Cardiovascular intensity attainment and walking outcomes for persons with spinal cord injury

Locomotor Clinical Practice Guidelines recommend intensities of 70–85% predicted maximum heart rate (HR) during gait training to improve walking speed and endurance for persons with chronic motor incomplete spinal cord injury (iSCI). However, attainment of these intensities may be limited during inpatient rehabilitation due to the significant physical assistance required for gait training. Therefore, the objective of this study was to examine the association between attainment of 70% HR max intensities and meaningful changes in walking outcomes for persons with SCI during inpatient rehabilitation who required physical assistance to ambulate. This cross-sectional study examined records of 127 persons with SCI admitted to inpatient rehabilitation from June 2020 to June 2023. We utilized data from locomotor training sessions and co-treatments to compare those who achieved 70% HR max intensity and those who did not. Change in Walking Index for Spinal Cord Injury II (WISCI II) and 10 Meter Walk Test (10MWT) scores were examined in fully adjusted regression models. Approximately 65% of persons with SCI achieved 70% HR max during at least 1 locomotor session. Attainment of 70% HR max intensity was associated with positive changes of WISCI II scores (OR = 2.52, 95% CI = 1.01–6.42) and positive changes in 10 MWT (OR = 3.72, 95% CI = 1.38–10.99). Higher locomotor training intensities were associated with meaningful improvements in walking function. Persons with SCI, who require physical assistance for ambulation, can achieve meaningful improvements in walking outcomes with attainment of 70% HR max intensity during inpatient rehabilitation.