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Systematic Review

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As the body of knowledge is growing in the field of cardiovascular management for spinal cord injury (SCI) it is becoming increasingly important to review the literature and ensure that the information used both in research and in practice is current and evidence based. The aim of this section of the cardiovascular chapter is to provide an overview of the current systematic reviews available in areas related to cardiovascular fitness and health management in SCI population, such as the effect of exercise on cardiovascular risk factors.

Table 3 : Systematic Review

Discussion

Six systematic reviews examined the effectiveness of cardiovascular and health management in SCI patients. Carlson et al. (2009) focused on the effectiveness of exercise to improve carbohydrate and lipid metabolism disorders in adults with chronic SCI and found that evidence is insufficient to determine whether effects of exercise improves carbohydrate and lipid metabolism disorders in this population. Myers et al. (2012) reviewed the prevalence of CVD and associated cardiometabolic risk markers in SCI focusing on the available evidence supporting the benefits of routine physical activity. They found evidence that lipid profiles in persons with SCI respond favourably to both diet and exercise intervention. They also revealed that the use of arm ergometry or circuit resistance training can increase HDL in the range of 10-20% and reduce the ratio of total cholesterol to HDL. Thre was also evidence that physical activity and fitness levels were associated with insulin sensitivity in SCI (i.e. higher levels of activity/exercise were associated with lower risk for insulin resistance). Hicks et al. (2011) focused on fitness benefits of physical activity or exercise training intervention in persons with chronic SCI and found strong evidence that exercise could increase physical capacity and muscular strength. Evidence was insufficient however, to draw conclusions in terms of body composition and function. The authors also found that evidence was insufficient to draw any conclusion for the acute SCI population. Phillips et al. (2011) focused on the effect of various modes of exercise on arterial dynamics in patients with SCI and found strong evidence to support passive leg exercise program as a technique to improve vascular function among individuals with paraplegia.  The other modes of exercise (acute arm exercise, combined arm and passive leg exercise, stretch induced contraction and arm exercise) presented either insufficient evidence or mixed evidence which makes it difficult to draw any conclusion. Warburton et al. (2007) focused on literature regarding the risk for CVD and the effectiveness of varied exercise rehabilitation programs in attenuating the risk for CVD in SCI. They found evidence that both aerobic and FES training are effective in improving glucose homeostasis in persons with SCI. They found strong evidence that exercise is effective at reducing lipid lipoprotein profiles involved in the formation of atherosclerosis and the reduction of the risk for CVD in persons with SCI.They also found that FES training may be effective for improving musculoskeletal fitness, the oxidative potential of muscle, exercise tolerance, and cardiovascular fitness in this population. Cragg et al. (2012) focused on the management of modifiable CVD risk factors for the chronic SCI population. They found evidence that niacin was efficacious in improving lipid profiles in individuals with chronic tetraplegia and that the use of FES or treadmill walking favourably influences glycemic control.