Health Implications of Physical Activity in Individuals with Spinal Cord Injury: A Literature Review

By Fernhall, Bo; Heffernan, Kevin et al. | Journal of Health and Human Services Administration, Spring 2008 | Go to article overview

Health Implications of Physical Activity in Individuals with Spinal Cord Injury: A Literature Review


Fernhall, Bo, Heffernan, Kevin, Jae, Sae Young, Hedrick, Brad, Journal of Health and Human Services Administration


ABSTRACT

Physical activity has demonstrated beneficial effects on health and longevity in the general population, and physically active individuals are at lower risk for many chronic diseases compared to their sedentary peers. Individuals with disabilities in general are less active than individuals without disabilities, but it is still unknown if physical activity confers the same level of risk reduction in populations with as without disabilities. Individuals with spinal cord injury (SCI) have among the lowest levels of physical activity participation compared to other populations. They also demonstrate early onset of cardiovascular disease and other chronic diseases. This literature review discusses evidence for the potential benefits of physical activity in persons with SCI and provides a summary of pertinent studies to date. Although being physically active and physically fit appears to be associated with several health benefits in persons with SCI, most studies are small and little longitudinal evidence exists. Future studies will be needed to address this need.

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Spinal cord injury or disease includes a set of conditions that reflect a broad constellation of altered physiology, secondary medical complications and changed social roles, all of which influence activity participation (Weaver, Hammond, Guihan, & Hendricks, 2000). Estimates of national prevalence of SCI range from 250,000 to 400,000 individuals in the U.S. (National Spinal Cord Injury Statistical Center, 2001). Approximately 22% of these individuals are U.S. military veterans, of whom more than 40% were injured in military service (Berkowitz, Harvey, Green & Wilson, 1992; DeVivo, Black & Stover, 1993; DeVivo, Richards, & Go, 1991; Stover & Fine, 1987). Life expectancy of persons with SCI has improved dramatically, from 20-33 years in 1987 to 55-65 years in 1995 (when injury occurs at age 20) (DeVivo, et al., 1991; Frankel et al., 1998; Lasfargues, Custis, Morrone, Carswell, & Nguyen, 1995; Stover & Fine, 1987). Individuals most likely to incur SCI are between 16-30 years of age (NSCIA, 2004) and thus have many potentially productive work force years ahead of them.

Treatment costs for individuals with SCI are very high, but go beyond just the actual dollar amounts of the injury because the social cost of SCI is also very high. Average treatment costs for the first year after injury was reported in 1995 to be as high as $300,000/injury (DeVivo, 1997). Recurring treatment charges ranged from $17,275 to $33,439 annually, with a lifetime treatment cost of $969,659. In the U.S., total direct treatment costs for individuals with SCI nationwide were reported to exceed seven billion dollars in 1995 (Botel, Glaser, Niedeggen & Meindl, 1997; Burnett, Cifu, Kolakowsky-Hayner, & Kreutzer, 2001; Cifu, Seel, Kreutzer & McKinley, 1999; DeVivo, 1997; Fiedler, Prakash, Maiman & Apple, 1999; Harvey, Wilson, Greene, Berkowitz & Stripling, 1992; Johnson, Brooks & Whiteneck, 1996; Stover & Fine, 1987). Adding to these costs are social costs such as social isolation, decreased functional ability and independence, vocational limitations, and decreased quality of life. Consequently, identifying factors that contribute to improvements in health indices, improved functional ability, improved quality of life and decreased impact of common co-morbidities is a high priority for individuals with SCI.

PHYSICAL ACTIVITY AND HEALTH--GENERAL OVERVIEW

Regular physical activity is related to both health and longevity (Paffenbarger, 1978; Williams, 2001). Compared to sedentary individuals, physically active individuals are at approximately half the risk of early mortality (Thompson et al, 2003). Regular physical activity can significantly reduce the risk of coronary heart disease, colon cancer, diabetes and high blood pressure. Furthermore, regular physical activity helps to: 1) control weight; 2) contribute to healthy bones, muscles, and joints; 3) reduce falls among the elderly; 4) reduce the pain of arthritis; 5) reduce symptoms of anxiety and depression; 6) reduce the need for medication; 7) reduce hospitalizations and physician visits (Surgeon General, 1999). …

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