Guidelines for the Clinician for Development of Fitness Programs for the Physically Challenged

Consistent with the nondisabled population, cardiorespiratory disease is one of the leading causes of death in the spinal cord injury (SCI) population (1) . As a result, there is an ever-growing need for physical fitness for individuals with SCI . The primary and secondary cardiorespiratory complications that occur as a result of SCI were discussed in detail in Chapter One. Because of numerous health risks associated with a strenuous exercise program, wheelchair users should have a medical and fitness evaluation prior to beginning such a program. As late as 1972, individuals with injury levels higher than T6 were strongly discouraged by medical authorities from participating in endurance training due to suspected medical risks associated with autonomic deficiency (2) . More recently, however, the physiological responses to exercise in persons with SCI have been widely researched and this medical concern no longer exists. The psychological benefits of exercise supported by medical research studies for individuals with SCI are limited. These studies have shown that aerobic exercise increases self-esteem, improves employment opportunities, increases participation in social activities, decreases depression, increases confidence in coping with daily problems and increases a sense of well-being (3,4) . The documented physical benefits as a result of regular exercise for the SCI population are an improvement in functional capacities, an increased efficiency in performing activities of daily living, and a decrease in related hospitalizations (3,5,6). This chapter will address the research-related testing and training techniques developed specifically for persons with spinal cord injury . The various testing equipment, protocols, training programs, and other developed techniques will be discussed. As stated earlier, a thorough medical and fitness evaluation should always be performed at the local VA Medical Center prior to establishing an exercise program. In addition, a baseline of fitness should be established in order to appropriately suggest an exercise program that best suits the person and will be of maximal benefit to him or her.