Long-term exercise training in persons with spinal cord injury: effects on strength, arm ergometry performance and psychological well-being

Abstract

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.

Maintenance of exercise participation in individuals with spinal cord injury: effects on quality of life, stress and pain

“…6 In a 9-month randomized control trial (RCT) conducted in our centre, we found that regular aerobic and resistance training may reduce these health concerns in individuals with SCI regardless of the level or completeness of the injury. 7 We also found that despite their immobility, dependence on others for transporta-tion, and high susceptibility to illness, individuals with SCI may adhere to an exercise training programme outside of their own home with rates comparable to those found for the population at large. Specifically, their dropout rate over the 9-month RCT (48%) was very similar to the 50% dropout rate frequently cited for the able bodied.…”

“…In spite of the fact that the individuals in the exercise group reported less pain after the 9-month RCT than did the nonexercising controls, they were not pain free. 7 Our results suggested that the degree of pain after the 9-month RCT accounted for 83% of the variability in exercise adherence in our seven participants during the 3-month follow-up. When examining the relation between pain and exercise adherence, it is difficult to determine whether perceptions of pain cause decreases in exercise adherence or, alternately, if decreases in exercise participation cause increases in the perception of pain.…”

“…7 Of greater relevance however, a repeated measures analysis of covariance (ANCOVA), adjusted for baseline scores, showed that the seven individuals included in the present follow-up study had significant increases in quality of life after 9 months of exercise training (P ¼ 0.05), although they made no significant changes in pain or stress. This relative maintenance of perceived pain and stress, however, may be seen as beneficial, as the nonexercising control group showed nonsignificant increases in both measures over the 9-month period.…”

“…To expand, although the high exercise adherence rates that were found in our initial RCT (for those who completed the entire 9 months) were extremely encouraging, 7 it now seems apparent that the same compliance may not necessarily carry over to real-world practice. It is unclear why exercise participation decreased so dramatically in the 3-month follow-up to our RCT.…”

“…All participants had previously completed a 9-month RCT in our laboratory examining the effects of exercise training on strength, arm ergometry performance and psychological well-being. 7 In brief, all participants were in the intervention group of a much larger (n ¼ 34; 21 exercisers, 11 of whom successfully completed the 9 months of training; 13 sedentary controls, 12 of whom completed the study) supervised, progressive exercise study at a frequency of twice per week. Each session lasted approximately 90-120 min and involved a warm-up (wheeling and stretching), arm ergometry (approximately 15-30 min at a Borg (1-10 scale) rating 13 of 3-4) and resistance training (three sets per exercise at approximately 70-80% of their one repetition maximum).…”