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Abstract
Objective: To synthesize and appraise research testing the effects of exercise interventions on fitness, cardiometabolic health, and bone health among adults with spinal cord injury (SCI).
Methods: Electronic databases were searched (1980–2016). Included studies employed exercise interventions for a period ≥2 weeks, involved adults with acute or chronic SCI, and measured fitness (cardiorespiratory fitness, power output, or muscle strength), cardiometabolic health (body composition or cardiovascular risk factors), or bone health outcomes. Evidence was synthesized and appraised using Grading of Recommendations Assessment, Development, and Evaluation (GRADE).
Results: A total of 211 studies met the inclusion criteria (22 acute, 189 chronic). For chronic SCI, GRADE confidence ratings were moderate to high for evidence showing exercise can improve all of the reviewed outcomes except bone health. For acute SCI, GRADE ratings were very low for all outcomes. For chronic SCI, there was low to moderate confidence in the evidence showing that 2–3 sessions/week of upper body aerobic exercise at a moderate to vigorous intensity for 20–40 minutes, plus upper body strength exercise (3 sets of 10 repetitions at 50%–80% 1-repetition maximum for all large muscle groups), can improve cardiorespiratory fitness, power output, and muscle strength. For chronic SCI, there was low to moderate confidence in the evidence showing that 3–5 sessions per week of upper body aerobic exercise at a moderate to vigorous intensity for 20–44 minutes can improve cardiorespiratory fitness, muscle strength, body composition, and cardiovascular risk.
Conclusions: Exercise improves fitness and cardiometabolic health of adults with chronic SCI. The evidence on effective exercise types, frequencies, intensities, and durations should be used to formulate exercise guidelines for adults with SCI.
GLOSSARY
- AIS=
- American Spinal Injury Association Impairment Scale;
- FES=
- functional electrical stimulation;
- GRADE=
- Grading of Recommendations Assessment, Development, and Evaluation;
- PEDro=
- Physiotherapy Evidence Database;
- RCT=
- randomized controlled trial;
- SCI=
- spinal cord injury;
- SCIRE=
- Spinal Cord Injury Research Evidence
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at Neurology.org
- Received January 30, 2017.
- Accepted in final form May 15, 2017.
- © 2017 American Academy of Neurology
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