When thinking about your quality of life after spinal cord injury, exercise and fitness may seem something you feel is out of your reach: your body will, of course, undergo changes which can make conventional exercise seem daunting. Despite your new capabilities however, engaging in physical activity can actually be a key indicator of your how your overall health and independence is progressing. It can also make you feel happier, stronger, and healthier.
Establishing a fitness routine that fits in with your lifestyle and is tailored to your level of injury can add a whole new dimension to your life after SCI. Before you embark on a new routine, however, it’s essential you understand how to proceed safely, and what you need to do to get the most out of your body.
How your body changes after spinal cord injury
A number of physiological changes occur after a spinal cord injury in a process often referred to as physical deconditioning1. As a result of the injury and reduced mobility, SCI patients can often experience muscle atrophy (wasting of the muscles), spasticity (an abnormal increase in muscle tone), joint contractures (rigid or deformed joints), and reduced bone mineral density2 (less calcium and other minerals in bone causing weaker bones and increased risk of fractures). Physical deconditioning therefore results in reduced muscle and bone strength, and changes in weight and body composition. The changes may also result in discomfort or pain, and further restrict mobility, which is already compromised as a result of your injury.
In parallel with the musculoskeletal changes, spinal cord injury also leads to changes in the cardiovascular system. The structure and function of your heart may be similar to before the injury, but there are significant changes in circulation3, blood pressure, blood clotting, insulin function and cholesterol parameters. People living with spinal cord injury experience the same cardiovascular decline as non-injured people, but at an accelerated rate4. This decline combined with a sedentary lifestyle can lead to cardiovascular disease, diabetes, and obesity5.
Why should I exercise?
Despite physical deconditioning and physiological changes being serious challenges for those living with a spinal injury, they should not be feared. Ironically, these challenges are also the reasons why you should consider returning to exercise. Physical activity results in better muscle and bone strength, increased mobility, and lower risk of cardiovascular disease6. Furthermore, proper physical activity is important in preventing many of the complications which you may experience as a spinal cord injury patient, such as infection, constipation, pressure sores and breathing difficulties7.
As well as the physical benefits of exercise, you may also find your mental health may benefit8. Exercise leads to better self-esteem and confidence, enhanced independence and general wellbeing. It is also known to combat symptoms of depression and anxiety, which you may be experiencing.
Safety and awareness
It is vitally important that you seek medical advice before embarking on an exercise programme. Based on your spinal cord lesion, your overall health and your circumstances, your doctor will advise on what exercise is appropriate for you, and how to assess your body so that your activities are both beneficial and safe. In addition to consulting with your doctor, regular consultations with a physiotherapist experienced in spinal cord injuries are strongly recommended. A physiotherapist will prescribe exercise appropriate for you, assist you in developing fitness goals, and advise on equipment and exercise facilities9.
As an SCI patient it is especially important to monitor your own progress and physiology. This may not only allow you to stay in tune with your body, but also could give a great sense of achievement. Due to reduced sensation and risk of autonomic dysfunction after spinal cord injury, this self-monitoring process becomes all the more important 10. Examine your skin regularly, and avoid friction, pressure and shearing while exercising. Similarly, it is also important to avoid joint strain and overuse injuries, which can last for longer periods of time.
People with spinal cord injury need to pay particular attention to their blood pressure, heart rate, and temperature11. Autonomic dysregulation results in changes in these parameters, and it may be more difficult to perceive exercise intensity. Those with higher injuries above T6 (the sixth thoracic vertebral segment), should take particular care here. Blood pressure is typically low in people with spinal cord injury, and they are vulnerable to sudden drops in blood pressure, particularly when changing position. Your healthcare professional may advise on methods to manage this problem, including the use of compression stockings or medication. It is important to change positions slowly, and to measure blood pressure throughout.
Keeping yourself hydrated is essential to retaining a normal blood pressure as well as thermoregulation, so you should ensure that you are drinking enough fluids. Awareness of the signs and symptoms of autonomic dysreflexia is paramount in preventing and managing this serious medical condition. The risk of autonomic dysreflexia can be reduced by emptying your bladder and bowel before you start with your exercise session.
Listening to your body and responding accordingly is key to ensuring that exercise in spinal cord injury is performed safely. If you experience pain, dizziness, nausea or shortness of breath, you should stop exercising and consult with a healthcare professional.
Establishing a fitness routine
Cardiovascular (aerobic) exercise, muscle strengthening and resistance training, and flexibility exercise are the three important types of physical activity12. The amount, frequency and techniques of these exercises will be explained to you by the physiotherapist. Make your workouts short and frequent, rather than putting your body under strain over long sessions.
Finding the time and motivation to initiate and maintain a fitness routine can be very challenging. Devise a well-structured exercise schedule with your physiotherapist, 13 comprised of varied activities that are suited to your needs and that you enjoy. Build up gradually, track your progress, and work towards realistic goals. Consistency and safety should be viewed as priorities as you improve your health and functional independence through physical activity.
For more help and advice on how to reintroduce exercise back into your life, get in touch with a Bard nurse, who will be more than happy to lend their expertise. Or have a browse through our Learn section for more information and advice.