Case Studies in Physiology: Exercise-induced diaphragm fatigue in a paralympic champion rower with spinal cord injury

Introduction. The aim of this case report was to determine whether maximal upper-body exercise was sufficient to induce diaphragm fatigue in a Paralympic champion adaptive rower with low-lesion spinal cord injury (SCI). Case Presentation. An elite arms-only oarsman (age 28 y, stature 1.89 m, mass 90.4 kg) with motor-complete SCI (T₁₂) performed a 1000 m time-trial on an adapted rowing ergometer. Exercise measurements comprised pulmonary ventilation and gas exchange, diaphragm EMG-derived indices of neural respiratory drive and intrathoracic pressure-derived indices of respiratory mechanics. Diaphragm fatigue was assessed by measuring pre- to post-exercise changes in the twitch transdiaphragmatic pressure (P_di,tw) response to anterolateral magnetic stimulation of the phrenic nerves. The time-trial (248 ± 25 W, 3.9 min) elicited a peak O₂ uptake of 3.46 L·min^–1 and a peak pulmonary ventilation of 150 L·min^–1 (57% MVV). Breath-to-stroke ratio was 1:1 during the initial 400 m and 2:1 thereafter. The ratio of inspiratory transdiaphragmatic pressure to diaphragm EMG (neuromuscular efficiency) fell from rest to 600 m (16.0 vs. 3.0). Potentiated P_di,tw was substantially reduced (–33%) at 15-20 min post-exercise, with only partial recovery (–12%) at 30-35 min. Conclusions. This is the first report of exercise-induced diaphragm fatigue in SCI. The decrease in diaphragm neuromuscular efficiency during exercise suggests that the fatigue was partly due to factors independent of ventilation (e.g., posture and locomotion).

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