Maximal and submaximal aerobic tests for wheelchair-dependent persons with spinal cord injury: a systematic review to summarize and identify useful applications for clinical rehabilitation

Purpose: To summarize the available maximal and submaximal aerobic exercise tests for wheelchair-dependent persons with a spinal cord injury (SCI) and to identify useful applications for clinical rehabilitation. Method: The databases of PubMed, CINAHL^®, EMBASE, and PsycINFO^® were searched for English-language studies published prior to March 2015. Two independent raters identified and examined studies that reported on laboratory-based aerobic exercise tests in persons with an SCI, according to the PRISMA statement. Results: The test protocols of maximal (n = 105) and submaximal (n = 28) exercise tests, covered by 95 included studies, were assessed. A large variety in patient characteristics, test objectives, test protocols, exercise modes, and outcome parameters was reported. Few studies reported on adherence to recommendations, adverse events, and peak outcome validation. Conclusions: An incremental test protocol with small, individualized, increments per stage seems preferable for testing maximal aerobic capacity, but additional validation of the available test modes is required to draw conclusions. Submaximal testing is relevant for assessing the performance at daily life intensities and for estimating VO_2peak. Consensus regarding reporting test procedures and outcomes needs to be achieved to enhance comparability of rehabilitation results.Implications for Rehabilitation Regularly testing the cardiovascular capacity during SCI rehabilitation will enable us to monitor the impact of rehabilitation interventions on an individual level. The incremental arm ergometry test with small increments per stage is most relevant for the assessment of the peak cardiovascular capacity. For the assessment of daily life functioning, the submaximal wheelchair ergometer test is preferable. Hand cycling is a promising exercise mode for both testing and training. Systematically reporting on test termination, criteria for attaining valid peak outcomes and adverse events is necessary to enhance comparability of results.