Spinal cord injury and exercise

Staff at Loughborough University have played a key role in the development of international scientific guidelines to inform people with spinal cord injury (SCI) how much exercise is necessary for important fitness and health benefits.

Over recent years, physical activity guidelines have been developed to enable people to maintain or enhance performance, fitness and health. Produced by national and international agencies - such as the World Health Organization (WHO), these age- and ability-specific guidelines aim to reduce morbidity or mortality rates in the general population.

However, these guidelines had never been specifically tailored for people with spinal chord injury (SCI), and did not consider their exercise capacity, specific health risks or limitations. Neither did they consider the benefits, risks, values, and preferences of the SCI population.

When evidence-based, SCI-specific physical activity guidelines were produced and proven to be efficacious for improving fitness in adults with SCI, these guidelines did not specifically address cardiometabolic health - a leading cause of death in adults with SCI.

As a healthcare professional working in the rehabilitation of newly injured individuals with spinal cord injury, it is important that clear principles and guidance is imparted from the start, to both promote positive behaviours and prevent avoidable complications following injury.

Dot Tussler, Head Physiotherapist Spinal Injuries National Spinal Injuries Centre Stoke Mandeville Hospital

Research in focus

Evidence-based scientific exercise guidelines for adults with spinal cord injury

To address this gap, in 2018 an international group of researchers, clinicians, community organisations and people with spinal cord injury (SCI), developed scientific guidelines to inform people with SCI how much exercise is necessary for important fitness and health benefits.

This process was led by Loughborough University's Professor Vicky Tolfrey and Professor Kathleen Martin Ginis from the University of British Columbia, Canada.

Prof Tolfrey explained: "We have tried to explore and use the evidence to try and underpin a document that is looking at the exercise guidelines for perscription of exercise for persons with a spinal cord injury. There are two components to the guidelines. We have broken it down to fitness, as one of the key aspects, and cardiometabolic factors as the second."

For more information, please read the guidance in full

  • Hutchinson MJ, Goosey-Tolfrey VL. (2021). Rethinking aerobic exercise intensity prescription in adults with spinal cord injury: time to end the use of “moderate to vigorous” intensity? Spinal Cord. DOI: 10.1038/s41393-021-00733-2  

Translation into other languages 

Following the development of the international spinal cord injury (SCI) exercise guidelines in October 2017, it was acknowledged that the guidelines needed to be tailored to the language, research, needs and preferences of adults with SCI and SCI clinicians in Asian countries.

To address this need, in 2019, Dr Kyungsu Jung and leading medical doctor (Prof Fumihiro Tajima), from Wakayama Medical School approached Dr Jan van der Scheer to apply for a Kyoten Grant. Their collective vision was to include key members of the International SCI Exercise Guidelines Project (Dr Jan van der Scheer, Prof Kathleen Martin Ginis and Prof Vicky Goosey-Tolfrey), and to work collaboratively with Asian rehabilitation medical staff to translate and begin to understand the landscape to developing clinical practice guidelines for adults with a SCI for use in Asia.

The main purpose of this project was to verify the applicability of the International SCI Exercise Guidelines for Asian countries by reviewing the combined SCI exercise intervention literature from Japanese, Korean, Indonesian and Thai scientific journals.

Download the guidelines in Japanese, Korean, Indonesian and Thai here.

Related research

  • Martin Ginis KA, van der Scheer JW, Latimer-Cheung AE, Barrow A, Bourne C, Carruthers P, Bernardi M, Ditor DS, Gaudet S, de Groot S, Hayes KC, Hicks AL, Leicht CA, Lexell J, Macaluso S, Manns PJ, McBride CB, Noonan VK, Pomerleau P, Rimmer JH, Shaw RB, Smith B, Smith KM, Steeves JD, Tussler D, West CR, Wolfe DL, Goosey-Tolfrey VL. (2018). Evidence-based scientific exercise guidelines for adults with spinal cord injury: an update and a new guideline. Spinal Cord 56, 308–321 (2018). DOI: 10.1038/s41393-017-0017-3
  • van der Scheer JW, Martin Ginis KA, Ditor DS, Goosey-Tolfrey VL, Hicks AL, West CR, Wolfe DL. (2017). Effects of exercise on fitness and health of adults with spinal cord injury: A systematic review. Neurology. 2017 Aug 15;89(7):736-745. DOI: 10.1212/WNL.0000000000004224
  • Hutchinson MJ, MacDonald MJ, Eston R, Goosey-Tolfrey VL. (2018). Peak oxygen uptake measured during a perceptually-regulated exercise test is reliable in community-based manual wheelchair users. Journal of Sports Sciences, Volume 37, 2019 - Issue 6. DOI: 10.1080/02640414.2018.1522941
  • Hutchinson MJ, Kouwijzer I, de Groot S, Goosey-Tolfrey VL. (2021). Comparison of two Borg exertion scales for monitoring exercise intensity in able-bodied participants, and those with paraplegia and tetraplegia. Spinal Cord, 59, 1162-1169. DOI: 10.1038/s41393-021-00642-4
  • van der Scheer JW, Hutchinson MJ, Paulson T, Martin Ginis KA, Goosey-Tolfrey VL. (2018). Reliability and Validity of Subjective Measures of Aerobic Intensity in Adults With Spinal Cord Injury: A Systematic Review. PM R. 2018 Feb;10(2):194-207. DOI: 10.1016/j.pmrj.2017.08.440

Meet the experts

Prof Vicky Tolfrey

Professor Vicky Tolfrey

Professor of Applied Disability Sport