Physical Activity

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.

Discussion

Several studies (Akkurt et al. 2017; Crane et al. 2017; Hicks et al. 2003; Latimer et al. 2004; Martin Ginis et al. 2003) evaluated the effect of exercise programs which included stretching, aerobic arm ergometry and resistance exercises among those with SCI. The studies found significant reduction in depressive symptoms post SCI post-treatment (Crane et al. 2017; Hicks et al. 2003; Latimer et al. 2004; Martin Ginis et al. 2003).

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 1 year of exercise; however, there was no change in reports of depressive symptoms.

Two studies (Curtis et al. 2017; Curtis et al. 2015) evaluated the effectiveness of yoga among persons with SCI. Curtis et al. (2017) found participants receiving  twice weekly yoga had a significant decrease in depressive symptoms compared to the waitlist control group. While, a pre-post study found no effect of yoga among those with SCI (Curtis et al. 2015).

Two studies, (Bradley 1994; Guest et al. 1997) examined the effects of an electrically stimulated walking program on individuals with SCI. In a cohort study, Bradley (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

There is level 1a evidence (from three randomized controlled trials: Hicks et al. 2003; Latimer et al. 2004; Martin Ginis et al. 2003) that small group exercise based programs reduced depressive symptoms post SCI.

There is level 4 evidence that body weight supported treadmill training (Hicks et al. 2005), or functional electrical stimulation exercise (Bradley 1994) may not improve symptoms of depression post SCI.

There is level 1b evidence (Curtis et al. 2017) that yoga improves depressive symptoms post SCI.

There is level 4 evidence (Guest et al. 1997) that Parastep FNS ambulation training may result in decrease in depressive symptoms post SCI.

There is level 4 evidence (Kennedy et al. 2006) that integrating sports and recreational activities may result in reduction of depressive symptoms post SCI.