Summary
The ultimate goal of comprehensive rehabilitation in individuals with spinal cord injury (SCI) has shifted over time from an extension of their life expectancy to attainment of an optimal level of independent living and quality of life. After World War II, the important influence of sport and exercise upon the course of rehabilitation following SCI was recognised. Nonetheless, 5 decades later, there remains a lack of understanding of how an exercise programme can contribute to an improvement of quality of life among individuals with SCI. In future, attention should be directed toward avoidance of secondary impairments, disabilities and handicaps. The World Health Organization model of disablement provides a suitable framework for addressing this issue.
The most common benefits of exercise are biological in nature. They target a reduction in secondary impairments (loss of cardiorespiratory, and muscular function, metabolic alterations and systemic dysfunctions). This in turn could minimise the development of disabilities and the appearance of such handicaps as loss of mobility, physical dependence and poor social integration. A lack of physical fitness for specific tasks can be a serious obstacle to autonomy following SCI. In a very short period of time, physical deconditioning can significantly decrease quality of life in individuals with SCI, ultimately placing them in a state of complete dependency.
Quality of life is closely associated with independent living and, increasingly, it is a key outcome when measuring the success of rehabilitation. Consequently, research designs that examine the impact of exercise upon individuals with disabilities should not only include objective outcome measures, but also subjective measures relating to life-satisfaction and quality of life.
Similar content being viewed by others
References
Bearsted JH. The Edwin Smith Surgical Papyrus. Vol. I. Chicago: University of Chicago, 1930
Brown-Sequard E. Possibility of repair and of return of function after a partial or a complete division of spinal cord in man and animals. Lancet 1859; 1: 96–7
Munro D. Thoracic and lumbarsacral cord injuries. JAMA 1946; 122: 1055–8
Munro D. The rehabilitation of patients totally paralysed below the waist, with special reference to making them ambulatory and capable of earning their own living: an end result of 445 cases. N Engl J Med 1954; 250: 4–14
Guttmann L. The treatment and rehabilitation of patients with injuries of the spinal cord. In: Cope Z, editor. Surgery. London: Her Majesty’s Stationery Office, 1953: 422–516
Davis GM. Exercise capacity of individuals with paraplegia. Med Sci Sports Exerc 1993; 25: 423–32
Dreisinger TE, Londeree BR. Wheelchair exercise: a review. Paraplegia 1982; 20: 20–34
Figoni SF. Exercise responses and quadriplegia. Med Sci Sports Exerc 1993; 25: 433–41
Glaser RM. Exercise and locomotion for the spinal cord injured. Ex Sport Sci Rev 1985; 13: 263–303
Hoffman MD. Cardiorespiratory fitness and training in quadriplegics and paraplegics. Sports Med 1986; 3: 312–30
Shephard RJ. Sports medicine and the wheelchair athlete. Sport Med 1988; 5: 226–47
Guttmann L. The place of our spinal paraplegic fellowman in society. Rehabilitation 1959: 15-27
Gehrig R, Michaelis LS. Statistics of acute paraplegia and tetraplegia on a national scale. Paraplegia 1968; 6: 93
Canadian Paraplegic Association. Paraplegic survey 1967–68. Canadian Paraplegic Association: Toronto, 1968
Lougheed WM, Bertrand G, Hay R. Paraplegic care in Canada, 1969. Mod Med Canada 1970; 25: 17–24
Fine PR, Kuhlemeier KV, De Vivo MJ, et al. Spinal cord injury: an epidemiologic perspective. Paraplegia 1979; 17: 237–50
Treischmann R. Spinal cord injuries: psychological, social and vocational rehabilitation. 2nd ed. New-York: Demos Publications, 1988
Stover SL, Fine PR. The epidemiology and economics of spinal cord injury. Paraplegia 1987; 25: 225–8
Baker F, Intagliata J. Quality of life in the evaluation of community support systems. Eval Program Plann 1982; 5: 69–79
Clayton KS, Chubon AC. Factors associated with the quality of life of long-term spinal cord injured persons. Arch Phys Med Rehabil 1994; 75: 633–8
Fuhrer MJ. Subjective well-being: implications for medical rehabilitation outcomes and models of disablement. Am J Phys Med Rehabil 1994; 73: 358–64
Day H. Quality of life: counterpoint. Can J Rehabil 1993; 6: 135–42
Whiteneck GG. Aging with spinal cord injury. New York: Demos Publishers, 1993
Dunnum L. Life satisfaction and spinal cord injury: the patient perspective. J Neurosci Nurs 1990; 22: 43–7
Fuhrer MJ, Rintala DH, Hart KA, et al. Relationship of life satisfaction to impairment, disability and handicap among persons with spinal cord injury living in the community. Arch Phys Med Rehabil 1992; 73: 552–7
Neives CC, Charter RA, Aspinall MJ. Relationship between effective coping and perceived quality of life in spinal cord injured patients. Rehabil Nurs 1991; 16: 129–32
Flanagan JC. A research approach to improving our quality of life. Am Psychol 1978; 2: 138–47
Whiteneck GG, Charlifue SW, Frankel HL, et al. Mortality, morbidity and psychosocial outcomes of persons spinal cord injured more than 20 years ago. Paraplegia 1992; 30: 617–30
Meenan R, Gertman P, Mason J, et al. The arthritis impact measurement scales: further investigation of a health status instrument. Arthritis Rheum 1982; 25: 1048–53
Roland M, Morris R. A study of the natural history of back pain. 1. Development of a reliable and sensitive measure of disability in low back pain. Spine 1983; 8: 141–4
Wood-Dauphinee S, Kuchler T. Quality of life as a rehabilitation outcome: are we missing the boat? Can J Rehabil 1992; 6: 3–12
DeVivo MJ, Richards JS. Community reintegration and quality of life following spinal cord injury. Paraplegia 1992; 30: 108–12
Eisenberg MG, Saltz CC. Quality of life among aging spinal cord injured persons: long term rehabilitation outcomes. Paraplegia 1991; 29: 514–20
Gerhart HA. Spinal cord injury outcomes in a population-based sample. J Trauma 1991; 31: 1529–35
Evans RL, Hendricks RD, Connis RT, et al. Quality of life after after spinal cord injury: a literature critique and meta-analysis (1983–1992). J Am Paraplegia Soc 1994; 17: 60–6
World Health Organization. International classification of impairments, disabilities and handicap. A manual of classification relating to the consequences of diseases. Geneva: WHO, 1980
Nagi S. Some conceptual issues in disability and rehabilitation. Sociology & rehabilitation. Ohio: Ohio State University Press, 1965
Wan TTH. Correlates and consequences of severe disabilities. J Occup Med 1974; 16: 234–44
Granger CV. A conceptual model for functional assessment. In: Granger CV, Gresham GE, editors. Functional assessment in rehabilitation medicine. Baltimore: Williams & Wilkins, 1984
Huang CT, McEachran AB, Kuhlemeier KV, et al. Prescriptive arm ergometry to optimize muscular endurance in acutely injured paraplegic patients. Arch Phys Med Rehabil 1983; 64: 578–82
Hjeltnes N. Cardiorespiratory capacity in tetra- and paraplegia shortly after injury. Scand J Rehabil Med 1986; 18: 65–70
Ellenberg M, MacRitchie M, Franklin B, et al. Aerobic capacity in early paraplegia: implications for rehabilitation. Paraplegia 1989; 27: 261–8
Morrison SA, Melton SL. Cardiorespiratory responses to exercise testing in acute spinal cord individuals. J Rehabil Res Dev 1994; 30-31: 363
Kofsky PR, Shephard RJ, Davis GM, et al. Fitness classification tables for lower-limb disabled individuals. In: Sherill C, editor. Sport and disabled athletes. Champaign IL.: Human Kinetics, 1986: 147–56
Flandrois R, Grandmontagne M, Guerin H, et al. Aerobic performance capacity in paraplegic subjects. Eur J Appl Physiol 1986; 55: 604–9
Coutts KD, Strogryn JL. Aerobic and anaerobic power of Canadian wheelchair track athletes. Med Sci Sports Exerc 1987; 19: 62–5
Van Loan MD, McCluer S, Loftin JM, et al. Comparison of physiological responses to maximal arm exercise among able-bodied, paraplegics and quadriplegics. Paraplegia 1987; 25: 397–405
Davis GM, Shephard RJ. Cardiorespiratory fitness in highly active versus inactive paraplegics. Med Sci Sports Exerc 1988; 20: 463–8
Hjeltnes N, Jansen T. Physical endurance capacity, functional status and medical complications in spinal cord injured subjects with long-standing lesions. Paraplegia 1990; 28: 428–32
Burkett LN, Chisum J, Stone W, et al. Exercise capacity of untrained spinal cord injured individuals and the relationship of peak oxygen uptake to level of injury. Paraplegia 1990; 28: 512–21
Cooper RA, Horvath SM, Bedi JF, et al. Maximal exercise response of paraplegic wheelchair road racers. Paraplegia 1992; 30: 573–81
Hooker SP, Wells CL. Aerobic power of competitive paraplegic road racers. Paraplegia 1992; 30: 428–36
Bhambhani YN, Holland LJ, Eriksson P, et al. Physiological responses during wheelchair racing in quadriplegics and paraplegics. Paraplegia 1994; 32: 253–60
Janssen TWJ, Van Oers C, Van der Woude LHV, et al. Physical strain in daily life of wheelchair users with spinal cord injuries. Med Sci Sports Exerc 1994; 26: 661–70
Noreau L, Shephard RJ, Simard C, et al. Relationship of impairment and functional ability to habitual activity and fitness following spinal cord injury. Int J Rehabil Res 1993; 16: 265–75
Noreau L, Shephard RJ, Simard C, et al. Cardiorespiratory and muscular fitness in a group of individuals with SCI: a distribution according to the classification of ISMGF [abstract]. J Am Paraplegia Soc 1994; 17: 127
Martel G, Noreau L, Jobin J. Physiological response to maximal exercise on arm cranking and wheelchair ergometer with paraplegics. Paraplegia 1991; 29: 447–56
Shephard RJ. Fitness and aging. In: Biais C, editor. Aging into the twenty first century. Downsview, Canada: Captus University Publications, 1991: 22–35
Bouchard C, Boulay MR, Simoneau JA, et al. Heredity and trainability of aerobic and anaerobic performances: an update. Sports Med 1988; 5: 69–73
Davis G, Plyley MJ, Shephard RJ. Gains of cardiorespiratory fitness with arm-crank training in spinally disabled men. Can J Sport Sci 1991 Mar; 16: 64–72
Hjeltnes N. Control of medical rehabilitation of para and tetraplegics by repeated evaluation of endurance capacity. Int J Sports Med 1984; 5 Suppl.: 171–4
Glaser RM, Davis GM. Wheelchair-Dependent Individuals. In: Franklin B, editor. Exercise and modern medicine. Baltimore: Williams & Wilkins, 1989: 237–67
Davis G, Shephard RJ, Leenen FHH. Cardiac effects of short term arm crank training in paraplegics: echocardiographic evidence. Eur J Apllied Physiol 1987; 56: 90–6
Knutsson E, Lewenhaupt-Olson E, Thorsen M. Physical work capacity and physical conditioning in paraplegics patients. Paraplegia 1973; 11: 202–16
Petrofsky JS, Philip CA. The use of functional electrical stimulation for rehabilitation of spinal cord injured patients. CNS Trauma 1984; 1: 29
Glaser RM. Arm exercise training for wheelchair users. Med Sci Sports Exerc 1989; 21: S149–56
Ragnarsson K, Pollack SF, Twist D. Lower limb endurance exercise after spinal cord injury: implications for health and functional ambulation. J Neuro Rehab 1991; 5: 37–48
Hooker SP, Figoni SF, Glaser RM, et al. Physiologie responses to prolonged electrically stimulated leg-cycle exercise in the spinal cord injured. Arch Phys Med Rehabil 1990; 71: 863–9
Figoni SF, Glaser RM, Rodgers MM. Acute hemodynamic response of spinal cord injured individuals to functional neuromuscular stimulation-induced knee extension exercise. J Rehabil Res Dev 1991; 28: 9–18
Figoni SF. Perspectives on cardiovascular fitness and spinal cord injury. J Am Paraplegia Soc 1990; 13: 63–71
Phillips CA, Danopoulos D, Kezdi P, et al. Muscular respiratory and cardiovascular responses of quadriplegic persons to an F.E.S. bicycle ergometer conditioning program. Int J Rehabil Res 1989; 12: 147–57
Faghri PD, Glaser RM, Figoni SF. Functional electrical stimulation leg cycle ergometer exercise: training effects on cardiorespiratory responses of spinal cord injured subjects at rest and during submaximal exercise. Arch Phys Med Rehabil 1992; 73: 1085–93
Petrofsky JS, Stacy R. The effect of training on endurance and the cardiovascular responses of individuals with paraplegia during dynamic exercise induced by functional electrical stimulation. Eur J Appl Physiol 1992; 64: 487–92
Pollack SF, Axen K, Spielholz N, et al. Aerobic training effect of electrically induced lower extremity exercises in spinal cord injured people. Arch Phys Med Rehabil 1989; 70: 214–9
Davis GM, Servedio FJ, Glaser RM, et al. Cardiovascular responses to arm cranking and FNS-inducted leg exercise in paraplegics. J Appl Physiol 1990 Aug; 69: 671–7
Hooker SP, Figoni SF, Rodgers MM, et al. Metabolic and hemodynamic responses to concurrent voluntary arm crank and electrical stimulation leg cycle exercise in quadriplegics. J Rehabil Res Dev 1992; 29: 1–11
Laskin JJ, Ashley EA, Olenik LM, et al. Electrical stimulationassisted rowing exercise in spinal cord injured people. A pilot study. Paraplegia 1993; 31: 534–41
Sipski ML, Alexander CJ, Harris M. Long-term use of computerized bicycle ergometry for spinal cord injured subjects. Arch Phys Med Rehabil 1993; 74: 238–41
Anke A, Aksnes AK, Stanghelle JK, et al. Lung volumes in tetraplegic patients according to cervical spinal cord injury level. Scand J Rehabil Med 1993; 25: 73–7
Wicks JR, Oldridge NB, Cameron BJ, et al. Arm cranking and wheelchair ergometry in elite spinal cord-injured athletes. Med Sci Sports Exerc 1983; 15: 224–31
Gass GC, Watson J, Camp EM. The effects of physical training on high level spinal cord patient. Scand J Rehabil Med 1980; 12: 61–5
Miles DS, Sawka MN, Wilde SW, et al. Pulmonary function changes in wheelchair athletes subsequent to exercise training. Ergonomics 1982; 25: 239–46
Taylor AW, McDonell E, Brassard L. The effects of an arm ergometer training programme on wheelchair subjects. Paraplegia 1986; 24: 105–14
Walker J, Cooney M, Norton S. Improved pulmonary function in chronic quadriplegics after pulmonary therapy and arm ergometry. Paraplegia 1989; 27: 278–83
Rhodes EC, McKenzie DC, Coutts KD, et al. A field test for the prediction of aerobic capacity in male paraplegics and quadriplegics. Can J Appl Sport Sci 1981; 6: 182–6
Gass GC, Camp HA, Eager DD, et al. The effects of prolonged exercise on spinally injured subjects. Med Sci Sports Exerc 1981; 13: 277–83
Coutts KD, Rhodes EC, McKenzie DC. Maximal exercise responses of tetraplegics and paraplegics. J Appl Physiol: Respirat Environ Exerc Physiol 1983; 55: 479–82
Bergh U, Kanstrup IL, Ekblom B. Maximal oxygen uptake during exercise with various combinations of arm and leg work. J Appl Physiol 1976; 41: 191–6
Jackson AB, Groomes TE. Incidence of respiratory complications following spinal cord injury. Arch Phys Med Rehabil 1994; 75: 270–5
Calmels P, Berthouze S, Barra FG, et al. A comparative study of the muscle strength and mass of the arm flexors and extensors in paraplegic and in non paraplegic basketball players. Paraplegia 1992; 30: 509–16
Grimby G. Aerobic capacity, muscle strength and fiber composition in young paraplegics. In: Natvig H, editor. First International Medical Congress on Sports for the Disabled. Royal Ministry for Church and Education. 1980: Oslo
Taylor AW, McDonell E, Royer D, et al. Skeletal muscle analysis of wheelchair athletes. Paraplegia 1979; 17: 456–60
Tesch PA, Karlsson J. Muscle fiber type characteristics of M deltoideus in wheelchair athletes: comparison with other trained athletes. Am J Phys Med 1983; 62: 239–43
Nakamura Y. Working ability of the paraplegics. Paraplegia 1973; 11: 182–93
Davis GM, Tupling SJ, Shephard RJ. Dynamic strength and physical activity in wheelchair users. In: Sherrill C, editor. Proceedings of the 1984 Olympic Scientific Congress: Sport for the Disabled; 1984 Aug: Eugene (Or). Champaign IL: Human Kinetics Publishers, 1986: 139–46
Kofsky PR, Davis GM, Shephard RJ, et al. Field testing: assessment of physical fitness of disabled adults. Eur J Appl Physiol 1983; 51: 109–20
Cameron BJ, Ward GR, Wicks JR. Relationship of type of training to maximum oxygen uptake and upper limb strength in male paraplegic athletes. Med Sci Sports Exerc 1978; 9: 58
Nilsson S, Staff PH, Pruett ED. Physical work capacity and the effect of training on subjects with long-standing paraplegia. Scand J Rehabil Med 1975; 7: 51–6
Davis GM, Shephard RJ. Strength training for wheelchair users. Br J Sport Med 1990; 24: 25–30
Gordon T, Mao J. Muscle atrophy and procedures for training after spinal cord injury. Phys Ther 1994; 74: 50–60
Kralj A, Bajd T. Functional electrical stimulation: standing and walking after spinal cord injury. Boca Raton, Fl.: CRC Press, 1989
Ragnarsson KT, Pollack S, O’Daniel W, et al. Clinical evaluation of computerized functional electrical stimulation after spinal cord injury: a muticenter pilot study. Arch Phys Med Rehabil 1988; 69: 672–7
Rodgers MM, Glaser RM, Figoni SF, et al. Musculoskeletal responses of spinal cord injured individuals to functional neuromuscular stimulation-induced knee extension exercise training. J Rehabil Res Dev 1991; 28: 19–26
Cox SA, Weiss SM, Posuniak EA, et al. Energy expenditure after spinal cord injury: an evaluation of stable rehabilitating patients. J Trauma 1985; 25: 419–23
Huang CT, Kuhlemeier KV, Moore NB, et al. Energy cost of ambulation in paraplegic patients using Craig-Scott Braces. Arch Phys Med Rehabil 1979; 60: 595–600
Clarke KS. Caloric costs of activity in paraplegic persons. Arch Phys Med Rehabil 1966; 47: 427–35
Mollinger LA, Spurr GB, ElGhatit AZ, et al. Daily energy expenditure and basal metabolic rate of patients with spinal cord injuries. Arch Phys Med Rehabil 1985; 66: 420–6
Yamasaki M, Irizawa M, Komura T, et al. Daily energy expenditure in active and inactive persons with spinal cord injury. J Hum Ergol 1992; 21: 125–33
Geisler WO, Jousse AT, Wynne-Jones M. Survival in traumatic transverse myelitis. Paraplegia 1977; 14: 262–75
Geisler WO, Jousse AT, Wynne-Jones M, et al. Survival in traumatic spinal cord injury. Paraplegia 1983; 21: 364–73
Le CT, Price M. Survival from spinal cord injury. J Chronic Dis 1982; 35: 487–92
Cardus D, Ribas-Cardus F, McTaggart WG. Coronary risk in spinal cord injury: assessment following a multivariate approach. Arch Phys Med Rehabil 1992; 73: 930–3
Janssen TWJ. Physical strain and physical capacity in men with spinal cord injuries [dissertation]. Amsterdam: Vrije University, 1994
Krum H, Howes LG, Brown DJ, et al. Risk factors for cardiovascular disease in chronic spinal cord injury patients. Paraplegia 1992; 30: 381–8
Walker J, Shephard RJ. Cardiac risk factors imediately following spinal injury. Arch Phys Med Rehabil 1993; 74: 1129–33
Bauman WA, Spungen AM, Zhong YG, et al. Depressed serum high density lipoprotein cholesterol levels in veterans with spinal cord injury. Paraplegia 1992; 30: 697–703
Bauman WA, Spungen AM, Raza M, et al. Coronary artery disease: metabolic risk factors and latent disease in individuals with paraplegia. Mt Sinai J Med 1992 2; 59: 163–8
Cardus D, Ribas-Cardus F, McTaggart WG. Lipid profiles in spinal cord injury. Paraplegia 1992; 30: 775–82
Shetty KR, Sutton CH, Rudman IW, et al. Lipid and lipoprotein abnormalities in young quadriplegic men. Am J Med Sci 1992; 303: 213–6
Zlotolow SP, Levy E, Bauman WA. The serum lipoprotein profile in veterans with paraplegia: the relationship to nutritional factors and body mass index. J Am Paraplegia Soc 1992; 15: 158–62
Bostom AG, Toner MM, McArdle WD, et al. Lipid and lipoprotein profiles relate to peak aerobic power in spinal cord injured men. Med Sci Sports Exerc 1991; 23: 409–11
Brenes G, Dearwater S, Shapera R, et al. High density lipoprotein cholesterol concentrations in physically active and sedentary spinal cord injured patients. Arch Phys Med Rehabil 1986; 67: 445–50
Dearwater SR, Laporte RE, Robertson RJ, et al. Activity in the spinal cord injured patient: an epidemiologic analysis of metabolic parameters. Med Sci Sports Exerc 1986; 18: 541–4
Hooker SP, Wells CL. Effects of low- and moderate-intensity training in spinal cord-injured persons. Med Sci Sports Exerc 1989; 21: 18–22
Leblanc J, Nadeau A, Boulay M, et al. Effects of physical training and adiposity on glucose metabolism and 125I-insulin binding. J Appl Physiol 1979; 46: 235–9
Leblanc J, Nadeau A, Richard D, et al. Studies on the sparing effect of exercise on insulin requirements in human subjects. Metabolism 1981; 30: 1119–24
Leon AS, Conrad J, Hunninghake DB. Effect of a vigorous walking program on body composition and carbohydrate and lipid metabolism of obese young men. Am J Clin Nutr 1979; 32: 1776–87
McLean KP. Training-induced changes in glucose regulation during prolonged exercise in persons with quadriplegia [dissertation]. Tempe, AZ: Arizona State University, 1992
Bloomfield SA, Jackson RD, Mysiw WJ. Catecholamine response to exercise and training in individuals with spinal cord injury. Med Sci Sports Exerc 1994; 26: 1213–9
Stotts KM. Health maintenance: paraplegic athletes and non-athletes. Arch Phys Med Rehabil 1986; 67: 109–14
Curtis KA, McClanahan S, Hall KM, et al. Health, vocational and functional status in spinal cord injured athletes and non-athletes. Arch Phys Med Rehabil 1986; 67: 862–5
Van der Woude LHV, De Groot G, Hollander AP, et al. Wheelchair ergonomics and physiological testing of prototypes. Ergonomics 1986; 29: 1561–73
Van der Woude LHV, Veeger HEJ, Rozendal RH. Wheelchair racing: effect of rim diameter and speed on physiology and technique. Med Sci Sports Exerc 1988; 20: 492–500
Hildebrandt G, Voight E, Bahn D, et al. Energy cost of propelling a wheelchair at various speed: cardiac responses and effect of steering accuracy. Arch Phys Med Rehabil 1970; 51: 131–6
Voight ED, Bahn D. Metabolism and pulse rate in physically handicapped when propelling a wheelchair up an incline. Scand J Rehabil Med 1969; 1: 101–6
Chantraine A, Crielaard JM, Onkelinx A, et al. Energy expenditure of ambulation in paraplegics: effects of long term use of bracing. Paraplegia 1984; 22: 173–81
Waters RL, Yakura JS, Adkins R, et al. Determinants of gait performance following spinal cord injury. Arch Phys Med Rehabil 1989; 70: 663–7
Merkel K, Miller NE, Merritt JL. Energy expenditure in patients with low-, mid-, or high thoracic paraplegia using Scott-Craig knee-anke-foot orthoses. Proc Mayo Clin 1985; 60: 165–8
Do MC, Bouisset C, Moynot C. Are paraplegics handicapped in the execution of a manual task. Ergonomics 1985; 28: 1363–75
Hjeltnes N, Vokac Z. Circulatory strain in everyday life of paraplegics. Scand J Rehabil Med 1979; 11: 67–73
Janssen TW, Van Oers C, Van der Woude LHV, et al. Relationship between physical capacity and physical strain during standardized ADL tasks in men with spinal cord injuries. Paraplegia 1994; 32: 844–59
Bracken MB, Shepard MJ, Webb SB. Psychological response to acute spinal cord injury: an epidemiological study. Paraplegia 1981; 19: 271–83
Cook DW. Psychological adjustment to spinal cord injury: incidence of denial, depression and anxiety. Rehabil Psychol 1979; 26: 97–104
Howell T, Fullerton D, Harvey R, et al. Depression in spinal cord injury patients. Paraplegia 1981; 19: 284–8
Rosenthiel AK, Roth S. Relationship between cognitive activity and adjustment in four spinal cord injured individuals: a longitudinal investigation. J Hum Stress 1981; 7: 35–43
Siller J. Psychological situation of the disabled with spinal cord injuries. Rehabil Lit 1969; 30: 290–6
Petruzzello SJ, Landers DM, Hatfield BD, et al. Ameta-analysis on the anxiety-reducing effects of acute and chronic exercise: outcome and mechanisms. Sports Med 1991; 11: 143–82
Williford Hn, Shralf-Olson M, Blessing DL. The physiological effects of aerobic dance: a review. Sport Med 1989; 8: 335–45
North TC, McCullagh P, Tran ZV. Effect of exercise on depression. Exerc Sport Sci Rev 1990: 379-415
Henschen K, Horvat M, French R. A visual comparison of psychological profiles between able-bodied and wheelchair athletes. Adapt Phys Activity Q 1984; 1: 188–24
Horvat M, French R, Henschen K. A comparison of the psychological characteristics of male and female able-bodied and wheelchair athletes. Paraplegia 1986; 24: 115–22
Jacobs DP, Roswal GM, Horvat MA, et al. A comparison between the psychological profiles of wheelchair athletes, wheelchair non-athletes and able-bodied athletes. In: Doll-Tepper G, Dams C, Doll B, et al., editors. Adapted physical activity: an interdisciplinary approach. Berlin: Springer Verlag, 1990
Goldberg G, Shephard RJ. Personality profiles of disabled individuals in relation to physical activity patterns. J Sports Med 1982; 22: 477–84
Jackson RW. Sport for the spinal paralysed person. Paraplegia 1987; 25: 301–4
Whiteneck GG, Charlifue SW, Gerhart KA, et al. Quantifying handicap: a new measure of long-term rehabilitation outcomes. Arch Phys Med Rehabil 1992; 73: 519–26
DeJong G, Hughes J. Independent living: methodology for measuring long-term outcomes. Arch Phys Med Rehabil 1982; 63: 68–73
DeJong G, Branch LG, Corcoran PJ. Independent living outcomes on spinal cord injury: multivariate analyses. Arch Phys Med Rehabil 1984; 65: 66–73
Wolfensberger W, Thomas S. PASSING: program analysis of service system’s implementation of normalization goals. Normalization criteria and ratings manual. Toronto: National Institute of Mental Retardation, 1983
Wolfensberger W, Glenn L. Programme d’analyse des systèmes de services (PASS 3): Méthode d’évaluation quantitative des services humains (version européenne). Agen, France. Comité Européen pour le Développement de l’Intégration Sociale, 1989
Shephard RJ. Benefits of sport and physical activity for the disabled: Implications for the individual and for society. Scand J Rehabil Med 1991; 23: 51–9
Noreau L, Shephard RJ. Return to work after spinal cord injury: the potential contribution of physical fitness. Paraplegia 1992; 30: 563–72
Kofsky PR, Shephard RJ. Factors influencing fitness and the adjustment of disabled individuals. Ottawa: Health & Welfare Canada, 1985. Report No.: Grant 6605-1915-46
Noreau L, Shephard RJ. Physical fitness and productive activity of paraplegics. Sports Med Training Rehabil 1992; 3: 165–81
Goldberg RT, Freed MM. Vocational ajustment, interests, work values and career plans of persons with spinal cord injuries. Scand J Rehabil Med 1973; 5: 3–11
Reynolds GG. Becoming successful health care consumers. In: Whiteneck GG, editor. Aging with spinal cord injury. New York: Demos Publishers, 1993: 229–38
Whiteneck GG, Menter RR. Where do we go from here? In: Whiteneck GG, editor. Aging with spinal cord injury. New York: Demos Publishers, 1993: 361–9
Botvin-Madorsky JG, Madorsky AG. Scuba diving: taking the wheelchair out of wheelchair sports. Arch Phys Med Rehabil 1988; 69: 215–8
Botvin-Madorsky JG, Kiley DP. Wheelchair mountaineering. Arch Phys Med Rehabil 1984; 65: 490–2
Pandavela J, Gordon S, Gordon G, et al. Martial arts for the quadriplegic. Am J Phys Med 1986; 65: 17–29
Kegel B. Physical fitness. Sports and recreation for those with lower limb amputation or impairment. J Rehabil Res Dev (VA) 1985 Jan 1; 1: 1–125
Whiteneck GG. Measuring what matters: key rehabilitation outcomes. Arch Phys Med Rehabil 1994; 75: 1073–6
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Noreau, L., Shephard, R.J. Spinal Cord Injury, Exercise and Quality of Life. Sports Med. 20, 226–250 (1995). https://doi.org/10.2165/00007256-199520040-00003
Published:
Issue Date:
DOI: https://doi.org/10.2165/00007256-199520040-00003