Lay Summary by Nicholas Jo
Edited by Rona Herzog and Crystal Han
This is a summary of research conducted by ICORD researchers Kendra Todd, Sarah Lawrason, Robert Shaw, Dr. Kathleen Martin Ginis, and their colleague Dr. Derrick Wirtz. Click here to access the original article.
65% of patients with a spinal cord injury (SCI) endure some form of chronic pain (e.g neuropathic or muscle-related). Post-SCI pain can be debilitating to an individual’s overall well-being and daily function. This can have adverse impacts on their psychological health, which has the potential to lead to an increased risk of anxiety and depressive symptoms. This highlights the urgency to investigate methods that may reduce chronic SCI pain and improve an individual’s well-being, while understanding the relationship between these two factors.
Purpose of the Study:
This was a scoping review, which means the researchers extracted and compiled findings from other studies in order to answer their research question. The purpose of this scoping review was to investigate the impact of leisure time physical activity (LTPA) on chronic pain and subjective-wellbeing among individuals with SCI.
How was this review conducted?
An inclusion criterion was created to filter relevant studies in order to investigate the effects of LTPA on both chronic pain and subjective well-being among individuals with SCI. For clarity purposes, chronic pain was defined as any pain lasting longer than twelve weeks. Subjective well-being measures included positive/negative affect, life satisfaction, and satisfaction in different areas of life (i.e. social relationships, employment, etc.). Based on the inclusion criterion the scoping review analyzed 15 published articles.
The articles chosen all included:
- experimental or quasi-experimental designs (designs where the researcher deliberately uses an intervention to see if it has an overall effect)
- participants 18 years or older, who had sustained a SCI for more than one year
- the effects of the LTPA intervention on both chronic pain and subjective well-being.
Findings from the systematic review:
The findings listed below are based on different research articles included in the systematic review. Researchers identified four key findings with regards to how individuals responded to a LTPA intervention:
- Increased pain, decreased subjective well-being: Following 8-weeks of yoga participation, individuals reported increased levels of general body pain, decreased mindfulness, and a greater negative affect.
- Increased pain, improved subjective well-being: Following a 6-week yoga program; average pain worsened, while overall anxiety-depression, self-compassion and mindfulness increased.
- Decreased pain, improved subjective well-being: This key finding was supported by 12 of 15 articles included in the scoping review. A variety of LTPA interventions led to decreased pain and improved subjective well-being (e.g., 9-month aerobic and resistance exercise training, wheelchair propulsion, tai chi).
- Unchanged levels of pain, improved subjective well-being: Following a 6-week home-based aerobic exercise program; no reported impact on shoulder or general body pain, improved self-efficacy and individual quality of life.
Exercise Guidelines for individuals with SCI
Two standardized exercise guidelines have been developed to improve overall health and fitness for individuals with SCI:
- To improve cardiorespiratory fitness and muscular strength, individuals should perform 90 minutes of moderate-high intensity aerobic activity twice a week, with strength training 2x a week consisting of 3 sets of 8-10 reps for each exercise in each major muscle group.
- To improve cardiometabolic health, individuals should perform 30 minutes of moderate-high intensity aerobic exercise 3x a week.
Individuals with pain post-SCI often refrain from physical activity in fear of elevating their pain sensations, which is contrary to what most research suggests. LTPA serves as an effective pain management modality among individuals with SCI. LTPA was demonstrated to reduce both neuropathic and musculoskeletal pain, highlighting the potential for LTPA to be prescribed as a pain management technique. The findings from the scoping review provide a direction for future research to evaluate the effects of LTPA on chronic pain and subjective well-being and develop new interventions to maximize the benefits of LTPA for individuals with SCI.
Although there is clear indication of an effect of LTPA on chronic pain and subjective well-being, limitations in the research do exist. LTPA protocols are markedly inconsistent (including intensity, duration, and frequency), which has the potential to influence pain and subjective well-being outcomes differently. Each study used in this review also had varying classification methods for measuring pain and subjective well-being among participants.