University of Southern California Division of Occupational Science and Occupational Therapy
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Exercise

Television, newspaper and magazines are full of reports of the benefits of exercise, but does this apply to people who are living with spinal cord injuries? Absolutely! Studies show exercise is a healthy habit for people who use wheelchairs, as it can improve cardiac fitness, help maintain the best possible weight and improve a person's overall functional abilities 1 2 3 4. In fact, a recent study found that people with spinal cord injury who get good nutrition and stay at a healthy weight, exercise, do general activities to prevent pressure ulcers (which means the same thing as "pressure sores" or "bedsores"), keep a good attitude, improve their skills at problem-solving, and stop smoking and recreational drug and alcohol use are much less likely to develop a pressure ulcer 5 or more years after their injury than people whose lifestyle habits are not as healthy 5.

It is important to keep in mind that the activities chosen should be right for you and how you feel. For example, Billy, a participant in our study who was athletic before his accident, has kept in shape with strength training and lifting weights at home, and his overall fitness has helped him recover quickly when he develops pressure ulcers. Charlie reported taking part in wheelchair marathons. And Frank enjoys going to his local rehabilitation facility and playing wheelchair basketball.

Exercise can be more challenging for people with a high spinal cord injury, but might still be done with assistance from a qualified care attendant or therapist; such movement can help to avoid contractures (that is, when joints become inflexible), aid in normalizing muscle tone and help maintain fitness. For example, our study participant Alma, who received a C-1 spinal cord injury after a fall from a balance beam at age 5, does range-of-motion and other exercises daily, and has exercise equipment in her home that she uses when time permits. Some people with tetraplegia might be able to exercise unaided; for example, former skiing champion Jill Kinmont Boothe, a person who is considered tetraplegic and whose story was the basis for the film The Other Side of the Mountain, enjoys a daily aerobics exercise routine designed to be performed while seated 6. Another example of unaided exercise is when people with an injury at C-4 (with C-5 return) use the Uppertone muscle strengthening workout device. The key to exercises at this level is finding activities that don't require gripping or pinching.

Beyond the physical benefit of exercise is the psychological and social value it has for people living with spinal cord injuries. In a recent study, participants described that exercising helped them to redefine themselves, creating a bridge from their lives and interests before their injuries to who they are now 1. One participant in that study reported that going on a hiking trip with her family gave her an opportunity to be an active part of her family, and that sitting in a beautiful mountain field of daisies during that outing was an uplifting experience that formed lifelong memories for her 1.

Like any other activity that you undertake, make sure you do not forget to make exercising safe. Check with your health care professional who is trained in issues regarding spinal cord injury, whether it's a physician or a physical or occupational therapist, before starting any type of exercise. As you move around doing the activity you choose, some degree of pressure relief will probably happen naturally, but this is not enough to substitute for your regular pressure relief practices. Remember to avoid friction that could irritate or scrape your skin. (Charlie, for example, fell out of his wheelchair during a marathon, leaving an injury that led to a pressure ulcer.) Find an activity that is enjoyable for you, whether it is participating in "extreme" wheelchair sports like sea kayaking, or something you can do at home at your own pace, like lifting weights.

To find out more about exercise, there are a number of websites on the Internet that have information about the benefits of exercise, or where people with spinal cord injuries write about the kinds of physical activities they enjoy. Spinal Cord Injury and Exercise is an excellent fact sheet on exercise on the website of the National Center on Physical Activity and Disability (NCPAD), which is maintained by the University of Illinois. (If you are interested in a scholarly article on the subject, try No More Sores: Preventing Pressure Sores for People with SCI, on NCPAD's website.) Craig Hospital in Denver, Colorado also has an information page about Exercise on their website.

A website with information about exercise opportunities is maintained by the United Spinal Association, which was formerly called the Eastern Paralyzed Veterans Association. This group advocates for adapted sports, especially for children and teens. To create the right workout program for yourself, you should probably start by talking to your physician and asking for a referral (that is, a prescription to see a medical specialist) to a physical therapist, occupational therapist or possibly a recreational therapist (who often work at hospitals or rehabilitation facilities). What is Therapeutic Recreation?, on the website of the American Therapeutic Recreation Association, goes into detail about recreational therapy, and talks about exercise and recreation in general.

Uppertone
www.quadriplegia.com/upprtone.htm

Spinal Cord Injury and Exercise
www.ncpad.org/111/860/Spinal~Cord~Injury~and~Exercise

No More Sores: Preventing Pressure Sores for People with SCI
www.ncpad.org/105/1007/No~More~Sores~~Preventing~Pressure~Sores~for~People~with~SCI

Exercise
www.craighospital.org/Left-Nav/Craig-Programs/Spinal-Cord-Injury--SCI--Rehab/Health-and-Wellness-Information/Educational-Brochures/Exercise

United Spinal Association
www.unitedspinal.org

What is Therapeutic Recreation?
atra-online.com/displaycommon.cfm?an=12

1 Levins, S. M., Redenbach, D. M., & Dyck, I. (2004). Individual and societal influences on participation in physical activity following spinal cord injury: A qualitative study. Physical Therapy, 84, 496-509.

2 Jacobs, P. L., Nash, M. S, & Rusinowski, J. W. (2001). Circuit training provides cardiorespiratory and strength benefits in persons with paraplegia. Medicine & Science in Sports & Exercise, 33, 711-717.

3 Durán, F. S., Lugo, L., Ramírez, L., & Eusse, E. (2001). Effects of an exercise program on the rehabilitation of patients with spinal cord injury. Archives of Physical Medicine & Rehabilitation, 82, 1349-54.

4 Franklin, B. A., Perkash, I, & Froelicher, V. (1998). Effect of spinal cord injury on the heart and cardiovascular fitness. Current Problems in Cardiology, 648-717.

5 Krause, J. S., & Broderick, L. (2004). Patterns of recurrent pressure ulcers after spinal cord injury: Identification of risk and protective factors 5 or more years after onset. Archives of Physical Medicine and Rehabilitation, 85, 1257-1264.

6 Boothe, J. K. (2000). Living a full life with a spinal cord injury. Advances in Skin and Wound Care, 13, 210-212.