Determining the priorities of individuals with spinal cord injury (SCI) can assist in aligning research priorities which ultimately improve these individuals' quality of life. This systematic review examined studies that directly surveyed people with SCI to ascertain their health priorities and life domains of importance. Twenty-four studies (combined sample of 5262) that met the inclusion criteria were identified using electronic databases (Medline, EMBASE, CINAHL, PsycINFO). The questionnaire methods and domains of importance were reviewed and described. While the questionnaires varied across the studies, a consistent set of priorities emerged. Functional recovery priorities were identified for the following areas: motor function (including arm/hand function for individuals with tetraplegia and mobility for individuals with paraplegia), bowel, bladder and sexual function. In addition, health, as well as relationships emerged as important life domains. The information from this study, which identified the priorities and domains of importance by individuals with SCI, may be useful for informing healthcare and research agenda-setting activities.

Objectives To describe the process and outcomes of using a new evidence base to develop scientific guidelines that specify the type and minimum dose of exercise necessary to improve fitness and cardiometabolic health in adults with spinal cord injury (SCI). Setting International. Methods Using Appraisal of Guidelines, Research and Evaluation (AGREE) II reporting criteria, steps included (a) determining the guidelines' scope; (b) conducting a systematic review of relevant literature; (c) holding three consensus panel meetings (European, Canadian and International) to formulate the guidelines; (d) obtaining stakeholder feedback; and (e) process evaluation by an AGREE II consultant. Stakeholders were actively involved in steps (c) and (d). Results For cardiorespiratory fitness and muscle strength benefits, adults with a SCI should engage in at least 20 min 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 (strong recommendation). For cardiometabolic health benefits, adults with a SCI are suggested to engage in at least 30 min of moderate to vigorous intensity aerobic exercise 3 times per week (conditional recommendation). Conclusions Through a systematic, rigorous, and participatory process involving international scientists and stakeholders, a new exercise guideline was formulated for cardiometabolic health benefits. A previously published SCI guideline was endorsed for achieving fitness benefits. These guidelines represent an important step toward international harmonization of exercise guidelines for adults with SCI, and a foundation for developing exercise policies and programs for people with SCI around the world.

Objectives: To systematically develop evidence-informed physical activity guidelines to improve physical fitness in people with spinal cord injury (SCI). Setting: This study was conducted in Canada Methods: The Appraisal of Guidelines, Research and Evaluation II guideline development protocol was used to develop exercise guidelines to improve physical capacity and muscular strength. The evidence base for the guideline development process consisted of a systematic review and quality appraisal of research examining the effects of exercise on physical fitness among people with SCI. A multidisciplinary expert panel deliberated the evidence and generated the guidelines. Pilot testing led to refinement of the wording and presentation of the guidelines. Results: The expert panel generated the following guidelines: for important fitness benefits, adults with a SCI should engage in (a) at least 20 min of moderate to vigorous intensity aerobic activity two times per week and (b) strength training exercises two times per week, consisting of three sets of 8-10 repetitions of each exercise for each major muscle group. Conclusion: People with SCI, clinicians, researchers and fitness programmers are encouraged to adopt these rigorously developed guidelines.Spinal Cord (2011Cord ( ) 49, 1088Cord ( -1096 doi:10.1038/sc.2011 published online 7 June 2011 Keywords: exercise; strength training; aerobic training; clinical practice guidelines; spinal cord injuries IntroductionThe amount of disability associated with a spinal cord injury (SCI) is unique to each injury and depends on both the level and completeness of damage to the spinal cord. However, physical deconditioning is a common consequence of most SCIs, and can further exacerbate the impact of the injury and lead to an increased risk for chronic secondary health complications. It has been suggested that much of the excessive (and early) morbidity and mortality in people with chronic SCI is caused by inactivity related illnesses, such as cardiovascular disease, type II diabetes and osteoporosis. 1 In addition, the loss of fitness and independence associated with physical inactivity significantly impacts quality of life and community participation. 2 These facts highlight the importance of promoting physical activity (PA) to improve health, fitness and overall quality of life within the SCI population. 3,4 PA promotion is very difficult in the absence of information regarding the types, amounts and intensities of activity that yield fitness benefits. Such information would assist clinicians and exercise programmers in prescribing and promoting exercise and PA. The able-bodied population has access to this type of information in the form of PA guidelines. [5][6][7] However, the able-bodied PA guidelines are not necessarily appropriate for people with SCI. The rigorous development of evidence-based PA guidelines that are specific to the needs and capabilities of the SCI population is long overdue. 8,9 This paper describes the methodological www.nature.com/sc approach underlyin...