Workshop on Disability in America A New Look: Summary and Background Papers (2006) / Chapter Skim
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Appendix L Impact of Exercise on Targeted Secondary Conditions--James H. Rimmer and Swati S. Shenoy
Appendix L Impact of Exercise on Targeted Secondary Conditions--James H. Rimmer and Swati S. Shenoy
Pages 205-221
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From page 205... ...
Shenoy* R egular exercise has been recognized as one of the most important health behaviors for reducing the risk of chronic diseases and im proving overall health.19 There is strong evidence that exercise leads to improved physiologic fitness; extends longevity; and protects against the development of coronary heart disease, hypertension, type 2 diabetes, obesity, osteoporosis, colon cancer, breast cancer, lung cancer, and clinical depression.13 As a result of this supportive literature base, regular exercise is considered one of the most essential health behaviors for reducing the risk of various health conditions and is listed as one of the primary target goals in the U.S.
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From page 206... ...
. The keywords used to identify peer reviewed articles were "exercise," "physical activity," "secondary conditions," "disability," "multiple sclerosis," and "spinal cord injury." The studies selected had to fulfill the following criteria: (1)
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From page 207... ...
Hicks and colleagues9 conducted an RCT of supervised progressive exercise training in 34 subjects with spinal cord injuries (time postinjury, >1 year; age range, 19 to 65 years; lesion level, C4 or below; intervention group, 21 subjects; control group, 13 subjects) to examine the effects of a long-term exercise training protocol on strength and cardiovascular endurance.
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Outcome measures included maximal aerobic capacity; isometric strength; body composition; blood lipids; performance in daily activities; mood, fatigue, and disease status as measured by the Profile of Mood States (POMS) , Fatigue Severity Scale (FSS)
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Trained physiotherapists instructed the patients individually on the home exercise program. Aerobic training during weeks 1 to 3 consisted of aquatic training, and during weeks 4 to 26 the subjects were encouraged to continue with aquatic training or with their earlier mode of aerobic exercise (the specific modes were not reported)
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, followed by a 6-week self-initiated home exercise program. The control group on the waiting list was offered the comprehensive outpatient rehabilitation program at the end of 12 weeks.
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The total aggregate sample that participated in the intervention arm was 21 subjects with spinal cord injuries and 156 subjects with multiple sclerosis. The sample sizes in the intervention arm ranged from 13 to 58.
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The home exercise program lasted 23 weeks, with four exercise sessions per week during weeks 1 to 17 and five exercise sessions per week during weeks 18 to 23. The subjects were provided with two different elastic therabands for the upper and the lower extremities that were used for training.
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From page 213... ...
PAIN Pain is one of the most common secondary conditions reported by people with disabilities.3 In particular, musculoskeletal pain in the neck and shoulder region are commonly observed in individuals with spinal cord injuries and is exacerbated by wheelchair transfers and propulsion.1,2,3,4 Only four exercise-related RCTs that targeted pain reduction in individuals with spinal cord injuries were identified. Hicks and colleagues9 targeted reduction in pain as one of their primary outcomes (see the study design discussed above in the section on deconditioning)
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From page 214... ...
Ginis and colleagues8 conducted an RCT of aerobic and resistance training with 34 individuals with traumatic spinal cord injuries (23 men and 11 women; mean age, 38.6 ± 11.7 years; average duration postinjury, 10.4 years; 14 had complete spinal cord injuries and 13 had incomplete spinal cord injuries)
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In the future, a more focused research agenda should use specific doses and modalities of exercise to address specific secondary conditions. Moreover, studies should be more homogeneous in terms of the age, health status, and functional levels of the study subjects and should use a consistent methodology and training dose to enhance the generalizability of the findings to certain subgroups of disabilities.
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SPECIFIC RESEARCH RECOMMENDATIONS 01. Prospective observational studies should be conducted to determine the frequency, intensity, and duration of physical activity associated with reducing the symptoms of targeted secondary conditions (e.g., deconditioning, fatigue, and pain)
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. There is still a lack of information on what types of programs or interventions are the most effective for ameliorating specific secondary conditions.
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Government funding agencies that support model systems involved in tracking the health status of a specific disability group (e.g., spinal cord injury, traumatic brain injury) , should consider funding similar networks that conduct intervention research aimed at reducing specific secondary conditions.
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. Long-term exercise training in persons with spinal cord injury: effects on strength, arm ergometry performance and psychological well-being.
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FI: Fatigue Index FI is the ratio between the integral of muscle strength decay over time and maximal voluntary contraction using a knee muscle dynamometer. The fatigue index was defined as the ratio of the force F at time t (Ft)
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It includes eight scales that assess the following general health concepts: physical functioning, role limitations due to physical health problems (role physical) , bodily pain, general health perceptions, vitality, social functioning, role limitations due to emotional problems (role emotional)
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