title: Maintenance of exercise participation in individuals with spinal cord injury: effects on quality of life, stress and pain The association of sports and physical recreation with life satisfaction in a community sample of people with spinal cord injuries. Long-term exercise training in persons with spinal cord injury: effects on strength, arm ergometry performance and psychological well-being The effects of an arm ergometer training programme on wheelchair subjects Exercise Research Issues in the Spinal Cord Injured Population Effects of an exercise programme on musculoskeletal and neuropathic pain after spinal cord injury—results from a seated double-poling ergometer study Reliability of the PEDro scale for rating quality of randomized controlled trials.
abstract: Study design : Follow-up study of seven individuals with spinal cord injury ( SCI ) who completed a 9-month r and omized control trial ( RCT ) of exercise training .  Objective : In a 9-month RCT conducted in our lab , individuals with SCI who participated in a twice-weekly supervised exercise training reported greater perceived quality of life ( PQOL ) , and less stress and pain than a nonexercising control cohort . The present follow-up study examined the voluntary continuation of exercise training after the study ended and the persistence of the accrued psychosocial benefits . Setting : Centre for Health Promotion and Rehabilitation , McMaster University , Hamilton , Ontario , Canada . Methods : Five men and two women ( age 42.3±3.6 years ) with SCI ( C5–T12 ; ASIA A – D 12.7±8.2 years postinjury ) were invited to continue supervised exercise training twice weekly at the completion of the 9-month RCT . Exercise adherence , PQOL , stress and bodily pain were measured at a 3-month follow-up and were compared to values obtained at baseline , and at 3 , 6 and 9 months during the intervention . Results : There was a significant decrease in adherence at the 3-month follow-up compared to the overall 9-month adherence rate ( 42.7 versus 80.6 % , respectively ; P<0.01 ) . There was also a significant decrease in PQOL ( P<0.05 ) and a trend for increased pain ( P=0.07 ) and stress ( P=0.12 ) , at follow-up compared to the end of the 9-month trial . Finally , there was a significant negative correlation between pain at the conclusion of the RCT and exercise adherence over the 3-month follow-up period ( r=−0.91 ; P<0.01 ) . Conclusions : These findings emphasize the importance of continued exercise adherence to the maintenance of exercise-related increases in psychological well-being among individuals with SCI The purpose of this study is to assess satisfaction with life domains in people with spinal cord injuries ( SCI ) and investigate whether participation in sports and physical recreation is associated with life satisfaction in SCI . 1,748 r and omly selected participants with SCI who fulfilled the criteria : SCI at level C5 or below , wheelchair dependent ; aged 18 - 50 at the time of injury ; at least 1 year post-injury , were approached to take part in this study . Completed replies were received from 985 individuals with SCI ( 198 women , 798 men ) . The measures used included the  Sports Participation Question naire , the Life Satisfaction Question naire and the Hospital Anxiety and Depression Scale . The numbers of hours participating in sports decreased significantly after injury . There was a greater decrease in numbers participating in team sports in comparison to the decrease seen in numbers participating in individual sports . The highest level of satisfaction existed within social domains such as : family life and contacts with friends . The lowest level of satisfaction was found in regard to the participant 's sexual life and vocational situation . Higher satisfaction with life in general was demonstrated in respondents with SCI involved in sports or physical recreation compared to those not participating in physical activities Study design : R and omized controlled trial of exercise training in persons with spinal cord injury . Objective : The purpose of this study was to examine the effects of 9 months of twice-weekly exercise training on strength , arm ergometry performance , and indices of psychological well-being and quality of life . Setting : Centre for Health Promotion and Rehabilitation , McMaster University , Hamilton , Ontario , Canada . Methods : Thirty-four men and women ( aged 19–65 years ) with traumatic spinal cord injury ( C4–L1 ; ASIA A – D ) of 1–24 years duration volunteered to participate , and were r and omized into exercise ( EX ; n=21 ) and control ( CON ; n=13 ) groups . Twenty-three subjects ( 11 EX ; 12 CON ) successfully completed the 9-month study . Subjects were assessed for one repetition maximum ( 1RM ) strength , arm ergometry performance , and several indices of quality of life and psychological well-being at baseline , 3 , 6 , and 9 months . Results : At baseline , there were no significant differences between groups in age , submaximal arm ergometry performance , muscle strength , or psychological well-being . Following training , the EX group had significant increases in submaximal arm ergometry power output ( 81 % ; P<0.05 ) , and significant increases in upper body muscle strength ( 19–34 % ; P<0.05 ) ; no significant changes occurred in CON . Participants in EX reported significantly less pain , stress and depression after training , and scored higher than CON in indices of satisfaction with physical function , level of perceived health and overall quality of life ( P<0.05 ) . Exercise adherence ( per cent of prescribed sessions attended ) in those subjects who completed the 9 months of training was 82.5 % . Conclusions : These results demonstrate that long-term twice-weekly exercise training in this population is feasible , and results in significant gains in both physical and psychological well-being The purpose of the present investigation was to study the effects of an arm ergometer training programme on several physiological variables of recreational wheelchair subjects . Ten paraplegics ( 5 experimental , 5 control ) were tested prior to and immediately after a 2 month exercise regimen at 80 % of peak heart rate ( 30 min per day , 5 days per week , for 8 consecutive weeks at 50 rev/min ) . The results demonstrated significant increases ( P<0.05 ) in VO2max ( 1 min-1 & ml kg-1 min-1 ) and workload but only mild improvements in maximal heart rate and post exercise blood lactates . Body fat , vital capacity and forced expiratory volume did not change with training . Triceps lateralis fibre distribution and fast twitch ( FT ) fibre area were unaffected by the endurance training programme . However , slow twitch ( ST ) fibre area increased ( P < 0·05 ) with training . The results indicate that physiological variables of paraplegic subjects  following an arm ergometer endurance training programme react similarly to changes previously observed in non-h and icapped subjects . The values when compared with normals are low as a result of the relative inactivity of the subjects due to the lack of available exercise programmes for wheelchair people Although considered the gold-st and ard research design , r and omized controlled trials ( RCT ) create a series of method ological , ethical , and practical challenges when applied to exercise training studies of people with spinal cord injury ( SCI ) . These challenges are discussed , and some pragmatic alternatives are suggested to advance SCI research while maintaining scientific integrity Objectives : To assess pain relieving effects of an intensive exercise programme on a seated double-poling ergometer in individuals with spinal cord injury ( SCI ) . Setting : Stockholm , Sweden . Methods : A total of 13 wheelchair-dependent individuals with a thoracic or lumbar SCI were recruited to a 10-week training period ( three times weekly ) assessing the effects of regular training on upper-body strength , aerobic and mechanical power , and crossover effects on functional performance , as well as cardiovascular risk factors . Eight of the participants reported pain and were included in this exploratory pain protocol and assessed using the International SCI Basic Pain Data set , the Wheelchair Users ’ Shoulder Pain Index and International SCI Quality of Life Basic Data set . Results : For those with neuropathic pain , median pain intensity ratings decreased from 5 on a 0–10 numerical rating scale at base-line to 3 at the end of study , and four of seven participants reported an improvement on the Patient Global Impression of Change scale . For those with musculoskeletal pain ( n=5 ) , median pain intensity ratings improved from 4 at baseline to 0 at the end of study . All but one rated no musculoskeletal pain at all at the end of study and number of days with pain per week decreased from 5.5 to 0.7 . None of the participants developed pain , because of overuse during the training period and few reported unwanted side effects . Conclusion : Considering its promising effects and safety , an intensive exercise programme can be tried for treating musculoskeletal pain and also neuropathic pain following SCI BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good .
target: Although there was a lack of consensus among the selected studies , the majority of them presented a strong correlation between physical activity and variables of quality of life and /or functional independence .
  Thus , physical activity appears to have an important influence on social relationships , functional independence , psychological factors , and physical aspects , which can enhance quality of life and independence in the performance of daily activities
background: This study aim ed to perform a systematic review of studies that address the influence of physical activity on the quality of life and functional independence of adult individuals with spinal cord injury .