You are here:Home1/Arm cranking (v no intervention) on cardiorespiratory fitness in people...
Weak For Recommendation
Arm cranking may be provided to improve cardiorespiratory fitness in people with SCI.
Arm cranking (v no intervention) on cardiorespiratory fitness in people with SCI
P
People with SCI
Evidence recommendation
Weak for (81%)
Weak evidence recommendation FOR
Arm cranking may be provided to improve cardiorespiratory fitness in people with SCI.
Clinical note: Arm cranking for cardiorespiratory fitness may not be appropriate for people with shoulder pain or overuse.
I
Arm cranking
C
No intervention
Consensus-based opinion statement
No opinion statements
O
Cardiorespiratory Fitness
SUMMARY
3 RCTs
(see references)
Mean difference (95% CI): Cardiorespiratory fitness expressed as Vo2 Peak
4.7 (1.4 to 8.0)
Favours arm cranking
GRADE
Very low certainty
⨁◯◯◯
Risk of bias
Very serious
Inconsistency
No serious
Imprecision
No serious
Indirectness
Serious
Publication bias
Serious
ARM CRANKING 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
ARM CRANKING ON CARDIORESPIRATORY FITNESS: Randomised Controlled Trial Details
STUDY
COMPARISON
DOSAGE/DETAILS
PARTICIPANTS
N (Rx/C)
OUTCOME
ROB 2
PEDRo
AKKURT 2017
Arm cranking (plus usual care)
V
Usual care
3 days per week, 1.5 hours/week 50-70% pVO2 (A borg scale score of lightly hard-moderately hard
C7-L5 SCI
17/16
Vo2 peak
High Risk of Bias
PEDro = 6/10
NIGHTINGALE 2018
Arm cranking (portable desktop ergometer)
V
No intervention
4 x per week for 6 weeks (moderate intensity)
Below T2 SCI
13/8
Vo2 peak
Some Concerns of
Risk of Bias
PEDro = 5/10
TAYLOR 1986
Arm cranking
V
No intervention
30 minutes, 5 x per week for 8 consecutive weeks (50rev/min)
paraplegia
5/5
Vo2 peak
High Risk of Bias
PEDro = 5/10
The Australian and NZ SCI Physiotherapy guideline committee recommends arm cranking to improve cardiorespiratory fitness in people with spinal cord injury. This is an evidence recommendation supported by the results of 3 randomised controlled trials. The guideline states:
Arm cranking may be provided to improve cardiorespiratory fitness in people with SCI.
This recommendation was formed by considering the results of three randomised controlled trials alongside other factors. The combined trial results indicate that arm cranking is better than no arm cranking in people with SCI. 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 arm cranking for cardiorespiratory fitness in people with SCI based on the evidence.
Nightingale TE, Rouse PC, Walhin JP, et al. Home-based exercise enhances health-related quality of life in persons with spinal cord injury: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation 2018 Oct;99(10):1998-2006.
Akkurt H, Karapolat HU, Kirazli Y, Kose T. The effects of upper extremity aerobic exercise in patients with spinal cord injury: a randomized controlled study. Eur J Phys Rehabil Med. 2017 Apr;53(2):219-227.
Taylor AW, E M and L B (1986) The effects of an arm ergometer training programme on wheelchair subjects. Paraplegia. 24:105-114.
