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Key Points

Physical Activity: Effects on Muscle Morphology, Strength and Endurance in Persons with SCI

  • Circuit resistance training, body-weight support treadmill training and functional electrical stimulation (upper and lower limbs) may be effective in increasing muscle strength and reducing atrophy, with the latter two more appropriate for those with great muscle impairment.

Physical Activity and Functional Improvement Including Activities of Daily Living

  • Generally physical activity programming may be useful in improving functional outcomes such as performance of ADLs, but specific exercise and program parameters are not readily available.

Physical Activity and Subjective Well-Being

  • Exercise is an effective strategy for improving at least two aspects of subjective well-being – depression and quality of life.

Physical Activity and Secondary Conditions

  • There is limited evidence that BWSTT can improve indicators of cardiovascular health in individuals with complete and incomplete SCI.
  • Persons with tetraplegia and paraplegia can improve their cardiovascular fitness and physical work capacity through moderate intensities of aerobic exercise or resistance training, although optimal program parameters are not known.
  • Interventions that involve FES training a minimum of 3 days per week for 2 months can improve muscular endurance, oxidative metabolism, exercise tolerance, and cardiovascular fitness.
  • Aerobic and FES exercise training may lead to clinically significant improvements in glucose homeostasis in persons with SCI. Preliminary evidence indicates that a minimum of 30 min of moderate intensity training 3 days per week is required to achieve and/or maintain the benefits from exercise training.
  • Aerobic and FES exercise training may lead to improvements in lipid lipoprotein profiles that are clinically relevant for the at-risk SCI population. The optimal training program for changes in lipid lipoprotein profiles remains to be determined. However, a minimal aerobic exercise intensity of 70% of heart rate reserve on most days of the week appears to be a good general recommendation for improving lipid lipoprotein profiles in persons with SCI.

Physical Activity and Respiratory Complications

  • For exercise training to improve respiratory function the training intensity must be relatively high (70-80% of maximum heart rate) performed three times per week for six weeks. Ideal training regimes have not been identified.
  • There is limited evidence that inspiratory muscle training improves respiratory muscle strength or endurance in people with SCI.

Physical Activity and Bone Health

  • 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.
  • Electrical stimulation can maintain or increase BMD over the stimulated areas.
  • Six months of FES cycle ergometry may increase lower extremity BMD over areas stimulated.
  • 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.

Physical Activity and Pain

  • Regular exercise reduces post-SCI pain.
  • Shoulder exercise protocol reduces post-SCI shoulder pain intensity.

Physical Activity and Spasticity

  • Hippotherapy may result in short-term reductions in spasticity.
  • A combination of neural facilitation techniques and Baclofen may reduce spasticity.
  • Rhythmic passive movements may produce short-term reductions in spasticity.
  • Prolonged standing or other methods of producing muscle stretch may result in reduced spasticity.
  • Active exercise interventions such as hydrotherapy and FES -assisted walking may produce short-term reductions in spasticity.

Physical Activity and Periodic Leg Movements

  • Aerobic exercise is effective in reducing night-time periodic limb movements in persons with complete paraplegia.

Physical Activity Participation Levels in SCI

  • There is tremendous variability in the amount of physical activity performed by people living with SCI. A large segment of the population does not engage in any leisure-time physical activity whatsoever.

Barriers to Physical Activity Participation in the SCI Population

  • Individuals with SCI encounter numerous impediments to physical activity participation including intrapersonal, systemic, and expertise barriers. Interventions are needed to help people with SCI manage these barriers.

Effectiveness of Interventions to Increase Physical Activity Participation in SCI

  • Behavioural interventions promoting physical activity in the SCI population can lead to increased levels of physical activity participation.