SCIPA Full-On: A Randomized Controlled Trial Comparing Intensive Whole-Body Exercise and Upper Body Exercise After Spinal Cord Injury

Abstract

Background. While upper body training has been effective for improving aerobic fitness and muscle strength after spinal cord injury (SCI), activity-based therapies intended to activate the paralyzed extremities have been reported to promote neurological improvement. Objective. To compare the effectiveness of intensive whole-body exercise compared with upper body exercise for people with chronic SCI. Methods. A parallel-group randomized controlled trial was conducted. Participants with a range of SCI levels and severity were randomized to either full-body exercise (FBE) or upper body exercise (UBE) groups (3 sessions per week over 12 weeks). FBE participants underwent locomotor training, functional electrical stimulation-assisted leg cycling, and trunk and lower extremity exercises, while UBE participants undertook upper body strength and aerobic fitness training only. The primary outcome measure was the American Spinal Injury Association (ASIA) motor score for upper and lower extremities. Adverse events were systematically recorded. Results. A total of 116 participants were enrolled and included in the primary analysis. The adjusted mean between-group difference was −0.04 (95% CI −1.12 to 1.04) for upper extremity motor scores, and 0.90 (95% CI −0.48 to 2.27) for lower extremity motor scores. There were 15 serious adverse events in UBE and 16 in FBE, but only one of these was definitely related to the experimental intervention (bilateral femoral condyle and tibial plateau subchondral fractures). No significant betweengroup difference was found for adverse events, or functional or behavioral variables. Conclusions. Full-body training did not lead to improved ASIA motor scores compared with upper body training in people with chronic SCI.

Activity-Based Therapy in a Community Setting for Independence, Mobility, and Sitting Balance for People With Spinal Cord Injuries

“…The results showed no neurological recovery after ABT and no significant differences between groups for functional or behavioural variables. 43 Similarly, a case series conducted by Padula et al 44 investigated the long-term effects of an 18-month multimodal ABT program and showed no effects of ABT on activities of daily living or participation outcomes.…”

Brain motor control assessment post intensive whole-body exercise <i>vs.</i> upper body exercise after spinal cord injury

“…Inclusion criteria for patients with SCI [22] were: ≥ 18 years old and able to give informed consent; sustained a traumatic SCI ≥ 6 months prior to consent and had completed their primary rehabilitation; and had a complete or incomplete SCI (C6-T12) [17] . Exclusion criteria for patients with SCI [22] were: brachial plexus, cauda equina or peripheral nerve injury; Stage 3 or 4 pressure ulcer [23] ; had recent major trauma or surgery (up to six months prior to this trial); were post-menopausal at the time of injury (females); had a BMI < 25; had endocrinopathy or metabolic disorders of the bone; had a medical history of exposure to medication(s) known to affect mineral or bone metabolism; had chronic systemic diseases; had significant impairment or disability; had severe spasticity; had uncontrolled neuropathic pain; were likely to experience clinically significant autonomic dysreflexia and/or orthostatic hypotension in response to electrical stimulation or prolonged upright postures; or had any contraindications to FES such as a cardiac pacemaker, lower limb fracture or pregnancy.…”

“…These subclinical responses can take various forms, for example repeatable responses to reinforcement manoeuvres or strong vibration [14] or the ability to volitionally suppress responses evoked by plantar surface stimulation [15,16] . This paper presents the results of the BMCA assessments conducted in patients at one site of a multi-centre, assessor-blinded, randomised controlled trial (Spinal Cord Injury and Physical Activity Full-On) [17] , which investigated the effectiveness of an intensive activity-based therapy program for patients with clinically complete and incomplete SCI. For full details of the protocol, please refer to Galea et al [17] .…”

“…This paper presents the results of the BMCA assessments conducted in patients at one site of a multi-centre, assessor-blinded, randomised controlled trial (Spinal Cord Injury and Physical Activity Full-On) [17] , which investigated the effectiveness of an intensive activity-based therapy program for patients with clinically complete and incomplete SCI. For full details of the protocol, please refer to Galea et al [17] . The trial was registered on ClinicalTrials.gov (NCT01236976).…”

Physical Activity and the Health of Wheelchair Users: A Systematic Review in Multiple Sclerosis, Cerebral Palsy, and Spinal Cord Injury

“…In SCI, function (multifactorial) [102][103][104][105][106] and cardiovascular fitness (VO 2 peak) 107-109 may be improved when all exercise types were combined, but there was no clear benefit on depression scores. [110][111][112] (Appendix Figures 2-4)…”