Control approach for high sensitivity cardiopulmonary exercise testing during stimulated cycle ergometry in spinal cord injured subjects

Aim: People with complete lower-limb paralysis resulting from spinal cord injury (SCI) can perform cycle ergometry by means of functional electrical stimulation. Here, we propose and evaluate new exercise testing methods for estimation of cardiopulmonary performance parameters during this form of exercise. Methods: We utilised a customised ergometer incorporating feedback control of stimulated exercise workrate and cycling cadence. This allowed the imposition of arbitrary workrate profiles with high precision with the potential for improved sensitivity in exercise testing. New incremental exercise test (IET) and step exercise test (SET) protocols for determination of peak and steady-state performance parameters were assessed. Results: The IET protocol allowed reliable determination of the ventilatory threshold, peak workrate and oxygen uptake-workrate relationship, but gave unrepresentative peak oxygen uptake values and highly variable measures of oxygen uptake kinetics. The SET protocol gave reliable estimation of steady-state oxygen uptake and metabolic efficiency of constant load exercise, but high variability in the estimation of oxygen uptake kinetics. Conclusion: The feedback-controlled testbed and the new IET and SET protocols have the potential for estimation of cardiopulmonary performance parameters with improved sensitivity during stimulated cycle ergometry in subjects with SCI. (C) 2007 Elsevier Ltd. All rights reserved.