Background: Exercise has beneficial effects on muscle and motor function after spinal cord injury (SCI). Little is known regarding effects of prolonged intense exercise (IE) in humans with chronic SCI. Design: Prospective, non-randomized, controlled observational study. The intervention was either a multimodal IE program (n ¼ 21) or a control (CTL) intervention consisting of self-regulated exercise (n ¼ 8).Objective: Measure sensorimotor function over 6 months in relation to an IE program. Setting: Single outpatient center. Subjects: Subjects with chronic SCI (n ¼ 29 total), mainly ASIA Impairment Scale A and B, injury levels C4-T11. Results: Baseline neurological assessments (for example, ASIA motor score, 39±3 vs 42±5, IE vs CTL, P40.5, mean ± s.e.m.) did not differ between the two groups. During the 6 months, IE subjects averaged 7.3±0.7 h per week exercise, not significantly different from CTL subjects (5.2±1.3 h per week, P40.1). However, after 6 months, IE subjects showed significantly greater motor gains than CTL subjects in the main outcome measure, ASIA motor score (change of 4.8 ± 1.0 vs À0.1 ± 0.5 points, P ¼ 0.0001). The main outcome measure was calculated by ASIA motor score. These IE subject ASIA motor gains correlated with number of exercise hours per week (r ¼ 0.53, Po0.02), and with type of specific IE components, particularly load bearing. Conclusions: Multimodal IE can significantly improve motor function in subjects with chronic SCI. An organized program may provide greater motor benefits than a self-regulated program; load bearing might be of particular value. IE might have therapeutic value in chronic SCI, and as an adjunct to other restorative therapies.

Increasing activity and exercise is essential for health and quality of life for people living with spinal cord injury (SCI). Obesity, cardiovascular disease, and diabetes are 2 to 4 times higher for people with SCI compared to the general population. This is due, in part, to low levels of activity, limited access and opportunities to participate in exercise, as well as changes in muscle and heart function that are common after injury. Exercise is necessary to improve fitness and reduce long-term health complications after SCI. Below are exercise recommendations for improving cardiovascular health, muscular strength and endurance, and flexibility for people with SCI.* These cardiovascular and muscular strength/endurance recommendations are adapted with permission from SCI Action Canada (www. sciactioncanada.ca/guidelines accessed August, 2014).y Moderate intensity: somewhat hard but can be sustained for long periods without experiencing excessive fatigue; Vigorous intensity: very hard, close to maximum and cannot be sustained for long without experiencing excessive fatigue.

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Purpose Osteoporosis is a severe complication of spinal cord injury (SCI). Many exercise modalities are used to slow bone loss, yet their efficacy is equivocal. This study examined the effect of activity-based therapy (ABT) targeting the lower extremities on bone health in individuals with SCI. Methods Thirteen men and women with SCI (age and injury duration = 29.7 ± 7.8 and 1.9 ± 2.7 years) underwent 6 months of ABT. At baseline and after 3 and 6 months of training, blood samples were obtained to assess bone formation (serum procollagen type 1 N propeptide (PINP) and bone resorption (serum C-terminal telopeptide of type I collagen (CTX), and participants underwent dual-energy X-ray absorptiometry scans to obtain total body and regional estimates of bone mineral density (BMD). Results Results demonstrated significant increases (p < 0.05) in spine BMD (+4.8 %; 1.27 ± 0.22–1.33 ± 0.24 g/cm2) and decreases (p < 0.01) in total hip BMD (−6.1 %; 0.98 ± 0.18–0.91 ± 0.16 g/cm2) from 0 to 6 months of training. BMD at the bilateral distal femur (−7.5 to −11.0 %) and proximal tibia (− 8.0 to −11.2 %) declined but was not different (p > 0.05) versus baseline. Neither PINP nor CTX was altered (p> 0.05) with training. Conclusions Chronic activity-based therapy did not reverse bone loss typically observed soon after injury, yet reductions in BMD were less than the expected magnitude of decline in lower extremity BMD in persons with recent SCI.

This article summarizes presentations of a symposium examining the potential impact of activity-based therapies (ABT) in promoting neurological and functional recovery after spinal cord injury (SCI). The symposium addressed 3 key questions concerning activity-based therapy in SCI: (1) What clinical approaches are used? (2) Is there empirical evidence supporting efficacy of ABT in promoting neurological recovery and improving overall function, health, and quality of life? (3) What are the issues related to long-term viability of ABT? Key words: activity-based therapy, fitness and health, functional recovery, neurologic recovery, quality of life, spinal cord injury, therapeutic exercise