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Physical Activity and Bone Health

Osteoporosis is a condition characterized by low bone mass and deterioration of the skeletal system and is often cited as a secondary complication associated with SCI (Giangregorio and McCartney 2006; Jiang et al. 2006). This bone deterioration results in skeletal fragility and leads to an increased risk of fractures. Physical activity interventions have been suggested as potential strategies for both prevention and treatment of bone mineral density loss and the reader is referred to SCIRE Chapter: Bone Health Following Spinal Cord Injury (Ashe et al. 2010) for more information on this topic. In the following section, we present those specific evidence-based statements and bottom-line conclusions from this chapter related to physical activity.

Conclusions – From SCIRE Bone Health Following SCI

Non-Pharmacologic Therapy: Rehabilitation Modalities – Prevention (within 12 months of injury)

There is level 1 evidence (from one RCT) (Warden et al. 2001) that short-term (6 weeks) ultrasound is not effective for treating bone loss after SCI.There is level 2 evidence (from 1 non-randomized prospective controlled trial) (Shields et al. 2006) that ES reduced the decline in BMD in the leg.

There is level 2 evidence (from 1 non-randomized prospective controlled trial) (Eser et al. 2003) that FES-cycling did not improve or maintain bone at the tibial midshaft in the acute phase.

There is level 4 evidence (from 1 pre-post study) (Giangregorio et al. 2005) that walking and level 1 evidence (from 1 RCT) (Ben et al. 2005) that standing in the acute phase did not differ from immobilization for bone loss at the tibia.

  • Short term (6 weeks) therapeutic ultrasound is not effective for preventing
    bone loss after SCI.
    FES-cycling does not improve or maintain bone at the tibial midshaft in the acute phase but may increase/maintain lower extremity BMD the greater the time since injury.

Non-Pharmacologic Therapy: Rehabilitation Modalities – Treatment – Electrical Stimulation

There is level 2 evidence (from 1 prospective controlled trial) (Bélanger et al. 2000) that electrical stimulation either increased or maintained BMD over the stimulated areas.There is level 4 evidence (from 1 pre-post study) (Melchiorri et al. 2007) that vibration training did not improve or maintain BMC in the arms.

  • Electrical stimulation can maintain or increase BMD over the stimulated areas.

Non-Pharmacologic Therapy: Rehabilitation Modalities – Treatment – FES Cycle Ergometry

There is level 4 evidence (from 1 pre-post study) (Chen et al. 2005) that 6 months of FES cycle ergometry increased regional lower extremity BMD over areas stimulated.

  • Six months of FES cycle ergometry may increase lower extremity BMD over areas stimulated.

Non-Pharmacologic Therapy: Rehabilitation Modalities –  Treatment – Standing and Walking

There is inconclusive evidence for Reciprocating Gait Orthosis, long leg braces, passive standing or self-reported physical activity as a treatment for low bone mass

  • There is inconclusive evidence for Reciprocating Gait Orthosis, long leg braces, passive standing or self-reported physical activity as a treatment for low bone mass.