Psychological impact of sports activity in spinal cord injury patients M. C. Gioia 1,2, *, A. Cerasa 1,2, *, L. Di Lucente 1 , S. Brunelli 1 , V. Castellano 1 , M. Traballesi 1 1 Fondazione Santa Lucia IRCSS, Rome, Italy, 2 Laboratory of Neuroimaging, Institute of Neurological Sciences, National Research Council, Piano Lago di Mangone, Cosenza, Italy Corresponding author: Marco Traballesi, MD, Direttore Unita ` Operativa D – sezione amputati, Fondazione Santa Lucia, Istituto di Ricovero e Cura a Carattere Scientifico, via Ardeatina 306 – 00179 Roma, Italy. Tel: 139 06 51501840, Fax: 139 06 51501919, E-mail: m.traballesi@hsantalucia.it Accepted for publication 1 November 2005 Objective: To investigate whether sports activity is asso- ciated with better psychological profiles in patients with spinal cord injury (SCI) and to evaluate the effect of demo- graphic factors on psychological benefits. Methods: The State-Trait Anxiety Inventory, Form X2 (STAI-X2), the Eysenck Personality Questionnaire for extraversion (EPQ- R (E)) and the questionnaire for depression (QD) were administered in a cross-sectional study of 137 males with spinal cord injury including 52 tetraplegics and 85 para- plegics. The subjects were divided into two groups according to sports activity participation (high frequency vs no sports participation). Moreover, multiple regression analysis was adopted to investigate the influence of demographic vari- ables, such as age, educational level, occupational status and marital status, on psychological variables. Results: Ana- lysis of variance revealed significant differences among the groups for anxiety (STAI-X2), extraversion (EPQ-R (E)) and depression (QD). In particular, SCI patients who did not practice sports showed higher anxiety and depression scores and lower extraversion scores than sports partici- pants. In addition, with respect to the paraplegics, the tetra- plegic group showed the lowest depression scores. Following multiple regression analysis, only the sports activity factor remained as an independent factor of anxiety scores. Con- clusion: These findings demonstrate that sports activity is associated with better psychological status in SCI patients, irrespective of tetraplegia and paraplegia, and that psycho- logical benefits are not emphasized by demographic factors. Spinal cord injury (SCI) results in personal life changes. These are often accompanied by psychological conse- quences that affect rehabilitation potential and the opportunity of returning to previous, familiar social life and work (Scivoletto et al., 1997). In particular, higher levels of anxiety and depression were found in individuals with spinal cord injury (Hancock et al., 1993) than in able-bodied persons. Our study focused on sports activity as a possible method for improving SCI patients’ psychological status. It has been found that regular exercise confers positive health benefits on the SCI population (Curtis et al., 1986; Hanson et al., 2001). Several studies document objective physical and psychological gain for the spinal cord injured individual (Jeon et al., 2002; Jones et al., 2002,). However, even though physical benefits have been well defined in SCI patients, few studies have investigated the effects of sports activity on psychological status. Early studies showed that sports and recreation offer participants physiological benefits (Slater & Meade, 2004). Phy- sical activity has been found to decrease mortality, hypertension and obesity in SCI patients (Ragheb, 1980). Indeed, disabled individuals are even more likely to be sedentary than able-bodied persons and those who remain active not only enjoy physical and emotional health benefits but also demonstrate im- proved overall functional status. Evidence first in- dicated that high levels of fitness correlate with decreased time in bed, increased social interaction and overall improved life satisfaction (Heath & Fentem, 1997). Regarding investigation of the psychological ben- efits of sports activity for persons with SCI, most studies have been conducted using qualitative meth- odology. Muraki et al. (2000) compared a group of wheelchair basketball players with a group of varsity college players and a control group of college men. The participants who used wheelchairs were found to have significantly better mental health profiles than the two comparison groups. Moreover, Jacobs et al. (1990) and Paulsen et al. (1990) reported the psycho- logical profiles of wheelchair athletes compared to non-athletes; while Sherrill (1986) and Shepard (1991) showed that participation in sports could provide new opportunities for individuals with disabilities and facilitate their reintegration in the community. Previous studies (Paulsen et al., 1990; *These authors contributed equally to the realization of this study. Scand J Med Sci Sports 2006: 16: 412–416 COPYRIGHT & BLACKWELL MUNKSGAARD 2006 Printed in Singapore . All rights reserved DOI: 10.1111/j.1600-0838.2005.00518.x 412