Hicks et al. 2003
Canada
PEDro=8
RCT
Initial N=43; Final N=32

Population: Age = 19-65 yrs; Gender: both; Time since injury = 1-24 yrs.
Treatment: Experimental group participated in a progressive exercise training program twice weekly for 9 mths on alternative day’s 90-120 mins starting with warm up, upper extremity stretching, and 15 to 30 min of aerobic training. As the rate of perceived exertion decreased, workload was increased.  Some resistance training took place.
Outcome Measures: Changes in cardiovascular function, muscle strength & quality of life.

1. Quality of life components:  Exercisers reported less stress, fewer depressive symptoms, and greater satisfaction with their physical functioning than the controls. (p=0.06).  Exercisers reported less pain (p<0.01) and a better Q of L (p<0.05).
2. Performance on the 3-stage arm crank protocol was different paraplegics and tetraplegics. (p<0.05).
3. No changes in HR and BP between groups or after 9 months of training. 
4. Arm crank protocol was different between tetraplegia and paraplegia.  Training induced increases occurred in all subjects in the experimental group.   
5. No significant differences in heart rate response over the 9 mths.  
6. Significant group x lesion x time interactions were found in stages 2 (p=0.006) and stage 3 (p=0.02), indicating the tetraplegics had the greatest decrease in heart rate. 
7. Changes in muscle strength: Experimental group showed changes in muscle strength over the 9 mth period.  The control group did not show any significant changes.

Latimer et al. 2002;
PEDro=6
RCT
N=20

Population: Age: 19-65 years; Gender males = 5, females = 16; Time since injury = 1 year.
Treatment:  A nine-month program of twice-weekly small group exercise sessions of 60-90 minutes duration incorporating stretching, arm ergometry, and resistance exercise under the supervision of volunteers at a university health promotion centre.  Control subjects were instructed to continue with their normal activities and were requested to refrain from starting a regular exercise routine during the length of the study.  Monthly health information sessions were discontinued due to poor attendance.
Outcome Measures: Pain perception (two items from the Short Form 36-Item Health Survey - SF-36 scale); PSS, CES-D scale (score out of 60).

1. Path A (treatment-exercise to outcome) (ΔR2=0.19, p<0.05), and path B (exercise and perceived pain) (ΔR2=0.28, p<0.01) and stress (ΔR2=0.23, p<0.01) were significant. 
2. Path C (mediator-outcome) revealed that depression was predicted by stress (β=0.49, p=0.02) but not by perceived pain (β=0.29, p=2.25).

Ginis et al. 2003
Canada
PEDro=6
RCT
Initial N=34; Final N=34

Population: Age: 19-65 years; Gender males = 5, females = 16; Time since injury = 10.4 yrs.
Treatment: Those in the exercise sessions of stretching, arm ergometry, and resistance exercise under the non-exercise group were asked to continue their usual activities and were asked not to exercise regularly.
Outcome Measures: Pain perception (SF-36); Symptom self efficacy and perceived control (2 core items from the Beliefs Scale a modified version of the Arthritis Beliefs Scale); PSS.

1. Path A (treatment-exercise to outcome) (ΔR2=0.19, p<0.05), and path B (exercise and perceived pain) (ΔR2=0.28, p<0.01) and stress (ΔR2=0.23, p<0.01) were significant. 
2. Path C (mediator-outcome) revealed that depression was predicted by stress (β=0.49, p=0.02) but not by perceived pain (β=0.29, p=2.25).

Latimer et al. 2005
Canada
PEDro=3
RCT
N=23

Population: Intervention group - Tetraplegic=7, Paraplegic=6; Gender: m=9, f=4; Mean age=37.54 yrs; Mean time post injury= 9.23 yrs. Control group - Tetraplegic=4, Paraplegic=6; Gender: m=5, f=5; Mean age=43.30 yrs; Mean time post injury= 15.70 yrs
Treatment: Intervention group: A 6 mos exercise program 2x/wk in small groups (avg 3-5 people), run by student volunteer personal trainers. Control group: Asked to continue daily activities normally and not begin an exercise routine within 6 mos.
Outcome Measures: PSS, CESD, PQOL

1. At baseline, increased stress levels were related to increased depression rates (p<0.05). At 6 mos, the exercise group's stress and depression association had decreased but remained significant in the control group (p<0.05).
2. At baseline, increased stress levels were associated to decreased perceived QOL (p<0.05). At 3 & 6 mos, the exercise group's stress and QOL association decreased, but remained high across all time points for the control group (p<0.05).
3. Exercise was found to buffer the effects of stress on QOL & depression.

Hicks et al. 2005
Canada
Downs & Black score=18
Pre-Post
N=14

Population: Chronic incomplete SCI: N=14; Tetraplegic=11, Paraplegic=3; Gender: m=11, f=3; Age range= 20-53 yrs; Mean time post injury=7.4 yrs; ASIA: B=2, C=12
Treatment: Body weight supported treadmill training (BWSTT -robotic) – up to 45 min, 3x/week, 144 sessions (12 months).
Outcome Measures: CESD

1. Increased life satisfaction & increased physical function satisfaction (p<0.05), after BWSTT.
2. No change in depression or perceived health.

Warms et al. 2004
USA
Downs & Black score=14
Pre-Post
N=16

Population: Gender: m=13, f=3; Mean age= 43.2 yrs; Mean time post injury=14.4 yrs.
Treatment: “Be Active in Life” program: included educational materials (2 pamphlets, 2 handouts), a home visit with a nurse (90 min. scripted motivational interview, goal and personal action plan establishment), and follow up calls at day 4, 7, 11 & 28 (approx. 8 min each). Program lasted for 6 wks, and had a final follow up 2 wks post-completion.
Outcome Measures: SRHS, CESD

1. Physical activity: Counts/day increased in 60% of subjects and self-reported activity increased in 69% of subjects, but both were not significant.
2. Self-rated abilities: no change. Exercise self-efficacy: ↑ (p=0.01).
3. Self-rated health: increased (p=0.04).
4. Depression: no change.

Guest et al. 1997
USA
Downs & Black score=13
Pre-Post
N=15

Population: Traumatic complete paraplegics; N=15; Gender: m=12, f-3; Mean age= 28.8 yrs; Mean time post injury=3.8 yrs.
Treatment: Electrically stimulated walking program - 32-sessions, using the Parastep® FNS ambulation system.
Outcome Measures: TSCS, BDI

1. Physical Self-Concept: decreased after electrically stimulated walking (p<0.05). Those with lower baseline score had the most significant improvements. 
2. Depression: decreased after electrically stimulated walking (p<0.05).

Kennedy et al. 2006
UK
Downs & Black score=11
Pre-Post
N=35

Population: Gender: males=30, females=5; Age: 18-61yrs, Level of injury: paraplegia = 20, tetraplegia=15.
Treatment: Back-Up: a 1-week single or multi-activity course in an integrated, residential environment. Activities include skiing, horseback riding, waterskiing, canoeing, rappelling and gliding.  Questionnaires were completed at baseline and end of 1 wk activity courses
Outcome Measures: LSQ, HADS

1. Significant improvement (p=0.016) in life satisfaction and satisfaction with leisure (p=0.007)
2. Anxiety levels were significantly reduced (p<0.01).
3. No overall improvement in perceived manageability however some difference (p=0.016) post test was observed for engage “in what happens around me” indicating some use of Perceived Manageability strategy.
4. Self-efficacy scores improved post test (p=0.012).
5. HADS scores demonstrated significant (p<0.01) improvement in anxiety levels over the duration of the course.

Bradley et al. 1994
USA
Downs & Black score=10
Cohort
N=37

Population: Gender: males=24, females=13; Mean age=32.03 yrs; Level of injury: tetraplegic=12, paraplegic=25; Mean time post injury=6.51 yrs
Treatment: Intervention group: 3 mos. FES exercise program; Control group: no intervention.
Outcome Measures: MAACLR

1. Increased in depression & hostility for those who had unrealistic expectations of the FES program (p<0.01 & p<0.05, respectively).  
2. No other significant effects were found.