Various forms of exercise interventions have been used in an attempt to improve the health status of persons with SCI (Hopman et al. 1996, Duran et al. 2001, Ter Woerds et al. 2006, Ballaz et al. 2008, Harness et al. 2008). The forms of potential interventions are numerous and varied. As such, it is difficult to systematically review the literature regarding alternative forms of exercise interventions for SCI. Therefore, we have provided a brief summary of studies that have incorporated non-traditional forms of rehabilitation in SCI (Table 9). New technology has potential for physical activity, for example, Gaffurini et al. (2013) used Wii sport video games, and it showed that it had immediate effects on energy expenditure (EE), but training effects were not evaluated.
The evidence supporting non-traditional forms of exercise interventions in SCI is not clear. This is to be expected given the varied training methodologies that can be employed. The lack of concrete information should not however dissuade researchers from considering non-traditional rehabilitation models when for the SCI population. It is clear that novel models of exercise rehabilitation are warranted and desired in the rehabilitation of SCI. For instance, stand locomotor training has been shown to be highly effective in improving blood pressure control and orthostatic tolerance in persons with tetraplegia.
Some modalities of exercise that have been applied with success in able-bodied individuals (such as interactive video games (Warburton et al. 2007a)) or other clinical populations (e.g. interval training (Warburton et al. 2005)) may hold great promise for persons with SCI. As with early research with FES, it is essential that researchers demonstrate innovative thinking that is based upon a strong theoretical foundation. In addition, it is essential to find exercise routines and modalities that an individual can continue with in the long term. Interactive video games or circuit training might offer affordable and accessible approaches that maintain the interest of the person.
There is level 4 evidence (Fisher et al. 2013) that whole body vibration training increases VO2.
There is level 5 evidence (Guilherme et al. 2014, Schreiber et al. 2014) that tetraplegic and paraplegic athletes, with regular physical activity, have improved left ventricular diastolic function. There is level 5 evidence (Currie et al., 2014) that tetraplegic athletes compared to non-athletic group have higher peak HR and lower reductions in systolic and diastolic blood pressure.
There is level 2 evidence (Totosy de Zepetnek et al, 2015) that moderate to vigorous aerobic exercise training maintained body composition and carotid stiffness in individuals with SCI. The training program had no impact on other CVD risk factors.