Exercise barriers seen for spinal cord injury survivors

November 21, 2002

ANN ARBOR, MI - It's no secret that Americans are getting fatter, exercising less and suffering the health problems that go along with a sedentary lifestyle.

But for one often-overlooked group of Americans -- people with spinal cord injuries -- the problem is even worse. They may survive the accident that caused their injury, only to die of a disease that could have been prevented through exercise and diet.

Now, researchers are looking at ways to help them cut their extra-high risk of such diseases. The first step: To figure out what barriers, both psychological and physical, stand in the way of people with SCI who want to improve their health.

New research results announced today by a University of Michigan Health System team give the first indications of what some of those barriers are, and hint at what might be done to remove them. The data are being given at the annual meeting of the American Academy of Physical Medicine and Rehabilitation, in Orlando, Florida.

The study, of SCI patients taking part in a unique U-M research project, shows that while nearly three-quarters of those surveyed said they want to exercise, less than half actually do. And less than half said their doctor had encouraged them to exercise.

The participants cited many of the same reasons as able-bodied Americans when asked why they don't exercise, including lack of motivation and lack of energy.

But many also cited special concerns relating to their spinal cord injury. About half worried that fitness center staff wouldn't know how to work with them to develop an exercise program that fit their needs, and a sizable minority felt that their condition prevented them from exercising, or that exercise might worsen their condition.

"We need to encourage people with SCI to exercise," says William Scelza, M.D., who led the study while completing his residency in physical medicine and rehabilitation at U-M this year. "There are indeed exercise regimens that can increase the health and well being of these patients, and make them more robust so they can participate in life to a greater degree and live a longer, healthier, happier life -- as well as being healthier for any potential cure." Scelza is now doing a fellowship in spinal cord injury at the Kessler Institute for Rehabilitation in New Jersey.

Scelza knows the issue first-hand: He sustained a spinal cord injury at age 17 and uses a wheelchair. An active wheelchair basketball player, he knows that people with SCI can work out, but that doctors and fitness centers often don't offer exercise help.

More research is needed, and programs led by U-M SCI program directors David Gater, M.D., Ph.D. and Denise Tate, Ph.D. are aimed at learning more.

Gater and Tate head the UMHS Model Spinal Cord Injury Care System, one of only 16 comprehensive programs in the United States that combines advanced clinical care, research and education of SCI specialists under a grant from the National Institute on Disability and Rehabilitation Research. The UMHS program is the only one of its kind in the Midwest.

Together, the 16 SCI centers aim to improve the care of the more than 200,000 people living with a spinal cord injury, and the 11,000 more who are injured each year.

"Improvements in medical care and rehabilitation are giving SCI patients a longer post-accident life expectancy and better quality of life," says Gater, who holds positions at the Veterans Affairs Ann Arbor Medical Center and the U-M Department of Physical Medicine and Rehabilitation. "Now, we need to focus more and more on the outsize risk of heart disease, diabetes and other disorders that SCI patients face because of a combination of lifestyle factors and the secondary physical effects of spinal cord injury."

The study results being presented today come from the Wellness with SCI Project begun by Tate and her colleagues early in 2001, and funded by the U-M Venture Investment Fund. It's the first-ever randomized controlled trial designed to help people with spinal cord injuries discover ways to improve their health and well-being with nutrition, exercise and lifestyle options.

The study's participants completed a two-hour questionnaire before being assigned to one of two groups: an intervention group that attended workshops on exercise and other wellness issues, and had regular physical exams; and a control group that only had the physical exams.

The survey results, taken from participants' responses on a standard Barriers to Physical Exercise and Disability questionnaire, are the first to be compiled. In addition to showing that 73.6 percent of SCI patients wanted to exercise but only 45.8 percent currently do exercise, it found that only 47.2 percent had been encouraged to exercise by their physicians, and that nearly 60 percent identified "lack of motivation" as a barrier between them and fitness. There were no significant differences between groups of patients with spinal cord injuries of different severity.

"These initial results show the importance of health promotion in all people with physical disability, including spinal cord injury," says Tate, a professor and director of research in the Department of Physical Medicine & Rehabilitation. "For people who have survived the cause of their disability, it's crucial to help them prevent secondary conditions that can be partly attributed to their primary condition, from carpal tunnel syndrome and pressure sores, to life-threatening heart disease."

Physicians and fitness instructors can play a key role in raising SCI patients' awareness of their exercise options, Scelza says, from sports like basketball and hand-cycling to neuromuscular electrical stimulation that "exercises" the muscles SCI patients can't move themselves. And, he recommends that patients seek out SCI specialists and major SCI treatment centers to make sure they get the best care and can exchange information with other people with SCI.

These specialists may be better able to deal with the special physical issues that come with SCI, such as muscle spasms and autonomic dysreflexia, in which blood pressure shoots dangerously high due to nervous system problems linked to the injury.

The dramatic and sudden physical changes that come with a spinal cord injury can also lead to psychological effects, says Tate, who specializes in the psychosocial aspects of SCI. People living with SCI have a much higher incidence of depression and substance abuse than the general population, she adds, and these may interfere with the drive to exercise or live well.

Tate and colleagues are now compiling other results from the wellness study, including follow-up results on whether patients continued with exercise and wellness practices after the study ended.

Meanwhile, Gater is awaiting completion of a state-of-the-art Exercise Physiology and Body Composition Laboratory at the Ann Arbor VAMC that's designed specifically for the SCI population.

"Methodologies for exercise screening, body composition analysis, fitness determinations and exercise prescription have not yet been validated and reliably used in this special population," says Gater. "Our short term goal is to set the standards for these important facets of health within the next few years, and to begin a systematic implementation of these standards over the next decade."

For more information on the UMHS Model Spinal Cord Injury Care System, call 734-763-0971, visit http://www.med.umich.edu/pmr/model_sci/, or e-mail model_sci@umich.edu.
In addition to Scelza and Tate, the research team included U-M SCI fellow Eric Zemper, Ph.D., clinical assistant professor Anthony Chiodo, M.D., and clinical associate professor Virginia Nelson, M.D., M.P.H., who directs pediatric, adolescent and young adult rehabilitation at UMHS.

University of Michigan Health System

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