Wolfe DL, McIntyre A, Ravenek K, Martin Ginis KA, Latimer AE, Eng JJ, Hicks AL, Hsieh JTC (2012). Physical Activity and SCI. In Eng JJ, Teasell RW, Miller WC, Wolfe DL, Townson AF, Hsieh JTC, Connolly SJ, Mehta S, Sakakibara BM, editors. Spinal Cord Injury Rehabilitation Evidence. Version 4.0.

Many authors have noted the importance of participation in physical activity and exercise programming for persons with spinal cord injury (SCI) and several of these have provided reviews of the various purported benefits that may occur with regular and appropriate physical activity (Cowell et al. 1986; Washburn & Fignoni 1999; Jacobs & Nash 2001; Nash 2005; Devillard et al. 2007; Fernhall et al. 2008). Despite this assertion and the relative plethora of studies cited within these reviews, especially in some areas (e.g., cardiovascular fitness), there is much that remains to be established about the relationship of exercise and physical activity to the health and well-being of persons with SCI. It has been noted that the majority of physical activity studies are often lower quality with few randomized controlled trials (RCTs) (Valent et al. 2007; Fernhall et al. 2008), which is not surprising as exercise studies are challenging to conduct in and of themselves and this is compounded by multiple further challenges that are presented within the SCI population (Ginis & Hicks 2005). Little is known about the details of what exercise modality might be best suited for individuals with SCI relative to their varying physical levels of function. Specific information about frequency, intensity and duration is typically lacking. In general, there is a dearth of evidence-based information on which to provide guidance for the promotion and prescription of exercise, especially for the various subsets of individuals that comprise this population (Ginis & Hicks 2007; Myslinski 2005).

The present chapter aims to describe the level of evidence that exists for physical activity and its effect on various aspects of health and wellness for persons with SCI. In particular, we review the evidence that exists for the effectiveness of physical activity on enhancing strength, muscle function, rehabilitation recovery (i.e., functional outcomes) and subjective well-being (including depression and quality of life) as well as the relationship of physical activity to the prevention and minimization of various secondary complications and other health conditions associated with SCI. Following this, we examine the studies that assess the rates of physical activity participation and identify barriers to participation noted in the literature. Finally, we describe the level of evidence associated with interventions targeted at persons with SCI designed to enhance participation in physical activity.