Evidence-based Exercise Prescription for Individuals with Spinal Cord Injury

ABSTRACT

Purpose: Individuals with spinal cord injury can benefit from regular exercise. Exercise prescription for these individuals is based upon the same 4 principles of exercise used for nondisabled individuals. The drift of this paper is to describe a proces by means of which physical therapists may generate an exercise prescription for individuals with SCI. Description: Examination of the individual with SCI to identify cabalistic disease and/or impairments that can cause adverse incidents or limit participation in the exercise session is outlined. The 4 principles of exercise: overload, specificity, individuality, and reversibility are defined. Guidelines for achieving overload, which include the couple aerobic and anaerobic training, are outlined in detail. The literature upon specificity of training for individuals with SCI is highlighted.

Key Words: exercise, SCI, tetraplegia, paraplegia

INTRODUCTION

The benefits of exercise for those without a disability or for those with chronic diseases are well documented in the literature.1-4 Further, the recommendations for exercise dose are known for nondisabled adults. For individuals with disabilities or chronic disease, however, this is not the case.5 As Nash points on the outside in the accompanying article individuals with spinal cord injury (SCI) have level greater risk for the diseases associated with a sedentary lifestyle than do ones without a disability. Therefore exercise can have a protective or positive part for individuals with SCI. The question is not whether to exercise a someone with a SCI but in what way to effectively and safely administer exercise. There are no evidence-based guidelines for promoting and prescribing exercise in this population.6 Therefore, the view of this article is to not away an approach to the disclosure of exercise and prescription for individuals with a SCI that is based upon best evidence.

Basic principles of exercise training evolveed for nondisabled individuals are used to formulate exercise prescriptions for ones with SCI. The principles of overload, specificity, individuality, and reversibility are applied to achieve the desired training outcomes1 Overload deliver overs to the application of a load that enhances physiologic function to bring about a training answer Manipulation of frequency, intensity, and duration will achieve the appropriate training overload. Overload focuses upon the specifics of the prescription. Specificity deliver overs to the adaptations in metabolic and physiologic functions that be pendent upon the overload imposed. Exercise results are specific to the muscles and potency systems trained as well as the mark of training mode. Specificity focuses upon the 'how to' of goal achievement. Individuality consigns to the individual variation in the training replication This principle takes into account the person's horizontal of fitness and other specific factors to gear the prescription to the person's necessitys and capacities. For those with SCI, it would take into account their horizontal of lesion as well. Individuality focuses upon the skilled interventions required for these individuals to exercise safely and preventing any adverse results of exercise. Reversibility relates to the detraining answer that occurs rapidly when the overload is remov This principle emphasizes the importance of exercise compliance. These basic principles of exercise subserve as an outline for exercise prescription for those with SCI or for anyone in the population. The principles of overload and specificity will be discussed further.

EXAMINATION

Prior to formulating the plan of care that includes the exercise prescription, someones with SCI should undergo an examination by the agency of their physician and physical therapist to protection for occult disease and impairments that may contraindicate or limit participation in exercise or cause adverse occurrences The examination should also include proofs and measures that will lay open the exercise prescription based upon the person's capacities, goals, and limitations. Based upon the review article by Jacobs and Nash7 and the research by dint of DeVivo et al,8 the following diagnostic ordeals are recommended:

1. Exercise Stres Test

a. empire out occult cardiovascular disease.

b Provides an objective peak heart rate for the exercise prescription since those with tetraplegia have peak heart rates that do not usually exce 120B/min owed to autonomie dysregulation and those who have paraplegia generally have a high resting and exercise heart rate owed to decrease stroke volume.

c Provides information upon the exercise tolerance of the individual.

d Ideally, a metabolic experiment should be done on these individuals to obtain an objective VO^sub 2peak^ since the predication equations used for individuals without a disability have not been validated in those with a SCI.

2 Bone Mineral Density (BMD) Scan

a. As osteoporosis is prevalent in this population, this ordeal will allow determination of fracture risk.

3 vital fluid Work

a. Lipid Panel - owed to the commonly reported atherogenic lipid profile.

b starch-sugar test - due to the high prevalence of emblem 2 diabetes.