Exercise improves cardiorespiratory fitness but not arterial health after spinal cord injury: the CHOICES trial

Arterial stiffness, as measured by carotid-femoral pulse wave velocity (cfPWV), is elevated after spinal cord injury (SCI). In the uninjured population, exercise training has been shown to reduce arterial stiffness. In a randomized, clinical multicenter trial, we evaluated the impact of two exercise interventions on cardiovascular disease risk factors in individuals with chronic SCI. A total of forty-six adults with motor-complete SCI with neurological levels of injury between the fourth cervical and sixth thoracic spinal cord segments were randomly assigned to either body weight-supported treadmill training (BWSTT) or arm-cycle ergometer training (ACET). Participants trained 3 days per week for 24 weeks. Exercise session duration progressed gradually to reach 30 and 60 minutes for ACET and BWSTT, respectively. The primary outcome was arterial stiffness, measured by cfPWV, and was measured at baseline, 12 weeks of training, and at 24 weeks. Secondary outcomes included cardiorespiratory fitness (CRF) and cardiometabolic health measures and were measured before and after completion of training. Fourteen participants per intervention arm completed the exercise intervention. Our results show no changes over time for either arterial stiffness (P = .07) and cardiometabolic health measures (P>.36) with either exercise intervention. However, peak oxygen uptake increased with ACET compared with BWSTT (P = .04). The findings of this trial demonstrate that while 24 weeks of upper-body exercise improved CRF in individuals with motor-complete SCI ≥ T6, neither intervention was associated with improvements in arterial stiffness or cardiometabolic health measures.