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Weak For Recommendation
Circuit training may be provided to improve cardiorespiratory fitness in people with SCI.
Circuit training (v no intervention) on cardiorespiratory fitness in people with SCI
P
People with SCI
Evidence recommendation
Weak for (100%)
Weak evidence recommendation FOR
Circuit training may be provided to improve cardiorespiratory fitness in people with SCI.
I
Circuit training
C
No intervention
Consensus-based opinion statement
No opinion statements
O
Cardiorespiratory Fitness
SUMMARY
4 RCTs
(see references)
Standardised Mean Difference (95% CI)
0.5 (0 to 0.9)
Favours circuit training
GRADE
Very low certainty
⨁◯◯◯
Risk of bias
Serious
Inconsistency
No serious
Imprecision
Very serious
Indirectness
Serious
Publication bias
Serious
CIRCUIT TRAINING ON CARDIORESPIRATORY FITNESS: GRADE Evidence to Decision
PROBLEM
No
Probably no
Probably yes
Yes
Don't know
DESIRABLE EFFECTS
Trivial
Small
Moderate
Large
Don't know
UNDESIRABLE EFFECTS
Large
Moderate
Small
Trivial
Don't know
CERTAINTY OF EVIDENCE
Very low
Low
Moderate
High
No included studies
HOW MUCH PEOPLE VALUE THE MAIN OUTCOME
Important uncertainty or variability
Possibly important uncertainty or variability
Probably no important uncertainty or variability
No important uncertainty or variability
BALANCE OF EFFECTS
Favours the Control
Probably favours the Control
Does not favour either the intervention (I) or the comparison (C)
Probably favours the I
Favours the I
Don't know
RESOURCES REQUIRED
Large costs
Moderate costs
Negligible costs and savings
Moderate savings
Large savings
Don't know
CERTAINTY OF EVIDENCE OF REQUIRED RESOURCES
Very low
Low
Moderate
High
No included studies
COST EFFECTIVENESS
Favours the comparison
Probably favours the comparison
Does not favour either the intervention or the comparison
Probably favours the intervention
Favours the intervention
No included studies
EQUITY
Reduced
Probably reduced
Probably no impact
Probably increased
Increased
Don't know
ACCEPTABILITY
No
Probably no
Probably yes
Yes
Don't know
FEASIBILITY
No
Probably no
Probably yes
Yes
Don't know
CIRCUIT TRAINING ON CARDIORESPIRATORY FITNESS: Randomised Controlled Trial Details
STUDY
COMPARISON
DOSAGE/DETAILS
PARTICIPANTS
N (Rx/C)
OUTCOME
ROB 2
PEDRo
BOMBARDIER 2000
Circuit training (telehealth)
V
No intervention
16 sessions of telehealth over 6 months
People with SCI
6/7
Vo2 Peak
Some Concerns of
Risk of Bias
PEDro = 6/10
HICKS 2003
Circuit training (Pushing, arm ergometry and PRE)
V
Sham (education)
Supervised progressive exercise 2 x weekly for 9 months. Each session 90-120 minutes
C4-L2 SCI
11/10
Power output in Watts
High Risk of Bias
PEDro = 5/10
KIM 2019
Circuit training (Resistance and aerobic training)
V
No intervention
3 x weekly for 6 weeks. Each session was one hour
C5-T10 SCI
11/6
Vo2 Peak
Some Concerns of
Risk of Bias
PEDro = 6/10
MA 2019
Circuit training
(Physical activity coaching including a programme)
V
No intervention
8 sessions, 1x week for 8 weeks. Each session was 140-180 minutes
People with SCI
14/14
Vo2 Peak
Some Concerns of
Risk of Bias
PEDro = 5/10
The Australian and NZ SCI Physiotherapy guideline committee recommends circuit training to improve cardiorespiratory fitness in people with SCI. This is an evidence recommendation supported by the results of four randomised controlled trials. The guideline states:
Circuit training may be provided to improve cardiorespiratory fitness in people with SCI.
This recommendation was formed by considering the results of four randomised controlled trials alongside other factors. The trial results indicate that circuit training is better than no circuit training to improve cardiorespiratory fitness. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility.
This is an evidence-based recommendation. Evidence-based recommendations are more robust than consensus-based opinion statements. They can be strong or weak. This is a weak evidence-based recommendation which means the guideline panel is confident that they can probably recommend circuit training to improve cardiorespiratory fitness in people with SCI based on evidence.
Hicks Al, Martin KA, Ditor DS, et al. Long-term exercise training in persons with spinal cord injury: effects on strength, arm ergometry performance and psychological well-being. Spinal cord 2003; 41: 34.
Bombardier CH, Dyer JR, Burns P, et al. A tele-health intervention to increase physical fitness in people with spinal cord injury and cardiometabolic disease or risk factors: a pilot randomized controlled trial. Spinal cord 2020.
Kim J, Lee BS, Lee H-J, et al. Clinical efficacy of upper limb robotic therapy in people with tetraplegia: a pilot randomized controlled trial. Spinal cord 2019; 57: 49-57.
Ma, J. K. West, C. R. Martin Ginis, K. A. The effects of a patient and provider co-developed, behavioral physical activity intervention on physical activity, psychosocial predictors, and fitness in individuals with spinal cord injury: a randomized controlled trial. Sports Medicine 2019 Jul;49(7):1117-1131.
