title: Effects of exercise training and inspiratory muscle training in spinal cord injury: a systematic review.
abstract: OBJECTIVE
  To provide a systematic review of the studies assessing exercise training and inspiratory muscle training (IMT) in individuals for the improved respiratory function of patients with spinal cord injury (SCI).
  
  
  METHODS
  Thirteen studies (5 exercise training, 8 IMT) were identified. Articles were scored for their methodological quality using the Physiotherapy Evidence Database scores and Downs and Black tools for randomized and nonrandomized studies, respectively. Conclusions were based on the most rigorously executed studies using Sackett's levels of evidence.
  
  
  RESULTS
  Study comparison was compromised by diverse research designs; small sample sizes; and heterogeneity of studied populations, protocols, and outcome measures. Based on current literature, there is level 2 evidence supporting exercise training as an intervention to improve respiratory strength and endurance and level 4 evidence to support exercise training as an intervention that might improve resting and exercising respiratory function in people with SCI. There is level 4 evidence to support IMT as an intervention that might decrease dyspnea and improve respiratory function in people with SCI.
  
  
  CONCLUSIONS
  There are insufficient data to strongly support the use of exercise training or IMT for improved respiratory function in people with SCI. There is some evidence of efficacy of both regimens; however, the evidence is not of the best possible quality.
authors.affiliation: School of Human Kinetics, University of British Columbia, Vancouver, British Columbia, USA. bill.sheel@ubc.ca
authors.forename: A William
authors.initials: AW
authors.lastname: Sheel
authors.forename: Wendy Darlene
authors.initials: WD
authors.lastname: Reid
authors.forename: Andrea F
authors.initials: AF
authors.lastname: Townson
authors.forename: Najib T
authors.initials: NT
authors.lastname: Ayas
authors.forename: Kristin J
authors.initials: KJ
authors.lastname: Konnyu
mesh_terms: D016208:Databases, Factual / Q000706:statistics & numerical data; D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D053580:Muscle Strength / Q000502:physiology; D009132:Muscles / Q000502:physiology; D012138:Respiratory Therapy / Q000379:methods*; D013119:Spinal Cord Injuries / Q000503:physiopathology* / Q000534:rehabilitation*