**3. The clinical advantages that spinal cord injured individuals gain from habitual physical activity and exercise**

The need for regular aerobic, strength and flexibility training among spinal cord injured individuals is paramount in their daily personal pursuit to maintain a healthier quality of life.


*Therapy Approaches in Neurological Disorders*

waist circumference) and metabolic risk factors (elevated systolic blood pressure, fasting insulin and triglycerides levels) [3–5]. Jordaan and Farrow et al. reported that there is an upsurge in a sub-category of metabolic syndrome among spinal cord injured individuals that being cardiometabolic diseases [2, 6]. Cardiometabolic diseases entail non-insulin dependent diabetes mellitus, renal failure, cardiovascular diseases (especially hypertension) and dyslipidaemia [2]. Considering the paucity of awareness of the clinical therapeutic benefits of habitual physical activity and exercise rehabilitation towards spinal cord injuries, this chapter intends to review empirical literature associate with this topic. A secondary aim is to demonstrate the need for an interprofessional clinical and therapeutic team strategy to enhance the

wellbeing and quality of life of the spinal cord injured individuals.

**experience because of habitual physical inactivity**

Markers of obesity are increased body mass index (beyond 30kg/m2

loss of muscle mass, as well aid with the reduction of fat mass [2].

**2. The clinical disadvantages that spinal cord injured individuals'** 

In this sub-section the authors will describe the altered metabolic profile, body composition, physical capacity, muscle strength and functional capabilities of spinal cord injured individuals. After sustaining the unfortunate occurrence of a spinal cord injury, most individuals become physical inactive (sedentary) which lowers their metabolism, which is pragmatically evident in their metamorphosis of their body composition [7, 8]. Hick *et al* reported that many spinal cord injured individuals become obese (excessive body fat content) and develop obesity-related pathologies, which include non-insulin diabetes mellitus and cardiovascular diseases [9].

hip ratio circumferences (males beyond 0.8 and females 0.7) [10]. Physical inactivity after spinal cord injury with normal energy consumption results in an increased body fat mass and diminished lean muscle mass (muscle atrophy) from disuse [9, 11]. Fisher *et al* reported that spinal cord injured individuals who are habitually physically active and/or exercise, increase their metabolism, which expends more energy, thereby lowering body mass, fat mass and maintains lean muscle mass [11]. Resistance training has proven to be especially helpful to maintain and/or restore

Obese individuals muscle cells become insensitive to identify their endogenous insulin; therefore they cannot enter the cells, which prevent the insulin from converting the glucose to glycogen. Sometimes the obese person may become insulin resistant. The obese person is in a state of hyperglycemia. Rajan *et al.* postulated that 66% of spinal cord injured individuals, who are obese, find themselves susceptible to obesity-related pathologies [12]. Obese persons have increased levels of low density lipoprotein cholesterol (LDL-C), which is associated with hypertension (elevated blood pressure) and enlarged atria and ventricles. These cardiovascular morphological adaptations adversely impact the functioning of the heart, leading to various secondary cardiovascular diseases [13]. Clinical literature indicates that spinal cord injured individuals have low HDL-C and elevated LDL-C that increases the risk of atherosclerosis [2, 14, 15]. Tanhoffer *et al* reported that diminished HDL-C levels are a consequence of physical inactivity among spinal cord injured individuals, whilst physical active individuals maintain a high HDL-C and lower LDL-C levels that limit the occurrence of cardiovascular diseases [15]. De Groot *et al* suggested that habitual moderate intensity physical activity and/or exercise among spinal cord injured individuals favorably influence their cardiometabolic profiles curtailing the unfortunate incidence of cardiovascular and metabolic diseases [13]. Post spinal cord injury there is inevitably muscle mass loss due decreased physical inactivity, which consequently reduces muscle strength and endurance [16].

) and waist-to-

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