Cited by 78Spinal Cord Injury ResearchCardiovascular and exercise physiologyPhysical Activity and Health

Exercise Guidelines to Promote Cardiometabolic Health in Spinal Cord Injured Humans: Time to Raise the Intensity?

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Nightingale, Tom E., Metcalfe, Richard S., Vollaard, Niels B., Bilzon, James L.·2017·Archives of Physical Medicine and Rehabilitation

Abstract

Spinal cord injury (SCI) is a life-changing event that, as a result of paralysis, negatively influences habitual levels of physical activity and hence cardiometabolic health. Performing regular structured exercise therefore appears extremely important in persons with SCI. However, exercise options are mainly limited to the upper body, which involves a smaller activated muscle mass compared with the mainly leg-based activities commonly performed by nondisabled individuals. Current exercise guidelines for SCI focus predominantly on relative short durations of moderate-intensity aerobic upper-body exercise, yet contemporary evidence suggests this is not sufficient to induce meaningful improvements in risk factors for the prevention of cardiometabolic disease in this population. As such, these guidelines and their physiological basis require reappraisal. In this special communication, we propose that high-intensity interval training (HIIT) may be a viable alternative exercise strategy to promote vigorous-intensity exercise and prevent cardiometabolic disease in persons with SCI. Supplementing the limited data from SCI cohorts with consistent findings from studies in nondisabled populations, we present strong evidence to suggest that HIIT is superior to moderate-intensity aerobic exercise for improving cardiorespiratory fitness, insulin sensitivity, and vascular function. The potential application and safety of HIIT in this population is also discussed. We conclude that increasing exercise intensity could offer a simple, readily available, time-efficient solution to improve cardiometabolic health in persons with SCI. We call for high-quality randomized controlled trials to examine the efficacy and safety of HIIT in this population.

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  1. Myers J, Lee M, Kiratli J. Cardiovascular Disease in Spinal Cord Injury. Am J Phys Med Rehabil 2007;86(2):142-52.

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Authors
Nightingale, T. E., Metcalfe, R. S., Vollaard, N. B., & Bilzon, J. L.
Affiliations
  • University of Bath (GB)
  • University of Ulster (GB)
  • University of Stirling (GB)
Corresponding author
Bilzon, James L.
Venue
Archives of Physical Medicine and Rehabilitation
Publisher
Elsevier BV
Published
2017-08
Volume
98
Issue
8
Pages
1693-1704
ISSN
0003-9993 (ISSN-L)
OpenAlex
W2577808230
Cited by
78
References
170
Citations by year
2026: 4 · 2025: 2 · 2024: 4 · 2023: 12 · 2022: 9 · 2021: 11 · 2020: 15 · 2019: 12 · 2018: 4 · 2017: 5
FWCI
7.73
Type
journal article
Language
en
Open access
Locations
  • Archives of Physical Medicine and Rehabilitation (publishedVersion)
  • PubMed (publishedVersion)
  • Ulster University Research Portal (Ulster University) (acceptedVersion, other-oa)
  • Stirling Online Research Repository (University of Stirling) (submittedVersion, cc-by-nc-nd)
  • University of Birmingham Research Portal (University of Birmingham) (submittedVersion, cc-by-nc-nd)
Topics
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Spinal Cord Injury Research
  • Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
Keywords
spinal cord injury, high-intensity interval training, cardiometabolic health, exercise recommendations, exercise intensity, high-intensity exercise, moderate-intensity aerobic exercise, cardiorespiratory fitness, insulin sensitivity, vascular function, cardiometabolic disease prevention, exercise safety
MeSH terms
Cardiorespiratory Fitness, Blood Glucose, Blood Pressure, Body Composition, Humans, Insulin, Physical Fitness, Risk Factors, Spinal Cord Injuries, Exercise, Practice Guidelines as Topic, Dyslipidemias, Patient Safety

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