Physical Activity and the Health of Wheelchair Users: A Systematic Review in Multiple Sclerosis

[ActiveMSers]

Archives of Physical Medicine and Rehabilitation

Available online 13 October 2021
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Review Article (Meta-Analyses)

Physical Activity and the Health of Wheelchair Users: A Systematic Review in Multiple Sclerosis, Cerebral Palsy, and Spinal Cord Injury

Shelley S.SelphM.D., M.P.H.¹Andrea C.SkellyPh.D., M.P.H.²NgocWassonM.P.H.¹Joseph R.DettoriPh.D., M.P.H., M.P.T.³Erika D.BrodtB.S.²ErikEnsrudM.D.⁴DianeElliotM.D.⁴Kristin M.DissingerD.P.T.⁴MarianMcDonaghPharm.D.¹

https://doi.org/10.1016/j.apmr.2021.10.002

Under a Creative Commons license

FULL STUDY (FREE): https://www.sciencedirect.com/science/article/pii/S0003999321014842

Abstract

Objective
To understand the benefits and harms of physical activity in people who may require a wheelchair with a focus on people with multiple sclerosis (MS), cerebral palsy (CP), and spinal cord injury (SCI).

Data Sources: Searches were conducted in MEDLINEŽ, CINAHLŽ, PsycINFOŽ, Cochrane CENTRAL, EmbaseŽ, (January 2008 through November 2020).
Study Selection
Randomized controlled trials (RCTs), nonrandomized trials, and cohort studies of observed physical activity (at least 10 sessions on 10 days) in participants with MS, CP, and SCI.

Data Extraction
We conducted dual data abstraction, quality assessment, and strength of evidence. Measures of physical functioning are reported individually where sufficient data exist and grouped as “function” where data are scant.

Data Synthesis
No studies provided evidence for prevention of cardiovascular conditions, development of diabetes, or obesity. Among 168 included studies, 44% enrolled participants with MS (38% CP, 18% SCI). Studies in MS found walking ability may be improved with treadmill training and multimodal exercises; function with treadmill, balance exercises, and motion gaming; balance is likely improved with balance exercises and may be improved with aquatic exercises, robot-assisted gait training (RAGT), motion gaming, and multimodal exercises; activities of daily living (ADL), female sexual function, and spasticity may be improved with aquatic therapy, sleep may be improved with aerobic exercises and aerobic fitness with multimodal exercises. In CP, balance may be improved with hippotherapy and motion gaming; function with cycling, treadmill, and hippotherapy. In SCI, ADL may be improved with RAGT.

Conclusion
Depending on population and type of exercise, physical activity was associated with improvements in walking, function, balance, depression, sleep, ADL, spasticity, female sexual function, and aerobic capacity. Few harms of physical activity were reported in studies. Future studies are needed to address evidence gaps and to confirm findings.

List of abbreviations
ADL
Activities of daily living
AHRQ
Agency for HealthBIHcare Research and Quality
AIS
American Spinal Injury
CP
cerebral palsy
EDSS
Expanded Disability Status Scale
EPC
Evidence-based Practice Center
GMFCS
Gross Motor Function Classification System
MS
multiple sclerosis
NIH
National Institutes of Health
P2P
Pathways to Prevention
RCTs
Randomized controlled trials
RAGT
robot-assisted gait training
SCI
spinal cord injury
TOO
Task Order Officer