Physical Activity and the Health of Wheelchair Users

Ruben Salinas, Jr.; Aaron Saguil

RUBEN SALINAS, JR., MD, FAAFP, Carl R. Darnall Army Medical Center Family Medicine Residency Program, Fort Hood, Texas

AARON SAGUIL, MD, MPH, FAAFP, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland

Am Fam Physician. 2022;105(5):534-539

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

Key Clinical Issue

What are the benefits of physical activity in patients with multiple sclerosis (MS), cerebral palsy, and spinal cord injury who use or are at risk of using wheelchairs?

Evidence-Based Answer

Physical activity improves aerobic capacity, balance (i.e., reducing risk of falls), walking ability, depression, sleep, female sexual function, global function, and activities of daily living, depending on the population and activity being considered.¹ (Strength of Recommendation [SOR]: B, inconsistent or limited-quality patient-oriented evidence.)

Intervention	Strength of evidence (direction of finding)

	Multiple sclerosis	Cerebral palsy	Spinal cord injury
Aerobic exercise
Dance (one randomized controlled trial in multiple sclerosis and cerebral palsy)	● ○ ○ (function improvement)	● ○ ○ (function improvement)	○ ○ ○
Aerobics	● ○ ○ (sleep improvement)	○ ○ ○	○ ○ ○
Aquatics	● ○ ○ (balance, activities of daily living, female sexual function improvement)	○ ○ ○	○ ○ ○
Cycling	● ○ ○ (no clear benefit on walking)	● ○ ○ (function improvement)	○ ○ ○
Robot-assisted gait training	● ○ ○ (balance improvement, no clear benefit on function)	○ ○ ○	● ○ ○ (activities of daily living improvement, no clear benefit on function)
Treadmill	● ○ ○ (walking, function, and balance improvement)	● ○ ○ (function improvement)	○ ○ ○
Postural control
Balance exercises	● ● ○ (balance improvement)	○ ○ ○	○ ○ ○
	● ○ ○ (fall risk improvement)	○ ○ ○	○ ○ ○
	● ○ ○ (function improvement)	○ ○ ○	○ ○ ○
Hippotherapy	○ ○ ○	● ○ ○ (balance and function improvement)	○ ○ ○
Tai chi	○ ○ ○	○ ○ ○	○ ○ ○
Motion gaming	● ○ ○ (function, balance improvement)	○ ○ ○ (balance improvement)	○ ○ ○
Whole body vibration	○ ○ ○	○ ○ ○	○ ○ ○
Yoga	● ○ ○ (no clear benefit on function)	○ ○ ○	○ ○ ○
Strength interventions
Muscle strength exercise	● ○ ○ (no clear benefit on walking, function, balance, quality of life, spasticity)	● ○ ○ (no clear benefit on walking and function)	○ ○ ○
Multimodal exercise
Progressive resistance or strength plus aerobic and/or balance exercise	● ○ ○ (walking, balance, VO₂ improvement)	● ○ ○ (no clear benefit on function, quality of life)	○ ○ ○
All types of exercise	● ● ● (walking improvement)	● ○ ○ (function improvement)	● ○ ○ (function improvement)
	● ● ○ (balance, depression improvement; no clear benefit on function)	● ○ ○ (VO₂ improvement)	● ○ ○ (VO₂ improvement, increased episodes of autonomic dysreflexia, no clear benefit on depression)

Selph SS, Skelly AC, Wasson N, et al. Physical activity and the health of wheelchair users: a systematic review of evidence in multiple sclerosis, cerebral palsy, and spinal cord injury. Comparative effectiveness review no. 241. (Prepared by the Pacific Northwest Evidence-Based Practice Center under contract no. 290-2015-00009-I) AHRQ publication no. 21(22)-EHC017. Agency for Healthcare Research and Quality; October 2021. Accessed December 14, 2021. https://effectivehealthcare.ahrq.gov/sites/default/files/cer-241-physical-activity-wheelchair-evidence-summary-updated.pdf

U.S. Department of Health and Human Services. Physical activity guidelines for Americans, 2nd ed. 2018. Accessed December 14, 2021. https://health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf

Department of Health and Social Care; Llywodraeth Cymru Welsh government; Department of Health Northern Ireland; Scottish government. UK chief medical officers' physical activity guidelines. September 7, 2019. Accessed December 14, 2021. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/832868/uk-chief-medical-officers-physical-activity-guidelines.pdf

American Heart Association recommendations for physical activity in adults and kids. April 18, 2018. Accessed December 14, 2021. https://cpr.heart.org/en/healthy-living/fitness/fitness-basics/aha-recs-for-physical-activity-in-adults

Centers for Disease Control and Prevention. Increasing physical activity among adults with disabilities. Accessed December 14, 2021. https://www.cdc.gov/ncbddd/disabilityandhealth/pa.html

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