Spinal Cord Injury and Exercise

Spinal cord injury (SCI) refers to damage resulting from trauma (e.g. motor vehicle accidents or falls). SCI will usually result in impairments of motor and sensory function, as well as autonomic function (e.g. sweating and heart rate control).

Two factors determine which of these functions are impaired and how much they are impaired

  1. How high the injury is: The higher the injury occurs, the more function is impaired. Tetraplegia refers to injuries in the neck region and typically results in impairments of arm, trunk and leg function. Paraplegia refers to injury below the neck and while trunk and leg function is impaired, arm function is preserved.

  2. The completeness of the injury: When an injury does not damage the full thickness of the spinal cord, some connections with the brain remain intact and some function can be preserved. The amount of function preserved is highly variable, even for people with injuries at the same level.

How does exercise help?

People with mobility impairments, including people with SCI, are among the most physically inactive members of society. Physical inactivity is very harmful for health, fitness and function, and compounds the consequences of SCI. Research demonstrates that aerobic exercise (e.g. wheelchair pushing, hand cycling, swimming) improves cardiorespiratory fitness, reduces the risk of cardiovascular disease and may reduce the incidence of urinary tract infections; whereas Resistance training improves strength of non-paralysed muscles and may improve strength of partially-paralysed muscles. Exercise interventions can enhance functional independence and include specific upper-limb strengthening can reduce shoulder pain (a common problem for manual wheelchair users). Exercise can decrease depression and anxiety, and increase quality of life. Exercise may be associated with greater health of the bones in paralysed limbs

What exercise is best for people with SCI?

Because this population is extremely varied and the quantity and quality of research is limited, specific, prescriptive recommendations for exercise programs are not possible. However some recommendations include:

  • People with SCI should be as physically active as they can be; aim to accrue at least 150 minutes of moderate-intensity aerobic activity on most or all days of the week; and flexibility training is a recommended component of a comprehensive exercise training program.

  • When first commencing, exercise intensity and duration should start low and increase gradually, particularly those with tetraplegia or a history of low blood pressure.

  • Short Interval training (5 min work: 5min recovery) at low intensity may assist the very unfit to accumulate sufficient aerobic duration.


References: Norton L. Spinal Cord Injury, Australia 2007-08, Canberra, Australian Institute of Health and Welfare; 2010. Figoni SF, Kiratli BJ, Sasaki R. Spinal Cord Dysfunction, Chapter 5, in ACSM's resources for clinical exercise physiology: musculoskeletal, neuromuscular, neoplastic, immunologic, and hematologic conditions. Myers J, Nieman DC, American College of Sports M, ed^eds. Philadelphia, Wolters Kluwer Health/Lippincott Williams & Wilkins Health, 2010. Harvey L. Management of spinal cord injuries: a guide for physiotherapists, New York, Butterworth-Heinemann; 2008. Eng JJ, Teasell RW, Miller WC, Wolfe DL, Townson AF, Hsieh JTC, Connolly SJ, Noonan V, Mehta S, Sakakibara BM, Boily K,editors. Spinal Cord Injury Rehabilitation Evidence. Version. 0, Vancouver 2012 (Available at http://www.scireproject.com/). Ginis KA, Hicks AL, Latimer AE, et al. The development of evidence-informed physical activity guidelines for adults with spinal cord injury. Spinal cord. 2011; 49(11):1088-1096