Physical Activity: Cardiovascular Health and Fitness
Gaps in the Evidence
There is very little evidence on the effect of physical activity/exercise on the severity of orthostatic intolerance. As such, future interventional studies should seek to determine whether various forms of exercise improves orthostatic tolerance following SCI.
There is still inconsistent data regarding the effect of various forms of exercise on markers of cardiometabolic health, particularly the effect on exercise on blood lipids.
Though not specifically discussed here, we are not aware of any studies that have specifically looked at whether there are sex- or age-differences in the response to exercise interventions in people with SCI.
There is a need to identify target exercise intensity in robotic and/or body-weight supported treadmill training that leads to consistent improvements in cardiorespiratory fitness.
There is a need to determine a clinically-relevant minimum magnitude of improvement in cardiorespiratory fitness that results in improved functional capacity.
Few studies have directly compared the effects of different modalities, exercise intensities or volumes of physical activity in individuals with SCI. Larger RCTs with different intervention arms are required to elucidate the optimal dose or type of exercise to improve cardiovascular health in this at-risk population.
It remains to be seen whether injury characteristics (e.g., neurological level of injury, severity or time since injury) influence the degree of improvement in certain health outcomes.