Chapter 3 - Exercise programs and spinal cord injury (SCI): Linking the clinical, physiological, and psychological consequences of SCI

Abstract

People with a spinal cord injury (SCI) face major life events that lead to serious physical and mental challenges. Physical challenges include impairments in their lower and upper extremities (depending on the level of SCI). These lead to changes in body composition as well as physical inactivity, musculoskeletal and cardiometabolic diseases such as shoulder problems, cardiovascular disease, and diabetes mellitus, which greatly impact their quality of life (QoL). Moreover, people with SCI often experience elevated levels of fatigue, anxiety, and depression. Much of their physical and mental health problems directly result from their paralysis or physical impairment. In this regard, it is important to understand that exercise could reverse their primary (paralysis) and secondary health consequences. Functional electrical stimulation (FES) could elicit the contraction of paralyzed muscles, which may enable them to use their paralyzed muscles to exercise. FES-assisted exercise could be combined with voluntary joint movements of the unparalyzed muscles, such as arm crank and rowing exercises, which may elicit greater health benefits. Exercise without FES reduces the risk of musculoskeletal and cardiometabolic diseases in people with SCI. Furthermore, exercise may also improve their mental health and QoL. In summary, exercise is increasingly considered to be a complementary strategy to SCI rehabilitation. In this chapter, we summarize the recent research progress on the beneficial effects of exercise on SCI, discuss the underlying mechanisms, and highlight the various exercise programs for people with SCI.