Physical Activity for Spinal Cord Injury

Original Editor - Naomi O'Reilly

Top Contributors - Naomi O'Reilly and Tarina van der Stockt  

Introduction

Although many people think of health in terms of illness, health is a positive concept that covers your physical, mental and social well-being (Department of Health and Children, 2000). Physical activity benefits every aspect of health. Regular physical activity shows benefits for everyone including children, adolescents, adults, older adults, and people with a disability across all ethnic groups and importantly has been shown to reduce the risk of non-communicable diseases, such as Coronary Heart Disease, Type 2 Diabetes, Stroke, Cancer, Osteoporosis and Depression. [1]

Benefits of Physical Activity

Physical activity improves; [4][5]
  • Breathing Ability
  • Circulation
  • Energy Levels
  • Flexibility
  • Immune System Function
  • Independence
  • Lean Body Mass
  • Mobility
  • Mood
  • Muscular Strength
  • Muscle Endurance
  • Performance of everyday activities
  • Quality of Life
  • Self Esteem
  • Sleep
  • Slows Bone Density Loss
  • Transfers
  • Prevention of Secondary Conditions (e.g. urinary tract infection, ulcers, diabetes etc.)

Physical activity decreases:

  • Risk Factors associated with Cardiovascular Disease
  • Colon Cancer
  • Diabetes
  • Weight Gain & Obesity
  • Pain

Barriers to Physical Activity 

There are a wide range of barriers to physical activity identified by individuals with a spinal cord injury, with some variances between those post-discharge and those with a more chronic spinal cord injury; [6][7]

  • lack of accessible exercise equipment
  • lack of accessible venues
  • costs of memberships
  • costs of adaptive equipment
  • lack of transportation
  • physical health problems
  • mental health problems
  • frustrations with performance

Medical Considerations for Physical Activity

Individuals with a spinal cord injury are predisposed to medical conditions and have a higher prevalence than that of a non-spinal cord injury individual. Understanding these conditions is vital to proper prevention, care, and return to activity for these individuals. The following briefly describes some of these considerations, though this is not an exhaustive list due to the vast anatomical and structural variances that occur within individuals with a spinal cord injury.
Robert Kozarek competing in the New York Marathon, 2015.

One of the most pressing conditions individuals with a spinal cord injury can encounter is autonomic dysreflexia. This condition is normally seen in individuals whose injury is at or above the T6 spinal level[8]. Autonomic dysreflexia begins with a noxious stimulus below the level of the lesion and the body’s exhibits an uncontrolled sympathetic response. While this is a medical emergency requiring immediate attention, some athletes, regardless of the dangers, attempt to intentionally induce autonomic dysreflexia leading them to a competitive advantage because of an increase in cardiac output.[8]

Other medical considerations for individuals with a spinal cord injury involved in physical activity include thermoregulation, pressure sores, neurogenic bladders, urinary tract infections, premature osteoporosis, peripheral nerve entrapment syndromes, and musculoskeletal injuries.

Thermoregulation is decreased due to loss of the autonomic nervous system and cooling and heating mechanisms such as sweating and shivering. Losing sensation also contributes to temperature-related injury, especially during temperature and environment extremes.

Individuals with a spinal cord injury require skin monitoring not only for environmental exposure, but also for areas of increased pressure. These areas include the sacrum and ischial tuberosities; sports wheelchairs that position the knees higher than the buttocks and provide a decrease in the risk of developing pressure sores.[8] The lack of bowel and bladder control poses an increased risk for urinary tract infections due to incomplete voiding, increased pressure, and catheter use. Individuals with a spinal cord injury are also more prone to musculoskeletal co-morbidities, in particular overuse injuries of the upper limb. Premature osteoporosis may be present due to decreased muscle use and demineralization while peripheral nerve entrapment in upper extremities is likely due to increased use and pressure over soft tissues from manual propulsion.[8]

Resources

Physical Activity Recall Assessment for People with Spinal Cord Injury (PARA-SCI)

Physical Activity Recall Assessment for People with Spinal Cord Injury (PARA-SCI) is a self-report physical activity measure for individuals with spinal cord injury. It aims to measure type, frequency, duration, and intensity of physical activity performed by individuals with a spinal cord injury who use a wheelchair as their primary mode of mobility. 

ProACTIVE SCI Toolkit

The ProACTIVE SCI Toolkit, from SCI Action Canada, is designed to help physiotherapists work with individuals with a spinal cord injury to be physically active outside of the clinic. It's a step-by-step resource that uses three overarching strategies including education, referral, and prescription to develop tailored strategies that work for both the physiotherapist and the individual with a spinal cord injury.

Active Living Leaders

Active Living Leaders is comprised of a series of peer-mentor training videos with a goal of helping people who would like to use the latest physical activity knowledge, sport resources, and transformational leadership principles to inform and motivate adults living with a spinal cord injury to lead more active lives.

SCI-U Physical Activity Course for Individuals with Spinal Cord Injury

SCI-U Physical Activity Course is a collection of modularized training sessions.  It includes Modules on Living an Active Life, Ways to Get Fit, Overcoming Barriers and Reaching Your Goal.

SCI Action Canada Knowledge Mobilization Training Series

SCI Action Canada's Knowledge Mobilization Training Series (KMTS) is a collection of modularized training sessions, with the goal of advancing physical activity knowledge and participation among individuals living with spinal cord injury. It includes Modules on the Physical Activity Guidelines and Physical Activity Planning.

References

  1. Physical Activity Guidelines Advisory Committee. Physical Activity Guidelines Advisory Committee Report, 2008. Washington, DC: U.S. Department of Health and Human Services, 2008. 
  2. MSKTCtv. Exercise, Health and Happiness after a Spinal Cord Injury. Available from: https://youtu.be/S8mUuYdqS5A[last accessed 20/02/19][last accessed 20/02/19]
  3. National Centre for Sport and Exercise Medicine. Peter Carruthers | The Importance of Exercise. Available from: https://youtu.be/RbJ0K75SmMM[last accessed 20/02/19][last accessed 20/02/19]
  4. Miller LE, Herbert WG. Health and economic benefits of physical activity for patients with spinal cord injury. ClinicoEconomics and Outcomes Research: CEOR. 2016;8:551.
  5. Wolfe DL, McIntyre A, Ravenek K, Martin Ginis KA, Latimer AE, Eng JJ, Hicks AL, Hsieh JTC (2013). Physical Activity and SCI. In Eng JJ, Teasell RW, Miller WC, Wolfe DL, Townson AF, Hsieh JTC, Connolly SJ, Mehta S, Sakakibara BM, editors. Spinal Cord Injury Rehabilitation Evidence. Version 4.0.
  6. Williams TL, Smith B, Papathomas A. The barriers, benefits and facilitators of leisure time physical activity among people with spinal cord injury: a meta-synthesis of qualitative findings. Health Psychology Review. 2014 Oct 2;8(4):404-25.
  7. Vissers M, Van den Berg-Emons R, Sluis T, Bergen M, Stam H, Bussmann H. Barriers to and facilitators of everyday physical activity in persons with a spinal cord injury after discharge from the rehabilitation centre. Journal of Rehabilitation Medicine. 2008 Jun 5;40(6):461-7.
  8. 8.0 8.1 8.2 8.3 Klenck C., and Gebke, K. (2007). Practical management: Common medical problems in disabled athletes. Clinical Journal of Sports Medicine, 17(1), 55-60.