Setting: Spinal cord injury (SCI) causes devastating loss of function and can result in serious secondary complications. Although significant advances are being made to develop cellular and molecular therapies to promote regeneration, it is important to optimize physical interventions.
Objectives: The objective of this review was to examine the evidence for the effects of physical rehabilitation strategies on health and fitness, and maintenance of target systems below the level of injury (for example, muscle, bone, circulation).
Results: Exercise appears to be a potent means of achieving these goals, using a variety of strategies.
Conclusion: Physical rehabilitation after SCI needs to move beyond the goal of maximizing independence to focus on maintenance of optimum health and fitness as well as maintenance of target system function below the level of injury. Issues requiring further investigation include identification of the optimum dosage of interventions to achieve specific goals, for example, prevention of muscle atrophy and osteoporosis, and development and validation of simple clinical measures to monitor the changes in body composition. Adoption of a classification system for physical interventions and standardized outcome measures would facilitate large-scale observational studies to identify the critical variables contributing to better outcomes.