Hybrid cycle exercise training after spinal cord injury.

Participants will be recruited from the databases of two Dutch rehabilitation centres.

Many individuals with a chronic spinal cord injury show a serious inactive lifestyle, associated with secondary complications (e.g. pressure sores, osteoporosis and metabolic syndrome) and a decreased physical capacity. The purpose of this study is to evaluate and compare the effects of a hybrid cycle exercise training program versus a hand cycle exercise training program and a non-training group on secondary complications, physical capacity and active lifestyle. It is hypothesized that both training interventions will lead to an increased physical capacity and active lifestyle, as well as to a reduced risk of secondary complications, such as metabolic syndrome. Furthermore it is hypothesized that, due to the lower-body exercise, hybrid cycle training will improve vascular function, skin tissue viability, bone mineral density and interface pressure profile of the lower extremity, while arm exercise alone will not lead to these improvements.

Timepoints:

1. Pre-test (just before the training intervention);

2. Mid-test (8 weeks);

3. Post-test (end of the training intervention: after 16 weeks);

4. Rollow-up (26 weeks after the end of the intervention).



Methods:

1. Physical capacity: Will be expressed as the peak power output, measured by a graded exercise test in a wheelchair. Additionally, the hybrid cycle training group and the hand cycle training group will perform a graded exercise test in the hybrid cycle and the hand cycle, respectively. Timepoints: 1-4.

2. Metabolic syndrome: Fasting blood samples will be taken to determine the lipoprotein profile, insulin and glucose. Waist circumference will be measured using a tape measure, and blood pressure will be taken on the right arm. Timepoints: 1,3,4;

3. Bone mineral density of the distal femur and proximal tibia: dual energy X-ray absorptiometry (DXA). Timepoints: 1,3,4;

4. Vascular function: Echo Doppler (diameter, flow, thickness and compliance of the a. carotis and a. femoralis).Timepoints: 1,3,4;

5. Interface pressure profile: Interface pressure mat. Timepoints: 1-4;

6. Skin tissue viability: Near Infrared Spectroscopy (NIRS). Timepoints: 1-4;

7. Active lifestyle: PASIPD (questionnaire), odometer. Timepoints: 1-4.

1. Hybrid cycle training group: 16 weeks of training in a hybrid cylce; 2x30 min/week; 70% Heart Rate Reserve (HHR);

2. Hand cylce training group: 16 weeks of training in a hand cycle; 2x30 min; 70% HRR;

3. Non-training control group: No training.