By Jennifer Green, B.S.

Jennifer Green, NCHPAD Visiting Information Specialist

Roughly 250,000 Americans have spinal cord injuries (SCIs), and approximately 11,000 new injuries occur each year. SCI injuries are most commonly caused by vehicular accidents (37%), violence (28%), falls (21%), sports (6%), and other causes (8%). The most rapidly increasing cause of injury is violence. These injuries typically result in an incomplete loss of somatic, sensory, and autonomic function below the level of injury. Lesions in the cervical region typically result in quadriplegia; whereas injuries in the thoracic and lumbar regions lead to paraplegia. The degree of physical activity and deconditioning imposed by a spinal cord injury can strongly contrast the preinjury status of an individual, in which most persons tend to be relatively young and active.

The results of deconditioning and the adoption of a sedentary lifestyle can cause or contribute to lifelong medical complications, such as accelerated cardiovascular disease, insulin resistance, osteopenia, obesity, and immune system dysfunction. Exercise can have a protective and encouraging role for persons with an SCI when included as part of a healthy lifestyle; as a result, the question should not be whether to exercise, but how to safely and effectively administer physical activity.

Prior to creating an exercise prescription and beginning an exercise regimen, individuals with spinal cord injuries should first undergo an examination by their physician to screen for any diseases or impairments that may contraindicate, limit, or cause adverse effects during physical activity. In general, exercise prescription guidelines for the general population can be applied to individuals with SCI, while tailoring the time, mode, and intensity to your individual clients' needs. Intensity for aerobic training should be 40% to 80% of HRR, keeping in mind more specific considerations that will be discussed later. Clients should try to complete at least 30 minutes of aerobic activity 2 to 3 days per week. As always, the mode is dependant upon the individual and can include the arm ergometer, wheelchair ergometer, free wheeling, wheelchair treadmill, seated aerobics, swimming, etc. Anaerobic or resistance training is also important for this population, focusing especially on muscles used for activities of daily living, such as the shoulders, upper back, chest, and arms. Intensity should range from 50% to 80% of 1 RPM with a duration of 2-3 sets of 10 repetitions. These clients should be weight training 2 times per week using weight stations, free weights, or Thera-bands depending on their ability level.

There are a variety of additional considerations that must be taken into account when creating an effective exercise program for individuals with SCI, including:

• Avoid autonomic dysreflexia by having clients empty their urinary bags before exercise as it can be triggered by a full bladder or bowel distension. Know that autonomic dysreflexia is characterized by severe paroxysmal hypertension and know the symptoms commonly associated with it (headaches, sweating above the level of injury, stuffy nose, and bradycardia).
• Avoid pressure sores and potential risk areas - these should be checked frequently Individuals with complete spinal cord lesions (above T6) may have decreased cardiovascular performance. Especially in clients with complete quadriplegia who have no sympathetic innervation to the heart, their maximum heart rate may only be 115-130 beats per minute.
• Unfit clients will suffer from peripheral fatigue before any central training effect occurs. When beginning an exercise program, sessions should consist of short bouts of 5 to 10 minutes at a moderate intensity. Alternate activity with 5-minute recovery periods. This training method should also be used in quadriplegics due to their minimal amount of active musculature.
• Individuals with spinal cord injuries will benefit from complementing strength-training sessions from a seated position in the wheelchair with non-wheelchair exercise bouts in order to involve all trunk-stabilizing muscles. However, transfers should be limited due to the increased hemodynamic load and potential risk of injury. Individuals with SCIs tend to have higher core temperatures during endurance exercise and generally have lower sweat rates. Appropriate clothing and protective measures are recommended to improve heat tolerance. Avoid the following factors as they reduce heat tolerance:

- Lack of acclimatization
- Dehydration
- Glycogen depletion
- Sleep loss
- Alcohol
- Infectious disease

It is important for trainers and health care professionals to stress the importance and benefits of incorporating physical activity into a healthy lifestyle, especially for individuals with spinal cord injuries. Considerations must be taken into account to guarantee that both physical and daily activities can be sustained without disruption. If cautiously and innovatively prescribed, exercise has the potential to enhance the quality of life and protect against secondary health conditions that are commonly associated with spinal cord injuries.

Resources:

Myslinski, M. J. Ed.D., PT. (2005). Evidence-based exercise prescription for individuals with spinal cord injury. Journal of Neurological Physical Therapy, 29(2), 104.

Nash, M. S. Ph.D., FACSM. (2005). Exercise as a health-promoting activity following spinal cord injury. Journal of Neurological Physical Therapy, 29(2), 87.

Spinal cord injury facts and statistics. (2009). Retrieved May 27, 2010, from http://www.sci-info-pages.com/facts.html

Thompson, W. R. Ph.D., FACSM, Gordon, N. F. MD, Ph.D., MPH, FACSM, & Pescatello, L. S, Ph.D., FACSM. (Eds.). (2010). ACSM's guidelines for exercise testing and prescription (8th ed.). Baltimore: Lippincott Williams & Wilkins.

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Please send any questions or comments to Jennifer Green at jn.green2@gmail.com.