Physical Activity and Spinal Cord Injury: Lessons Learned at the Lowest End of the Physical Activity Spectrum

in Kinesiology Review
Restricted access

Purchase article

USD  $24.95

Student 1 year subscription

USD  $41.00

1 year subscription

USD  $54.00

Student 2 year subscription

USD  $77.00

2 year subscription

USD  $101.00

Given profound physical, psychosocial, and environmental barriers to physical activity (PA), people living with spinal cord injury (SCI) are less active than virtually every other segment of the population. Nevertheless, people with SCI are not universally “sedentary.” Many people with SCI live physically active lives, and behavioral interventions have proven effective at increasing and maintaining both PA and fitness. This paper discusses PA and inactivity in the SCI population and reviews the who, what, and how of effective SCI PA-enhancing interventions. The authors conclude with 3 recommendations for increasing PA in other low-active populations: Know your audience and the issues, develop audience-specific messages and tailored interventions, and use behavior-change theory to develop messages and interventions.

The authors are with the School of Health and Exercise Sciences, University of British Columbia, Kelowna, Canada, and the International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada. Martin Ginis is also with the Dept. of Medicine, University of British Columbia, Kelowna, and holds the Reichwald Family UBC Southern Medical Program Chair in Preventive Medicine.

Todd (ktodd03@mail.ubc.ca) is corresponding author.
  • Arbour-Nicitopoulos, K.P., Martin Ginis, K.A., & Latimer, AE. (2009). Planning, leisure-time physical activity, and coping self-efficacy in persons with spinal cord injury: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 90, 2003–2011. PubMed ID: 19969161 doi:10.1016/j.apmr.2009.06.019

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Buchholz, A.C., McGillivray, C.F., & Pencharz, P.B. (2003). Differences in resting metabolic rate between paraplegic and able-bodied subjects are explained by differences in body composition. Journal of Clinical Nutrition, 77, 371–378. doi:10.1093/ajcn/77.2.371

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Burke, S.M., Tomasone, J.R., Scime, N.V., Ma, J.K., Harden, S.M., Wolfe, D.L., & SCIRE Research Team. (2018). Physical activity self-management interventions for adults with spinal cord injury: Part 2—Exploring the generalizability of findings from research to practice. Psychology of Sport and Exercise, 37, 286–295. doi:10.1016/j.psychsport.2018.02.013

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Campbell, M., Fitzpatrick, R., Haines, A., Kinmonth, A.L., Sandercock, P., Spiegelhalter, D., & Tyrer, P. (2000). Framework for design and evaluation of complex interventions to improve health. British Medical Journal, 321, 694–696. PubMed ID: 10987780 doi:10.1136/bmj.321.7262.694

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Claydon, V.E., Steeves, J.D., & Krassioukov, A. (2006). Orthostatic hypotension following spinal cord injury: Understanding clinical pathophysiology. Spinal Cord, 44, 341–351. PubMed ID: 16304564 doi:10.1038/sj.sc.3101855

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Fenuta, A.M., & Hicks, A.L. (2014). Metabolic demand and muscle activation during different forms of bodyweight supported locomotion in men with incomplete SCI. BioMed Research International, 2014, 1–10. PubMed ID: 24971340 doi:10.1155/2014/632765

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gainforth, H.L., Latimer-Cheung, A.E., Davis, C., Casemore, S., & Martin Ginis, K.A. (2015). Testing the feasibility of training peers with a spinal cord injury to learn and implement brief action planning to promote physical activity to people with spinal cord injury. Journal of Spinal Cord Medicine, 38, 515–525. PubMed ID: 25429692 doi:10.1179/2045772314Y.0000000239

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Garriguet, D., & Colley, R.C. (2014). A comparison of self-reported leisure-time physical activity and measured moderate-to-vigorous physical activity in adolescents and adults. Health Reports, 25, 3–11. PubMed ID: 25029491

    • Search Google Scholar
    • Export Citation
  • Griggs, K.E., Leicht, C.A., Price, M.J., & Goosey-Tolfrey, V.L. (2015). Thermoregulation during intermittent exercise in athletes with a spinal-cord injury. International Journal of Sports Physiology and Performance, 10, 469–475. PubMed ID: 25365654 doi:10.1123/ijspp.2014-0361

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hayes, E., & Balcazar, F. (2008). Peer-mentoring and disability: Current applications and future directions. In T. Kroll (Ed.), Focus on disability: Trends in research and application (pp. 89–108). New York, NY: Nova Science.

    • Search Google Scholar
    • Export Citation
  • Holmlund, T., Ekblom-Bak, E., Franzén, E., Hultling, C., & Wahman, K. (2018). Energy expenditure after spinal cord injury in people with motor-complete tetraplegia or motor-complete paraplegia. Spinal Cord, 56, 274–283. PubMed ID: 29238094 doi:10.1038/s41393-017-0024-4

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Jette, M., Sidney, K., & Blümchen, G. (1990). Metabolic equivalents (METs) in exercise testing, exercise prescription, and evaluation of functional capacity. Clinical Cardiology, 13, 555–565. PubMed ID: 2204507 doi:10.1002/clc.4960130809

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kang, Y., Ding, H., Zhou, H., Wei, Z., Liu, L., Pan, D., & Feng, S. (2017). Epidemiology of worldwide spinal cord injury: A literature review. Journal of Neurorestoratology, 6, 1–9. doi:10.2147/JN.S143236

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Krassioukov, A.V., Karlsson, A.K., Wecht, J.M., Wuermser, L.A., Mathias, C.J., & Marino, R.J. (2007). Assessment of autonomic dysfunction following spinal cord injury: Rationale for additions to international standards for neurological assessment. Journal of Rehabilitation Research & Development, 44, 103–112. PubMed ID: 17551864 doi:10.1682/JRRD.2005.10.0159

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Latimer, A.E., Martin Ginis, K.A., & Arbour Nicitopolous, K.P. (2006). The efficacy of an implementation intention intervention for promoting physical activity among individuals with spinal cord injury: A randomized controlled trial. Rehabilitation Psychology, 51, 273–280. doi:10.1037/0090-5550.51.4.273

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Latimer-Cheung, A.E., Arbour-Nicitopoulos, K.P., Brawley, L.R., Gray, C., Wilson, J.A., Prapavessis, H., . . . Martin Ginis, K.A. (2013). Developing physical activity interventions for adults with spinal cord injury. Part 2: Motivational counseling and peer-mediated interventions for people intending to be active. Rehabilitation Psychology, 58, 307–315. PubMed ID: 23978086 doi:10.1037/a0032816

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lee, M., Zhu, W., Hedrick, B., & Fernhall, B. (2010). Determining metabolic equivalent values of physical activities for persons with paraplegia. Disability and Rehabilitation, 32, 336–343. PubMed ID: 20055572 doi:10.3109/09638280903114402

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Letts, L., Martin Ginis, K.A., Faulkner, G., Colquhoun, H., Levac, D., & Gorczynski, P. (2011). Preferred methods and messengers for delivering physical activity information to people with spinal cord injury: A focus group study. Rehabilitation Psychology, 56, 128–137. PubMed ID: 21574732 doi:10.1037/a0023624

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lynch, M., McCormick, Z., Liem, B., Jacobs, G., Hwang, P., Hornby, T., . . . Roth, E. (2015). Energy cost of lower body dressing, pop-over transfers, and manual wheelchair propulsion in people with paraplegia due to motor-complete spinal cord injury. Topics in Spinal Cord Injury Rehabilitation, 21, 140–148. PubMed ID: 26364283 doi:10.1310/sci2102-140

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Ma, J.K., Cheifetz, O., Todd, K.R., Chebaro, C., Phang, S.H., Shaw, R.B., . . . Martin Ginis, K.A. (2018). Combining an integrated knowledge translation approach and behavior change theory to develop a physiotherapist-delivered physical activity intervention for adults with spinal cord injury. Manuscript under review.

    • Search Google Scholar
    • Export Citation
  • Ma, J.K., & Martin Ginis, K.A. (2018). A meta-analysis of physical activity interventions in people with physical disabilities: Content, characteristics, and effects on behaviour. Psychology of Sport and Exercise, 37, 262–273. doi:10.1016/j.psychsport.2018.01.006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Ma, J.K., West, C., & Martin Ginis, K.A. (2018). Use of education, referral, and prescription to increase physical activity, psychosocial predictors, and fitness in individuals with spinal cord injury: A randomized controlled trial. Manuscript submitted for publication.

    • Search Google Scholar
    • Export Citation
  • Martin Ginis, K.A. (2012). Takin’ it to the streets: A community–university partnership approach to physical activity research and knowledge translation. Kinesiology Review, 1, 190–196. doi:10.1123/krj.1.4.190

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Martin Ginis, K.A., Latimer, A.E., Arbour-Nicitopoulos, K.P., Buchholz, A.C., Bray, S.R., Craven, B.C., . . . Smith, K. (2010). Leisure time physical activity in a population-based sample of people with spinal cord injury Part I: Demographic and injury-related correlates. Archives of Physical Medicine and Rehabilitation, 91, 722–728. doi:10.1016/j.apmr.2009.12.027

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Martin Ginis, K.A., Latimer, A.E., Buchholz, A.C., Bray, S.R., Craven, B.C., Hayes, K.C., . . . Wolfe, D.L. (2008). Establishing evidence-based physical activity guidelines: Methods for the Study of Health and Activity in People With Spinal Cord Injury (SHAPE SCI). Spinal Cord, 46, 216–221. PubMed ID: 17646838 doi:10.1038/sj.sc.3102103

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Martin Ginis, K.A., Latimer, A.E., Hicks, A.L., & Craven, B.C. (2005). Development and evaluation of an activity measure for people with spinal cord injury. Medicine and Science in Sports and Exercise, 37, 1099–1111. doi:10.1249/01.mss.0000170127.54394.eb

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Martin Ginis, K.A., Ma, J.K., Latimer-Cheung, A.E., & Rimmer, J.H. (2016). A systematic review of review articles addressing factors related to physical activity participation among children and adults with physical disabilities. Health Psychology Review, 10, 478–494. PubMed ID: 27265062 doi:10.1080/17437199.2016.1198240

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Martin Ginis, K.A., Nigg, C.R., & Smith, A.L. (2013). Peer-delivered physical activity interventions: An overlooked opportunity for physical activity promotion. Translational Behavioral Medicine, 3, 434–443. doi:10.1007/s13142-013-0215-2

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Martin Ginis, K.A., van der Scheer, J.W., Latimer-Cheung, A.E., Barrow, A., Bourne, C., Carruthers, P., . . . Goosey-Tolfrey, V.L. (2018). Evidence-based scientific exercise guidelines for adults with spinal cord injury: An update and a new guideline. Spinal Cord, 56, 308–321. PubMed ID: 29070812 doi:10.1038/s41393-017-0017-3

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Michie, S., Atkins, L., & West, R. (2014). The behaviour change wheel: A guide to designing interventions. London, UK: Silverback.

  • Nas, K., Yazmalar, L., Şah, V., Aydın, A., & Öneş, K. (2015). Rehabilitation of spinal cord injuries. World Journal of Orthopedics, 6(1), 8. PubMed ID: 25621206 doi:10.5312/wjo.v6.i1.8

    • Crossref
    • Search Google Scholar
    • Export Citation
  • National Spinal Cord Injury Statistical Center. (2016). Spinal cord injury (SCI) facts and figures at a glance. Birmingham: University of Alabama at Birmingham.

    • Search Google Scholar
    • Export Citation
  • Noonan, V.K., Fingas, M., Farry, A., Baxter, D., Singh, A., Fehlings, M.G., & Dvorak, M.F. (2012). Incidence and prevalence of spinal cord injury in Canada: A national perspective. Neuroepidemiology, 38, 219–226. PubMed ID: 22555590 doi:10.1159/000336014

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Perrier, M.J., & Martin Ginis, K.A. (2016). A description and estimate of very low-intensity activity and inactive awake time in community-dwelling adults with chronic spinal cord injury. Spinal Cord, 54, 709–713. PubMed ID: 26782843 doi:10.1038/sc.2015.232

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Perrier, M.J., & Martin Ginis, K.A. (2017). Communicating physical activity information to people with physical disabilities. In B. Jackson & J. Dimmock (Eds.), Persuasion and communication in sport, exercise and physical activity (pp. 233–249). New York, NY: Routledge.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Perrier, M.J., Smith, B., Latimer-Cheung, A.E., (2013). Narrative environments and the capacity of disability narratives to motivate leisure-time physical activity among individuals with spinal cord injury. Disability and Rehabilitation, 35, 2089–2096. PubMed ID: 23919641 doi:10.3109/09638288.2013.821179

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Phillips, A.A., & Krassioukov, A.V. (2017). Cardiovascular dysfunction following spinal cord injury. In N. Weidner, R. Rupp, & K.E. Tansey (Eds.) Neurological aspects of spinal cord injury (pp. 325–361). Basel, Switzerland: Springer.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Randall, W.C., Wurster, R.D., & Lewin, R.J. (1966). Responses of patients with high spinal transection to high ambient temperatures. Journal of Applied Physiology, 21, 985–993. PubMed ID: 5222542 doi:10.1152/jappl.1966.21.3.985

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Rimmer, J.H., Schiller, W., & Chen, M.D. (2012). Effects of disability-associated low energy expenditure deconditioning syndrome. Exercise and Sport Sciences Review, 40, 22–29. doi:10.1097/JES.0b013e31823b8b82

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Rocchi, M., Routhier, F., Latimer-Cheung, A.E., Martin Ginis, K.A., Noreau, L., & Sweet, S.N. (2017). Are adults with spinal cord injury meeting the spinal cord injury–specific physical activity guidelines? A look at a sample from a Canadian province. Spinal Cord, 55, 454–459. doi:10.1038/sc.2016.181

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Salci, L., Perrier, M.J., Ginis, S., & Martin Ginis, K.A. (2016). Active living leaders training program for adults with spinal cord injury: A pilot study. Spinal Cord, 54, 662–669. PubMed ID: 26481706 doi:10.1038/sc.2015.168

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Schwarzer, R. (2008). Modeling health behavior change: How to predict and modify the adoption and maintenance of health behaviors. Applied Psychology, 57, 1–29.

    • Search Google Scholar
    • Export Citation
  • Singh, A., Tetreault, L., Kalsi-Ryan, S., Nouri, A., & Fehlings, M.G. (2014). Global prevalence and incidence of traumatic spinal cord injury. Clinical Epidemiology, 6, 309. PubMed ID: 25278785

    • Search Google Scholar
    • Export Citation
  • Sweet, S.N., Martin Ginis, K.A., & Latimer-Cheung, A.E. (2012). Examining physical activity trajectories for people with spinal cord injury. Health Psychology, 31, 728–732. PubMed ID: 22429126 doi:10.1037/a0027795

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Tanhoffer, R.A., Tanhoffer, A.I.P., Raymond, J., Hills, A.P., & Davis, G.M. (2012). Comparison of methods to assess energy expenditure and physical activity in people with spinal cord injury. Journal of Spinal Cord Medicine, 35, 35–45. PubMed ID: 22330189 doi:10.1179/2045772311Y.0000000046

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Teasell, R.W., Arnold, J.M.O., Krassioukov, A., & Delaney, G.A. (2000). Cardiovascular consequences of loss of supraspinal control of the sympathetic nervous system after spinal cord injury. Archives of Physical Medicine and Rehabilitation, 81, 506–516. PubMed ID: 10768544 doi:10.1053/mr.2000.3848

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Tomasone, J.R., Arbour-Nicitopoulos, K.P., Latimer-Cheung, A.E., & Martin Ginis, K.A. (2016). The relationship between the implementation and effectiveness of a nationwide physical activity telephone counseling service for adults with spinal cord injury. Disability and Rehabilitation, 40, 527–537. PubMed ID: 28029067 doi:10.1080/09638288.2016.1261415

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Tomasone, J.R., Flood, S.M., Ma, J.K., Scime, N.V., Burke, S.M., Sleeth, L., Marrocco, S., & The SCIRE Research Team. (2018). Physical activity self-management interventions for adults with spinal cord injury: Part 1—A systematic review of the use and effectiveness of behavior change techniques. Psychology of Sport and Exercise, 37, 274–285. doi:10.1016/j.psychsport.2018.01.012

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Tremblay, M.S., Aubert, S., Barnes, J.D., Saunders, T.J., Carson, V., Latimer-Cheung, A.E., . . . Chinapaw, M.J. (2017). Sedentary behavior research network (SBRN)—Terminology consensus project process and outcome. International Journal of Behavioral Nutrition and Physical Activity, 14, 75. PubMed ID: 28599680 doi:10.1186/s12966-017-0525-8

    • Crossref
    • Search Google Scholar
    • Export Citation
  • van den Berg-Emons, R.J., Bussmann, J.B., & Stam, H.J. (2010). Accelerometry-based activity spectrum in persons with chronic physical conditions. Archives of Physical Medicine and Rehabilitation, 91, 1856–1861. PubMed ID: 21112426 doi:10.1016/j.apmr.2010.08.018

    • Crossref
    • Search Google Scholar
    • Export Citation
  • van der Scheer, J.W., Martin Ginis, K.A., Ditor, D.S., Goosey-Tolfrey, V.L., Hicks, A.L., West, C.R., & Wolfe, D.L. (2017). Effects of exercise on fitness and health of adults with spinal cord injury: A systematic review. Neurology, 89, 736–745. PubMed ID: 28733344 doi:10.1212/WNL.0000000000004224

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Williams, T.L., Ma, J.K., Martin Ginis, K.A. (2017). Participant experiences and perceptions of physical activity-enhancing interventions for people with physical impairments and mobility limitations: A meta-synthesis of qualitative research evidence. Health Psychology Review, 13, 1–18.

    • Search Google Scholar
    • Export Citation
  • Williams, T.L., Smith, B., & Papathomas, A. (2018). Physical activity promotion for people with spinal cord injury: Physiotherapists’ beliefs and actions. Disability and Rehabilitation, 40, 52–61. PubMed ID: 27917686 doi:10.1080/09638288.2016.1242176

    • Crossref
    • Search Google Scholar
    • Export Citation
  • World Health Organization. (2011). Global recommendations on physical activity for health. Retrieved from http://www.who.int/dietphysicalactivity/physical-activity-recommendations-18-64years.pdf

    • Export Citation
  • World Health Organization. (2013). Spinal cord injury. Retrieved from http://www.who.int/mediacentre/factsheets/fs384/en/

    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 161 161 51
Full Text Views 4 4 0
PDF Downloads 4 4 0