Physical Activity Guidelines for Spinal Cord Injury

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Original Editor - Naomi O'Reilly

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The World Health Organisation developed the Global Recommendations on Physical Activity for Health with the overall aim of providing national and regional level policy makers with guidance on the dose-response relationship between the frequency, duration, intensity, type and total amount of physical activity needed for the prevention of Non Communicable Diseases. [1]


Development of Scientific Guidelines

Translating Scientific Guidelines to Practice Guidelines

Role of Physiotherapy in Promoting Guidelines

Physiotherapists have always had a close relationship with exercise, the profession was founded on the work of remedial gymnasts and the profession has a rich history of prescribing rehabilitative exercise. The global physical inactivity crisis, and the epidemic of life-style related diseases (non-communicable diseases) has created an urgent need to build on our rich history of prescribing exercise and develop our approaches for prescribing physical activity. Creating a more active population requires joined up thinking and action from many stakeholders; physiotherapists need to be active in engaging with individuals and communities.

Spinal Cord Injury Exercise Guidelines

Who Do They Apply To

Men and Women aged 18 - 64 with a Chronic Traumatic or Non-Traumatic Spinal Cord Injury > 12 Months Post Onset, with a Neurological Level C3 or Lower including tetraplegia and paraplegia, irrespective of race, ethnicity or socio-economic status, who are not active above and beyond daily activities. [8]

While there is currently insufficient scientific evidence to draw firm conclusions about the risks and benefits of these guidelines for individuals with a Spinal Cord Injury < 12 months post-onset, aged 65 years or older, and those with co-morbid conditions, they may be appropriate following consultation with a health care provider prior to beginning an exercise program. [8]

What Settings Do They Apply To

The Guidelines are meant to be applicable to exercise performed in a range of settings including but not limited to rehabilitation settings, fitness centers, and individuals own homes. [8]

Cardiorespiratory Fitness and Muscle Strength

Cardiometabolic Health

Cardiometabolic disease, which includes a spectrum of conditions from insulin resistance, progressing to the metabolic syndrome, pre-diabetes, and finally to more severe conditions including Cardiovascular Disease and Type 2 Diabetes, currently poses a serious health and economic burden worldwide, with prevalence predicted to increase. Independent risk factors include prolonged sitting, lack of physical activity, poor diet, and short sleep duration, which have all become common place worldwide. [9]


National Centre for Sport & Exercise Medicine - Spinal Cord Injury Exercise Guidelines


  1. World Health Organization. Global recommendations on physical activity for health. World Health Organization; 2010.
  2. National Centre for Sport and Exercise Medicine. Peter Carruthers | The Importance of Exercise. Available from:[last accessed 20/02/19]
  3. National Centre for Sport and Exercise Medicine. Jan van der Scheer | How SCI Exercise Guidelines were Developed. Available from:[last accessed 20/02/19]
  4. National Centre for Sport and Exercise Medicine. Prof Vicky Tolfrey | Why We Need SCI-Specific Evidence. Available from:[last accessed 20/02/19]
  5. National Centre for Sport and Exercise Medicine. Jan van der Scheer | How the Guidelines will be Translated. Available from:[last accessed 20/02/19]
  6. National Centre for Sport and Exercise Medicine. Dot Tussler | The Importance of SCI Exercise Guidelines for Physios. Available from:[last accessed 20/02/19]
  7. National Centre for Sport and Exercise Medicine. Dot Tussler | Role of Physios in helping People with SCI be Active. Available from:[last accessed 20/02/19]
  8. 8.0 8.1 8.2 Ginis KA, van der Scheer JW, Latimer-Cheung AE, Barrow A, Bourne C, Carruthers P, Bernardi M, Ditor DS, Gaudet S, de Groot S, Hayes KC. Evidence-based Scientific Exercise Guidelines for Adults with Spinal Cord Injury: An Update and a New Guideline. Spinal Cord. 2018 Apr;56(4):308.
  9. Vincent GE, Jay SM, Sargent C, Vandelanotte C, Ridgers ND, Ferguson SA. Improving Cardiometabolic Health with Diet, Physical Activity, and Breaking Up Sitting: What about Sleep?. Frontiers in Physiology. 2017 Nov 8;8:865.