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New Exercise Recommendations for Adults with Spinal Cord Injuries

basketball-102377_640(2).jpgPhysical activity guidelines are evidence-based, systematically developed exercise recommendations for the maintenance or enhancement of performance, fitness, or health. The World Health Organization (WHO) exercise guidelines recommend at least 150 minutes of moderate-intensity aerobic activity, or 75 minutes of vigorous-intensity aerobic activity, per week plus muscle-strengthening activities two times per week.

These and similar guidelines are not specifically tailored to people with spinal cord injuries (SCI). People with SCI were not included in the systematic reviews underpinning these guidelines, nor were potential risks of adverse events for people with SCI, such as upper-body over-use injuries and skin breakdown, considered. Further, no consideration was given to the feasibility of performing the 150 minute-per-week guideline for the SCI population, as these individuals often face significant physical, social, and environmental barriers to physical activity.

In 2011, a Canadian team developed evidence-based physical activity guidelines for adults with SCI. Using the same rigorous and systematic process that the WHO used, the team found that for important fitness benefits, adults with a spinal cord injury should engage in at least 20 minutes of moderate to vigorous intensity aerobic activity two times per week and strength-training exercises two times per week. This guideline has been translated into more than a dozen languages and adopted internationally, and has been proven to be effective in improving the fitness of adults with SCI. One limitation, however, is that the guideline does not specifically address cardiometabolic health, which encompasses risk factors for cardiovascular disease.

Because cardiometabolic diseases, such as heart disease, diabetes and stroke, are some of the leading causes of death in adults with SCI, a recent study looked at the effects of exercise interventions on fitness and health outcomes in adults with spinal cord injuries. The authors of the study reported that the evidence showed that exercise can improve fitness and cardiometabolic health for adults with SCI, and endorsed the 2011 guideline as the minimum dose required to achieve fitness benefits. Through the study, the guidelines were also updated:

For cardiorespiratory fitness and muscle strength benefits, adults with a spinal cord injury should engage in at least 20 minutes of moderate to vigorous intensity aerobic exercise 2 times per week AND 3 sets of strength exercises for each major functioning muscle group, at a moderate to vigorous intensity, 2 times per week.

For cardiometabolic health benefits, adults with a spinal cord injury are suggested to engage in at least 30 minutes of moderate to vigorous intensity aerobic exercise 3 times per week.

These guidelines advocate for a lower frequency and duration of aerobic exercise than the amount recommended for the general population by the WHO. This reflects the use of the minimal effective dose of exercise using evidence specific to adults with SCI, instead of from an able-bodied population. The lower frequency and duration also reflects the fact that most people with SCI are less active and more physically deconditioned than most able-bodied adults. As a result, people with SCI can benefit from smaller doses of exercises in improving their fitness and cardiometabolic health.

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