title: Modes, benefits, and risks of voluntary an delectrically induced exercise in persons with spinal cord injury.
abstract: BACKGROUND
  Sedentary lifestyles and physical deconditioning are commonly reported among persons with spinal cord injury (SCI), although many forms of exercise have been shown to be beneficial. For individuals unable to perform voluntary exercise, involuntary exercise by electrically stimulated contractions has been used to train individual body segments, invoke cycling movements with or without arm propulsion, and stimulate ambulation.
  
  
  OBJECTIVE
  To evaluate the benefits and risks associated with various modes of exercise in persons with SCI.
  
  
  METHODS
  Literature review.
  
  
  RESULTS
  Electrical stimulation of local muscle sites increases muscle mass and circulation and favorably alters muscle fiber composition. Electrically stimulated cycling has been observed to improve fitness, lower-extremity circulation, and circulatory response to ischemia and to reverse cardiac muscle atrophy in persons with tetraplegia. Electrically stimulated ambulation improves upper-extremity endurance, lower-extremity circulation, and perception of body image. Studies of arm and wheelchair ergometry show increased arm endurance and decreased cardiovascular risks associated with hyperlipidemia, while resistance training of the upper extremities improves strength and endurance. Because autonomic hyperreflexia, orthostatic intolerance, thermal dysregulation, and fracture are associated with exercise in SCI, risk reduction strategies and prompt intervention are required.
  
  
  CONCLUSIONS
  Well-designed programs of exercise are beneficial for persons with tetraplegia and paraplegia. Risks and benefits vary with level of injury. Programs need to address prevention of and intervention for potential adverse effects associated with exercise in individuals with spinal cord dysfunction.
authors.affiliation: Department of Neurological Surgery, and The Miami Project to Cure Paralysis, University of Miami School of Medicine, Florida 33136, USA. pjacobs@miamiproj.med.miami.edu
authors.forename: P L
authors.initials: PL
authors.lastname: Jacobs
authors.forename: M S
authors.initials: MS
authors.lastname: Nash
mesh_terms: D004599:Electric Stimulation Therapy; D005081:Exercise Therapy; D006801:Humans; D018482:Muscle, Skeletal / Q000502:physiology; D010264:Paraplegia / Q000628:therapy*; D018570:Risk Assessment; D013119:Spinal Cord Injuries / Q000503:physiopathology* / Q000628:therapy*