Response of the arterial blood pressure of quadriplegic patients to treadmill gait training

D.C.L Carvalho,A Cliquet Jr

doi:10.1590/s0100-879x2005000900011

D.C.L Carvalho, A Cliquet Jr

Open Access

https://doi.org/10.1590/s0100-879x2005000900011

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Abstract

Blood pressure pattern was analyzed in 12 complete quadriplegics with chronic lesions after three months of treadmill gait training. Before training, blood pressure values were obtained at rest, during treadmill walking and during the recovery phase. Gait training was performed for 20 min twice a week for three months. Treadmill gait was achieved using neuromuscular electrical stimulation, assisted by partial body weight relief (30-50%). After training, blood pressure was evaluated at rest, during gait and during recovery phase. Before and after training, mean systolic blood pressures and heart rates increased significantly during gait compared to rest (94.16 +/- 5.15 to 105 +/- 5.22 mmHg and 74.27 +/- 10.09 to 106.23 +/- 17.31 bpm, respectively), and blood pressure decreased significantly in the recovery phase (86.66 +/- 9.84 and 57.5 +/- 8.66 mmHg, respectively). After three months of training, systolic blood pressure became higher at rest (94.16 +/- 5.15 mmHg before training and 100 +/- 8.52 mmHg after training; P < 0.05) and during gait exercise (105 +/- 5.22 mmHg before and 110 +/- 7.38 mmHg after training; P < 0.05) when compared to the initial values, with no changes in heart rate. No changes occurred in blood pressure during the recovery phase, with the lower values being maintained. A drop in systolic pressure from 105 +/- 5.22 to 86.66 +/- 9.84 mmHg before training and from 110 +/- 7.38 to 90 +/- 7.38 mmHg after training was noticed immediately after exercise, thus resulting in hypotensive symptoms when chronic quadriplegics reach the sitting position from the upright position.

Highlights

Cervical spinal cord injury which results in quadriplegia involves impairment of motor, sensory and sympathetic nervous system (SNS) functions
Systolic blood pressure significantly increased to 110 ± 7.38 mmHg, but no significant changes were observed in diastolic blood pressure (69.16 ± 7.92 mmHg)
Systolic and diastolic blood pressures significantly decreased to 90 ± 7.38 and 55.41 ± 7.82 mmHg, respectively

Summary

Introduction

Cervical spinal cord injury which results in quadriplegia involves impairment of motor, sensory and sympathetic nervous system (SNS) functions. The extensive muscle paralysis associated with the absence or decrease of SNS interferes negatively with the cardiovascular responses during exercise, since these factors provide insufficient support for aerobic metabolism [1,2]. Paraplegic subjects with injury level above the thoracic SNS outflow (T6 level) have impaired SNS activity. The lack of normal muscle activity damages the venous muscle pump, increases venous pooling in the lower extremities, and diminishes the venous return and cardiac.

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