendations for physical activity clearance: established cardiovascular disease1This paper is one of a selection of papers published in this Special Issue, entitled Evidence-based risk assessment and recommendations for physical activity clearance, and has undergone the Journal’s usual peer review process.

2011 ◽  
Vol 36 (S1) ◽  
pp. S190-S213 ◽  
Author(s):  
Scott G. Thomas ◽  
Jack M. Goodman ◽  
Jamie F. Burr
Keyword(s):  
Physical Activity ◽  
Risk Assessment ◽  
Adverse Events ◽  
Lower Risk ◽  
Peer Review Process ◽  
Screening Tools ◽  
Systematic Evaluation ◽  
Computer Assisted ◽  
Evidence Based ◽  
Intermediate Risk

Physical activity is an effective lifestyle therapy for patients at risk for, or with, documented cardiovascular disease (CVD). Current screening tools — the Physical Activity Readiness Questionnaire (PAR-Q) and the Physical Activity Readiness Medical Evaluation (PARmed-X) — require updating to align with risk/benefit evidence. We provide evidence-based recommendations to identify individuals with CVD at lower risk, intermediate risk, or higher risk of adverse events when participating in physical activity. Forms of exercise and the settings that will appropriately manage the risks are identified. A computer-assisted search of electronic databases, using search terms for CVD and physical activity risks and benefits, was employed. The Appraisal of Guidelines for Research and Evaluation were applied to assess the evidence and assign a strength of evidence rating. A strength rating for the physical activity participation clearance recommendation was assigned on the basis of the evidence. Recommendations for physical activity clearance were made for specific CVD groups. Evidence indicates that those who are medically stable, who are involved with physical activity, and who have adequate physical ability can participate in physical activity of lower to moderate risk. Patients at higher risk can exercise in medically supervised programs. Systematic evaluation of evidence indicates that clinically stable individuals with CVD may participate in physical activity with little risk of adverse events. Therefore, changes in the PAR-Q should be undertaken and a process of assessment and consultation to replace the PARmed-X should be developed. Patients at lower risk may exercise at low to moderate intensities with minimal supervision. Those at intermediate risk should exercise with guidance from a qualified exercise professional. Patients at higher risk should exercise in medically supervised programs.

scholarly journals Establishing evidence-based physical activity guidelines: methods for the Study of Health and Activity in People with Spinal Cord Injury (SHAPE SCI)

Spinal Cord ◽  
2007 ◽  
Vol 46 (3) ◽  
pp. 216-221 ◽  
Author(s):  
K A Martin Ginis ◽  
A E Latimer ◽  
A C Buchholz ◽  
S R Bray ◽  
B C Craven ◽  
...  
Keyword(s):  
Physical Activity ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Evidence Based ◽  
Physical Activity Guidelines ◽  
Cord Injury

scholarly journals Heart rate changes associated with autonomic dysreflexia in daily life of individuals with chronic spinal cord injury

2021 ◽  
Author(s):  
Belinda Yee ◽  
Tom E Nightingale ◽  
Andrea L Ramirez ◽  
Matthias Walter ◽  
Andrei V Krassioukov
Keyword(s):  
Physical Activity ◽  
Spinal Cord ◽  
Heart Rate ◽  
Spinal Cord Injury ◽  
Daily Life ◽  
Autonomic Dysreflexia ◽  
Chronic Spinal Cord Injury ◽  
Design Data ◽  
Thoracic Spinal ◽  
Cord Injury

Objective: To characterize heart rate (HR) changes during autonomic dysreflexia (AD) in daily life for individuals with chronic spinal cord injury (SCI). Design: Data analysis of two prospective clinical studies and one cross-sectional study. Setting: Single-center study. Participants: Forty-five individuals (including 8 females) with a chronic SCI at or above the sixth thoracic spinal segment with confirmed AD, and a median age and time since injury of 43 years (interquartile range [IQR] 36 - 50) and 17 years (IQR 6 - 23) respectively, were included for analysis. Interventions: Not applicable. Main outcome measure: Any systolic blood pressure (SBP) increase > 20mmHg from baseline from a 24-hour ambulatory surveillance period was identified and categorized as either confirmed (i.e. known AD trigger), unknown (i.e. no diary entry), and unlikely (i.e. potential physical activity driven SBP increase). SBP-associated HR changes were categorized as either unchanged, increased or decreased compared to baseline. Results: A total of 797 episodes of SBP increase above AD threshold were identified and classified as confirmed (n = 250, 31.4%), unknown (n = 472, 59.2%) or unlikely (n = 75, 9.4%). Median SBP changes and median SBP-related HR changes were 37 mmHg and -8 bpm, 28 mmHg and -6 bpm, or 30 mmHg and -4 bpm for confirmed, unknown, or unlikely episodes, respectively. HR-decrease/increase ratio was 3:1 for confirmed and unknown, and 1.5:1 for unlikely episodes. HR changes resulting in brady-/tachycardia were 34.4% / 2.8% for confirmed, 39.6% / 3.4% unknown, and 26.7% / 9.3% for unlikely episodes, respectively. Conclusions: Our findings suggest that the majority of confirmed AD episodes are associated with a HR decrease. Further improvements, such as more precise participant diaries combined with the use of 24-hour Holter electrocardiogram and wearable-sensors-derived measures of physical activity could provide a better, more detailed characterization of HR changes during AD.

Evidence-based risk assessment and recommendations for physical activity clearance: respiratory disease1This paper is one of a selection of papers published in the Special Issue entitled Evidence-based risk assessment and recommendations for physical activity clearance, and has undergone the Journal’s usual peer-review process.

2011 ◽  
Vol 36 (S1) ◽  
pp. S80-S100 ◽  
Author(s):  
Neil D. Eves ◽  
Warren J. Davidson
Keyword(s):  
Physical Activity ◽  
Risk Assessment ◽  
Adverse Events ◽  
Exercise Intervention ◽  
Peer Review Process ◽  
Chronic Obstructive ◽  
Evidence Based ◽  
Screening Process ◽  
Obstructive Pulmonary Disease ◽  
Asthma Patients

The 2 most common respiratory diseases are chronic obstructive pulmonary disease (COPD) and asthma. Growing evidence supports the benefits of exercise for all patients with these diseases. Due to the etiology of COPD and the pathophysiology of asthma, there may be some additional risks of exercise for these patients, and hence accurate risk assessment and clearance is needed before patients start exercising. The purpose of this review was to evaluate the available literature regarding the risks of exercise for patients with respiratory disease and provide evidence-based recommendations to guide the screening process. A systematic review of 4 databases was performed. The literature was searched to identify adverse events specific to exercise. For COPD, 102 randomized controlled trials that involved an exercise intervention were included (n = 6938). No study directly assessed the risk of exercise, and only 15 commented on exercise-related adverse events. For asthma, 30 studies of mixed methodologies were included (n = 1278). One study directly assessed the risk of exercise, and 15 commented on exercise-related adverse events. No exercise-related fatalities were reported. The majority of adverse events in COPD patients were musculoskeletal or cardiovascular in nature. In asthma patients, exercise-induced bronchoconstriction and (or) asthma symptoms were the primary adverse events. There is no direct evidence regarding the risk of exercise for patients with COPD or asthma. However, based on the available literature, it would appear that with adequate screening and optimal medical therapy, the risk of exercise for these respiratory patients is low.

Evidence-based risk assessment and recommendations for physical activity clearance: diabetes mellitus and related comorbidities1This paper is one of a selection of papers published in this Special Issue, entitled Evidence-based risk assessment and recommendations for physical activity clearance, and has undergone the Journal’s usual peer review process.

2011 ◽  
Vol 36 (S1) ◽  
pp. S154-S189 ◽  
Author(s):  
Michael C. Riddell ◽  
Jamie Burr
Keyword(s):  
Physical Activity ◽  
Risk Assessment ◽  
Adverse Events ◽  
Randomized Controlled Trials ◽  
Controlled Trials ◽  
Evidence Based ◽  
Safe Procedure ◽  
Randomized Controlled ◽  
Risk Algorithm ◽  
Wide Range

Physical activity (PA) is one of the most powerful treatment options for persons with prediabetes or diabetes. However, some elevation in risk occurs with increased PA, at least initially, and certain precautions need to be made to lower these risks, particularly if these persons are unaccustomed to exercise. We conducted a standardized search of all adverse events associated with increased PA in persons with prediabetes or diabetes (type 1 or type 2) and provided evidence-based guidelines on PA screening in these apparently high-risk individuals. A systematic literature review was performed of all studies reporting on adverse events in persons with prediabetes or diabetes. Studies included were from all designs (retrospective and prospective including randomized controlled trials) and were assessed according to evaluation criteria adapted by a consensus panel. A total of 47 studies, involving >8000 individuals, were deemed eligible. A number of these studies identified a range of mild to severe acute risks with exercise (musculoskeletal injury, hypoglycemia, foot ulceration, proliferative retinopathy, hypotension, sudden death) but the overall prevalence was low. Based on several randomized controlled trials and prospective studies in which prescribed exercise was performed at a wide range of intensities, it appears that increased PA is a relatively safe procedure with no evidence of a loss of life. Based on our assessment of the available literature, we provide a new PA risk algorithm for persons with prediabetes and diabetes and comment on the role of the patient, the qualified exercise professional, and the patient’s physician in the risk screening process.

Evidence-based risk assessment and recommendations for physical activity: arthritis, osteoporosis, and low back pain1This paper is one of a selection of papers published in the Special Issue entitled Evidence-based risk assessment and recommendations for physical activity clearance, and has undergone the Journal’s usual peer-review process.

2011 ◽  
Vol 36 (S1) ◽  
pp. S49-S79 ◽  
Author(s):  
Philip D. Chilibeck ◽  
Hassanali Vatanparast ◽  
Stephen M. Cornish ◽  
Saman Abeysekara ◽  
Sarah Charlesworth
Keyword(s):  
Physical Activity ◽  
Risk Assessment ◽  
Low Back Pain ◽  
Back Pain ◽  
Adverse Events ◽  
Controlled Trials ◽  
Evidence Based ◽  
Cochrane Central Register ◽  
Low Back ◽  
Level 2

We systematically reviewed the safety of physical activity (PA) for people with arthritis, osteoporosis, and low back pain. We searched PubMed, MEDLINE, Sport Discus, and the Cochrane Central Register of Controlled Trials (1966 through March 2008) for relevant articles on PA and adverse events. A total of 111 articles met our inclusion criteria. The incidence for adverse events during PA was 3.4%–11% (0.06%–2.4% serious adverse events) and included increased joint pain, fracture, and back pain for those with arthritis, osteoporosis, and low back pain, respectively. Recommendations were based on the Appraisal of Guidelines for Research and Evaluation, which applies Levels of Evidence based on type of study ranging from high-quality randomized controlled trials (Level 1) to anecdotal evidence (Level 4) and Grades from A (strong) to C (weak). Our main recommendations are that (i) arthritic patients with highly progressed forms of disease should avoid heavy load-bearing activities, but should participate in non-weight-bearing activities (Level 2, Grade A); and (ii) patients with osteoporosis should avoid trunk flexion (Level 2, Grade A) and powerful twisting of the trunk (Level 3, Grade C); (iii) patients with acute low back pain can safely do preference-based PA (i.e., PA that does not induce pain), including low back extension and flexion (Level 2, Grade B); (iv) arthritic patients with stable disease without progressive joint damage and patients with stable osteoporosis or low back pain can safely perform a variety of progressive aerobic or resistance-training PAs (Level 2, Grades A and B). Overall, the adverse event incidence from reviewed studies was low. PA can safely be done by most individuals with musculoskeletal conditions.

Evidence-based risk assessment and recommendations for physical activity clearance: cognitive and psychological conditions1This paper is one of a selection of papers published in this Special Issue, entitled Evidence-based risk assessment and recommendations for physical activity clearance, and has undergone the Journal’s usual peer review process.

2011 ◽  
Vol 36 (S1) ◽  
pp. S113-S153 ◽  
Author(s):  
Ryan E. Rhodes ◽  
Viviene A. Temple ◽  
Holly A. Tuokko
Keyword(s):  
Physical Activity ◽  
Risk Assessment ◽  
Intellectual Disability ◽  
Adverse Events ◽  
Psychotic Disorders ◽  
Peer Review Process ◽  
Risk Of Bias ◽  
Psychological Disorder ◽  
Atlantoaxial Instability ◽  
Evidence Based

Physical activity has established mental and physical health benefits, but related adverse events have not received attention. The purpose of this paper was to review the documented adverse events occurring from physical activity participation among individuals with psychological or cognitive conditions. Literature was identified through electronic database (e.g., MEDLINE, psychINFO) searching. Studies were eligible if they described a published paper examining the effect of changes on physical activity behaviour, included a diagnosed population with a cognitive or psychological disorder, and reported on the presence or absence of adverse events. Quality of included studies was assessed, and the analyses examined the overall evidence by available subcategories. Forty trials passed the eligibility criteria; these were grouped (not mutually exclusively) by dementia (n = 5), depression (n = 10), anxiety disorders (n = 12), eating disorders (n = 4), psychotic disorders (n = 4), and intellectual disability (n = 15). All studies displayed a possible risk of bias, ranging from moderate to high. The results showed a relatively low prevalence of adverse events. Populations with dementia, psychological disorders, or intellectual disability do not report considerable or consequential adverse events from physical activity independent of associated comorbidities. The one exception to these findings may be Down syndrome populations with atlantoaxial instability; in these cases, additional caution may be required during screening for physical activity. This review, however, highlights the relative paucity of the reported presence or absence of adverse events, and finds that many studies are at high risk of bias toward reporting naturally occurring adverse events.

Spinal cord injury and pregnancy

2021 ◽  
pp. 1753495X2110119
Author(s):  
Katherine Robertson ◽  
Felicity Ashworth
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Respiratory Infections ◽  
Obstetric Care ◽  
Autonomic Dysreflexia ◽  
Existing Problems ◽  
Cord Injury ◽  
Relative Rarity ◽  
Obstetric Population ◽  
Tract Infections

Pregnancy in women with spinal cord injury is considered high risk because it may exacerbate many of their existing problems, including autonomic dysreflexia, spasms, decubitus ulcers, urinary tract infections and respiratory infections. Due to the relative rarity of spinal cord injury in the general obstetric population, clinicians often lack familiarity of these specific problems and the women themselves are usually more experienced in their own management than their obstetric team. However, studies have demonstrated that pregnancy outcomes are generally good with appropriate and experienced obstetric care. In this review, we examine the available literature and provide advice on pre-conception counselling and the antenatal, intrapartum and postnatal management of pregnant women with spinal cord injury.

scholarly journals Autonomic dysreflexia associated with cervical spinal cord gliofibroma: case report

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hiroyuki Mizuno ◽  
Fumiaki Honda ◽  
Hayato Ikota ◽  
Yuhei Yoshimoto
Keyword(s):  
Spinal Cord ◽  
Cervical Spinal Cord ◽  
Spinal Cord Tumor ◽  
Autonomic Dysreflexia ◽  
Tumor Biopsy ◽  
Intramedullary Lesion ◽  
First Case ◽  
Cord Injury ◽  
Paroxysmal Hypertension ◽  
Upper And Lower Extremities

Abstract Background Autonomic dysreflexia (AD) is an abnormal reflex of the autonomic nervous system normally observed in patients with spinal cord injury from the sixth thoracic vertebra and above. AD causes various symptoms including paroxysmal hypertension due to stimulus. Here, we report a case of recurrent AD associated with cervical spinal cord tumor. Case presentation The patient was a 57-year-old man. Magnetic resonance imaging revealed an intramedullary lesion in the C2, C6, and high Th12 levels. During the course of treatment, sudden loss of consciousness occurred together with abnormal paroxysmal hypertension, marked facial sweating, left upward conjugate gaze deviation, ankylosis of both upper and lower extremities, and mydriasis. Seizures repeatedly occurred, with symptoms disappearing after approximately 30 min. AD associated with cervical spinal cord tumor was diagnosed. Histological examination by tumor biopsy confirmed the diagnosis of gliofibroma. Radiotherapy was performed targeting the entire brain and spinal cord. The patient died approximately 3 months after treatment was started. Conclusions AD is rarely associated with spinal cord tumor, and this is the first case associated with cervical spinal cord gliofibroma. AD is important to recognize, since immediate and appropriate response is required.

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