{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T14:41:42Z","timestamp":1787064102242,"version":"build-2736575974"},"reference-count":138,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2025,4,30]],"date-time":"2025-04-30T00:00:00Z","timestamp":1745971200000},"content-version":"unspecified","delay-in-days":29,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Heart Research United Kingdom","award":["RG2698\/21\/23"],"award-info":[{"award-number":["RG2698\/21\/23"]}]},{"DOI":"10.13039\/501100000334","name":"International Spinal Research Trust","doi-asserted-by":"crossref","award":["NRB123"],"award-info":[{"award-number":["NRB123"]}],"id":[{"id":"10.13039\/501100000334","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,4,11]]},"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Individuals with spinal cord injury (SCI) face heightened cardiovascular disease (CVD) risks. While general exercise guidelines are promoted for SCI individuals, when and how to incorporate exercise during the subacute phase post-SCI remains unclear. Consequently, early aerobic exercise to reduce CVD risks is not standard practice in subacute SCI care, potentially missing an opportunity for optimal cardiovascular rehabilitation, especially given observed reductions in cardiac structure and function within the first year post-SCI. Addressing this gap could improve long-term cardiovascular health and health-related quality of life (HRQOL) for individuals with SCI. Early intervention might prevent worsening cardiovascular function and establish beneficial exercise habits. However, few studies have evaluated the effectiveness of early exercise interventions in this population. This study aims to provide insight into the impact of moderate-intensity arm-crank exercise training (ACET) on cardiometabolic, HRQOL, functional and fitness parameters in individuals with subacute (&lt;12 months postinjury) SCI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>We will conduct a single-centre, two-group, single-blind randomised controlled trial with 42 participants who have sustained a cervical or thoracic SCI within the past year. The non-intervention group will receive hospital standard of care (control group) while the intervention group will receive hospital standard of care plus moderate-intensity ACET for 10 weeks in line with the SCI-specific exercise guidelines to improve cardiometabolic health. The primary outcome measure will be central arterial stiffness (carotid-to-femoral pulse wave velocity). Secondary outcomes include assessments of (1) blood biomarkers linked to CVD, (2) cardiac structure and function, (3) extracranial vasculature, (4) HRQOL, (5) cognitive function, (6) physical activity level, (7) cardiorespiratory fitness, (8) motor function and (9) feasibility outcomes. Assessments will occur at baseline (rehabilitation centre admission, \u22122 weeks), preintervention (0 weeks), postintervention (10 weeks) and follow-up (6 months after postintervention), for HRQOL outcomes only.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethical approval was obtained from the Wales Research Ethics Committee (HREC 22\/WA\/0329). Outcome data will be presented at international conferences, patient advocacy groups, health professional networks and community health events. Findings will be published in peer-reviewed journals and widely disseminated through strategic channels to reach researchers, healthcare providers, patients and the public.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"isrctn\" xlink:href=\"ISRCTN99941302\">ISRCTN99941302<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-089868","type":"journal-article","created":{"date-parts":[[2025,4,30]],"date-time":"2025-04-30T21:45:15Z","timestamp":1746049515000},"page":"e089868","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["\u2018Time is of the essence\u2019: upper-body aerobic exercise to improve cardiovascular health during inpatient rehabilitation within the first year following spinal cord injury \u2013 protocol for a randomised clinical trial"],"prefix":"10.1136","volume":"15","clinical-trial-number":[{"clinical-trial-number":"isrctn99941302","registry":"10.18810\/isrctn"},{"clinical-trial-number":"isrctn99941302","registry":"10.18810\/isrctn"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8860-2898","authenticated-orcid":false,"given":"Shane J T","family":"Balthazaar","sequence":"first","affiliation":[{"name":"School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK"},{"name":"University of Birmingham Institute of Cardiovascular Sciences, Birmingham, UK"},{"name":"Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK"},{"name":"International Collaboration On Repair Discoveries (ICORD), The University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3626-0640","authenticated-orcid":false,"given":"Daniel D","family":"Hodgkiss","sequence":"additional","affiliation":[{"name":"School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4200-5243","authenticated-orcid":false,"given":"Shin-Yi","family":"Chiou","sequence":"additional","affiliation":[{"name":"School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK"},{"name":"University of Birmingham Centre of Precision Rehabilitation for Spinal Pain, Birmingham, UK"},{"name":"Centre for Human Brain Health, University of Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8713-2457","authenticated-orcid":false,"given":"Samuel J E","family":"Lucas","sequence":"additional","affiliation":[{"name":"School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK"},{"name":"Centre for Human Brain Health, University of Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afroditi","family":"Stathi","sequence":"additional","affiliation":[{"name":"School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manish","family":"Kalla","sequence":"additional","affiliation":[{"name":"Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK"},{"name":"Department of Cardiovascular Medicine, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aheed E F","family":"Osman","sequence":"additional","affiliation":[{"name":"Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Srinivasa C","family":"Budithi","sequence":"additional","affiliation":[{"name":"Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naveen","family":"Kumar","sequence":"additional","affiliation":[{"name":"Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK"},{"name":"Keele University Faculty of Medicine & Health Sciences, Keele, UK"},{"name":"Edge Hill University, Ormskirk, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joy Roy","family":"Chowdhury","sequence":"additional","affiliation":[{"name":"Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2947-4931","authenticated-orcid":false,"given":"Tom E","family":"Nightingale","sequence":"additional","affiliation":[{"name":"School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,4,30]]},"reference":[{"key":"2025121409551250000_15.4.e089868.1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00942.2003"},{"key":"2025121409551250000_15.4.e089868.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.resp.2009.08.003"},{"key":"2025121409551250000_15.4.e089868.3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2147\/JN.S143236","article-title":"Epidemiology of worldwide spinal cord injury: a literature review","volume":"6","author":"Kang","year":"2017","journal-title":"J Neurorestoratology"},{"key":"2025121409551250000_15.4.e089868.4","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1038\/sc.2017.23","article-title":"Long-term survival after traumatic spinal cord injury: a 70-year British study","volume":"55","author":"Savic","year":"2017","journal-title":"Spinal Cord"},{"key":"2025121409551250000_15.4.e089868.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-9993(99)90252-6"},{"key":"2025121409551250000_15.4.e089868.6","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2015.3903"},{"key":"2025121409551250000_15.4.e089868.7","doi-asserted-by":"crossref","DOI":"10.3390\/jpm12071110","article-title":"Autonomic Dysfunction and Management after Spinal Cord Injury: A Narrative Review","volume":"12","author":"Henke","year":"2022","journal-title":"J Pers Med"},{"key":"2025121409551250000_15.4.e089868.8","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1212\/WNL.0b013e3182a1aa68","article-title":"Cardiovascular disease and spinal cord injury: results from a national population health survey","volume":"81","author":"Cragg","year":"2013","journal-title":"Neurology (ECronicon)"},{"key":"2025121409551250000_15.4.e089868.9","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1310\/sci2303-175","article-title":"Exercise and Health-Related Risks of Physical Deconditioning After Spinal Cord Injury","volume":"23","author":"Maher","year":"2017","journal-title":"Top Spinal Cord Inj Rehabil"},{"key":"2025121409551250000_15.4.e089868.10","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1310\/sci1301-98","article-title":"Cardiovascular Health and Exercise Rehabilitation in Spinal Cord Injury","volume":"13","author":"Warburton","year":"2007","journal-title":"Top Spinal Cord Inj Rehabil"},{"key":"2025121409551250000_15.4.e089868.11","doi-asserted-by":"crossref","DOI":"10.3389\/fgene.2012.00290","article-title":"Mechanisms of arterial remodeling: lessons from genetic diseases","volume":"3","author":"van Varik","year":"2012","journal-title":"Front Genet"},{"key":"2025121409551250000_15.4.e089868.12","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.1089\/neu.2016.4694","article-title":"Increased Central Arterial Stiffness after Spinal Cord Injury: Contributing Factors, Implications, and Possible Interventions","volume":"34","author":"Lee","year":"2017","journal-title":"J Neurotrauma"},{"key":"2025121409551250000_15.4.e089868.13","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.112.194779"},{"key":"2025121409551250000_15.4.e089868.14","doi-asserted-by":"publisher","DOI":"10.2174\/1568016043477242"},{"key":"2025121409551250000_15.4.e089868.15","doi-asserted-by":"publisher","DOI":"10.1007\/s00421-012-2400-2"},{"key":"2025121409551250000_15.4.e089868.16","doi-asserted-by":"publisher","DOI":"10.1038\/sc.2012.136"},{"key":"2025121409551250000_15.4.e089868.17","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.autneu.2017.02.004","article-title":"Alterations in cardiac autonomic control in spinal cord injury","volume":"209","author":"Biering-S\u00f8rensen","year":"2018","journal-title":"Auton Neurosci"},{"key":"2025121409551250000_15.4.e089868.18","doi-asserted-by":"publisher","DOI":"10.1038\/sc.2012.17"},{"key":"2025121409551250000_15.4.e089868.19","doi-asserted-by":"crossref","DOI":"10.3390\/ijms20102464","article-title":"The Blood Pressure Pendulum following Spinal Cord Injury: Implications for Vascular Cognitive Impairment","volume":"20","author":"Sachdeva","year":"2019","journal-title":"Int J Mol Sci"},{"key":"2025121409551250000_15.4.e089868.20","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1038\/s41393-019-0316-y","article-title":"Associations between arterial stiffness and blood pressure fluctuations after spinal cord injury","volume":"57","author":"Currie","year":"2019","journal-title":"Spinal Cord"},{"key":"2025121409551250000_15.4.e089868.21","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.eurheartj.a014868"},{"key":"2025121409551250000_15.4.e089868.22","doi-asserted-by":"publisher","DOI":"10.1152\/ajpheart.00869.2007"},{"key":"2025121409551250000_15.4.e089868.23","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1097\/WCO.0000000000001206","article-title":"Assessing the efficacy of duration and intensity prescription for physical activity in mitigating cardiometabolic risk after spinal cord injury","volume":"36","author":"Farkas","year":"2023","journal-title":"Curr Opin Neurol"},{"key":"2025121409551250000_15.4.e089868.24","doi-asserted-by":"publisher","DOI":"10.1179\/2045772314Y.0000000245"},{"key":"2025121409551250000_15.4.e089868.25","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1007\/s40141-016-0124-7","article-title":"Contributors to Metabolic Disease Risk Following Spinal Cord Injury","volume":"4","author":"Smith","year":"2016","journal-title":"Curr Phys Med Rehabil Rep"},{"key":"2025121409551250000_15.4.e089868.26","doi-asserted-by":"crossref","first-page":"36","DOI":"10.46292\/sci20-00063","article-title":"Neurogenic Obesity-Induced Insulin Resistance and Type 2 Diabetes Mellitus in Chronic Spinal Cord Injury","volume":"27","author":"Gordon","year":"2021","journal-title":"Top Spinal Cord Inj Rehabil"},{"key":"2025121409551250000_15.4.e089868.27","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1038\/s41393-024-00996-5","article-title":"Does cardiometabolic risk profile differ among individuals with traumatic and non-traumatic spinal cord injury (SCI): the evidence from the multicenter SCI cohort in Switzerland (SwiSCI)","volume":"62","author":"Raguindin","year":"2024","journal-title":"Spinal Cord"},{"key":"2025121409551250000_15.4.e089868.28","doi-asserted-by":"crossref","first-page":"681","DOI":"10.2165\/11531960-000000000-00000","article-title":"Energy expenditure and metabolism during exercise in persons with a spinal cord injury","volume":"40","author":"Price","year":"2010","journal-title":"Sports Med"},{"key":"2025121409551250000_15.4.e089868.29","doi-asserted-by":"crossref","first-page":"2449","DOI":"10.1016\/j.apmr.2017.05.009","article-title":"Cardiovascular Stress During Inpatient Spinal Cord Injury Rehabilitation","volume":"98","author":"Zbogar","year":"2017","journal-title":"Arch Phys Med Rehabil"},{"key":"2025121409551250000_15.4.e089868.30","doi-asserted-by":"crossref","DOI":"10.1186\/s40798-017-0077-0","article-title":"Measurement of Physical Activity and Energy Expenditure in Wheelchair Users: Methods, Considerations and Future Directions","volume":"3","author":"Nightingale","year":"2017","journal-title":"Sports Med Open"},{"key":"2025121409551250000_15.4.e089868.31","doi-asserted-by":"crossref","DOI":"10.1186\/s12966-017-0590-z","article-title":"Energy balance components in persons with paraplegia: daily variation and appropriate measurement duration","volume":"14","author":"Nightingale","year":"2017","journal-title":"Int J Behav Nutr Phys Act"},{"key":"2025121409551250000_15.4.e089868.32","doi-asserted-by":"publisher","DOI":"10.1053\/apmr.2002.36835"},{"key":"2025121409551250000_15.4.e089868.33","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-9993(99)90285-X"},{"key":"2025121409551250000_15.4.e089868.34","doi-asserted-by":"publisher","DOI":"10.1016\/S0304-3959(02)00452-9"},{"key":"2025121409551250000_15.4.e089868.35","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychores.2012.07.005"},{"key":"2025121409551250000_15.4.e089868.36","doi-asserted-by":"publisher","DOI":"10.1016\/0003-9993(85)90148-0"},{"key":"2025121409551250000_15.4.e089868.37","first-page":"67","article-title":"Time characteristics in wheelchair tennis played on hard surfaces","volume":"41","author":"Filip\u010di\u010d","year":"2009","journal-title":"Kinesiology (Zagreb)"},{"key":"2025121409551250000_15.4.e089868.38","doi-asserted-by":"publisher","DOI":"10.1038\/sj.sc.3100802"},{"key":"2025121409551250000_15.4.e089868.39","doi-asserted-by":"publisher","DOI":"10.1038\/sc.1995.65"},{"key":"2025121409551250000_15.4.e089868.40","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4614-4090-1_5"},{"key":"2025121409551250000_15.4.e089868.41","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2016.4632"},{"key":"2025121409551250000_15.4.e089868.42","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1212\/WNL.0000000000006244","article-title":"Cognitive function after spinal cord injury: A systematic review","volume":"91","author":"Sachdeva","year":"2018","journal-title":"Neurology (ECronicon)"},{"key":"2025121409551250000_15.4.e089868.43","doi-asserted-by":"crossref","first-page":"2649","DOI":"10.4103\/1673-5374.339475","article-title":"Spinal cord injury-induced cognitive impairment: a narrative review","volume":"17","author":"Alc\u00e1ntar-Garibay","year":"2022","journal-title":"Neural Regen Res"},{"key":"2025121409551250000_15.4.e089868.44","doi-asserted-by":"crossref","DOI":"10.1038\/s41394-018-0038-y","article-title":"Adverse cognitive effect of gabapentin in individuals with spinal cord injury: preliminary findings","volume":"4","author":"Shem","year":"2018","journal-title":"Spinal Cord Ser Cases"},{"key":"2025121409551250000_15.4.e089868.45","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2007.11.055"},{"key":"2025121409551250000_15.4.e089868.46","doi-asserted-by":"publisher","DOI":"10.1179\/2045772312Y.0000000056"},{"key":"2025121409551250000_15.4.e089868.47","doi-asserted-by":"publisher","DOI":"10.1191\/026921599666105472"},{"key":"2025121409551250000_15.4.e089868.48","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1038\/s41393-018-0076-0","article-title":"Cognitive performance of people with traumatic spinal cord injury: a cross-sectional study comparing people with subacute and chronic injuries","volume":"56","author":"Molina","year":"2018","journal-title":"Spinal Cord"},{"key":"2025121409551250000_15.4.e089868.49","doi-asserted-by":"publisher","DOI":"10.1038\/sc.2008.120"},{"key":"2025121409551250000_15.4.e089868.50","doi-asserted-by":"crossref","DOI":"10.1186\/s12984-016-0208-8","article-title":"Physical activity outside of structured therapy during inpatient spinal cord injury rehabilitation","volume":"13","author":"Zbogar","year":"2016","journal-title":"J Neuroeng Rehabil"},{"key":"2025121409551250000_15.4.e089868.51","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph18179148","article-title":"Quality of Life and Physical Activity of Persons with Spinal Cord Injury","volume":"18","author":"Filipcic","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"2025121409551250000_15.4.e089868.52","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph19031787","article-title":"The Relationship between Physical Activity Level and Functional Status of Subjects with High Spinal Cord Injury","volume":"19","author":"Szeliga","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"2025121409551250000_15.4.e089868.53","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1113\/EP085978","article-title":"Effects of early and delayed initiation of exercise training on cardiac and haemodynamic function after spinal cord injury","volume":"102","author":"Popok","year":"2017","journal-title":"Exp Physiol"},{"key":"2025121409551250000_15.4.e089868.54","doi-asserted-by":"crossref","DOI":"10.3389\/fcvm.2022.881741","article-title":"Temporal Changes of Cardiac Structure, Function, and Mechanics During Sub-acute Cervical and Thoracolumbar Spinal Cord Injury in Humans: A Case-Series","volume":"9","author":"Balthazaar","year":"2022","journal-title":"Front Cardiovasc Med"},{"key":"2025121409551250000_15.4.e089868.55","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1016\/j.apmr.2022.12.001","article-title":"Exercise Training Does Not Attenuate Cardiac Atrophy or Loss of Function in Individuals With Acute Spinal Cord Injury: A Pilot Study","volume":"104","author":"Ely","year":"2023","journal-title":"Arch Phys Med Rehabil"},{"key":"2025121409551250000_15.4.e089868.56","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1080\/10790268.2017.1412562","article-title":"Arm crank ergometry improves cardiovascular disease risk factors and community mobility independent of body composition in high motor complete spinal cord injury","volume":"42","author":"Bresnahan","year":"2019","journal-title":"J Spinal Cord Med"},{"key":"2025121409551250000_15.4.e089868.57","doi-asserted-by":"crossref","DOI":"10.3389\/fphys.2022.831372","article-title":"Effects of Arm-Crank Exercise on Fitness and Health in Adults With Chronic Spinal Cord Injury: A Systematic Review","volume":"13","author":"Chiou","year":"2022","journal-title":"Front Physiol"},{"key":"2025121409551250000_15.4.e089868.58","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1212\/WNL.0000000000004224","article-title":"Effects of exercise on fitness and health of adults with spinal cord injury: A systematic review","volume":"89","author":"van der Scheer","year":"2017","journal-title":"Neurology (ECronicon)"},{"key":"2025121409551250000_15.4.e089868.59","doi-asserted-by":"crossref","first-page":"2177","DOI":"10.1016\/j.apmr.2020.04.020","article-title":"Effect of Exercise on Cardiometabolic Risk Factors in Adults With Chronic Spinal Cord Injury: A Systematic Review","volume":"101","author":"Farrow","year":"2020","journal-title":"Arch Phys Med Rehabil"},{"key":"2025121409551250000_15.4.e089868.60","article-title":"Effectiveness of the \u201cEvidence-Based Scientific Exercise Guidelines\u201d in Increasing Cardiorespiratory Fitness, Cardiometabolic Health, and Muscle Strength in Acute Spinal Cord Injury Rehabilitation: A Systematic Review","volume":"5","author":"Richings","year":"2023","journal-title":"Arch Rehabil Res Clin Transl"},{"key":"2025121409551250000_15.4.e089868.61","doi-asserted-by":"publisher","DOI":"10.2147\/CEOR.S115103"},{"key":"2025121409551250000_15.4.e089868.62","unstructured":"National Clinical Guideline Centre U . Cost-effectiveness analysis: diagnosis of traumatic spinal injury. 2016. Available: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK367866\/ [Accessed 24 Nov 2023]."},{"key":"2025121409551250000_15.4.e089868.63","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehq165"},{"key":"2025121409551250000_15.4.e089868.64","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1016\/j.apmr.2024.11.006","article-title":"Consensus-Based Recommendations for Designing, Delivering, Evaluating, and Reporting Exercise Intervention Research Involving People Living With a Spinal Cord Injury","volume":"106","author":"Ponzano","year":"2025","journal-title":"Arch Phys Med Rehabil"},{"key":"2025121409551250000_15.4.e089868.65","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-158-3-201302050-00583"},{"key":"2025121409551250000_15.4.e089868.66","doi-asserted-by":"crossref","first-page":"1998","DOI":"10.1016\/j.apmr.2018.05.008","article-title":"Home-Based Exercise Enhances Health-Related Quality of Life in Persons With Spinal Cord Injury: A Randomized Controlled Trial","volume":"99","author":"Nightingale","year":"2018","journal-title":"Arch Phys Med Rehabil"},{"key":"2025121409551250000_15.4.e089868.67","doi-asserted-by":"crossref","unstructured":"Dorey T , Nightingale T , Alrashidi A , et al . Effects of exercise on autonomic cardiovascular control in individuals with chronic, motor-complete spinal cord injury: an exploratory randomised clinical trial. In Review [Preprint] 2023. doi:10.21203\/rs.3.rs-2944633\/v1","DOI":"10.21203\/rs.3.rs-2944633\/v1"},{"key":"2025121409551250000_15.4.e089868.68","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-023-49053-w","article-title":"Home-based arm cycling exercise improves trunk control in persons with incomplete spinal cord injury: an observational study","volume":"13","author":"van Helden","year":"2023","journal-title":"Sci Rep"},{"key":"2025121409551250000_15.4.e089868.69","unstructured":"NICE Guideline . Spinal injury: assessment and initial management. 2016. Available: https:\/\/www.nice.org.uk\/guidance\/ng41\/resources\/spinal-injury-assessment-and-initial-management-pdf-1837447790533"},{"key":"2025121409551250000_15.4.e089868.70","unstructured":"British Society of Physical & Rehabilitation Medicine . Standards for specialist rehabilitation of spinal cord injury (BSPRM). 2022. Available: https:\/\/www.spinal.co.uk\/wp-content\/uploads\/2023\/01\/Standards-for-Specialist-Rehabilitation-of-SCI-Final-Sept-2022.pdf"},{"key":"2025121409551250000_15.4.e089868.71","unstructured":"National Spinal Cord Injury Strategy Board (NSCISB) . The initial management of adults with spinal cord injuries advice for major trauma networks and SCI centres on the development of joint protocols with advice for clinicians in acute hospitals approved by the National Spinal Cord Injury Strategy Board on 18th. 2012."},{"key":"2025121409551250000_15.4.e089868.72","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1038\/s41393-021-00733-2","article-title":"Rethinking aerobic exercise intensity prescription in adults with spinal cord injury: time to end the use of \u201cmoderate to vigorous\u201d intensity?","volume":"60","author":"Hutchinson","year":"2022","journal-title":"Spinal Cord"},{"key":"2025121409551250000_15.4.e089868.73","doi-asserted-by":"publisher","DOI":"10.2522\/ptj.20090023"},{"key":"2025121409551250000_15.4.e089868.74","doi-asserted-by":"publisher","DOI":"10.1038\/s41393-017-0017-3"},{"key":"2025121409551250000_15.4.e089868.75","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1016\/j.jsams.2016.02.001","article-title":"Exercise and sports science Australia (ESSA) position statement on exercise and spinal cord injury","volume":"20","author":"Tweedy","year":"2017","journal-title":"J Sci Med Sport"},{"key":"2025121409551250000_15.4.e089868.76","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2020-102955"},{"key":"2025121409551250000_15.4.e089868.77","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2022-068507","article-title":"Feasibility study of high-intensity interval training to reduce cardiometabolic disease risks in individuals with acute spinal cord injury","volume":"13","author":"Maher","year":"2023","journal-title":"BMJ Open"},{"key":"2025121409551250000_15.4.e089868.78","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1249\/MSS.0b013e3181b72cbc","article-title":"Regulating intensity using perceived exertion in spinal cord-injured participants","volume":"42","author":"Goosey-Tolfrey","year":"2010","journal-title":"Med Sci Sports Exerc"},{"key":"2025121409551250000_15.4.e089868.79","doi-asserted-by":"publisher","DOI":"10.1037\/0003-066X.55.1.68"},{"key":"2025121409551250000_15.4.e089868.80","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0b013e32834fa8b0"},{"key":"2025121409551250000_15.4.e089868.81","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1179\/2045772314Y.0000000232","article-title":"Physical exercise improves arterial stiffness after spinal cord injury","volume":"37","author":"Hubli","year":"2014","journal-title":"J Spinal Cord Med"},{"key":"2025121409551250000_15.4.e089868.82","doi-asserted-by":"crossref","DOI":"10.1186\/s12872-016-0224-4","article-title":"Measurement of pulse wave velocity in normal ageing: comparison of Vicorder and magnetic resonance phase contrast imaging","volume":"16","author":"Parikh","year":"2016","journal-title":"BMC Cardiovasc Disord"},{"key":"2025121409551250000_15.4.e089868.83","doi-asserted-by":"crossref","first-page":"2469","DOI":"10.1249\/MSS.0000000000001390","article-title":"Impact of Exercise on Cardiometabolic Component Risks in Spinal Cord-injured Humans","volume":"49","author":"Nightingale","year":"2017","journal-title":"Med Sci Sports Exerc"},{"key":"2025121409551250000_15.4.e089868.84","doi-asserted-by":"publisher","DOI":"10.1038\/sc.2010.88"},{"key":"2025121409551250000_15.4.e089868.85","doi-asserted-by":"crossref","unstructured":"Balthazaar SJT , Nightingale TE , Alrashidi AA , et al . Effects of exercise interventions on cardiac structure, function, and mechanics in individuals with chronic motor-complete spinal cord injury: an exploratory randomized clinical trial. Top Spinal Cord Inj Rehabil 2024. doi:10.46292\/sci24-00002","DOI":"10.46292\/sci24-00002"},{"key":"2025121409551250000_15.4.e089868.86","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2014.10.003"},{"key":"2025121409551250000_15.4.e089868.87","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1093\/ejechocard\/jer021","article-title":"Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE\/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography","volume":"12","author":"Mor-Avi","year":"2011","journal-title":"Eur J Echocardiogr"},{"key":"2025121409551250000_15.4.e089868.88","doi-asserted-by":"crossref","first-page":"1956","DOI":"10.1152\/jappl.2000.89.5.1956","article-title":"Arterial properties of the carotid and femoral artery in endurance-trained and paraplegic subjects","volume":"89","author":"Schmidt-Trucks\u00e4ss","year":"2000","journal-title":"J Appl Physiol (1985)"},{"key":"2025121409551250000_15.4.e089868.89","doi-asserted-by":"publisher","DOI":"10.1152\/ajpregu.00211.2015"},{"key":"2025121409551250000_15.4.e089868.90","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1161\/01.STR.30.2.402","article-title":"Standardization of carotid ultrasound: a hemodynamic method to normalize for interindividual and interequipment variability","volume":"30","author":"Ranke","year":"1999","journal-title":"Stroke"},{"key":"2025121409551250000_15.4.e089868.91","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1152\/jappl.2001.91.2.929","article-title":"Improved analysis of brachial artery ultrasound using a novel edge-detection software system","volume":"91","author":"Woodman","year":"2001","journal-title":"J Appl Physiol (1985)"},{"key":"2025121409551250000_15.4.e089868.92","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00840.2016"},{"key":"2025121409551250000_15.4.e089868.93","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2017.00258","article-title":"An Overview of Heart Rate Variability Metrics and Norms","volume":"5","author":"Shaffer","year":"2017","journal-title":"Front Public Health"},{"key":"2025121409551250000_15.4.e089868.94","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2009.09.543"},{"key":"2025121409551250000_15.4.e089868.95","doi-asserted-by":"crossref","DOI":"10.3389\/fpsyg.2014.00756","article-title":"Heart rate variability biofeedback: how and why does it work?","volume":"5","author":"Lehrer","year":"2014","journal-title":"Front Psychol"},{"key":"2025121409551250000_15.4.e089868.96","doi-asserted-by":"crossref","first-page":"1483","DOI":"10.1002\/pmrj.12770","article-title":"Methodologic implications for rehabilitation research: Differences in heart rate variability introduced by respiration","volume":"14","author":"Solinsky","year":"2022","journal-title":"PM R"},{"key":"2025121409551250000_15.4.e089868.97","doi-asserted-by":"publisher","DOI":"10.2478\/hukin-2020-0004"},{"key":"2025121409551250000_15.4.e089868.98","doi-asserted-by":"publisher","DOI":"10.1038\/sc.2011.156"},{"key":"2025121409551250000_15.4.e089868.99","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1080\/10790268.2007.11753405","article-title":"Pain after spinal cord injury: an evidence-based review for clinical practice and research. Report of the National Institute on Disability and Rehabilitation Research Spinal Cord Injury Measures meeting","volume":"30","author":"Bryce","year":"2007","journal-title":"J Spinal Cord Med"},{"key":"2025121409551250000_15.4.e089868.100","doi-asserted-by":"publisher","DOI":"10.1038\/sc.2009.164"},{"key":"2025121409551250000_15.4.e089868.101","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.1989.00520460115022"},{"key":"2025121409551250000_15.4.e089868.102","doi-asserted-by":"crossref","first-page":"1278","DOI":"10.1002\/pmrj.12161","article-title":"Reliability of Cognitive Measures in Individuals With a Chronic Spinal Cord Injury","volume":"11","author":"Nightingale","year":"2019","journal-title":"PM R"},{"key":"2025121409551250000_15.4.e089868.103","doi-asserted-by":"crossref","first-page":"1963","DOI":"10.1089\/neu.2019.6913","article-title":"Vascular-Cognitive Impairment following High-Thoracic Spinal Cord Injury Is Associated with Structural and Functional Maladaptations in Cerebrovasculature","volume":"37","author":"Sachdeva","year":"2020","journal-title":"J Neurotrauma"},{"key":"2025121409551250000_15.4.e089868.104","doi-asserted-by":"publisher","DOI":"10.1016\/j.physbeh.2019.112742"},{"key":"2025121409551250000_15.4.e089868.105","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/j.apmr.2023.08.006","article-title":"The Clinical Relevance of Autonomic Dysfunction, Cerebral Hemodynamics, and Sleep Interactions in Individuals Living With SCI","volume":"105","author":"Ji","year":"2024","journal-title":"Arch Phys Med Rehabil"},{"key":"2025121409551250000_15.4.e089868.106","doi-asserted-by":"crossref","first-page":"78","DOI":"10.46292\/sci23-00068","article-title":"Cerebrovascular Reactivity Following Spinal Cord Injury","volume":"30","author":"Weber","year":"2024","journal-title":"Top Spinal Cord Inj Rehabil"},{"key":"2025121409551250000_15.4.e089868.107","first-page":"522","article-title":"Increased Prevalence of Blood Pressure Instability Over Twenty-Four Hours in Chronic Spinal Cord Injury","volume":"3","author":"Wang","year":"2022","journal-title":"Neurotrauma Rep"},{"key":"2025121409551250000_15.4.e089868.108","doi-asserted-by":"publisher","DOI":"10.1093\/ajh\/hpt175"},{"key":"2025121409551250000_15.4.e089868.109","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2013.3148"},{"key":"2025121409551250000_15.4.e089868.110","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.109.140798"},{"key":"2025121409551250000_15.4.e089868.111","doi-asserted-by":"crossref","DOI":"10.1136\/bmjsem-2015-000008","article-title":"Predicting physical activity energy expenditure in wheelchair users with a multisensor device","volume":"1","author":"Nightingale","year":"2015","journal-title":"BMJ Open Sport Exerc Med"},{"key":"2025121409551250000_15.4.e089868.112","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ejcn.1602118"},{"key":"2025121409551250000_15.4.e089868.113","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1139\/apnm-2015-0670","article-title":"Predicting peak oxygen uptake from submaximal exercise after spinal cord injury","volume":"41","author":"Totosy de Zepetnek","year":"2016","journal-title":"Appl Physiol Nutr Metab"},{"key":"2025121409551250000_15.4.e089868.114","first-page":"71","article-title":"Cardiac Vagus and Exercise","volume":"34","author":"Gourine","year":"2019","journal-title":"Physiology (Bethesda)"},{"key":"2025121409551250000_15.4.e089868.115","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1111\/sms.13580","article-title":"Arm crank ergometer \u201cspin\u201d training improves seated balance and aerobic capacity in people with spinal cord injury","volume":"30","author":"Williams","year":"2020","journal-title":"Scand J Med Sci Sports"},{"key":"2025121409551250000_15.4.e089868.116","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1111\/j.1600-0838.2006.00621.x","article-title":"Dynamic trunk stability is improved in paraplegics following kayak ergometer training","volume":"17","author":"Bjerkefors","year":"2007","journal-title":"Scand J Med Sci Sports"},{"key":"2025121409551250000_15.4.e089868.117","doi-asserted-by":"crossref","DOI":"10.3389\/fnhum.2020.583579","article-title":"Crossed Corticospinal Facilitation Between Arm and Trunk Muscles Correlates With Trunk Control After Spinal Cord Injury","volume":"14","author":"Chiou","year":"2020","journal-title":"Front Hum Neurosci"},{"key":"2025121409551250000_15.4.e089868.118","doi-asserted-by":"crossref","first-page":"1961","DOI":"10.1016\/j.apmr.2020.06.014","article-title":"Psychometric Testing and Clinical Utility of a Modified Version of the Function in Sitting Test for Individuals With Chronic Spinal Cord Injury","volume":"101","author":"Palermo","year":"2020","journal-title":"Arch Phys Med Rehabil"},{"key":"2025121409551250000_15.4.e089868.119","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2004.21.1371"},{"key":"2025121409551250000_15.4.e089868.120","doi-asserted-by":"crossref","first-page":"1276","DOI":"10.1016\/S0003-9993(03)00200-4","article-title":"The relationship between sitting stability and functional performance in patients with paraplegia","volume":"84","author":"Chen","year":"2003","journal-title":"Arch Phys Med Rehabil"},{"key":"2025121409551250000_15.4.e089868.121","doi-asserted-by":"crossref","first-page":"1571","DOI":"10.1016\/j.apmr.2009.02.016","article-title":"Validity and reliability of assessment tools for measuring unsupported sitting in people with a spinal cord injury","volume":"90","author":"Boswell-Ruys","year":"2009","journal-title":"Arch Phys Med Rehabil"},{"key":"2025121409551250000_15.4.e089868.122","doi-asserted-by":"publisher","DOI":"10.1682\/JRRD.2005.11.0172"},{"key":"2025121409551250000_15.4.e089868.123","doi-asserted-by":"crossref","first-page":"110","DOI":"10.13189\/nh.2015.030502","article-title":"Feasibility and acceptability of a resistance exercise intervention: for women undergoing chemotherapy for breast cancer","volume":"3","author":"Visovsky","year":"2015","journal-title":"Nh"},{"key":"2025121409551250000_15.4.e089868.124","doi-asserted-by":"crossref","DOI":"10.1038\/s41394-022-00518-6","article-title":"Wheelchair-modified ergometer rowing exercise in individuals with spinal cord injury: a feasibility, acceptability, and preliminary efficacy study","volume":"8","author":"Hansen","year":"2022","journal-title":"Spinal Cord Ser Cases"},{"key":"2025121409551250000_15.4.e089868.125","doi-asserted-by":"publisher","DOI":"10.1111\/nhs.12048"},{"key":"2025121409551250000_15.4.e089868.126","unstructured":"Ritchie J , Lewis J , Nicholls CM , et al . Qualitative research practice: a guide for social science students and researchers. 2nd edn. London, Thousand Oaks, CA: SAGE Publications Ltd, 2014."},{"key":"2025121409551250000_15.4.e089868.127","unstructured":"Yin RK . Qualitative research: from start to finish. 2nd edn. New York London: GUILFORD Press, 2016:417."},{"key":"2025121409551250000_15.4.e089868.128","unstructured":"Cohen J . Statistical power analysis for the behavioral sciences. 2nd edn. New York: Academic Press, 1988. Available: http:\/\/www.utstat.toronto.edu\/~brunner\/oldclass\/378f16\/readings\/CohenPower.pdf"},{"key":"2025121409551250000_15.4.e089868.129","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2018-023540","article-title":"Effects of exercise interventions on cardiovascular health in individuals with chronic, motor complete spinal cord injury: protocol for a randomised controlled trial [Cardiovascular Health\/Outcomes: Improvements Created by Exercise and education in SCI (CHOICES) Study]","volume":"9","author":"Krassioukov","year":"2019","journal-title":"BMJ Open"},{"key":"2025121409551250000_15.4.e089868.130","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1179\/2045772312Y.0000000042","article-title":"Test-retest reliability of pulse wave velocity in individuals with chronic spinal cord injury","volume":"35","author":"Miyatani","year":"2012","journal-title":"J Spinal Cord Med"},{"key":"2025121409551250000_15.4.e089868.131","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.10.061"},{"key":"2025121409551250000_15.4.e089868.132","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1038\/s41393-019-0345-6","article-title":"Sprint interval training versus moderate-intensity continuous training during inpatient rehabilitation after spinal cord injury: a randomized trial","volume":"58","author":"Mcleod","year":"2020","journal-title":"Spinal Cord"},{"key":"2025121409551250000_15.4.e089868.133","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-021-83211-2","article-title":"Evaluating patient perspectives on participating in scientific research and clinical trials for the treatment of spinal cord injury","volume":"11","author":"Bahsoun","year":"2021","journal-title":"Sci Rep"},{"key":"2025121409551250000_15.4.e089868.134","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.jphys.2015.11.004","article-title":"Physiotherapy rehabilitation for people with spinal cord injuries","volume":"62","author":"Harvey","year":"2016","journal-title":"J Physiother"},{"key":"2025121409551250000_15.4.e089868.135","doi-asserted-by":"crossref","DOI":"10.1038\/s41467-022-29066-1","article-title":"Spinal cord injury impairs cardiac function due to impaired bulbospinal sympathetic control","volume":"13","author":"Fossey","year":"2022","journal-title":"Nat Commun"},{"key":"2025121409551250000_15.4.e089868.136","doi-asserted-by":"crossref","first-page":"H933","DOI":"10.1152\/ajpheart.00249.2023","article-title":"Impact of exercise training on pulse wave velocity in healthy and clinical populations: a systematic review of systematic reviews","volume":"325","author":"Liu","year":"2023","journal-title":"Am J Physiol Heart Circ Physiol"},{"key":"2025121409551250000_15.4.e089868.137","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1004082","article-title":"Exercise and aerobic capacity in individuals with spinal cord injury: A systematic review with meta-analysis and meta-regression","volume":"20","author":"Hodgkiss","year":"2023","journal-title":"PLoS Med"},{"key":"2025121409551250000_15.4.e089868.138","doi-asserted-by":"publisher","DOI":"10.1038\/s41393-019-0285-1"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-089868","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T17:55:28Z","timestamp":1765734928000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-089868"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4]]},"references-count":138,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4,30]]},"published-print":{"date-parts":[[2025,4]]}},"alternative-id":["10.1136\/bmjopen-2024-089868"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-089868","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4]]}}}