SCI patients at risk for other health woes

Study shows lack of exercise a significant problem

Workers with spinal cord injuries (SCI) face more than just the challenge of successful rehab and recovery — they are often at greater risk than the general worker population for developing diseases related to a sedentary lifestyle due to a lack of exercise.

This higher level of risk and some of its major causes were highlighted in a recent study conducted by researchers at the University of Michigan (UM) Health System, Ann Arbor. Their findings were presented at the annual meeting of the American Academy of Physical Medicine and Rehabilitation in Orlando, FL.

"People with SCI are living a lot longer nowadays," explains William Scelza, MD, who led the study while completing his residency in physical medicine and rehabilitation at UM. "A long time ago, when you would get such an injury, a lot of this wasn’t addressed because patients were not living very long. Now, we’re getting much better with general overall care, but many people are now looking at a greater risk in terms of such things as heart disease and diabetes."

In fact, he adds, it appears that people with SCI seem to have some degree of glucose intolerance that puts them a bit more at risk because they are not using the majority of their muscle mass. "In addition, a lot of them have not been following an exercise regimen because they were either unable to, or because they were fearful of injuring themselves or having trouble finding accessible places or programs," Scelza notes, hinting at some of the study’s findings.

Not an impossible task

While there are specific challenges for SCI patients when it comes to regular exercise, they can be overcome, says Scelza, currently a fellow in spinal cord injury at Kessler Institute for Rehabilitation in West Orange, NJ, and himself a spinal cord injury patient at age 17. 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. "For example, a lot of people with high-level spinal cord injuries have limited use of their upper extremities and legs, but so many things are being developed now — like electrical stimulation — that we are constantly finding new ways for people to exercise," he observes.

Of course, exercise regimens need to be individualized because each person has different needs and abilities and problems. "One thing that would really be beneficial would be for therapists familiar with spinal cord injuries, their related limitations and abilities to help coordinate the program," Scelza offers. "In addition, it will take lots of encouragement from the occupational health care team to recommend programs for these people and encourage them to participate. They can also educate them about the risks and benefits of exercise, and how much it is practical for them to endure."

How can occupational health professionals help these employees overcome their lack of motivation? "If you consider the general population, barriers to exercise most often cited are lack of motivation and time — this is also very high for people with SCIs," he explains. "Not everyone with an SCI is going to be gung ho about going out and exercising. It’s good to inform people what the benefits of the exercise program would be. And the programs should not only be geared to exercise, but to wellness and other activities as well."

A potential model

A potential model for such a program is currently being studied at UM. The program was designed to improve wellness and prevent secondary complications associated with SCI such as carpal tunnel syndrome, pressure sores, spasticity, obesity, and so forth, notes Denise G. Tate, PhD, ABPP, professor and director of research in the department of physical medicine and rehabilitation.

"It is well known that persons with SCI have a very sedentary lifestyle, which contributes to these complications after the onset of injury," says Tate. "One way for those with SCI to avoid secondary conditions and take control over their lives and health is through participation in health promotion programs."

The program, funded by the University of Michigan Venture Investment Fund and supported in partial collaboration by the UM Model SCI Care System through a grant from the National Institute on Disability and Rehabili-tation Research, U.S. Department of Education, consisted of a series of six four-hour workshops, Well on Wheels, held over a period of three months at University Hospital in Ann Arbor. The program focused on improving physical activity, promoting appropriate nutrition, and teaching stress management skills.

Forty-four adults having spinal lesions participated in the program. They were randomly assigned to either program or control groups. The results showed no differences on biometric data such as levels of blood cholesterol, body mass index, or blood pressure, but significant gains in health behaviors. Workshop participants also reported fewer secondary conditions by the end of the study, when compared to their baseline data.

"Keep in mind this was a very small sample," says Tate. "I believe if we had a larger sample to compare with, we would have obtained significant differences. And we did obtain them on some of the health behaviors; people who went through the program seemed to have made health behavior changes which would have impacted [the biometrics] over time."

[For more information, contact:

William Scelza, MD, Kessler Institute for Rehabilitation, West Orange, NJ. E-mail: wscelza@yahoo.com.

Denise G. Tate, PhD, ABPP, Professor and Director of Research, Department of Physical Medicine and Rehabilitation, University of Michigan Health System, D4101 MPB, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0718. Telephone: (734) 936-7052. Fax: (734) 936-7048. E-mail: dgtate@umich.edu.]