Exercise Rehabilitation and Cardiovascular Fitness

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Exercise rehabilitation has been shown to be an effective means of attenuating or reversing chronic disease in persons with SCI. Similar to the general able-bodied population (Warburton et al. 2006), habitual physical activity (beyond activities of daily living) can lead to numerous health benefits that significantly reduce the risk for multiple chronic conditions (in particular CVD) and premature mortality in persons with SCI. However, supporting evidence is relatively low in comparison to the general population and other clinical conditions (e.g. chronic heart failure (Warburton et al. 2006, Warburton et al. 2010)).    

The cardiovascular research conducted within the field of SCI has examined predominantly the effects of aerobic exercise and/or functional electrical stimulation (FES) training. In the following sections we will review the literature regarding the effects of varied exercise interventions on the risk for CVD in persons with SCI. Particular attention will be given to the changes in cardiovascular fitness, glucose metabolism, and lipid lipoprotein profiles that occur after training interventions in persons with SCI. The recent systematic review of Phillips et al. (2011) is recommended for a detailed assessment of the effects of different exercise training modalities on vascular health and function. This comprehensive review of the literature reveals that a variety of exercise interventions (including passive exercise, upper body wheeling, FES, and electrically stimulated resistance exercise) can lead to physiologically and clinically relevant improvements in arterial function in persons living with SCI (Phillips et al. 2011). Owing to the relationship between vascular function and CVD, these changes can be associated with a decreased risk for CVD.

It is important to highlight, that our original search included many studies that examined the short term effects of an exercise intervention. However, for inclusion in this chapter the article must have included the examination of the changes in cardiovascular fitness/health that occurred as a result of the training intervention (and not simply the temporal changes in cardiovascular parameters with the exercise modality).