Physical Activity Guidelines for Spinal Cord Injury

Original Editor - Naomi O'Reilly

Top Contributors - Naomi O'Reilly, Ewa Jaraczewska, Kim Jackson, Tarina van der Stockt, Jess Bell, Wanda van Niekerk, Merinda Rodseth and Admin  

Introduction

While it was acknowledged that exercise is an important tool for improving wellbeing and enhancing independence for individuals with a spinal cord injury, many health and fitness professionals highlighted a lack of clear guidance on how best to prescribe physical activity for this population group.

The World Health Organisation developed 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. While these guidelines were not specifically tailored to the spinal cord injury population, the WHO suggested that the recommendations could be applied to adults with disabilities with adjustment to the guidelines for each individual based on their exercise capacity and specific health risks or limitations.

Development of Scientific Guidelines

The team, collaborating with an international panel of researchers, clinicians, community organisations, adults with a spinal cord injury, and knowledge translation specialists, jointly devised a set of exercise guidelines which were launched at the International Spinal Cord Society Annual Meeting in 2017.

Translating Scientific Guidelines to Practice Guidelines

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.

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.

What Settings Do They Apply To

Physical activity as we know can occur in a range of venues, indoors and outdoors, in all sorts of weather. The Spinal Cord Injury Exercise Guidelines are meant to be applicable to exercise and physical activity performed in a wide range of settings, which include but not limited to;

• Rehabilitation Settings
• Fitness Centers
• Individuals Own Homes

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.

The new guideline, states that for cardiometabolic health benefits, adults with a spinal cord injury are suggested to engage in at least;

• 30 min of moderate to vigorous intensity aerobic exercise, 3 times per week.

Cardiorespiratory Fitness and Muscle Strength

To improve cardiorespiratory fitness and muscle strength, adults with a spinal cord injury should engage in at least;

• 20 min of moderate to vigorous intensity aerobic exercise, 2 times per week, and
• Three sets of strength exercises for each major functioning muscle group, at a moderate-vigorous intensity, 2 times per week.

This guideline affirms the 2011 Spinal Cord Injury Physical Activity Guidelines, but has also been updated to align with the evidence base by referring to ‘exercise’ rather than ‘physical activity’

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, 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.

"Physiotherapists are ideally placed to help the dissemination of these Physical Activity Guidelines for Spinal Cord Injury because they interact on a daily basis with patients at the start of their journey after their Spinal Cord Injury." Dot Tussler, Physiotherapist at Stoke Mandeville Hospital

Resources

National Centre for Sport & Exercise Medicine 

• Spinal Cord Injury Exercise Guidelines

SCI Action Canada

• A Physiotherapist’s Guide to Promoting Physical Activity to Clients who have Spinal Cord Injuries

Peter Harrison Centre for Disability Sport

• Fit For Life; A Guide for Adults with Spinal Cord Impairment
• Fit for Sport; A Guide for Adults with a Spinal Cord Impairment

References