Cardiopulmonary function, exercise capacity and quality of life in patients with spinal cord injury

Abstract

Spinal Cord Injury (SCI) is one of the causes of serious long-term disability. SCI survivors usually have neurological deficits and complications such as muscle weakness and atrophy, respiratory and cardiovascular problems, pressure sores, bladder, bowel and sexual dysfunctions, spasticity, depression, pain, bone loss and fracture due to SCI. Early onset of cardiovascular disease, premature coronary heart disease, higher cardiovascular mortality rates, and mortality at a younger age have been observed in this population compared to able-bodied individuals. Physical inactivity and reduced aerobic fitness, decreased lean body mass and increased adiposity, abnormal glucose homeostasis and increased prevalence of diabetes, abnormal lipoprotein profiles with elevated low-density lipoprotein, triglycerides, total cholesterol levels, and lower high-density lipoprotein, abnormal hemostatic and inflammatory markers, and increased activation of the renin-angiotensin-aldosterone system and hypertension are suggested as specific risk factors for cardiovascular disease in this population. Another important cause of mortality and morbidity in SCI patients is respiratory dysfunction. The main causes for respiratory dysfunction and complications reported in SCI population are reduced chest wall and lung compliance, increased secretions and bronchial tone, impaired cough, and denervation of the respiratory pump (reduced respiratory muscle force and fatigue). Exercise capacity has been reported to be lower in SCI subjects than those in healthy controls due to the decreased voluntarily active muscle mass; increased venous pooling of the blood in the lower extremities and impaired venous return, reduced cardiac output, lower stroke volume and mean exercise blood pressure, and decreased respiratory function. Reduced exercise capacity, lower energy expenditure, marked deconditioning and physical inactivity are commonly observed in SCI patients. Regardless of the injury level, reduced quality of life (QoL) is observed in SCI population as compared with healthy controls and normative data. Previous studies have shown that there are significant associations between physical activity and QoL in subjects with SCI. It is also reported that physical exercise is the main influencing determinant of QoL, especially in the physical and psychological domains. Physical inactivity, a sedentary lifestyle, and reduced exercise capacity not only impair the QoL but also increase the risk of secondary health problems such as cardiovascular disease, diabetes, obesity and metabolic syndrome in this population. Therefore, regular physical activity or exercise as a subcategory of physical activity should be added into comprehensive rehabilitation programs as early as possible to be able to prevent secondary health conditions and improve functional independence and QoL. © 2021 by Nova Science Publishers, Inc. All rights reserved.