Question
What are the current recommendations for exercise and strength training in older adults with spinal cord injury, and how do they differ from those for healthy older adults?
Answer
For healthy older adults, resistance training should be individualized, periodized, and progressive, typically involving two to three sets of multiple joint exercises per muscle group at 70–85% of one-repetition maximum, performed two to three times per week. For older adults with spinal cord injury, guidelines recommend at least 20 minutes of moderate-to-vigorous-intensity aerobic exercise twice a week and strength training for major functional muscle groups at moderate-to-vigorous intensity for 3 sets twice a week. For those aiming for greater cardiometabolic health, 30 minutes of moderate to vigorous intensity exercise three times a week is suggested. However, there is a lack of specific evidence-based recommendations for adults over 65 with spinal cord injury, so clinicians must blend general geriatric and SCI-specific guidelines, individualizing dosing and intensity based on the patient’s abilities, comorbidities, and goals. Importantly, dosing should be carefully monitored and adjusted, as generic exercise prescriptions may not yield optimal outcomes in this population.
This Ask the Expert is an edited excerpt from the course, 'Late-Onset Spinal Cord Injury: Rehabilitation Considerations for the Older Adult Experiencing SCI', presented by Kevin Cezat, PT, DPT, GCS, RAC-CT, and Kristen Cezat, PT, DPT, NCS, ATP/SMS.
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