Evidence-based scientific exercise guidelines for adults with spinal cord injury: an update and a new guideline

Research output: Contribution to journalArticle


Objectives: To describe the process and outcomes of using a new evidence base to develop scientific guidelines that specify the type and minimum dose of exercise necessary to improve fitness and cardiometabolic health in adults with spinal cord injury (SCI). Setting: International. Methods: Using Appraisal of Guidelines, Research and Evaluation (AGREE) II reporting criteria, steps included (a) determining the guidelines’ scope; (b) conducting a systematic review of relevant literature; (c) holding three consensus panel meetings (European, Canadian and International) to formulate the guidelines; (d) obtaining stakeholder feedback; and (e) process evaluation by an AGREE II consultant. Stakeholders were actively involved in steps (c) and (d). Results: For cardiorespiratory fitness and muscle strength benefits, adults with a SCI should engage in at least 20 min of moderate to vigorous intensity aerobic exercise 2 times per week AND 3 sets of strength exercises for each major functioning muscle group, at a moderate to vigorous intensity, 2 times per week (strong recommendation). For cardiometabolic health benefits, adults with a SCI are suggested to engage in at least 30 min of moderate to vigorous intensity aerobic exercise 3 times per week (conditional recommendation). Conclusions: Through a systematic, rigorous, and participatory process involving international scientists and stakeholders, a new exercise guideline was formulated for cardiometabolic health benefits. A previously published SCI guideline was endorsed for achieving fitness benefits. These guidelines represent an important step toward international harmonization of exercise guidelines for adults with SCI, and a foundation for developing exercise policies and programs for people with SCI around the world.


  • Kathleen A. Martin Ginis
  • Jan W. van der Scheer
  • Amy E. Latimer-Cheung
  • Andy Barrow
  • Chris Bourne
  • Peter Carruthers
  • Marco Bernardi
  • David S. Ditor
  • Sonja Gaudet
  • Sonja de Groot
  • Keith C. Hayes
  • Audrey L. Hicks
  • Christof A. Leicht
  • Steven Macaluso
  • Patricia J. Manns
  • Christopher B. McBride
  • Vanessa K. Noonan
  • Pierre Pomerleau
  • James H Rimmer
  • Robert B. Shaw
  • Brett Smith
  • Karen M. Smith
  • John D. Steeves
  • Dot Tussler
  • Christopher R. West
  • Dalton L. Wolfe
  • Victoria L. Goosey-Tolfrey
External organisations
  • University of British Columbia
  • Queen's University
  • Paralympian and Inspirational Speaker
  • Spinal Cord Injury Ontario
  • Bromakin Wheelchairs
  • Sapienza University of Rome
  • Brock University
  • Spinal Cord Injury British Columbia
  • University of Groningen
  • Ontario Neurotrauma Foundation
  • McMaster University
  • University of Western Ontario
  • University of Alberta
  • Rick Hansen Institute
  • Institut de Réadaptation en Déficience Physique de Québec
  • University of Alabama
  • University of Birmingham
  • Stoke Mandeville Hospital
  • Loughborough University
  • International Collaboration On Repair Discoveries (ICORD)
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Health Care Service and Management, Health Policy and Services and Health Economy


  • Spinal Cord Injuries, guidelines, excercise
Original languageEnglish
Pages (from-to)308-321
JournalSpinal Cord
Publication statusPublished - 2018
Publication categoryResearch

Bibliographic note

Affiliations were corrected by the publisher on October 4th, 2018.