**2. The clinical disadvantages that spinal cord injured individuals' experience because of habitual physical inactivity**

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]. Markers of obesity are increased body mass index (beyond 30kg/m2 ) and waist-tohip 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 loss of muscle mass, as well aid with the reduction of fat mass [2].

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].

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*The Interprofessional Clinical and Therapeutic Team Strategy to Manage Spinal Cord Injuries*

**3. The clinical advantages that spinal cord injured individuals gain from** 

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

i.The need for *regular aerobic training,* is important to increase the amount of energy expended thereby lowering the blood glucose level, which will prevent a state of hyperglycemia and non-insulin dependent diabetes mellitus. Van der Scheer *et al* reported that regular aerobic activity diminish hyperglycemia, adipose tissue, triglycerides, LDL-cholesterol while increasing HDL cholesterol levels, which favorably changes their individual's cardiometabolic profile [20]. Additional benefits include loss of excessive body mass, fat mass, body mass index and increased muscle mass (slow twitch muscle fibers) [21]. Torhaug *et al* and Tweedy *et al* concur that the use of arm cranking ergometry, circuit resistance strength training, manual wheelchair propulsion and swimming increase the spinal cord injured individuals aerobic fitness, upper body muscle strength and endurance [22, 23]. Tanhoffer *et al* has documented that spinal cord injured individuals who frequently use manual wheelchairs possess superior cardiorespiratory/ aerobic fitness, which precipitates healthier cardiometabolic profiles [15]. This enriched cardiorespiratory adaptation can be viewed as being beneficial to extend upper extremity aerobic training duration, which will escalate calorie expenditure, thereby decreasing body fat. West *et al* has reported that aerobic training complimentary enhances respiratory functioning of spinal

ii.Habitual circuit training improves the person's muscle strength and endurance and VO2peak through the utilization of the short-term energy system, which chiefly stimulates fast oxidative glycolytic fibers [17, 21, 25, 26].

The loss of muscle mass and strength has being associated with decreased functional capacity; leading to greater dependence of others thereby negatively impacting on the spinal cord injured individuals' quality of life [2, 9]. Hicks *et al* and Ellapen *et al* reported that spinal cord injured individuals can prevent drastic muscle strength and mass loss (atrophy) by engaging in regular strength exercises such as arm ergometry and circuit resistance exercises [9, 17]. Hicks *et al* contend that high levels of muscle strength and endurance is positive associated with maintaining the spinal cord injured individuals physical work capacity, functional capabilities and social independence [9]. Physical capacity is the measure of the volume of physical work an individual can perform by quantifying their aerobic capacity and power output [2, 9]. Barfield *et al* emphasized that irrespective of the classification of spinal injury, individuals who are habitually physically active and/or exercise at intensities at a sufficient metabolic equivalents (METS) level are capable of increasing their aerobic fitness [18]. Martin Ginis *et al* reported that spinal cord injured individuals tend to play sport at a prolonged higher METS intensity as compared to their injured counterparts who participate only in exercise regimes [16]. Jordaan concurs with Martin Ginis *et al.* and further recommend that these findings are suggestive that participating in sport might be a more effective mode of physical activity for exploiting optimal cardiorespiratory exercise-induced

*DOI: http://dx.doi.org/10.5772/intechopen.94850*

physiological adaptations [2, 19].

injured individual [24].

healthier quality of life.

**habitual physical activity and exercise**

*The Interprofessional Clinical and Therapeutic Team Strategy to Manage Spinal Cord Injuries DOI: http://dx.doi.org/10.5772/intechopen.94850*

The loss of muscle mass and strength has being associated with decreased functional capacity; leading to greater dependence of others thereby negatively impacting on the spinal cord injured individuals' quality of life [2, 9]. Hicks *et al* and Ellapen *et al* reported that spinal cord injured individuals can prevent drastic muscle strength and mass loss (atrophy) by engaging in regular strength exercises such as arm ergometry and circuit resistance exercises [9, 17]. Hicks *et al* contend that high levels of muscle strength and endurance is positive associated with maintaining the spinal cord injured individuals physical work capacity, functional capabilities and social independence [9]. Physical capacity is the measure of the volume of physical work an individual can perform by quantifying their aerobic capacity and power output [2, 9]. Barfield *et al* emphasized that irrespective of the classification of spinal injury, individuals who are habitually physically active and/or exercise at intensities at a sufficient metabolic equivalents (METS) level are capable of increasing their aerobic fitness [18]. Martin Ginis *et al* reported that spinal cord injured individuals tend to play sport at a prolonged higher METS intensity as compared to their injured counterparts who participate only in exercise regimes [16]. Jordaan concurs with Martin Ginis *et al.* and further recommend that these findings are suggestive that participating in sport might be a more effective mode of physical activity for exploiting optimal cardiorespiratory exercise-induced physiological adaptations [2, 19].
