Arm Cycling to Improve Fitness in Polio Survivors

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01271530
Recruitment Status : Completed
First Posted : January 6, 2011
Last Update Posted : September 19, 2013
Post Polio Support Group Ireland
Beaumont Hospital
Information provided by (Responsible Party):
Deirdre Murray, Royal College of Surgeons, Ireland

Brief Summary:
The aim of this study is to investigate the effect of upper limb cardiovascular training on fitness, energy cost of walking, fatigue and pain in polio survivors. Polio survivors often have difficulty accessing aerobic forms of exercise due to limitations in mobility, pain associated with walking and fatigue. This can result in becoming physically unfit and places polio survivors at risk of secondary heath problems due to inactivity. A large percentage of polio survivors have lower limb involvement but have strong arms. The participants in this study will exercise at home using simple arm cycles for 8 weeks. They will attend for assessment on two occasions. All exercise will be prescribed by a Physiotherapist and includes measures to ensure safety while exercising at home.

Condition or disease Intervention/treatment Phase
Postpoliomyelitis Syndrome Other: Upper Limb Ergometry Not Applicable

Detailed Description:

The American College of Sports Medicine (ACSM) recommendations state that stable muscle groups should be utilised for exercise in polio survivors and that patients with severe atrophic polio or with recent weakness should not exercise, while March of Dimes (2001) recommend not exercising muscle groups where new weakness is being experienced. Floor or treadmill walking or lower limb cycling may also aggravate pain in those with lower limb weakness and altered lower limb biomechanics.

Training with an upper limb ergometer is likely to be an appropriate form of exercise in patients with good, stable upper limb strength. One small, but well designed, trial of upper limb ergometry over 16 weeks resulted in a 19% increase in maximal oxygen uptake (VO2max) in 10 postpolio subjects exercising 3 times per week (Kriz et al 1992). ACSM recommend using a Schwinn Air-DyneTM four limb exerciser; however this is an expensive and bulky piece of equipment and is unlikely to be feasible for ongoing use by community dwelling polio survivors.

A small upper limb ergometer may be a cost effective, accessible option for exercise for community dwelling polio survivors. A closely monitored and carefully prescribed cardiovascular fitness programme may enable polio survivors, who have gained control of symptoms of fatigue and pain through changes in lifestyle and activity, to increase fitness and perhaps subsequently reduce energy cost of walking.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 55 participants
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Single (Outcomes Assessor)
Primary Purpose: Treatment
Official Title: The Impact of an Arm Ergometry Training Programme on Cardiovascular Fitness, Energy Cost of Walking and Fatigue in Prior Polio Patients
Study Start Date : July 2010
Actual Primary Completion Date : September 2013
Actual Study Completion Date : September 2013

Arm Intervention/treatment
Experimental: Exercise Other: Upper Limb Ergometry
Cardiovascular training will be performed using upper limb ergometers at home for 8 weeks. Each subject will receive an individually prescribed programme and will begin exercising for at least ten minutes per day three days per week. If an individual has difficulty exercising for 10 minutes continuously, the 10 minute session may be broken into 2-3 minute bursts of exercise, with one minute rests. Subjects will aim to increase exercise durations to 20 minutes per day five days per week and will exercise at moderate to high intensities.

No Intervention: Control

Primary Outcome Measures :
  1. Six Minute Arm Test [ Time Frame: Eight weeks ]
    The Six Minute Arm test is a submaximal cardiovascular fitness test. The American College of Sports Medicine recommend submaximal fitness testing, limited to 6-12 minutes and using either four limb ergometry or an upper limb ergometer in prior polio patients. The 6 Minute Arm Test (Hol et al 2007) is such a submaximal upper limb exercise test, which has been developed and found valid and reliable in spinal cord injury.

  2. The Physical Activity Scale for Persons with Physical Disabilities [ Time Frame: Eight weeks ]
    The Physical Activity Scale for Persons with Physical Disabilities is a subjectively reported survey of activity levels in people with physical disabilities. Preliminary validation has been completed by Washburn et al (2002).

Secondary Outcome Measures :
  1. Upper Limb Maximal Voluntary Isometric Contraction [ Time Frame: Eight weeks ]
    Upper limb strength will be measured to determine suitability for exercise and to measure any training related changes. Maximal voluntary isometric contraction of the upper limbs will be measured using fixed dynamometry with the Quantitative Muscle Analysis system. Shoulder abduction, adduction, elbow flexion and extension and hand grip will be measured.

  2. Body Mass Index and Waist to hip Ratio [ Time Frame: Eight weeks ]
    Body composition will be assessed using Body Mass Index and Waist to hip ratio will be used to measure risk due to overweight / obesity.

  3. Hand Grip Motor Fatigue [ Time Frame: Eight weeks ]
    Hand grip motor fatigue will be measured using Quantitative Muscle Analysis. This will be measured pre and post training to provide an indication of changes in motor fatigue occurring with training.

  4. Short Form 36 Version 2 (SF-36 v2) [ Time Frame: Eight weeks ]
    The SF-36v2 is a tool developed by Ware (, which measures health status. It has been used previously in polio survivors (Vasiliadis et al 2002, Gonzales et al 2006)

  5. Short Form McGill Pain Questionnaire version 2 (SF-MPQ-2) [ Time Frame: Eight weeks ]
    Pain will be assessed using the SF-MPQ-2. The SF-MPQ-2 questionnaire is a well-developed tool for quantitative assessment of pain (Dworkin et al 2009).

  6. Physiological Cost Index [ Time Frame: Eight weeks ]
    The Physiological Cost Index is a measure, which aims to estimate energy cost of walking, using walking speed and change in heart rate from baseline.

  7. The Fatigue Severity Scale [ Time Frame: Eight weeks ]
    The Fatigue Severity Scale is a commonly used questionnaire used to assess subjective fatigue

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Ages Eligible for Study:   18 Years to 75 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • A confirmed history of Poliomyelitis affecting at least one lower limb, confirmed by the consultant Neurologist, Beaumont Hospital, Dublin, and documented in the medical chart.
  • Capable of walking for 6 minutes, with or without an aid or appliance (as reported by the patient).
  • Good upper limb strength, confirmed objectively by Quantitative Muscle Analysis (QMA) (Maximum Voluntary Isometric Contraction (MVIC)). MVIC scores of 7 out of 10 tested upper limb movements must lie above the 5th percentile of the normal range.
  • Completion of the Physical Activity Readiness Questionnaire (PAR-Q) and cleared by medical practitioner as safe for exercise if indicated.
  • Aged > 18 and < 75 NOTE: Participants must be resident in Ireland.

Exclusion Criteria:

  • History of unstable cardiac or respiratory conditions
  • Uncontrolled hypertension
  • Oxygen dependence
  • Significant upper limb pain (Visual Analogue Scale > 4 or more than 3 specific sites of pain)
  • Severe fatigue (Fatigue Severity Scale > 5)
  • Recent onset of upper limb weakness or severe upper limb weakness (< 5th percentile on more than 3 tested upper limb movements, either reported by the patient or measured using Quantitative Muscle assessment.
  • Steroid use in last 3 months
  • Use of medications which may influence cardiovascular testing (Beta-blockers etc)
  • Pregnant Women

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01271530

Beaumont Hospital
Dublin, Ireland, D 9
Sponsors and Collaborators
Royal College of Surgeons, Ireland
Post Polio Support Group Ireland
Beaumont Hospital
Principal Investigator: Deirdre E Murray, BSc Royal College of Surgeons in Ireland
Study Director: Dara Meldrum, MSc Royal College of Surgeons in Ireland
Study Director: Frances Horgan, PhD Royal College of Surgeons in Ireland
Study Chair: Orla Hardiman, MD Beaumont Hospital
Study Director: Roisin Moloney, BSc Beaumont Hospital

Publications automatically indexed to this study by Identifier (NCT Number):
Responsible Party: Deirdre Murray, Clinical Specialist Physiotehrapist in Neurosciences and PhD student, Royal College of Surgeons, Ireland Identifier: NCT01271530     History of Changes
Other Study ID Numbers: RoyalCSI DMurray
First Posted: January 6, 2011    Key Record Dates
Last Update Posted: September 19, 2013
Last Verified: September 2013

Keywords provided by Deirdre Murray, Royal College of Surgeons, Ireland:
Late Effects of Polio
Cardiovascular Fitness
Energy cost of Walking

Additional relevant MeSH terms:
Postpoliomyelitis Syndrome
Enterovirus Infections
Picornaviridae Infections
RNA Virus Infections
Virus Diseases
Muscular Disorders, Atrophic
Muscular Diseases
Musculoskeletal Diseases
Central Nervous System Infections
Central Nervous System Diseases
Nervous System Diseases
Spinal Cord Diseases
Neurodegenerative Diseases
Neuromuscular Diseases