Study design: Randomized controlled trial of exercise training in persons with spinal cord injury. Objective: The purpose of this study was to examine the e ects of 9 months of twice-weekly exercise training on strength, arm ergometry performance, and indices of psychological wellbeing and quality of life. Setting: Centre for Health Promotion and Rehabilitation, McMaster University, Hamilton, Ontario, Canada. Methods: Thirty-four men and women (aged 19 ± 65 years) with traumatic spinal cord injury (C4 ± L1; ASIA A ± D) of 1 ± 24 years duration volunteered to participate, and were randomized into exercise (EX; n=21) and control (CON; n=13) groups. Twenty-three subjects (11 EX; 12 CON) successfully completed the 9-month study. Subjects were assessed for one repetition maximum (1RM) strength, arm ergometry performance, and several indices of quality of life and psychological well-being at baseline, 3, 6, and 9 months. Results: At baseline, there were no signi®cant di erences between groups in age, submaximal arm ergometry performance, muscle strength, or psychological well-being. Following training, the EX group had signi®cant increases in submaximal arm ergometry power output (81%; P50.05), and signi®cant increases in upper body muscle strength (19 ± 34%; P50.05); no signi®cant changes occurred in CON. Participants in EX reported signi®cantly less pain, stress and depression after training, and scored higher than CON in indices of satisfaction with physical function, level of perceived health and overall quality of life (P50.05). Exercise adherence (per cent of prescribed sessions attended) in those subjects who completed the 9 months of training was 82.5%.Conclusions: These results demonstrate that long-term twice-weekly exercise training in this population is feasible, and results in signi®cant gains in both physical and psychological wellbeing.

Research on muscle fatigue suggests that greater fatigue resistance may be evident in females compared with males. The possible mechanisms for this sex difference include factors related to muscle mass, substrate utilization, muscle morphology, and neuromuscular activation.

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...

Exercise improves fitness and cardiometabolic health of adults with chronic SCI. The evidence on effective exercise types, frequencies, intensities, and durations should be used to formulate exercise guidelines for adults with SCI.

Chronic inflammation has been shown to contribute to the development of a wide variety of disorders by means of a number of proposed mechanisms. Depression and cognitive impairment are two such disorders which may share a closely linked inflammatory etiology. The ability of inflammatory mediators to alter the activity of enzymes, from key metabolic pathways, may help explain the connection between these disorders. The chronic up-regulation of the kynurenine pathway results in an imbalance in critical neuroactive compounds involving the reduction of tryptophan and elevation of tryptophan metabolites. Such imbalances have established implications in both depression and cognitive impairment. This may implicate the immune system as a potential therapeutic target in the treatment of these disorders. The most common treatment modalities currently utilized, involve drug interventions which act on downstream targets. Such treatments help to reestablish protein balances, but fail to treat the inflammatory basis of the disorder. The use of anti-inflammatory interventions, such as regular exercise, may therefore, contribute to the effectiveness of current drug interventions in the treatment of both depression and cognitive impairment.

Study design: Review article. Objectives: The objective of this study is to provide an overview of the many factors that contribute to the chronic inflammatory state typically observed following spinal cord injury (SCI). Methods: Literature review. Results: Not applicable. Conclusion: SCI is typically characterized by a low-grade inflammatory state due to a number of factors. As bidirectional communication exists between the nervous, endocrine and immune systems, damage to the spinal cord may translate into both endocrinal and immune impairment. Damage to the autonomic nervous system may induce immune dysfunction directly, through the loss of neural innervation of lymphoid organs, or indirectly by inducing endocrinal impairment. In addition, damage to the somatic nervous system and the corresponding loss of motor and sensory function increases the likelihood of developing a number of secondary health complications and metabolic disorders associated with a state of inflammation. Lastly, numerous related disorders associated with a state of chronic inflammation have been found to be at a substantially higher prevalence following SCI. Together, such factors help explain the chronic inflammatory state and immune impairment typically observed following SCI. An understanding of the interactions between systems, both in health and disease, and the many causes of chronic inflammation may aid in the effective future treatment of immune dysfunction and related disorders following SCI.

Study design: Four-month longitudinal within-subject exercise training study. Objective: Although body-weight supported treadmill training (BWSTT) has not shown promise as a means of improving ambulation in individuals with motor-complete spinal cord injury (SCI), it may still improve cardiovascular health and function in this population. The purpose of this study was to (i) investigate the effects of BWSTT on peripheral muscular and elastic artery dimension and function and measures of heart rate variability (HRV) and blood pressure variability (BPV) in individuals with motor-complete SCI, and (ii) to make a preliminary examination of what factors may predict favourable cardiovascular outcomes following BWSTT in this population. Setting: Centre for Health Promotion and Rehabilitation, McMaster University, Hamilton, Ontario, Canada. Methods: Six individuals (four male, two female; age 37.7715.4 years) with chronic SCI (C4-T12; ASIA A-B; 7.679.4 years post-injury) were included in the present investigation. Doppler ultrasound was used to determine femoral (exercising; muscular), carotid (elastic) and brachial (nonexercising control; muscular) artery dimension and function before and after 4 months of BWSTT. Continuous heart rate and blood pressure were also recorded before and after 4-months of BWSTT to determine frequency domain measures of HRV and BPV; clinically valuable indices of neurocardiac and neurovascular control, respectively. Results: Two-way ANOVA (vessel  time) revealed no exercise-induced change in femoral or carotid artery cross-sectional area, blood flow or resistance and no change in carotid artery compliance following the 4 months of BWSTT compared to the nonexercising control brachial artery. However, there was a significant exercise-induced increase in femoral artery compliance. There were no exercise-induced changes in HRV or BPV when all participants were considered together. However, the results suggest that the subgroup of individuals who had a substantial heart rate response to BWSTT (n ¼ 3), experienced exercise-training induced changes in HRV reflective of a relative shift toward cardiac vagal predominance and reductions in BPV. Conclusions: BWSTT may cause an increase in femoral artery compliance in individuals with motor-complete SCI and therefore, should be encouraged as a means of improving cardiovascular health in this population. BWSTT may also cause modest improvements in measures of HRV and BPV in a select subgroup of individuals who respond to ambulation with moderate to large increases in HR. In the present study, factors associated with a substantial HR response to BWSTT were a propensity to orthostatic intolerance and muscular spasticity.Spinal Cord (2005) 43, 664-673.