Effects of exercise on fitness and health of adults with SCI


Lay summary by Aidan Underwood

Edited by Crystal Han

This is a lay summary of the original research article by Dr. Kathleen Ginis, Dr. Christopher West, and their colleagues Jan W van der Scheer, David Ditor, Victoria Goosey-Tolfrey, Audrey Hicks, and Dalton Wolfe. Read the original article here.

People with spinal cord injury (SCI) often face limitations which cause them to exercise less than the rest of the general population, and even compared to other disability groups. Exercise guidelines are created to plan out a course of action to maintain or enhance the fitness, performance, and health of people with an SCI. The guidelines involve systematically-developed recommendations for various age groups and movement capabilities, that are based on scientific findings. This paper was done to create some recommendations to formulate scientific SCI guidelines which were highlighted in another paper, which is located here.

The creation of exercise guidelines for people with SCI requires the exploration of 3 key questions:

  1. Can exercise interventions improve fitness, cardiometabolic health, and/or bone health?
  2. What specific exercise prescriptions improve fitness, cardiometabolic health and/or bone health?
  3. How common are adverse events during interventions?

For the purpose of these guidelines, fitness consists of: cardiorespiratory (endurance), power output, and muscle strength. Cardiometabolic health is defined as body composition such as body fat percentage, and cardiovascular risk factors, such as the risk of having a heart attack. Adverse events would include the symptoms that a person with an SCI is experiencing become worse as result of exercise interventions.

Why is this study important?

Exercise improves fitness and cardiometabolic health for adults with an SCI. There is a moderate to high level of confidence in the evidence that all areas of health, excluding bone health, are improved with exercise interventions in those with an SCI. Guidelines for effective exercise types, frequencies, duration, and intensity can effectively be created for adults with chronic SCI.

How was the study done?

A systematic review of research findings on the effects on fitness, cardiometabolic health and bone health for adults with an SCI was performed to help provide evidence in updating the 2011 SCI guidelines using GRADE (Grading of Recommendations Assessment, Development, and Evaluation: a system that assesses confidence levels in evidence presented in research, in order to make recommendations in healthcare). Higher confidence levels in evidence would make findings more likely to me recommended in healthcare, and in this case, towards the creation of exercise guidelines.

What are the results of the study?

Previous guidelines from 2011 for adults with SCI are outdated. The 2011 guidelines stated that 20 minutes of moderate to vigorous aerobic activity should be conducted twice a week along with resistance training twice a week as well. Aerobic activity includes endurance activities that raise heart rate such as hand cycling, rowing, or swimming.

Evidence can be used to suggest two guidelines for adults with an SCI:

  1. A combination of upper body aerobic and strength (Resistance) training improves fitness, which has been previously stated in the 2011 guidelines. Due to new research, there is now more confidence in the effectiveness of this guideline. Specifically, there is more evidence supporting upper body aerobic training, along with resistance training, to improve fitness levels. Resistance training involves the training of large muscle groups, such as push exercises involving chest and shoulders, and pull exercises involving rows. This can improve overall fitness.
  2. If implementing solely upper body aerobic activities, these activities should be done more frequently, for a longer period of time. Evidence suggests that moderate to vigorous upper body aerobic exercise sessions several times a week can improve overall fitness and decrease cardiovascular risk. These types of exercises would include hand cycling, rowing, and swimming.

It was determined that if resistance training for people with chronic SCI is not incorporated in their exercise plan, then the frequency and duration of aerobic exercise should not be increased.

Why is this important?

Specific guidelines for exercise duration, rigour, and type allow people with SCI to better understand how to maintain and enhance fitness, performance and health. 

What were limitations of the study?

10 to 20% of the participants with a chronic SCI reported adverse effects including light-headedness and increased spasticity (prolonged muscle tightness). This paper focused mainly on recommendations for exercise for those with a chronic SCI, as those with acute SCI had higher reports of adverse effects, and the levels of confidence in the findings are not high enough to create guidelines for exercise.