Researchers Study Effects of Intensive Exercise on Neurological Recovery

To those who have undergone rehabilitation at Shepherd Center, intensive exercise is an activity they know well.

But for participants in Shepherd Center’s Crawford Research Institute ACTION Clinical Trial, intensive exercise has been ratcheted up to a new level. For 24 consecutive weeks, participants in this trial are undergoing a rigorous exercise regimen nine hours a week.

The clinical trial stems from research showing that high-intensity exercise can provide tremendous benefits for people with incomplete spinal cord injuries (SCI). Now, Shepherd researchers want to know whether intensive exercise promotes neurological recovery.

Shepherd researchers are about halfway through the trial, which will enroll 50 people with incomplete SCI classified by the American Spinal Injury Association (ASIA) as a C or D injury. Sixteen patients have either completed or are undergoing the 24-week program. Nine are in a control group, meaning they are being monitored, but are waiting 24 weeks before they begin. Researchers continue to enroll healthy adults, ages 18 to 60, who meet the study criteria.

The ACTION Trial is very demanding on patients, said research coordinator Candy Tefertiller, DPT, ATP, NCS. “The dosage and intensity is incredible,” she explained. “It’s an exhausting combination of locomotor training, developmental sequencing, and strengthening and resistance training.”

Research has shown recovery in people with incomplete SCI appears to be directly proportional to the exercise dosage – maybe even more so than the type of exercise.

“The research suggests that immobility does not lead to recovery, but that high-dosage intense activity might facilitate some recovery of function even in chronic neurological injuries,” Tefertiller said. “Sometimes, the success has not been specific to the treatment intervention, but to the amount. Plus, this kind of exercise addresses the body as a whole. We’re doing core strengthening and building stable foundations, as well as facilitating an appropriate walking pattern. This allows restoration of some capabilities and can give some patients the ability to walk faster.”

ACTION Trial participant Tonya Sheriff, 35, of Eastanollee, Ga., who sustained a C-3 to -5 incomplete SCI in a 1991 car accident, says the study’s exercise regimen was indeed difficult, but worthwhile.

“I gave it every effort I had,” Sheriff said. “I didn't realize I could push my body as far as I did.  However, I give credit to the research team for that because they pushed and encouraged me the whole way. 

“When I first began the ACTION Trial, I couldn't walk and control a walker with wheels on my own or stand up on my own,” Sheriff explained. “When I finished, I could stand from certain heights with assistance. Also, I started the program on the Lokomat (robotic locomotor training device) and was able to switch to a manual treadmill. Now that I am home, I am continuing to follow the exercise program I was given. It is a challenge to get in nine hours a week and work and plan a wedding. But I carve out time out to exercise.”

The kind of exercise regimen under study in the ACTION Trial differs from Shepherd’s other rehabilitation efforts, notes Mike Jones, Ph.D., vice president of research and technology.

“While therapeutic activity is a mainstay of rehabilitation, traditional therapy approaches are directed at compensation for – rather than restoration of – neurological function,” Jones said. “Rehabilitation after SCI has traditionally emphasized the use of the preserved and strongest muscles to achieve compensatory functioning.

“Time and energy are usually not devoted to facilitating weaker muscles and promoting neural recovery,” he explained. “In contrast to conventional physical rehabilitation, activity-based therapies, such as the ones being studied in the ACTION Trial, are interventions that provide activation of the neuromuscular system below the level of the lesion with the goal of retraining the nervous system to recover specific motor tasks.”

 When the ACTION Trial is completed, researchers hope to know how to better treat patients who might benefit from such activity-based regimens.

“We’ll analyze the results and see what is most beneficial for our patients,” Tefertiller said. “We recommend so many hours of walking training and resistance training per week, but that might not be realistic. With the results, we’ll get to see which clients benefit the most, and then we’ll be able make suggestions for clinical guidelines that can be used in clinical practice. And for those who don’t respond well, it’ll give us a better idea about how to treat them in another way.”

For more information on participating in Shepherd research, see www.shepherd.org/research and complete the intake form.