Abstract
Study design
Scoping review of experimental and quasi-experimental studies.
Objective
To systematically synthesize research testing the effects of leisure time physical activity (LTPA) interventions on chronic pain and subjective well-being (SWB) among adults with spinal cord injury (SCI).
Methods
Literature searches were conducted using multiple databases (Web of Science, Embase, CINAHL, Medline, PsychINFO and SPORTDiscus) to identify studies involving persons with SCI that measured and reported the effects of LTPA interventions on both chronic pain and at least one measure of SWB (e.g., affect, life satisfaction, satisfaction with various life domains). Relevant data were extracted from the studies and synthesized.
Results
A total of 3494 articles were screened. Fifteen published articles, consisting of 12 different studies met the review inclusion criteria. Four different patterns of findings were observed regarding the effect of LTPA on chronic pain and SWB outcomes: (1) increased chronic pain, decreased SWB (1 article); (2) decreased chronic pain, improved SWB (12 articles); (3) increased chronic pain, improved SWB (1 article); and (4) unchanged levels of pain, improved SWB (1 article).
Conclusions
Results of most articles included in this scoping review suggest that LTPA interventions can reduce chronic pain and improve SWB for persons with SCI. Further research is needed to identify the mechanisms by which LTPA affects pain and SWB, in order to formulate LTPA prescriptions that maximize improvements in these outcomes.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Finnerup NB, Johannesen IL, Sidrup SH, Bach FW, Jensen TS. Pain and dysesthesia in patients with spinal cord injury: a postal survey. Spinal Cord. 2001;39:256–62.
Dijkers M, Bryce T, Zanca J. Prevalence of chronic pain after traumatic spinal cord injury: a systematic review. J Rehabil Res Dev. 2009;46:13–29.
Siddall PJ, Loeser JD. Pain following spinal cord injury. Spinal Cord. 2001;39:63–73.
IASP. IASP taxonomy. http://www.iasp-pain.org/Education/Content.aspx?ItemNumber=1698&navItemNumber=576. Accessed 4 Aug 2019.
Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull. 2007;133:581–624.
Budh CN, Österåker AL. Life satisfaction in individuals with a spinal cord injury and pain. Clin Rehabil. 2007;21:89–96.
Diener E. Subjective well-being. Psychol Bull. 1984;95:542–75.
Van Campen C, Van, Santvoort M. Explaining low subjective well-being of persons with disabilities in Europe: the impact of disability, personal resources, participation and socio-economic status. Soc Indic Res. 2013;111:839–54.
Fuhrer MJ. Subjective well-being of people with spinal cord injury: relationships to impairment, disability, and handicap. Top Spinal Cord Inj Rehabil. 1996;4:56–71.
Weaver F, Guihan M, Pape TL-B, Legro M, LaVela S, Collins E, et al. Creating a research agenda in SCI based on provider and consumer input. Spinal Cord Injuries Psychosocial. Process. 2001;14:77–88.
Martin Ginis KA, Latimer AE, McKechnie K, Ditor DS, McCartney N, Hicks AL, et al. Using exercise to enhance subjective well-being among people with spinal cord injury: the mediating influences of stress and pain. Rehabil Psychol. 2003;48:157.
Hanley MA, Jensen MP, Ehde DM, Robinson LR, Cardenas DD, Turner JA, et al. Clinically significant change in pain intensity ratings in persons with spinal cord injury or amputation. Clin J Pain. 2006;22:25–31.
Burke D, Lennon O, Fullen BM. Quality of life after spinal cord injury: the impact of pain. Eur J Pain. 2018;22:1662–72.
Guy SD, Mehta S, Harvey D, Lau B, Middleton JW, O’Connell C, et al. The CanPain SCI clinical practice guideline for rehabilitation management of neuropathic pain after spinal cord: recommendations for model systems of care. Spinal Cord. 2016;54:S24.
Widerström-Noga E, Anderson KD, Perez S, Martinez-Arizala A, Cambridge JM. Subgroup perspectives on chronic pain and its management after spinal cord injury.J Pain 2018;19:1480–90.
Martin Ginis KA, Jetha A, Mack DE, Hetz S. Physical activity and subjective well-being among people with spinal cord injury: a meta-analysis. Spinal Cord. 2010;48:65.
Cardenas DD, Jensen MP. Treatments for chronic pain in persons with spinal cord injury: a survey study. J Spinal Cord Med. 2006;29:109–17.
Nawoczenski DA, Ritter-Soronen JM, Wilson CM, Howe BA, Ludewig PM. Clinical trial of exercise for shoulder pain in chronic spinal injury. Phys Ther. 2006;86:1604–18.
Mulroy SJ, Thompson L, Kemp B, Hatchett PP, Newsam CJ, Lupold DG, et al. Strengthening and optimal movements for painful shoulders (STOMPS) in chronic spinal cord injury: a randomized controlled trial. Phys Ther. 2011;91:305–24.
Hicks AL, Martin KA, Ditor DS, Latimer AE, Craven C, Bugaresti J, et al. Long-term exercise training in persons with spinal cord injury: effects on strength, arm ergometry performance and psychological well-being. Spinal Cord. 2003;41:34.
Martin Ginis KA, Jörgensen S, Stapleton J. Exercise and sport for persons with spinal cord injury. PMR. 2012;4:894–900.
Tomasone JR, Wesch NN, Ginis KA, Noreau L. Spinal cord injury, physical activity, and quality of life: a systematic review. Kinesiol Rev. 2013;2:113–29.
Buecker S, Simacek T, Ingwersen B, Terwiel S, Simonsmeier BA. Physical activity and subjective well-being in healthy individuals: a meta-analytic review. Health Psychol Rev. 2020;1–19.
Rintala DH, Loubster PG, Castro J, Hart KA, Fuhrer MJ. Chronic pain in a community-based sample of men with spinal cord injury: prevalence, severity, and relationship with impairment, disability, handicap, and subjective well-being. Arch Phys Med Rehabil. 1998;79:604–14.
Rejeski WJ, Martin K Jr, Ettinger WH, Morgan T. Treating disability in knee osteoarthritis with exercise therapy: a central role for self‐efficacy and pain. Arthritis Rheumatism. 1998;11:94–101.
Smeets RJ, Vlaeyen JW, Kester AD, Knottnerus JA. Reduction of pain catastrophizing mediates the outcome of both physical and cognitive-behavioral treatment in chronic low back pain. J Pain. 2006;7:261–71.
Kennedy P, Hasson L. The relationship between pain and mood following spinal cord injury. J Spinal Cord Med. 2017;40:275–9.
van der Scheer JW, Ginis KA, Ditor DS, Goosey-Tolfrey VL, Hicks AL, West CR, et al. Effects of exercise on fitness and health of adults with spinal cord injury: a systematic review. Neurology. 2017;89:736–45.
Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8:19–32.
Diener E, Heintzelman SJ, Kushlev K, Tay L, Wirtz D, Lutes LD, et al. Findings all psychologists should know from the new science on subjective well-being. Can Psychol/Psychol Can. 2017;58:87.
Diener E, Diener M. Cross-cultural correlates of life satisfaction and self-esteem. Culture and well-being. Dordrecht: Springer; 2009. p. 71–91.
Helliwell JF, Barrington-Leigh CP, Harris A, Huang H. International evidence on the social context of well-being. Cambridge, MA: National Bureau of Economic Research; 2009.
Barnett-Page E, Thomas J. Methods for the synthesis of qualitative research: a critical review. BMC Med Res Methodol. 2009;9:59.
McKinstry C, Brown T, Gustafsson L. Scoping reviews in occupational therapy: the what, why, and how to. Aust Occup Ther J. 2014;61:58–66.
Popay J, Roberts H, Sowden A, Petticrew M, Arai L, Rodgers M, et al. Guidance on the conduct of narrative synthesis in systematic reviews. A Prod ESRC Methods Program Version. 2006;1:b92.
Latimer AE, Ginis KA, Hicks AL, McCartney N. An examination of the mechanisms of exercise-induced change in psychological well-being among people with spinal cord injury. J Rehabil Res Dev. 2004;41:643–52.
Martin Ginis KA, Latimer AE. The effects of single bouts of body-weight supported treadmill training on the feeling states of people with spinal cord injury. Spinal Cord. 2007;45:112–15.
Kemp BJ, Bateham AL, Mulroy SJ, Thompson L, Adkins RH, Kahan JS. Effects of reduction in shoulder pain on quality of life and community activities among people living with SCI paraplegia: a randomized control trial. J Spinal Cord Med. 2011;34:278–84.
Norrbrink C, Lindberg T, Wahman K, Bjerkefors A. Effects of an exercise programme on musculoskeletal and neuropathic pain after spinal cord injury—results from a seated double-poling ergometer study. Spinal Cord. 2012;50:457–61.
Curtis KJ, Hitzig SL, Leong N, Wicks CE, Ditor DS, Katz J. Evaluation of a modified yoga program for persons with spinal cord injury. Ther Recreat J. 2015;49:97–117.
Shem K, Karasik D, Carufel P, Kao MC, Zheng P. Seated Tai Chi to alleviate pain and improve quality of life in individuals with spinal cord disorder. J Spinal Cord Med. 2016;39:353–8.
Wilbanks SR, Rogers R, Pool S, Bickel CS. Effects of functional electrical stimulation assisted rowing on aerobic fitness and shoulder pain in manual wheelchair users with spinal cord injury. J Spinal Cord Med. 2016;39:645–54.
Curtis K, Hitzig SL, Bechsgaard G, Stoliker C, Alton C, Saunders N, et al. Evaluation of a specialized yoga program for persons with a spinal cord injury: a pilot randomized controlled trial. J Pain Res. 2017;10:999–1017.
Sato G, Osumi M, Morioka S. Effects of wheelchair propulsion on neuropathic pain and resting electroencephalography after spinal cord injury. J Rehabil Med. 2017;49:136–43.
Nightingale TE, Rouse PC, Walhin JP, Thompson D, Bilzon JL. Home-based exercise enhances health-related quality of life in persons with spinal cord injury: a randomized controlled trial. Arch Phys Med Rehabil. 2018;99:1998–2006.
Todd KR, Martin Ginis KA. An examination of diurnal variations in neuropathic pain and affect, on exercise and non-exercise days, in adults with spinal cord injury. Spinal Cord Ser Cases. 2018;4:94.
Finley MA, Euiler E. Association of musculoskeletal pain, fear-avoidance factors, and quality of life in active manual wheelchair users with SCI: A pilot study. J Spinal Cord Med. 2019;1–8.
Martin Ginis KA, van der Scheer JW, Latimer-Cheung AE, Barrow A, Bourne C, Carruthers P, et al. Evidence-based scientific exercise guidelines for adults with spinal cord injury: an update and a new guideline. Spinal Cord. 2018;56:308–21.
Bryce TN, Biering-Sørensen F, Finnerup NB, Cardenas DD, Defrin R, Lundeberg T, et al. International spinal cord injury pain classification: part I. Background and description. Spinal Cord. 2012;50:413–7.
Tulsky DS, Kisala PA, Victorson D, Tate DG, Heinemann AW, Charlifue S, et al. Overview of the spinal cord injury–quality of life (SCI-QOL) measurement system. J Spinal Cord Med. 2015;38:257–69.
Sweet SN, Martin Ginis KA, Tomasone JR. Investigating intermediary variables in the physical activity and quality of life relationship in persons with spinal cord injury. Health Psychol. 2013;32:877.
Martin Ginis KA, van der Scheer JW, Todd KR, Davis JC, Gaudet S, Hoekstra F, et al. A pragmatic randomized controlled trial testing the effects of the international scientific SCI exercise guidelines on SCI chronic pain: protocol for the EPIC-SCI trial. Spinal Cord. 2020;1–9.
Funding
KRT is supported by a Joseph-Armand Bombardier Canada Graduate Scholarship (SSHRC), Killam Doctoral Scholarship (2019–2021), and WorkSafe BC Research Award (2019–2021). SVCL is supported by a Social Sciences and Humanities Research Council Doctoral Fellowship. RBS is supported by a Joseph-Armand Bombardier Canada Graduate Scholarship (SSHRC) and Gragopean Scholarship (2018–2021). KMG holds the Reichwald Family UBC Southern Medical Program Chair in Chronic Disease Prevention.
Author information
Authors and Affiliations
Contributions
All authors contributed to the conception and design of this study, in addition to drafting or critically revising the article. KRT was responsible for designing the review protocol, writing the protocol and report, conducting the search, screening potentially eligible studies, extracting and analyzing data, interpreting results, writing manuscript, updating reference lists and creating tables and figures. SVCL was responsible for designing the review protocol, screening potentially eligible studies, reviewing data abstraction, and manuscript revision. RBS was responsible for designing the review protocol, reviewing data abstraction, and manuscript revision. DW was responsible for designing the review protocol, providing insight into proper SWB terminology, reviewing elements of data abstraction, and manuscript revision. KMG was responsible for designing the review protocol, assisting with writing the protocol and report, screening potentially eligible studies, analyzing data, interpreting results, manuscript revision and designing tables and figures.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Todd, K.R., Lawrason, S.V.C., Shaw, R.B. et al. Physical activity interventions, chronic pain, and subjective well-being among persons with spinal cord injury: a systematic scoping review. Spinal Cord 59, 93–104 (2021). https://doi.org/10.1038/s41393-020-00550-z
Received:
Revised:
Accepted:
Published:
Version of record:
Issue date:
DOI: https://doi.org/10.1038/s41393-020-00550-z
This article is cited by
-
Influence of time since injury and physical activity level on upper limb kinematics and muscle activation during wheelchair propulsion in complete T12/L1 spinal cord injury
BMC Musculoskeletal Disorders (2025)
-
The influence of subjective well-being on anxiety, depression and quality of life in patients with functional dyspepsia
BMC Gastroenterology (2025)
-
A Comparison of Neuropathic Pain Experiences Among Paralympic Versus Recreational Athletes with Spinal Cord Injury
Sports Medicine - Open (2023)
-
The effects of active upper-limb versus passive lower-limb exercise on quality of life among individuals with motor-complete spinal cord injury
Spinal Cord (2022)
-
The Impact of Residents' Leisure Time Allocation Mode on Individual Subjective Well-being: The Case of China
Applied Research in Quality of Life (2022)
