Brief research report 273 The combined effects of controlled breathing techniques and ventilatory and upper extremity muscle exercise on cardiopulmonary responses in patients with spinal cord injury Serap T. Sutbeyaz, Belma F. Koseoglu and Nilufer K.O. Gokkaya This study investigated the effects of controlled breathing techniques and ventilatory and upper extremity muscle exercise on cardiopulmonary and metabolic functions and exercise tolerance in patients with spinal cord injury (SCI). The design of the study was prospective and was a before– after trial. Twenty patients with SCI were included in the study. Resting pulmonary functions were assessed spiro- metrically. Cardiopulmonary and metabolic responses to maximum exercise were determined with an electronically braked arm crank ergometer. The expired gases during this exercise were collected and analysed using a computer- ized gas analysis system. Patients with SCI participated in a 6-week ventilatory and upper extremity muscle exercise program for 1 h, three times per week. At the end of the exercise program, we observed significant improvement in spirometric values, peak oxygen uptake, time to fatigue, peak power output and minute ventilation compared with pre-training values for the patients. International Journal of Rehabilitation Research 28:273–276  c 2005 Lippincott Williams & Wilkins. International Journal of Rehabilitation Research 2005, 28:273–276 Keywords: paraplegia, exercise test, ventilatory muscle exercise Cardiopulmonary Rehabilitation Unit, Ankara Physical Medicine and Rehabilitation Education and Research Hospital, Ankara, Turkey. Correspondence and requests for reprints to Belma Fusun Koseoglu MD, Associate Professor, Barıs Sitesi 53, Sok No.1, 06530 Bilkent Kavsagı, Ankara, Turkey. Tel: +90 312 285 50 60; fax: +90 312 431 93 81; e-mail: tkoseoglu@yahoo.com Received 23 November 2004 Accepted 27 January 2005 Introduction The diaphragm, the external intercostals, the parasternal part of the internal intercostals and the scalene are essential muscles of respiration because they are active even during quiet breathing in normal individuals (Bartolome, 1994). In patients with paraplegia, motor innervation of the diaphragm and most of the accessory muscles of breathing will be intact. But there will be partial or total paralysis of the intercostals and abdominal musculature. Denervation of the intercostals and abdom- inal musculature results in changes in the mechanics of the lungs and thorax, such as a reduction in lung compliance and a strong restrictive ventilatory impair- ment (Rutchik et al., 1998; Uijl et al., 1999; Liaw et al., 2000). Furthermore, the efficiency of unaffected muscles may be decreased due to instability of the chest wall and due to an inactive lifestyle (Uijl et al., 1999). Within the past two decades, cardiopulmonary disease has emerged as the major cause of death and an important source of morbidity for aging persons with spinal cord injury (SCI). Several reports have associated this risk with sedentary lifestyle and low levels of fitness observed in persons with tetraplegia and paraplegia (Blocker et al., 1983; Yekutiel et al., 1983; Barstow et al., 1996; Silva et al., 1998; Jacobs et al., 2001, 2002). The aim of the study, therefore, was to evaluate the effects of controlled breathing techniques and ventilatory and upper extremity muscle training on cardiopulmonary and metabolic functions and exercise tolerance in patients with SCI. Materials and methods Participants Twenty patients with SCI (12 men and eight women) consented to participate in the study. All patients were drawn from the inpatient rehabilitation department. The design of the study was prospective and was a before– after trial. The exclusion criteria included chronic pulmonary or cardiac disease or clinical evidence of cardiac or respiratory disease. The criteria for recruitment of participants for the study were (1) sufficient upper torso and extremity nerve function and strength to accomplish arm crank ergometry, (2) no previous history of cardiovascular or respiratory problems and (3) no medication that would influence metabolic or cardio- respiratory responses to exercise. Fourteen patients were complete and six were incomplete as defined recently by the American Spinal Injury Association. All of them had thoracic lesions (T 6 –T 12 ). The mean time since injury was 3.81 ± 5.8 months. The mean age of the patients was 31.31 ± 8.17 years. All participants were considered minimally active and not upper body aerobically trained. Testing procedure Resting pulmonary function parameters including forced vital capacity (FVC), forced expiratory volume in 1 s 0342-5282  c 2005 Lippincott Williams & Wilkins Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.