Exercise recommendations for people with spinal cord injury

[Wise Young]

Jacobs PL and Nash MS (2004). Exercise recommendations for individuals with spinal cord injury. Sports Med 34: 727-51. Persons with spinal cord injury (SCI) exhibit deficits in volitional motor control and sensation that limit not only the performance of daily tasks but also the overall activity level of these persons. This population has been characterised as extremely sedentary with an increased incidence of secondary complications including diabetes mellitus, hypertension and atherogenic lipid profiles. As the daily lifestyle of the average person with SCI is without adequate stress for conditioning purposes, structured exercise activities must be added to the regular schedule if the individual is to reduce the likelihood of secondary complications and/or to enhance their physical capacity. The acute exercise responses and the capacity for exercise conditioning are directly related to the level and completeness of the spinal lesion. Appropriate exercise testing and training of persons with SCI should be based on the individual's exercise capacity as determined by accurate assessment of the spinal lesion. The standard means of classification of SCI is by application of the International Standards for Classification of Spinal Cord Injury, written by the Neurological Standards Committee of the American Spinal Injury Association. Individuals with complete spinal injuries at or above the fourth thoracic level generally exhibit dramatically diminished cardiac acceleration with maximal heart rates less than 130 beats/min. The work capacity of these persons will be limited by reductions in cardiac output and circulation to the exercising musculature. Persons with complete spinal lesions below the T(10) level will generally display injuries to the lower motor neurons within the lower extremities and, therefore, will not retain the capacity for neuromuscular activation by means of electrical stimulation. Persons with paraplegia also exhibit reduced exercise capacity and increased heart rate responses (compared with the non-disabled), which have been associated with circulatory limitations within the paralysed tissues. The recommendations for endurance and strength training in persons with SCI do not vary dramatically from the advice offered to the general population. Systems of functional electrical stimulation activate muscular contractions within the paralysed muscles of some persons with SCI. Coordinated patterns of stimulation allows purposeful exercise movements including recumbent cycling, rowing and upright ambulation. Exercise activity in persons with SCI is not without risks, with increased risks related to systemic dysfunction following the spinal injury. These individuals may exhibit an autonomic dysreflexia, significantly reduced bone density below the spinal lesion, joint contractures and/or thermal dysregulation. Persons with SCI can benefit greatly by participation in exercise activities, but those benefits can be enhanced and the relative risks may be reduced with accurate classification of the spinal injury. Department of Neurological Surgery, The Miami Project to Cure Paralysis, University of Miami School of Medicine, 1095 Northwest 14th Terrace, Miami, R-48, FL 33136, USA. pjacobs@miami.edu

[Spadfan]

Dr Young,

This question was posed by Daniel on 2/05/02 in the Sports & Travel forum and got no response.

Does anyone use heart rate monitors when doing serious cardio exercise, such as FES or hand cycling?
If so, I am curious what impact spinal cord injury has on maximum heart rates, the applicability of target heart rate zones and resting heart rates. I am trying to design an exercise program and curious if the formula for max heart rates works after a spinal cord injury.

Last Tuesday I had my one year follow-up with the doctor who did the arterial grafts that restored blood flow to my left leg. I have put on about 10 lbs in the intervening year, in addition to the already extra weight I had put on over the 30 years I have been injured. My extra girth (Buddha belly) is causing some pulling on the gortex graft and causing some pain where it runs along my ribs. I mentioned that I had a stationary handcycle that has been collecting dust for years and he recommended that I get a heart rate monitor and start using both the handcycle and the heart rate monitor.

Since this question has significance to me now, I am reposing it in this forum.

T 6/7 Complete
Injured 4/20/74

[Brian S]

Originally Posted by Spadfan

Does anyone use heart rate monitors when doing serious cardio exercise, such as FES or hand cycling?

I've been using a modified spinning bike for almost 4 years now and I usually wear a heart monitor. I find it very difficult to get my heart rate over 100 since my injury. My resting heart rate is about 60 and while I'm biking it usually averages between 80 and 90. Here's a short video. (My injury is C2/C3 incomplete.)

[fuentejps]

im inc c4-5, im easily able to get to my target heart rate for a non injured 32 yo male. i actually shoot for 25 to 30 yo target

[Surf_Sister]

swimming and walking gets my heart rate up pretty well. I swear one of the first times i tried walking in the supported treadmill, my heart rate was like 140 or something.

i'm worried about heart problems when i'm older, so i try to do cardio regularly. my life span's been shortened enough by sci

[dan_nc]

Originally Posted by Surf_Sister

swimming and walking gets my heart rate up pretty well. I swear one of the first times i tried walking in the supported treadmill, my heart rate was like 140 or something.

i'm worried about heart problems when i'm older, so i try to do cardio regularly. my life span's been shortened enough by sci

Yeah, swimming and walking gets my heart rate up too. I think it has to do with level of injury. I don't know if my heart rate has changed much since injury--I've always been a bit tachy. I am worried about that, but don't know what kind of cardio I can still do.

[Jeff Weeks]

In my experience, hand pedaling really sucks.

I wore a heart rate monitor while pedaling my hand cycle around my parking lot in Orlando for a whole year. I could only achieve 105 BPM. And I couldn't maintain it for 20 or 30 minutes cuz my arms always wore out. So I never got beyond it.

Using my FES bike..... my legs will keep pedaling until I'm sucking wind, feeling nauseous, losing my peripheral vision and about to pass out. This is the only way for me to beat my nearly complete injury. I stress my heart way beyond its capacity and slowly I just gain BPM in spite of my paralysis. It takes a looooong time. Especially because as you improve...... those first 20 minutes will not raise your heart rate much at all. As you get stronger you will need 30, 40, 50 minutes to keep making gains in BPM.

As we speak I'm going through it all over again. Out of 10 weeks I spent 7 abroad and didn't ride my FES biike at all. Oh my God. The pain of getting back into shape is horrendous. Much harder than for an AB.

My heartrate monitor is packed somewhere but I no longer need it. I know exactly what's happening. When I finally achieve 45-60 minutes on 3/8 on my bike...... it'll be 135-155 BPM. I was there. I was loving it. I want it back. [I'm more than halfway already.]

Oddly enough...... pedaling 20 minutes on 5/8, which causes lack-of-blood-to-the-brain-sickness, is the best way to make gains. The longer you pedal when you feel sick..... the better your gain will be for your next ride.

I constantly do this. I wish someone would study it. Because I really think I'm beating the complete injury blues. I pedal until I almost pass out..... doing everything I can think of to cause autonomic dysreflexia.... [LOL another topic altogether]...... and then the next time I pedal [48 hours later] I'm a lot stronger.

The best way to keep pedaling when you feel sick is to know that you are going to feel even sicker when you stop pedaling. It's true. While you keep pedaling..... the nausea slowly builds. When you hit that red stop button on your bike...... frig...... you'll be sucking wind and feeling worse than ever. So, keep pedaling....... make the pain mean something.

You will be really irritable from the nausea. Oh man. But eventually the feeling of accomplishment takes over and it's a huge high.

Keep track of minutes, miles, %stim and resistance. Do everything you can to gain even just a little bit with every ride. You will be amazed after a year.

It really works......... even above T4. Serious.

[fuentejps]

ive never experienced nausea doing cardio on a regular basis jeff. occassionally while riding my hand cycle in the heat and humidity once or twice. is that a complete injury thing

[The mom]

The acute exercise responses and the capacity for exercise conditioning are directly related to the level and completeness of the spinal lesion. Appropriate exercise testing and training of persons with SCI should be based on the individual's exercise capacity as determined by accurate assessment of the spinal lesion. The standard means of classification of SCI is by application of the International Standards for Classification of Spinal Cord Injury, written by the Neurological Standards Committee of the American Spinal Injury Association.

Dr. Young,
This seems to be very a typical one size fits all comment, offering little hope. This has not been our experience.
What impact does sparing have on the comments above? If the classification system does not consider the trunk, a relatively large part of the body which does move, how appropriate can this exercise assessment be?
Is this commentary about those who don't exercise and like the general population should work into an exercise regimen carefully, considering the additional needs? Have wheelchair athletes either recreational or Olympic been considered in this data?

[dan_nc]

bumping the topic