Exercise as a rehabilitative therapy in SCI involves the use of repetitive and effortful muscle contractions to increase motor unit activity (Sandrow-Feinberg et al., 2009; Ada et al., 2006). Exercise may be classified as strength training or functional strength training. Strength training involves isolation and stabilization of muscles through training protocols involving free weights or machines (Tomlijenovic et al., 2011), while functional strength training utilizes training programs centred around activities of daily living (Tomlijenovic et al., 2011). These exercises often involve multiple muscle groups and require functional movements that are more applicable to daily life, thereby improving strength for performing everyday tasks (Tomlijenovic et al., 2011).
Engaging in repetitive physical therapy that is active or passive has many beneficial effects for individuals with SCI including: preserved muscle mass (Houle et al., 1999), restored motor and sensory function (Hutchinson et al., 2004. Sandrow-Feinberg et al., 2009), induced synaptic plasticity by way of neurotrophic factor production (Vaynman et al., 2003), increased concentration of neurotrophic factors in spinal and muscle tissue (Gomez-Pinilla et al., 2002; Ying et al., 2005; Cote et al., 2011) and reduced inflammation around the lesion site (Sandrow-Feinberg et al., 2009). However, SCI often limits an individual’s ability to partake in exercise (Crane et al., 2015). This is a contributing factor to the incidence of obesity, cardiovascular disease and diabetes is two to four times higher in individuals with SCI compared to the general population (Evans et al., 2015).
Few evidence based analyses on the efficacy of specific exercise therapies on upper extremity function exist (Ginis et al., 2008). The majority of research has focused on individual components of physical capacity (e.g. peak oxygen uptake, muscle strength, or respiratory function), rather than functional outcomes. Additional studies regarding cardiovascular and exercise interventions are discussed in the Cardiovascular chapter and Physical Activity chapter.
The methodological details and results from seven studies evaluating exercise and strengthening for upper extremity function are presented in Table 1.