Effects of exercise on fitness and health of adults with spinal cord injury: a systematic review

Objective: To synthesize and appraise research testing the effects of exercise interventions on fitness, cardiometabolic health and bone health among adults with spinal cord injury (SCI). Methods: Electronic databases were searched (1980-2016). Included studies: employed exercise interventions for a period ≥2 weeks; involved adults with acute or chronic SCI; and measured fitness (cardiorespiratory fitness, power output and/or muscle strength), cardiometabolic health (body composition and/or cardiovascular risk factors), and/or bone health outcomes. Evidence was synthesized and appraised using GRADE. Results: 211 studies met the inclusion criteria (22 acute, 189 chronic). For chronic SCI, GRADE confidence ratings were moderate to high for evidence showing exercise can improve all of the reviewed outcomes except bone health. For acute SCI, GRADE ratings were very low for all outcomes. For chronic SCI, there was low-to-moderate confidence in the evidence showing that 2-3 sessions/week of upper-body aerobic exercise at a moderate-to-vigorous intensity for 20-40 min, plus upper-body strength exercise (3 sets of 10 repetitions at 50-80% 1RM for all large muscle groups) can improve cardiorespiratory fitness, power output and muscle strength. For chronic SCI, there was low-to-moderate confidence in the evidence showing that 3-5 sessions per week of upper-body aerobic exercise at a moderate-to-vigorous intensity for 20-44 min can improve cardiorespiratory fitness, muscle strength, body composition, and cardiovascular risk. Conclusions: 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.