Spinal cord injury, exercise and quality of life.

The ultimate goal of comprehensive rehabilitation in individuals with spinal cord injury (SCI) has shifted over time from an extension of their life expectancy to attainment of an optimal level of independent living and quality of life. After World War II, the important influence of sport and exercise upon the course of rehabilitation following SCI was recognised. Nonetheless, 5 decades later, there remains a lack of understanding of how an exercise programme can contribute to an improvement of quality of life among individuals with SCI. In future, attention should be directed toward avoidance of secondary impairments, disabilities and handicaps. The World Health Organization model of disablement provides a suitable framework for addressing this issue. The most common benefits of exercise are biological in nature. They target a reduction in secondary impairments (loss of cardiorespiratory, and muscular function, metabolic alterations and systemic dysfunctions). This in turn could minimise the development of disabilities and the appearance of such handicaps as loss of mobility, physical dependence and poor social integration. A lack of physical fitness for specific tasks can be a serious obstacle to autonomy following SCI. In a very short period of time, physical deconditioning can significantly decrease quality of life in individuals with SCI, ultimately placing them in a state of complete dependency. Quality of life is closely associated with independent living and, increasingly, it is a key outcome when measuring the success of rehabilitation. Consequently, research designs that examine the impact of exercise upon individuals with disabilities should not only include objective outcome measures, but also subjective measures relating to life-satisfaction and quality of life.