Time to reconsider the importance of autonomic function in paralympic athletes with spinal cord injury-reply

In Reply We welcome the letter by Alrashidi and colleagues demonstrating their interest in our recent article describing the physiological and clinical characteristics of the Paralympic athlete’s heart, and we appreciate the comments they raised. The correspondence underlines how Paralympic medicine is gaining momentum at present time and the importance to better define the cardiovascular and autonomic characteristics of these athletes, who have a high prevalence of cardiovascular risk factors. Our aim was to describe the cardiovascular characteristics of a sizeable cohort of Paralympic athletes and to provide reference values for the principal parameters easily obtained with non invasive cardiovascular evaluation, including electrocardiography, transthoracic echocardiography, and cardiopulmonary exercise test. We provided values for the overall study population, for male and female athletes, with respect to the type of disability (if spinal-cord injury [SCI] or non-SCI) and the type of sport practiced (schematically grouped in endurance or nonendurance). We acknowledged as a relevant limitation of our investigation that the classification we introduced (SCI vs non-SCI) is arbitrary and grossly imperfect and does not appropriately consider the variety of lesions and functional impairments existing in Paralympic athletes.