Why exercise?
Physical activity is important for all of us. Exercise reduces the risk of developing chronic health problems such as heart disease, high blood pressure, diabetes and even some forms of cancer. For people with a spinal cord injury there can be added health benefits. If you are able to be physically active, you have a lower risk of developing secondary complications such as urinary tract infections, pressure sores, and respiratory illness. Physical activity can also help you better manage problems such as spasticity, weight gain, and chronic pain. It can help improve your strength and endurance, which in turn can improve your ability to accomplish everyday tasks such as transferring and pushing a manual wheelchair. In addition, research has now shown that people who are physically active are less likely to experience feelings of anxiety, loneliness, and depression. Adjusting to life after a spinal cord injury is difficult. Exercise not only contributes to continuing rehabilitation but also to a healthy lifestyle. Attending a fitness centre or taking part in a sport or recreational activity provides an opportunity to meet people, have fun, and provide a real sense of accomplishment. This psychological aspect of exercise can be a great motivational tool for everyone and can go a long way in improving overall quality of life. Exercise for individuals with a spinal cord injury can be divided into three broad categories:
- Aerobic exercise to maintain cardiovascular health
- Strength-based training to maintain the ability to perform activities of daily living and mobility, as well as preventing injury from muscle weakness or imbalance
- Flexibility training to improve range of motion and reduce spasticity.
Currently, exercise is the only known intervention that can have lasting effects on function after a spinal cord injury, both in promoting neural recovery and in reducing secondary complications. The role of physical activity on neuroplasticity (the ability of nerve cells to regenerate and make new connections) and improving functional recovery is fast becoming a key area of research.
How does my spinal cord injury affect my ability to exercise?
Although a spinal cord injury can make physical activity and exercise much harder, it certainly does not make it impossible. The degree of functioning muscle after a spinal cord injury depends on the level and extent of the injury, and everyone is affected differently. Thus, your level of injury will determine the physical activities and exercise programs that are right for you. Exercise may be difficult for many individuals with high levels of impairment and fewer working
muscles, and it may be that some forms of exercise would be limited by your mobility, but you still have options. So, whether you are now settling back at home and readjusting to life back in the community or it is many years since you sustained your injury, what next? Remember, inactivity before an injury should not be an impediment to starting some form of exercise or activity afterwards. Undoubtedly, it is even more important now. In deciding upon a suitable exercise program or activity, your own personal expectations and goals must first be taken into consideration. They should be realistic. Everyone has different personal commitments and the amount of time you have available and the cost of programs must be taken into consideration. Where you live will also play a role in what is available. This brochure aims to provide clarity on what is currently available. It is not an exhaustive list but hopes to be comprehensive enough to provide the motivation to get you started or to re-embark on something that you enjoyed before your injury.
How much exercise is right for me?
There has not been a single prescription for the correct amount and type of exercise you should do if you have a spinal cord injury. Always seek advice from your doctor or physiotherapist to provide guidance on what is appropriate for your level of injury and fitness. It also depends on what your exercise goals are. You may want to improve your cardiovascular health or increase your wheelchair performance. In March 2011, the Rick Hansen Institute in partnership with SCI Action Canada released the first ever evidence-based guidelines on exercise for people with spinal cord injury. The guidelines state healthy adults with spinal cord injury should participate in at least 20 minutes of moderate-vigorous aerobic activity twice a week, as well as strength training exercises twice a week to improve fitness. More information can be found at www.sciactioncanada.ca/guidelines/. There are some physiological responses to exercise that are unique to a person with a spinal cord injury. Factors such as your age, time since injury, level of injury and your current fitness and ability, must be considered. To ensure you reach your desired outcomes safely, seek professional advice.
Remember, do not over exercise. Also, how you actually exercise is important. It is essential to balance the need to exercise and achieve a training stimulus with the need to protect the upper limbs from overuse (refer to the consumer guide “Preservation of Upper Limb Function,’’ Consortium for Spinal Cord Medicine and Paralyzed Veterans of America, 2008). Forces on the shoulder should be reasonably balanced by working muscles at the back and not just the chest muscles in front. A rotator cuff strength program designed by a physiotherapist should also be added into your fitness routine. Regardless of the type of exercise you undertake, the best results, as for athletes, come from practice and from focusing the attention and the effort. In other words, you get much better results if exercise is as active as possible and not merely passive. There is also increasing evidence that mental practice and visualization increases the brain’s activity as well as overall performance. So be engaged!