Effect of Exercise on Mental Health and Health-related Quality of Life in Adults with Spinal Cord Injury: A Systematic Review and Meta-Analysis

Abstract

Objectives: To determine the effect of exercise interventions on mental health and health-related quality of life (HRQoL) in individuals with SCI.

Data sources: We searched Embase, CINAHL, Medline, PsychINFO and SPORTDiscus from inception to September 2023.

Study selection: We included randomized controlled trials that: 1) involved participants >18 years old with a SCI; 2) administered an exercise intervention; 3) measured subjective well-being, psychological well-being, social well-being, and/or HRQoL as outcomes. We reported standardized means differences (d) with a 95% confidence interval (CI), assessed the risk of bias by using the Revised Cochrane Risk-of-bias Tool for Randomized Trials (RoB 2), and the certainty of the evidence using GRADE.

Data synthesis: Nineteen studies (797 participants, mean age < 65 years in every study) were included. Exercise improved overall well-being (d = 0.494; 95% CI 0.268, 0.720; low certainty evidence), subjective well-being (d = 0.543; 95% CI 0.270, 0.816; low certainty evidence), psychological well-being (d = 0.499; 95% CI 0.193, 0.805; low certainty evidence), social well-being (d = 0.452; 95% CI 0.151, 0.752; low certainty evidence), and HRQoL (d = 0.323; 95% CI 0.072, 0.574; low certainty evidence). Four serious adverse events probably attributable to the interventions were reported in three studies.

Conclusions: Exercise interventions can improve well-being and HRQoL in adults with SCI <65 years of age. Additional research is needed to determine effectiveness in adults ≥ 65 years of age.

Keywords: Depression; Disability; Physical Activity; Quality of Life; Spinal Cord Injury; Well-being.