Let’s talk cardio! Most of you have heard the term cardiopulmonary, which refers to your body’s heart and lungs, who function like an engine that keeps your body powered. The lungs take much needed oxygen from the air and your heart circulates this blood through the body like a pump, causing your muscles, bones, and tissues to receive much needed supplies to continue out daily functions. When a person suffers a stroke, spinal cord injury (SCI), or other debilitating injury, this can cause the cardiopulmonary system to underperform. Often, lack of mobility makes it difficult for a person with these types of injuries to participate in exercise and even simple daily tasks. This creates a vicious cycle where a person’s immobility leads to worsening cardiopulmonary performance and overall health. The Indego exoskeleton is designed to help people with mobility impairments participate in standing and walking activities, by helping to support their body. This blog will help you understand how the Indego exoskeleton can offer individuals an opportunity to flex their most important muscle: the heart.
The cardiopulmonary system can be affected by a stroke, SCI, or other debilitating injuries in the following ways:
1. Heart rate (HR) and blood pressure (BP) are two common ways to measure how hard the heart is working.
a. After an injury leading to mobility impairments, the heart must work harder to do the same amount of work as before the injury. Low blood pressure, hypotension, is common in individuals who spend much of the day sitting or lying down and can cause a lightheaded feeling or passing out when blood pressure drops quickly after standing up.
b. Exoskeleton training reduced the number of hypotensive episodes during an 8-week period. Training with an exoskeleton has been shown to increase HR and BP to levels associated with safe physical activity.1
2. Oxygen consumption (VO2) and metabolic equivalent (MET) refer to the amount of oxygen a person utilizes during exercise and energy expenditure, respectively.
a. Individuals with SCI who have decreased mobility can be limited in their ability to participate in physical exercise that moderately challenges their VO2 and MET levels, which is needed to improve health and fitness.2
b. Researchers found that cardiorespiratory and metabolic demands of walking with an Indego exoskeleton are consistent with activities performed at a moderate intensity.2 The American College of Sports Medicine (ACSM) recommends adults participate in 150 mins of moderate-intensity exercise per week of cardiorespiratory exercise per week.3
3. Rate of perceived exertion (RPE) is a subjective report of how difficult a task feels and the six-minute walk test (6MWT) which measures how far a person can walk in six minutes.
a. A debilitating SCI or stroke can cause an increase RPE for a given task and decreased 6MWT.
b. After exoskeleton training, users reported decreased RPE walking the same distance and were able to walk farther in the same amount of time due to the cardiopulmonary system working more efficiently.1 Researchers have found that exoskeleton training resulted in improved cardiopulmonary function that was maintained six weeks later.4
There are several ways to use the Indego exoskeleton to address cardiopulmonary fitness. A training program may include sit-to-stand and stand-to-sit movements, maintenance of balance in standing, increasing time on feet in standing, participating in standing exercises, and walking with variable assistance, speed, and distance. Users can change the amount of assistance at their hip or knee while using the Indego to respond to the demands on their cardiopulmonary system. Therapists can assess an individual’s vitals to ensure they are within a safe range for exercise when using the Indego.
How can the Indego exoskeleton be used to train the cardiopulmonary system?
Exoskeleton training is safe in first six months cute phase post SCI1
Exoskeleton training can increase HR, BP, METS and VO2 to levels consistent with moderate exercise as prescribed by the ACSM for cardiovascular health2
Exoskeleton training can improve cardiopulmonary outcome measures1,2,4,5
Exoskeleton training can reduce hypotensive episodes in individuals with SCI1
Exoskeleton training can reduce the burden of exercise on the heart for cardiopulmonary patients with lower limb weakness5
Walking, exercise programs, activity participation, standing, and transfer training are great ways to use the Indego exoskeleton to address cardiopulmonary limitations. Many people who suffer debilitating injuries have difficulty recovering their cardiopulmonary fitness. The Indego can help bolster cardio in the rehabilitation setting as well as personal users who take their Indego into their homes and communities. We are here for you if you have any questions or are interested in learning more about how the Indego exoskeleton can benefit your heart!
If you are interested in learning more about the Indego exoskeleton, please visit our website or give us a call at 1-844-846-3346.
About the Author:
Dr. Michelle Martin, PT, DPT, is a Neuro-IFRAH certified physical therapist for the Janz Corporation, a Service Disabled Veteran Owned Small Business. Michelle graduated Summa Cum Laude with a Bachelor’s Degree in Psychology from The University of Tennessee at Chattanooga where she continued her education to become a Doctor of Physical Therapy. Michelle has worked with patients with neurological, orthopedic, cardiopulmonary, and geriatric related impairments. She enjoys helping patients progress and find creative ways to overcome their barriers to mobility. Michelle hiked 2,190 miles of the Appalachian Trail from Georgia to Maine and cherishes her role as an Indego Instructor in-training where she is able to help individuals with mobility impairments enjoy the freedom of walking.
- McIntosh et al. The Safety and Feasibility of Exoskeletal-Assisted Walking in Acute Rehabilitation After Spinal Cord Injury. Arch Phys Med Rehabil. 2020 Jan;101(1):113-120.
- Evans et al. Acute Cardiorespiratory and Metabolic Responses During Exoskeleton-Assisted Walking Overground Among Persons with Chronic Spinal Cord Injury. Top Spinal Cord Inj Rehabil. 2015 Spring; 21(2): 122–132.
- Pescatello, L. S. ACSM's guidelines for exercise testing and prescription. 9th ed. 2014;5.
- Jang et al. Cardiopulmonary function after robotic exoskeleton-assisted over-ground walking training of a patient with an incomplete spinal cord injury: Case report. Medicine (Baltimore). 2019 Dec;98(50):e18286.
- Pak et al. Effects of a cyborg-type robot suit HAL on cardiopulmonary burden during exercise in normal subjects. Eur J Appl Physiol. 2019 Feb;119(2):487-493.