Table 1 Exercise and Strength Training

Author Year

Country

Research Design

Score

Total Sample Size

Methods Outcome

Trumbower et al., 2017

USA

RCT – Crossover

PEDro=9

N=6

Population: Mean age=43±5 yr; Gender: males=6; Time since injury: 19±1 yr; Level of injury: C5; Severity of injury: AISA C=3, D=3.

Intervention: Participants were randomized to normal or hypoxic conditions. Participants received daily (five consecutive d) acute intermittent hypoxia (AIH), which consisted of 15 episodes per day: 1.5 min of fraction inspired oxygen [FIO2] = 0.09, 1-min normoxic intervals) followed by 20 repetitions of hand opening practice and normoxia (sham FIo2=0.21). Treatments were followed by a two wk minimum wash out period. Outcome measures were assessed at baseline and one wk for each treatment group.

Outcome Measures: Hand dexterity and function – Box and Block hand function test; Jebsen-Taylor hand function test (JTHF); Maximum hand opening.

1.     Daily AIH and hand opening practice improved hand dexterity, function and maximum hand opening in all participants but was not statistically significant (p>0.05).

2.     AIH and hand opening practice significantly improved Box and Block Test scores versus controls in all 6 participants (p=0.016).

3.     No statistically significant difference was observed in JTHF between groups (p>0.05), however, all participants reduced their JTHF score after daily AIH and hand opening practice versus controls.

4.     Maximum hand opening versus baseline significantly improved with AIH and hand opening practice when compared to controls (p=0.030).

Nightingale et al., 2018

U.K.

RCT

PEDro=7

N=21

 

Population: Mean age=47±8 yr; Gender: males=15, females=6; Time since injury: 16±11 yr; Level of injury: T4 and below; Severity of injury: not reported.

Intervention: Participants were randomly assigned to a home-based moderate-intensity upper-body exercise intervention (n=13) or a lifestyle maintenance control group (n=8) for 6 weeks. Outcome measures were assessed at baseline and follow-up.

Outcome Measures: Physical and mental component scores (PCS and MCS); Health related quality of life (HRQOL); Fatigue; Global fatigue (FSS); WUPSI.

1.     The exercise intervention group significantly improved PCS and MCS (p=0.017) and FSS (p=0.036) outcomes in relation to controls.

2.     No statistically significant difference was observed in fatigue and WUPSI between groups(p>0.05).

 

Hicks et al., 2003

Canada

RCT

PEDro=5

NInitial=34; NFinal=11

Population: Age: 19-65 yr; Level of injury: C4-L1; Severity of injury: AIS A-D; Time since injury: 1-24 yr.

Intervention: Experimental group (EX) participated in progressive exercise training twice weekly for nine mo-each session offered on alternative days lasing 90-120 min.

Outcome Measures: Perceived stress scale, Muscle strength, Depression, Physical self-concept pain, Perceived health, Quality of Life (QoL).

1.     Overall 11 in the EX group (exercise adherence 82.5%) and 13 in the control group completed the study.

2.     No differences were noted between the two groups at baseline.

3.     Following training, EX group had significant increases in sub maximal arm ergometry power output (81%; p<0.05) and significant increases in upper body muscle strength (19-34%; p<0.05).

4.     EX group reported less pain, stress and depression after training + scored higher than CON in indices of satisfaction with physical function, level of perceived health + overall quality of life (p<0.05).

 

Haisma et al., 2006

Netherlands

Prospective Cohort

NInitial=186; NFinal=42

Population: Mean age: 40 yr; Gender: males=140, females=46; Level of Injury: paraplegia, tetraplegia; Severity of injury: complete=125, incomplete=61; Mean time since injury: 105 d.

Intervention: Assessments were taken at four time points: start of inpatient rehabilitation; three months later; discharge and at one year after discharge.

Outcome Measures: Power output (PO) peak, VO2 peak, strength of upper extremity, respiratory function.

1.     Age was related to the PO peak and handheld dynamometry (HHD) score (p<0.05), the older the subject the more improvement in either of these measures was significantly less than it was in younger subjects.

2.     Men had greater PO peak, VO2 peak and HHD score than women did (p<0.05), thus improvement in men was greater than women.

3.     In tetraplegia subjects the PO peak, VO2 peak, muscle strength and % of forced vital capacity (FVC) was lower (p<0.05) than it was in paraplegia subjects, but tetraplegia subjects improved more in muscle strength and % of forced expiratory flow (FEV1).

4.     Those with a complete lesion had greater HHD score and lower % of FVC than those with incomplete lesions (p<0.05).

Gant et al., 2018

USA

Pre-Post

N=8

Population: Mean age=31.4 yr; Gender: males=6, females=2; Time since injury: 10.5 yr; Level of injury: T2 – T10; Severity of injury: AISA A=4, B=4.

Intervention: Participants underwent three, four wk long multi-modal exercise conditioning and rehabilitation interventions, each separated by a one wk period of multiple body systems assessments.

Each participant was in the trial for 19 contiguous weeks. Outcome measurements were assessed after screening for two baseline assessments and at four, nine, 14 and 19 wk.

Outcome Measures: Neurological motor and sensory impairment; Upper extremity muscle strength and peak oxygen consumption; Blood pressure; Cholesterol, lipids and biomarkers or glycemic control and inflammation; Clinical and electrophysiological spasticity measures; Pain history and pain-related sensory function; Self-reported function; Patient global impression of change.

1.     No significant differences in neurological motor and sensory impairment, blood pressure, cholesterol, lipids, biomarkers of glycemic control and inflammation, as well as chronic pain were observed (p>0.05).

2.     Upper extremity muscle strength significantly improved from baseline (p=0.001); Peak oxygen consumption was not significantly different from baseline (p>0.05).

3.     Participants with high soleus (SL) and tibialis anterior (TA) F/M spasticity ratios at baseline improved significantly (p=0.001); Participants with high SL F/M spasticity ratios at baseline had a significant decrease in the Spinal Cord Assessment Tool for Spastic reflexes (SCATS) extensor score (p=0.047); Other measures of spasticity were not significant (p>0.05).

4.     Two participants experienced clinically significant improvements in self-reported function (p<0.05).

5.     All participants reported a perceived improvement.

Hoffman et al., 2017

USA

Pre-Post

N=17

Population: Mean age=31.3 yr; Gender: males=10, females=7; Time since injury: 7.6 yr; Level of injury: C1 – C7; Severity of injury: AISA A=12, B=1, C=2, D=2.

Intervention: Patients with SCI were enrolled in a weekly hand-focused therapy program that involved using a novel handgrip device on grip strength and hand function. Outcome measures were assessed at baseline and once a wk until the end of the trial at 20 wk.

Outcome Measures: Maximum voluntary contraction (MVC); Mean absolute accuracy (MAA); SCIM.

1.     The average MVC increased from 4.1N to 21.2N over 20 wk, but did not reach statistical significance (p>0.05).

2.     The average MAA significantly increased from 9 to 21% at the end of the study (p=0.02).

3.     The average SCIM was unchanged from baseline to the end of the study (p>0.05).

Drolet et al., 1999

Canada

Pre-post

NInitial=40; NFinal=31

Population: Mean age: 29.5 yr; Gender: males=27, females=4; Level of injury: paraplegia=18, tetraplegia=13; Severity of injury: AIS A-D; Mean time since injury: 2 mo; Mean length of stay: 4.5 mo.

Intervention: Rehab included physiotherapy (PT), occupational therapy (OT) and physical conditioning. There were four 1 hr sessions of each intervention.

Outcome Measures: Mean muscle strength, Muscle strength changes.

1.     Strength values at admittance were inversely repeated to strengthen changes during rehab (Pearson correlation coefficients ranging from -0.47 (p=0.001 shoulder flexors) to -0.73 (p<0.001 shoulder adductors).

2.     For those with paraplegia the range was from -0.48 (p=0.049 shoulder abductors to -0.72 (p=0.001 elbow flexors) compared to those with tetraplegia, the correlation coefficients ranged from -0.28 (p=0.345 elbow extensors) to -0.68 (p=0.010 shoulder adductors).

3.     Patterns of change in muscle strength from admittance to the 15 mo follow up differed between the paraplegia group and the tetraplegia group.

4.     Differences in strength have been observed for: elbow flexors (p=0.001) and shoulder extensors (p=0.04).

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