Physical Activity after a spinal cord injury

This page has been created to support people with a spinal cord injury (SCI) to become more physically active. Please use this information to give you some ideas about how to get started or to keep you moving forward.

Written by Hannah Houliston (PhD Student from Scotland) with guidance from:

  • People with an SCI in hospital and in the community
  • Healthcare professionals
  • SCI charities and researchers

Physical activity after spinal cord injury guidelines. 

Infographic for 'Physical Activity after a Spinal Cord Injury'

Creating the exercise guidelines

The original work to create these guidelines involved an international collaboration with research scientists, people with a SCI, healthcare professionals, and people from SCI organisations.

Research paper: Ginis, K.A.M., Van Der Scheer, J.W., Latimer-Cheung, A.E., Barrow, A., Bourne, C., Carruthers, P., Bernardi, M., Ditor, D.S., Gaudet, S., De Groot, S. and Hayes, K.C., 2018. Evidence-based scientific exercise guidelines for adults with spinal cord injury: an update and a new guideline. Spinal cord, 56(4), pp.308-321.

“I think having appropriate SCI resources in place would be beneficial for those looking to get back into physical activity after a period of inactivity – covering items such as appropriate exercises, lengths of activity, briefs on the importance of cardio and strength training, techniques to do at home with household items etc.” RO

From hospital to home

At the Spinal Injuries Centre there are lots of ways to help keep you active, and this will help make the transition home easier​. Ask your physical activity advisor or physiotherapist about:

  • Weekly physical activity taster sessions
  • ‘The Staying Healthy after a SCI’ education session
  • Peer support meetings
  • The Inter Spinal Unit Games

“On discharge my mobility was still quite limited so it was difficult to think about the sort of physical activity I could manage. I had always kept fit previously but a lack of knowledge about the options open to me following my SCI held me back a bit.” AC

Heading Home?

Before you leave hospital, speak with your healthcare team about how you can keep active at home.

What can help me prepare? A few weeks before you’re discharged from hospital, chat to your physio about maintaining your rehab, you can create a discharge pack together. Depending on your needs, this may contain:

  • Assisted stretches
  • Positioning examples
  • Exercise pictures or videos of you performing your exercises

Set goals before you go: Your goals continue beyond your time in hospital, and it’s important to keep making new ones to continue to progress​.

Why should I keep active? After a SCI you are at greater risk of developing health conditions e.g diabetes, urinary tract infections, and obesity. But regular physical activity, can help to reduce this risk, whilst improving health and fitness​.

Returning home after a SCI

“My transition home was relatively smooth in terms of exercise – there was advice from the therapies teams as to what kind of exercises I should be doing to help build on the functioning muscles groups for my specific SCI. Heading home from hospital, this helped me when not only looking into getting into the gym (finding a suitable one) to continue building my strength but also in respect of the messages they instilled and their importance – highlighting the direct correlation between improved physical health and ease of all aspects of life moving forward into the future.​ Upon discharge, before returning to work, I used physical activity as a rehab tool. It was a great focus for my days and I went to the gym regularly, it was my main focus from the point of discharge.” RO

Inter Spinal Unit Games

The WheelPower Inter Spinal Unit Games Every year at the Stoke Mandeville Stadium, WheelPower hosts the Inter Spinal Unit Games. Patients from the 15 spinal units across the UK and Ireland, who are less than 1 year post-injury, are invited to compete in sporting events. Wheelchair sports include Rugby, Athletics, Table Tennis, Handcycling, Tennis, Fencing, Basketball and Archery. There are often special guests including Paralympians. Ask your Physical Activity Advisor or Physio about how you can get involved.  If you are an adult who isn't in a Spinal Unit but would like to try out a range of sports then check out the WheelPower Sports Festivals, for a great alternative to the Inter Spinal Unit Games.

FIND OUT MORE

Let’s get started!

The guidelines tell us what we should aim for, but how do we actually do this?​ This article will explain what aerobic and strength activity is, and will give you some tips as to how to achieve ‘moderate to vigorous’ intensity.

Aerobic Activity

What is aerobic activity?

Aerobic activity is the continuous movement of the body. Depending on your level of injury, it may increase your heart rate, breathing and make you a bit warm and sweaty.

Types of aerobic activity:

  • Everyday activities such as housework, playing with your children, walking the dog, and gardening
  • Walking or wheeling at the park, or commuting to work
  • Sport such as badminton, cycling, and rugby
  • Gym classes like body pump or home workouts online

Understanding Intensity

You may have used the Rating of Perceived Exertion (RPE) scale at your spinal unit. It is a scale from 6 (no exertion at all) to 20 (maximal exertion) The image below uses the scale to explain how moderate intensity and vigorous intensity may feel, and the types of activity that each intensity may correspond to.

What is intensity poster

Strength Activity

What is strength activity? 

Strength activities involve using your body weight, resistance bands or weights to increase strength.

Types of strength activity: 

  • Everyday activities such as carrying your shopping, or digging in the garden
  • Strengthening classes like yoga or pilates
  • Traditional strength training such as squats, calf raises, chest press, bicep curl etc

Resources: 

WheelPower has lots of strength workout videos:

A Canadian research team has created strength-training guides:

‘Strength-training guide for people with paraplegia’

‘Strength-training guide for people with tetraplegia’

"As a new wheelchair user you soon realise that a 'flat' road is anything but! The camber, rough tarmac, lack of kerb cuts etc all make just the equivalent of 'going for a walk' really tough, especially when your arms feel like wee chicken wings!" EF

Physical Activity

There are lots of great resources to help you become more physically active.

WheelPower

WheelPower is the national charity for wheelchair sport. They regularly post exercise videos on their website and YouTube. Including aerobic and strength workouts, with and without equipment. At the moment, they are even offering a free set of resistance bands!

Hand cyclist smiling to camera

Every Body Moves

Every Body Moves (previously Parasport) powered by Toyota is the new way to discover inclusive local opportunities to become more active. Their ambition is to create the UK’s biggest fun and vibrant community for players, parents and coaches to share their experiences of para-sport, and find useful hints, tips and information on what’s happening near you.

Visiting the Gym?

If the gym is what you are looking for, then here are some tips.

  • After a SCI you may be entitled to discounted or free gym/leisure centre membership.
  • Before your first visit to the gym, you may want to contact them to find out about their facilities.
  • Before your first visit to the gym, you may want to contact them to find out about their facilities. See the checklist below for some ideas.

Gym Visit Checklist

Water Based Activity

If you are looking to get back in the water, or want to give it a try, here are some tips and advice to find out more about Water Based Activity with a SCI in the poster below.

Water based activity poster

Find your local pool

"I joined a local gym after doing a tour and speaking to management about my access needs. They were all very helpful and bent over backwards to ensure I got the support I needed. I have always enjoyed the gym and it’s been part of my life for a long time. Getting back to it was a big step towards life feeling more normal after my discharge from hospital." AC

"I have always been a fan of the 'traditional' modes of exercise like the gym and swimming, so I continue to do these post injury, albeit slightly adapted from before with a few extra considerations." RO

Still looking for more info?

The University of Loughborough has created two leaflets about keeping active after a SCI. These are titled ‘Fit for Life‘ and ‘Fit for Sport‘.

Goal Setting​

Whether you want to get back to what you did before your SCI, or you want to give yourself new goals and challenges, having something to aim for can be a big help​. You know your body better than anyone else, challenge yourself but make sure this is realistic. Choosing an activity that you enjoy will help you stick to your goal. There are lots of ways you can be physically active. Here is how you can put your ideas into action…

Putting Goals into Action

By setting a goal and planning how you will achieve this, you are more likely to reach your goal​.

1. Ask yourself, what is my physical activity goal? e.g Swim for 15mins, twice a week.

2. Create a plan to achieve this goal: See examples of weekly plans below. Use this template to fill in a weekly schedule for each day of planned physical activity. (Click on the image to download the template .pdf)

3. Ask yourself the following questions…

  • What type of activity?
  • When will I do this activity?
  • How long will the activity last?
  • Where will I do this?
  • What intensity will I aim for?

4. Think about what you might need for each session: e.g The night before lay out your workout clothes or any equipment you might need​

5. After each activity, write down what you actually did. Think about how you might progress this for the next time, or next week ​

Have a look at the example schedules below, they show someone who is starting out and someone who is already active:

Goal Setting Template empty image

Goal Setting Template filled in example

"Take it slowly. Rome wasn’t built in a day and your strength and fitness are no different! So don’t be daunted by the challenge ahead. Take it in wee chunks and do what you can." EF

Benefits of Being Active

After a Spinal Cord Injury, regular physical activity can have a big impact on improving your quality of life, independence and function. This can then help improve your ability to do day-to-day tasks e.g transferring in and out of the car​. Physical activity gives you more energy and you may feel less tired throughout the day.

Health

Reduced risk of developing health complications such as:

  • Diabetes
  • Obesity
  • Urinary tract infections
  • Pressure sores
  • Respiratory illness​

Also helps you manage:

  • Spasticity
  • Weight gain
  • Pain
  • Function
  • Regular physical activity can help improve strength, mobility, fitness and balance​

Social

Physical activity can get you out of the house. You can spend time with your friends or loved ones, or even meet new people. By joining a local sports club or gym, you can socialise with others.

Mental Health

Activity can help to reduce symptoms of depression and anxiety. It can lift your mood, and improve your self-esteem. If you find an activity or sport that you enjoy, it can be much more fun.

"Physical activity helps keep me healthy and well - when I’m training regularly everything else seems to run a little bit more smoothly. It helps keep spasticity under control" AC

"Wheelchair Rugby League was great; I felt I had found a way to have fun, increasing my fitness and upper body strength at the same time. This helped with even the most basic things around the house; just transferring into a chair of a different height for example; when newly injured that's a workout! So the fitter and stronger you are the easier daily life becomes" EF

Overcoming Barriers to Exercise

Created by Loughborough University – Peter Harrison Centre for Disability Sport (Vicky Tolfrey) Click the image below to download. 

Physical activity and exercise can help you become both physically and mentally fit.

Exercise can help improve health and well-being by improving mood, reducing stress and decreasing depression. It can also help boost your self-esteem and give you confidence in other areas of life. To gain these psychological benefits you must maintain a regular exercise routine but this isn’t always easy. As a disabled person you may face a number of barriers to physical activity which can make becoming and staying active a real challenge. Here are a few of the common barriers and how you can try to overcome them:

“I really don’t know where to start”

The most important thing is to find an activity that you enjoy doing so that you will keep doing it. Join a friend at the gym, try an exercise class or head to the park with your family; adding a social element can make it much more fun. Don’t be afraid of trying new and unfamiliar activities as these can often surprise you and leave you wanting more. Find some like-minded people to exercise with in your area, you will help motivate each other. Also visit www.parasport.org.uk for information on what sports are available for disabled people and to help you find local sports clubs.

“I just don’t have the time”

Many people live hectic lifestyles that are busy with both work and family commitments. Not having sufficient time to exercise is a genuine concern. Difficulties with travel can make your trip to an exercise venue annoyingly long or expensive and so it is important to consider where else you might be able to exercise. A long commute to your local gym is no longer needed if you can do a workout at your local park or even in your own home/garden. The amount of exercise you need to do to gain benefits is often overestimated too. As little as 30 minutes of moderate intensity activity a day, five times a week is enough to help you feel physically and mentally fit. Multiple bouts of at least 10 minutes are also just as good; how about before or after work and a short session during your lunch hour?

“My local facility isn’t accessible”

Accessibility is a common issue faced by disabled people. However, you do not necessarily need a gym or leisure centre to become more active. You can do lots of exercises with minimal equipment in many different environments such as in your home or at the park. However, if you do fancy the gym, the Inclusive Fitness Initiative (IFI) has an application where you can find a local club that has accessible equipment for disabled people. Visit www.efds.co.uk/inclusive_fitness/ifi_gyms

“I feel too tired to exercise”

f this sounds like you then consider when it is that you are most tired. If it’s in the evening after work, then try to exercise in the early morning or during your lunch break. If you feel most fatigued first thing in the morning simply plan to do your exercise later in the day. These simple steps are common sense but will help you get started. It is also worth considering that regular exercise can actually reduce fatigue and help you sleep better. After a few weeks of regular physical activity you should notice your energy levels improve.

“Because I’ve always been rubbish at exercise and sport”

You may have disliked PE at school because of an emphasis on competitive sport, the group atmosphere, a lack of choice or that age-old classic of being picked last. It may be hard to forget these feelings but remember that as an adult you can choose exactly what type of exercise and/or sport you do, who you do it with, when and also whether you do it for leisure or competitively; you are in control! Finding a type of exercise that you enjoy will hopefully prolong your involvement.

Other barriers …

“I find exercise boring”  … If you haven’t found something you like, exercise can be boring! Try out different types of activities to find something you enjoy. Or make it more interesting by teaming up with a friend or family member. If you can find something you enjoy, you will be more likely to stick with it

“I don’t have any equipment”  … That’s ok! You don’t need special equipment to be active. If you are doing strength work, you can use your body weight. If you would like weights, you can use tins from the kitchen cupboard, or Filled water bottles. If you want resistance bands, you can use an old pair of tights. There are lots of great workouts online that do not require any specialist equipment.

“Getting ready takes ages now, I don’t have the time for extra activity” … To begin with getting ready in the morning may feel like a workout, but the more extra activity you can squeeze in, the easier this will become, giving you more time to do the things you enjoy. Planning out your day or week can help with this. To start out, find ways of incorporating more activity into your daily routine, e.g: Walking or wheeling to a bus stop that is further away from your home. Parking further away from the supermarket entrance. Taking the stairs instead of the lift or escalator

“I can’t afford my local gym, and I don’t know if it is accessible to me” … There are schemes in place to offer free or discounted memberships to gym users with a disability. Unfortunately, accessibility issues are common. ‘Euan’s Guide’ is a website that includes disabled access reviews, from gyms to holiday homes! If you are still unsure about your gym, give them a call. Remember, there are other ways to keep fit and active: Outside, at home, without equipment.

Helpful Tips

From Transport to Toilets

To make it easier to get out and about, the Accessible Travel Hub has lots of great information about finding an accessible toilet, blue badge parking, and accessible transport.

Wheelchair Skills App

In February 2021, ‘Back-Up‘ (Spinal Cord Injury Charity) launched a Wheelchair Skills App. This includes videos showing staff and volunteers demonstrating key skills needed to get around using your wheelchair.

Overcoming barriers from a person with a SCI

"When leaving the unit and going home I was certainly full of good intentions to keep up with my workouts or keep as active as I could, but once home and dealing with that transition of going from the comfort and ease of the spinal unit with accessible equipment, nurses to hand, flat surfaces to manoeuvre on etc, it was all too much and I stopped having that enthusiasm. My mental health took over my physical and it was hard to get out of that funk for a long time. After a while, a long while, I soon got fed up with myself if I’m being honest. Something just clicked and I wanted to be more independent and not rely on others, or have to wait until someone could come with me, even if just transferring into a car and going to the shops. Family and friends were a massive influence and motivation. Once I had more confidence in myself and went to the gym, I’d go to the shopping centres myself and push for longer and in turn that helped both my physical and mental wellbeing" LT​​

Adaptive Equipment and Funding

Adaptive Equipment

You may need adaptive equipment like grip support to assist you with physical activity. Active hands sell a variety of adaptive equipment​.

Specialist Sport Wheelchairs

The University of Loughborough have created a document to help with selecting the most suitable sporting wheelchair for you.

Funding

If you are aged 16-25 years old in Scotland, you could be eligible for funding to try new activities and experiences.

Fundraising

Aspire‘ the spinal injury charity, support people by raising money through crowdfunding. This can help you purchase equipment or access services.

close up of sports wheelchairs

Safety Tips

This section includes safety tips about being active with a SCI

Look after your shoulders

Your shoulders are at greater risk of ‘overuse’ injuries​. Tips:​

  • Overuse injuries are more common when you repeat the same movement over a long period of time.
  • Avoid doing the same activity every day, mix it up​.
  • Building up slowly and gradually will make sure your body has time to adapt to your activities. You should feel a bit of muscle soreness but not pain​.
  • Make sure you have at least one rest day a week​.
  • Technique is key! Using a mirror can help you adjust your position to improve your technique. Check workout videos or pictures, look to see how the instructor exercises, are you: In the same position? Well supported?​​
Wheelchair user doing shoulder exercises

Autonomic Dysreflexia

If you have a SCI at or above T6 it is important to be aware of ‘Autonomic Dysreflexia’ (AD) This is a sudden increase in blood pressure and altered heart rate.

Signs:

  • Headache
  • Blurred vision
  • Sweating
  • Hot Flashes
  • Goosebumps
  • Anxiety

Causes:

  • Tight clothing
  • Full bladder
  • A kink in the urinary catheter
  • Faecal impaction
  • Pressure sores
  • Ingrown toenail

How to prevent AD:

  • Wear loose clothing
  • Do not tie your shoe laces too tight
  • Empty your bladder and bowels before activity

If you experience AD:

  • Sit upright
  • Try to identify the cause
  • Loosen or remove restrictive clothing​

This should resolve as soon as the stimulus/cause is removed​. If your symptoms do not go away, go to A&E.

Complications to Avoid

In the video below Shannon Sproule, a Physiotherapist from Canada discusses the risks to be aware of during exercise after a SCI, and provides tips on how to avoid complications. This video was made by SCIRE The Spinal Cord Injury Research Evidence group in Canada​.

Other videos from SCIRE:

Exercise after SCI: Why do it?
Exercise after SCI: How to begin
Exercise after SCI: How to adapt equipment

Frequently Asked Questions

Who are the physical activity guidelines for?

The guidelines are recommended to: Adults with a SCI (Injury levels up to C3) Aged 18 – 64 years old. Injured for more than one year. But they may also be suitable for people aged 65+ or people who have been injured for less than a year. If this applies to you, please speak to your healthcare team for advice​

Can I do more than the exercise guidelines?

The starting goal and progress goal are the minimum amount of activity to gain fitness and health benefits. So yes, if you feel able, do more! Build up to this gradually​

Is physical activity safe after a SCI?

The physical activity guidelines are based on scientific evidence which suggests that activity is safe after a SCI. However, there are risks – check out the safety tips on this page.

LINKS

SCI Organisations:

Aspire
Back Up
Scottish Disability Sport
Spinal Injuries Association
Spinal Injuries Scotland
EverybodyMoves
WheelPower

Other links: 

Loughborough University 

Peter Harrison Centre for Disability 

Thank you 

The following people we would like to be acknowledge for their part in this translational research
so far at various stages of the project:
Loughborough University:
Final design and co-production of infographic – Funded by an EPG grant from Loughborough
University and The Peter Harrison Centre for Disability Sport
(https://www.lboro.ac.uk/research/phc/) in partnership with Princess Royal Spinal Cord Injuries
Centre https://www.princessroyalspinalcentre.nhs.uk/ and
WheelPower https://www.wheelpower.org.uk/ (Emily Weller https://www.wheelpower.org.uk/ourpeople/emily-weller/)
• Vicky Goosey-Tolfrey, The Peter Harrison Centre for Disability Sport, Loughborough
University. https://www.lboro.ac.uk/schools/sport-exercise-health-sciences/people/vickytolfrey/
• Sven Hoekstra, The Peter Harrison Centre for Disability Sport, Loughborough University.
• David Maidment, The Peter Harrison Centre for Disability Sport, Loughborough
University. https://www.lboro.ac.uk/schools/sport-exercise-health-sciences/people/davidmaidment/
• Lynsey Speirs, The Peter Harrison Centre for Disability Sport, Loughborough
University. https://www.lboro.ac.uk/research/phc/team/
• James Haley, The Peter Harrison Centre for Disability Sport, Loughborough
University. https://www.lboro.ac.uk/research/phc/team/
University of Lincoln:
Designer of the infographic:
Lesley Sharpe, School of Sport and Exercise Science, University of
Lincoln https://staff.lincoln.ac.uk/f06a9741-ad2a-4b61-a5f0-123999241674
Durham University:
Original researcher who led the initial stages of the co-production of physical activity exercise
guidelines and translation to clinical staff (networking) workshop:
Toni Williams, Department of Sport and Exercise Sciences, Durham
University https://www.durham.ac.uk/staff/toni-williams/
Clinical Rehabilitation links:
Hannah Houliston, Royal National Orthopaedic Hospital, Stanmore.
Claire Lincoln, Scottish Centre for Innovation in SCI (Research Physiotherapist Spinal
Injuries) https://www.gla.ac.uk/research/az/scisci/staff/msclairelincoln/
Dot Tussler, Former Head Physiotherapist National Spinal Injuries Centre, Stoke Mandeville
Emily Whicher, Spinal Cord Injury Link Worker, Imperial College Healthcare NHS Trust
Vicki Middleton, Sheffield Teaching Hospitals NHS Foundation Trust, Princess Royal Spinal Cord
Injuries Centre
Rehabilitation and Health Sciences input:
Andy Pringle, School of Human Sciences, University of Derby https://www.derby.ac.uk/staff/andypringle/
Kathleen A. Martin Ginis, School of Health and Exercise Sciences, University of British Columbia,
Canada https://hes.ok.ubc.ca/about/contact/kathleen-martin-ginis/
Jennifer Tomasone, School of Kinesiology and Health Studies, Queen’s University,
Canada https://skhs.queensu.ca/people/faculty/jennifer-tomasone-phd/

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