Physical Activity in Spinal Cord Injury

Health is often understood as the absence of disease, but in a broader perspective it encompasses physical, mental, and social well-being. This view implies that good health is not only about avoiding illness, but also about maintaining functional ability, quality of life, and participation in everyday activities. Physical activity plays a central role in achieving these outcomes.

Regular physical activity provides health benefits for people of all ages, including children, adolescents, adults, older adults, and individuals with disabilities. Physical activity has been shown to reduce the risk of several non-communicable diseases, including coronary heart disease, type 2 diabetes, stroke, cancer, osteoporosis, and depression¹.

For individuals with spinal cord injury, physical activity is particularly important. Regular activity can help maintain functional capacity, reduce secondary complications, and improve overall quality of life. It also promotes independence and supports participation in everyday life.

Health Effects of Physical Activity

Physical activity influences a wide range of physiological and functional processes in the body. Regular participation in physical activity can lead to improvements across several areas of health and function⁴⁵.

Key benefits include improvements in:

• respiratory function and breathing capacity

• circulation

• energy levels

• flexibility and range of motion

• immune system function

• independence in daily activities

• lean body mass

• mobility

• mood and psychological well-being

• muscular strength

• muscular endurance

• ability to perform activities of daily living

• quality of life

• self-esteem

• sleep quality

• slowing of bone density loss

• transfers

• prevention of secondary complications such as urinary tract infections, pressure ulcers, and metabolic disorders

In addition, physical activity contributes to the reduction of several disease risk factors.

Regular physical activity may reduce the risk of:

• cardiovascular disease

• colon cancer

• diabetes

• weight gain and obesity

• pain-related conditions

Barriers to Physical Activity in Spinal Cord Injury

Individuals with spinal cord injury may encounter a variety of challenges that make participation in physical activity more difficult. These barriers can vary depending on injury severity, time since injury, and individual circumstances⁶⁷.

Common barriers include:

• lack of accessible exercise equipment

• limited access to accessible training facilities

• high membership costs

• expenses related to adaptive equipment

• transportation difficulties

• physical health problems

• mental health challenges

• frustration related to performance or functional limitations

Without appropriate support and environmental adaptations, these barriers may contribute to reduced levels of physical activity.

Medical Considerations in Physical Activity

Individuals with spinal cord injury have an increased risk of several medical conditions compared with individuals without spinal cord injury. Understanding these conditions is essential for ensuring safe participation in physical activity.

One of the most serious conditions that can occur in individuals with spinal cord injury is autonomic dysreflexia. This condition typically occurs in individuals with injuries at or above the T6 spinal level⁸. Autonomic dysreflexia develops when a noxious or irritating stimulus below the level of injury triggers an uncontrolled sympathetic nervous system response.

This condition is considered a medical emergency and requires immediate attention. Despite the risks, there have been reports of athletes intentionally inducing autonomic dysreflexia in order to increase cardiac output and gain a competitive advantage, which can be extremely dangerous⁸.

Other Medical Considerations

Several additional medical factors must be considered when individuals with spinal cord injury engage in physical activity.

These include:

• impaired thermoregulation

• pressure ulcers

• neurogenic bladder

• urinary tract infections

• premature osteoporosis

• peripheral nerve entrapment

• musculoskeletal injuries

Thermoregulation may be impaired due to disruption of the autonomic nervous system. This can reduce the body’s ability to regulate temperature through mechanisms such as sweating or shivering, increasing the risk of temperature-related injury during extreme environmental conditions.

Individuals with spinal cord injury must also carefully monitor skin areas exposed to increased pressure, particularly around the sacrum and ischial tuberosities. Proper adjustment of wheelchairs and sports equipment can reduce the risk of pressure ulcers.

Loss of bowel and bladder control may increase the risk of urinary tract infections, partly due to incomplete bladder emptying and the use of catheters.

In addition, individuals with spinal cord injury are more prone to musculoskeletal conditions, particularly overuse injuries of the upper extremities. Increased reliance on the arms and shoulders for transfers and manual wheelchair propulsion places greater stress on these structures. Reduced use of the lower limbs may also lead to decreased bone mineral density and the development of osteoporosis⁸.

References

1. Physical Activity Guidelines Advisory Committee. Physical Activity Guidelines Advisory Committee Report, 2008. Washington, DC: U.S. Department of Health and Human Services; 2008.

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3. Miller LE, Herbert WG. Health and economic benefits of physical activity for patients with spinal cord injury. ClinicoEconomics and Outcomes Research. 2016;8:551–558.

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5. Williams TL, Smith B, Papathomas A. The barriers, benefits and facilitators of leisure-time physical activity among people with spinal cord injury: a meta-synthesis of qualitative findings. Health Psychology Review. 2014;8(4):404–425.

6. Vissers M, Van den Berg-Emons R, Sluis T, Bergen M, Stam H, Bussmann H. Barriers to and facilitators of everyday physical activity in persons with spinal cord injury after discharge from the rehabilitation centre. Journal of Rehabilitation Medicine. 2008;40(6):461–467.

7. Klenck C, Gebke K. Practical management: common medical problems in disabled athletes. Clinical Journal of Sport Medicine. 2007;17(1):55–60.