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Exercise

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Strategies to encourage health, reduce secondary complications and consequently support positive emotional adjustment following SCI have emerged as a source of increasing research interest. As examples, the following studies review the impact of regular exercise upon various measures of physical health and emotional well-being.

Table 3: Exercise for Depression following SCI

Discussion

In a series of Canadian studies, Ginis et al. (2003), Hicks et al. (2003) and Latimer et al. (2004) reported RCT investigations of sedentary community dwelling SCI adult volunteers who participated in 3, and later 9 month trials of twice weekly, 60-90 minute sessions of stretching, aerobic arm ergometry and resistance exercises or a “wait” control condition who were asked to continue usual activities and refrain from beginning an exercise program. Among other findings, Exercisers reported less stress, fewer depressive symptoms and greater satisfaction with physical functioning than did controls. While the average frequency of depressive symptoms in the intervention group did not vary substantively over the 9 months (and remained below clinically significant levels), depressive symptoms in the control group increased and the average exceeded levels considered “at risk” for clinical depression. The authors suggested the benefits of exercise as offering a prophylactic or stabilizing effect on pain – perhaps reducing the propensity for flare-ups, and the potential benefits of targeting sources of recurrent pain (i.e. shoulder pain). Consistent with the Chronic Pain Process Model, a series of regression analyses the nine-month data revealed that changes in perceived pain mediated changes in stress, and the change in stress mediated a change in reported depression. It was recommended that clinicians prescribe exercise as a therapeutic modality for improving and maintaining well-being among people with SCI.

A Canadian pre-post study (Hicks et al. 2005) examined the effect of body weight supported treadmill training provided three times a week. This study reported an increase in life satisfaction and physical function satisfaction after one year of exercise; however, there was no change in reports of depressive symptoms.

Two studies (Bradley et al. 1994; Guest et al. 1997), examined the effects of an electrically stimulated walking program on SCI individuals. In a cohort study, Bradley et al. (1994) reported a significant increase in depression in participants with “unrealistic” expectations of their program. In contrast, Guest et al. (1997) used a pre-post design and found a decrease in reported depression after completion of their study intervention. Warms et al. (2004) reported no change in participant depression levels after six weeks of increased physical activity through a “Be Active in Life” intervention program. A pre-post study (Kennedy et al. 2006), found an intensive 1-week residential program (“Back Up”) involving participation in recreational activities resulted in fewer symptoms of anxiety and depression.

Conclusion

  • Regular physical exercise may contribute to a reduction of pain, stress, and depression as well as potentially offering a prophylactic effect on sources of recurrent pain and in preventing a decline in quality of life following SCI.There is level 1a evidence (from three randomized controlled trials; Hicks et al. 2003; Ginis et al. 2003; Latimer et al. 2005) that exercise based programs reduced subjective pain, stress and resulting depressive symptoms.

    There is level 1b evidence (from one randomized controlled trial and one pre-post study; Ginis et al. 2003; Guest et al. 1997) that exercise reduces depressive symptoms.

    There is level 2 evidence (from one cohort study; Bradley et al. 1994) that individuals with unrealistic expectations report more depressive symptoms following a functional electrical stimulation exercise program. 

  • Programs to encourage regular exercise, reduce stress, and improve or maintain health appear to have benefits in reducing reports of depressive symptoms in persons with SCI.