Effects of Exercise Training and Inspiratory Muscle Training in Spinal Cord Injury: A Systematic Review

Objective: To provide a systematic review of the studies assessing exercise training and inspiratory muscle training (IMT) in individuals for the improved respiratory function of patients with spinal cord injury (SCI).Methods: Thirteen studies (5 exercise training, 8 IMT) were identified. Articles were scored for their methodological quality using the Physiotherapy Evidence Database scores and Downs and Black tools for randomized and nonrandomized studies, respectively. Conclusions were based on the most rigorously executed studies using Sackett's levels of evidence.Results: Study comparison was compromised by diverse research designs; small sample sizes; and heterogeneity of studied populations, protocols, and outcome measures. Based on current literature, there is level 2 evidence supporting exercise training as an intervention to improve respiratory strength andendurance and level 4 evidence to support exercise training as an intervention that might improve restingand exercising respiratory function in people with SCI. There is level 4 evidence to support IMT as anintervention that might decrease dyspnea and improve respiratory function in people with SCI.Conclusions: There are insufficient data to strongly support the use of exercise training or IMT for improved respiratory function in people with SCI. There is some evidence of efficacy of both regimens; however, the evidenceis not of the best possible quality.