Declining health and fitness are commonly known to accompany spinal cord injuries and disorders (SCI/D). Physical deconditioning and weakening of the upper limbs make essential daily activities such as wheelchair propulsion and body transfers more difficult to perform, thus challenging the activity and independence that persons with physical disabilities require throughout their lives. During the past few decades, attention has also focused on so-called cardiometabolic risk factors, including five critical health hazards: overweight/obesity, insulin resistance, hypertension, and lipid abnormalities. Evidence now suggests that these health risks appear soon after discharge from initial rehabilitation, tend to cluster, and in doing so represent more severe health hazards. They are also more challenging for stakeholders with SCI/D, their caregivers, and health care professionals to manage within the first year of living with a SCI/D and after that throughout their lifespans.
Current health guidelines designed for persons with SCI/D all recommend incorporating physical activity to a level permitted by their ability. Outdoor exercise is an option to fulfill this need. However, it may expose the individual to temperature extremes and uneven rolling surfaces that risk a fall from the wheelchair and ensuing injury. Thus, recent evidence suggests that home-based exercise is preferred for those with SCI. Home-based exercise also circumvents exercise barriers involving transportation, lack of physical access, and exercising in facilities that serve, have staff trained for, and use equipment designed for persons without a disability.
