REVIEW The development of evidence-informed physical activity guidelines for adults with spinal cord injury KA Martin Ginis 1 , AL Hicks 1 , AE Latimer 2 , DER Warburton 3 , C Bourne 4 , DS Ditor 5 , DL Goodwin 6 , KC Hayes 7 , N McCartney 1 , A McIlraith 8 , P Pomerleau 9 , K Smith 10 , JA Stone 11 and DL Wolfe 7 1 Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada; 2 School of Kinesiology and Health Studies, Queen’s University, Kingston, Ontario, Canada; 3 Experimental Medicine Program, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; 4 Active Living Alliance for Canadians with a Disability, Ottawa, Ontario, Canada; 5 Department of Kinesiology, Brock University, St Catharines, Ontario, Canada; 6 Faculty of Physical Education and Recreation, The Steadward Centre for Personal & Physical Achievement, University of Alberta, Edmonton, Alberta, Canada; 7 Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, Ontario, Canada; 8 Consumer (No Affiliation); 9 Institut de Re´adaptation en De´ficience Physique du Que´bec, Quebec City, Quebec, Canada; 10 Department of Physical Medicine & Rehabilitation, St Mary’s of the Lake Hospital, Kingston, Ontario, Canada and 11 Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada Objectives: To systematically develop evidence-informed physical activity guidelines to improve physical fitness in people with spinal cord injury (SCI). Setting: This study was conducted in Canada Methods: The Appraisal of Guidelines, Research and Evaluation II guideline development protocol was used to develop exercise guidelines to improve physical capacity and muscular strength. The evidence base for the guideline development process consisted of a systematic review and quality appraisal of research examining the effects of exercise on physical fitness among people with SCI. A multidisciplinary expert panel deliberated the evidence and generated the guidelines. Pilot testing led to refinement of the wording and presentation of the guidelines. Results: The expert panel generated the following guidelines: for important fitness benefits, adults with a SCI should engage in (a) at least 20 min of moderate to vigorous intensity aerobic activity two times per week and (b) strength training exercises two times per week, consisting of three sets of 8–10 repetitions of each exercise for each major muscle group. Conclusion: People with SCI, clinicians, researchers and fitness programmers are encouraged to adopt these rigorously developed guidelines. Spinal Cord (2011) 49, 1088–1096; doi:10.1038/sc.2011.63; published online 7 June 2011 Keywords: exercise; strength training; aerobic training; clinical practice guidelines; spinal cord injuries Introduction The amount of disability associated with a spinal cord injury (SCI) is unique to each injury and depends on both the level and completeness of damage to the spinal cord. However, physical deconditioning is a common consequence of most SCIs, and can further exacerbate the impact of the injury and lead to an increased risk for chronic secondary health complications. It has been suggested that much of the excessive (and early) morbidity and mortality in people with chronic SCI is caused by inactivity related illnesses, such as cardiovascular disease, type II diabetes and osteoporosis. 1 In addition, the loss of fitness and independence associated with physical inactivity significantly impacts quality of life and community participation. 2 These facts highlight the impor- tance of promoting physical activity (PA) to improve health, fitness and overall quality of life within the SCI population. 3,4 PA promotion is very difficult in the absence of informa- tion regarding the types, amounts and intensities of activity that yield fitness benefits. Such information would assist clinicians and exercise programmers in prescribing and promoting exercise and PA. The able-bodied population has access to this type of information in the form of PA guidelines. 5–7 However, the able-bodied PA guidelines are not necessarily appropriate for people with SCI. The rigorous development of evidence-based PA guidelines that are specific to the needs and capabilities of the SCI population is long overdue. 8,9 This paper describes the methodological Received 22 February 2011; revised 26 April 2011; accepted 4 May 2011; published online 7 June 2011 Correspondence: Dr KAM Ginis, Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada L8S 4K1. E-mail: martink@mcmaster.ca Spinal Cord (2011) 49, 1088–1096 & 2011 International Spinal Cord Society All rights reserved 1362-4393/11 $32.00 www.nature.com/sc