The effects of active upper-limb versus passive lower-limb exercise on quality of life among individuals with motor-complete spinal cord injury.

ABSTRACT

STUDY DESIGN: Multi-centre randomized clinical trial. OBJECTIVES: (1) compare the effects of arm-cycle ergometry (ACET) and body weight supported treadmill training (BWSTT) on quality of life (QOL) and intermediary variables in individuals with spinal cord injury (SCI); (2) examine correlations between baseline measures, and changes in physical activity, QOL, and intermediaries. SETTING: Hospital-based research institutes (Vancouver, Toronto) and University-based exercise program (Hamilton). METHODS: 35 participants with motor-complete SCI above T6 completed baseline assessments of physical activity, life satisfaction, independence, autonomy, positive and negative affect, and pain. Twenty-eight participants were randomized to 72 sessions of ACET (n = 14) or BWSTT (n = 14) with measures repeated following 36 sessions, 72 sessions, and 6-months post-intervention. RESULTS: Neither intervention significantly impacted QOL. Pain was reduced in ACET compared to BWSTT (interaction effect p = 0.022) and was significantly less at 72 sessions vs. baseline in the ACET group (p = 0.009). At baseline, QOL was positively correlated with independence, autonomy, and positive affect and negatively correlated with negative affect (all p < 0.05). Following BWSTT, changes in moderate-vigorous physical activity correlated with changes in QOL (r = 0.87, p = 0.010). Following ACET, changes in autonomy and independence were positively correlated with changes in QOL (both r > 0.64, p < 0.048). CONCLUSIONS: Contrary to previous studies, there was no benefit of either intervention on measures of QOL. The social context of exercise may be important for improving QOL. However, individuals may benefit more from active (ACET) than passive (BWSTT) exercise modalities through reduced pain. Exercise interventions that improve autonomy and independence may lead to improvements in QOL.