Lower Limb Endurance Exercise After Spinal Cord Injury: Implications for Health and Functional Ambulation

are to reach and maintain a degree of physical fitness. It is felt that physiologically stressful exercise, i.e., 70% of age predicted maximum heart rate, for a minimum of 30-60 minutes, three to five times a week, is required to increase work capacity, maintain a high level work capacity or achieve fitness. It is fortunate, however, that there is scientific evidence that a relatively low and moderate intensity exercise such as walking, if consistently carried out, may be perfectly adequate to achieve optimal health benefits (2-4.) Spinal cord injury (SCI) is a significant health problem in the United States that usually results in extensive paralysis and reduced capacity for physical exercise. As a consequence, physical fitness is severely diminished and a series of degenerative physiological changes occur, that have negative implications for both physical fitness and health. The reported incidence of SCI varies according to the source, but recent data indicate an annual incidence of 30-32 new cases per million individuals (5). Those who sustain SCI are generally young (5) and, if they survive the acute phase, they are likely to live for many decades with a severe disability (6) particularly if they receive optimal care and maintain an active life style. While the incidence of SCI has remained stable or has even fallen slightly, its prevalence is rising due to increased life expectancy. Urinary complications are no longer a major of evaluation and management, but have been replaced by respiratory and cardiovascular conditions (5,7). So far little has been done to actively prevent these secondary complications which contribute so significantly to both morbidity and mortality. This paper will address some of