Effectiveness of the ‘evidence-based scientific exercise guidelines’ in increasing cardiorespiratory fitness, cardiometabolic health and muscle strength in acute spinal cord injury rehabilitation: a systematic review

Objective: To determine the effect of exercise and physical activity interventions that meet current guideline recommendations (1) on cardiorespiratory fitness, cardiometabolic health and muscle strength in adults in the acute stage (<1 year post onset) of spinal cord injury (SCI) rehabilitation.

Data sources: Six electronic databases (PubMed, CINAHL, SPORTDiscus, Google Scholar, National Institute Clinical Excellence, World Health Organisation) were searched (January 2016-March 2022) to extend a previously published review (2).

Study Selection: Included studies implemented exercise interventions in the acute stage of SCI rehabilitation participants which met the exercise guidelines and measured cardiorespiratory fitness, cardiometabolic health and strength outcomes.

Data Extraction: Titles and abstracts were screened against eligibility criteria and duplicates removed using EndNote X8. Full texts were independently assessed and results presented in a PRISMA flowchart. Data extraction was completed on included studies by two reviewers (LR & VB) using a modified Cochrane Group form.

Data synthesis: Data were synthesised, appraised using the Modified Downs & Black checklist and presented in narrative and tabular format. This review was registered on PROSPERO (Register ID:CRD42021249441). Of the 1255 studies, four were included, featuring 108 total participants <1-year post-SCI. Functional electrical stimulation cycle ergometry reduced muscle atrophy after 3 months training and increased lean body mass after 6 months. Resistance training increased muscle peak torque, perceived muscle strength and function. Aerobic exercise interventions did not increase cardiorespiratory fitness.

Conclusions: Interventions meeting the exercise guidelines did not increase cardiorespiratory fitness, but were shown to improve cardiometabolic health and perceived muscle strength and function in adults in the acute stage of SCI rehabilitation. Further empirical research using standardised outcome measures are required to explore the effectiveness of aerobic exercise and strengthening interventions in acute stage of SCI rehabilitation to support the development of exercise guidelines.