Effectiveness of a community-based exercise program for ambulatory individuals with spinal cord injury: a randomized controlled trial

Objective: To evaluate the effectiveness of a community-based structured exercise program, compared to usual care, in enhancing physical, functional, and psychological outcomes for ambulatory individuals with spinal cord injury (SCI).

Design: Randomized controlled trial comparing exercise group with usual care group.

Setting: One university-affiliated rehabilitation hospital.

Participants: Fifty-seven participants with chronic SCI who could walk more than 10 meters.

Interventions: A supervised 20-session program focusing on flexibility, aerobic, and strengthening exercises was provided over 8 weeks for the exercise group, while the usual care group maintained their regular daily exercise routines.

Main outcome measures: Primary outcome included 6-minute walk test, while secondary outcomes assessed EuroQol-5 Dimensions 5-Level, Spinal Cord Independence Measure III, Berg Balance Scale (BBS), timed up and go, grip strength, 30-second sit to stand (30-STS) test, sit and reach test (SRT), Beck Anxiety Inventory, Beck Depression Inventory, and bioelectrical impedance analysis.

Results: The 51 participants were allocated to intervention (n=36) and usual care (n=15) groups, consisting of 34 males and 17 females (average age 59.78±13.19 years). The participants included 24 with cervical, 17 with thoracic, 8 with lumbar, and 2 with sacral lesions, with all participants having motor incomplete injuries. The exercise group showed significant improvement compared to the usual care group in the 6-Minute Walk Test by 49.80 meters (95% CI: 13.04, 86.55), BBS scores by 3.50 (95% CI: 0.96, 6.03), 30-STS by 2.38 (95% CI: 0.29, 4.47), and SRT by 3.89 centimeters (95% CI: 0.96, 6.82). The adherence rate was remarkably high at 89.6%, suggesting the feasibility of community exercise programs for this population. However, no significant changes were observed in psychological and quality of life measures.

Conclusion: Community-based structured exercise programs have been shown to be both feasible and effective in improving walking capacity, balance, lower extremity strength, and flexibility in ambulatory individuals with SCI.