Table 1.

Effects of Upper Extremity Training on Cardiovascular Fitness and Health

Author Year Country Score Research Design Total Sample Size	Methods	Key Outcomes
Arm Ergometry
de Groot et al. 200327 Netherlands PEDro=7 RCT N=6	Population: 4 male, 2 female, C5-L1, ASIA A (n=1), B (n=1), C (n=4), age 36yr. Treatment: Interval training (3min exercise:2min rest), 1hr/d, 3d/wk, 8 wk. Randomized to low intensity (50–60% HRR) or high intensity (70–80% HRR).	Greater changes in VO2peak in the high intensity (59%) versus low intensity group (17%).
Davis et al. 199129 Canada PEDro=4 RCT N=24	Population: 8 spina bifida, 16 traumatic, age 17–42yr. Treatment: Random assignment to 1) control or 1 of 3 arm ergometry programs 2 d/wk, 24 wk: 1) high-intensity long duration (40 min at 70% VO2peak), 2) high-intensity short duration (20 min at 70% VO2peak), and 3) low- intensity short duration (20 min at 50% VO2peak) training.	Training increased VO2peak in the 3 arm ergometry groups (~21%). There were increases in submaximal stroke volume and cardiac output in the high intensity long and the low intensity long training groups. The low intensity short duration training and control groups exhibited small non-significant decreases in stroke volume.
Davis et al. 198728 Canada PEDro=4 RCT N=14	Population: Sedentary SCI (n=9 exercise group, n=5 control group), age 20–39yr. Treatment: Arm ergometry, 50–70%VO2peak, 20–40min/d, 3d/wk, 16wk	Significant improvement in VO2peak (31%) and HR (−9.5%) with training. During isometric handgrip exercise, decreased rate pressure product (20%), and increased stroke volume (12–16%).
Hjeltnes & Wallberg-Henriksson 199832 Norway D&B=16 Prospective Controlled Trial N=27	Population: Exercise group: 10 tetraplegia, C6-8, 7 ASIA A & 3 ASIA B, Control: 10 paraplegia, T7-11, all ASIA A. Treatment: Exercise group: standard rehabilitation + Arm ergometry, 30min/d, 3d/wk, 12–16wk; Control: standard rehabilitation.	Tetraplegics increased peak workload (45%) with no change in VO2peak. Peak workload (45.5%) and VO2peak (27.7) increased significantly in the paraplegics. No change in peak HR, systolic BP, submaximal exercise stroke volume or cardiac output in either SCI group.
Mixed Arm and Other Exercise
Hicks et al. 200330 Canada PEDro=5 RCT N=23	Population: 18 tetraplegia and 16 paraplegia, ASIA A-D, C4-L1, ages 19–65 yr. Treatment: Exercise: 90–120min/d, 2d/wk, 9mth of arm ergometry (15–30 mins, ~70%VO2max) and circuit resistance exercise. Control group: bimonthly education session.	Power output increased by 118% and 45% after training in the tetraplegic and paraplegic groups, respectively. There were progressive increases in strength over the 9 months of training (ranging from 19–34%).
Wheelchair Ergometry
Hooker & Wells 198931 USA D&B=9 Prospective Controlled Trial N=8	Population: Low-intensity group n=6, C5-T7, moderate- intensity group n=5, C5-T9. Treatment: Wheelchair ergometry 20min/d, 3 d/wk, 8 wk: Low-intensity (50–60% max HRR) and moderate-intensity (70–80% max HRR).	The moderate-intensity group had significantly lower post-training submaximal HR, lactate, and RPE but no changes in oxygen consumption. 70% maximal HRR appears to be the beneficial training threshold.