DESIGN: Systematic review and meta-analysis. BACKGROUND AND PURPOSE: Traditional forms of upper-body moderate intensity exercise consistently provide little cardiovascular benefits for persons with spinal cord injury (PwSCI). Explorations of new training methods are vital to improve cardiovascular fitness among PwSCI. This study sought to evaluate the effectiveness of vigorous training on cardiorespiratory fitness in PwSCI. METHODS: Database search through PubMed, Web of Science, Scopus, SPORTDiscus, and Cumulative Index of Nursing and Allied Health Literature (CINAHL) was conducted from the databases' inception to November 2020 to identify relevant exercise studies with PwSCI. Two independent reviewers screened articles for inclusion. Data were extracted from included studies and methodological quality evaluated. RESULTS: Sixteen trials (eight pre-post trials and eight controlled trials (CTs)) with a total of 145 participants were analyzed. Results from pre-post studies revealed significant improvements in cardiorespiratory fitness following high-intensity interval training (HIIT) (peak oxygen uptake (VO2peak) standardized mean difference (SMD) 0.81; 95% CI 0.23 to 1.39; p < 0.01 and peak power output (PPO), SMD 0.91; 95% CI 0.32 to 1.5; p < 0.01) and circuit resistance training (CRT) (VO2peak MD 0.38; 95% CI 0.19 to 0.57; p < 0.01 and PPO MD 20.17; 95% CI 8.26 to 32.08; p < 0.01). Meta-analysis of CTs did not demonstrate significant improvements in cardiorespiratory fitness following vigorous training interventions in comparison to lower intensity training interventions. CONCLUSION: Evidence from HIIT and CRT interventions suggest benefits for cardiovascular functions; however, vigorous training was not more beneficial than other forms of endurance training. More CTs are needed to better understand the effectiveness of vigorous training on cardiorespiratory fitness in PwSCI.
Reprinted by permission from Spinal Cord, Macmillan Publishers Ltd.

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