Exercising Safely and Effectively with a Spinal Cord Injury

How do you exercise safely and effectively with a spinal cord injury?

Staying healthy requires regular exercise, but individuals with SCI may face additional challenges in finding suitable exercise options.

Blunted heart rate response, low blood pressure, and inability to sweat are just a few of the common symptoms of SCI that must be considered to exercise safely.

Here are some practical tips for maintaining a safe and effective workout routine.

Exercising Safely Infographic
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Don't Use Typical Intensity Indicators

Heart Rate Can be Misleading

People with an SCI above T5 often experience a blunted heart rate response while exercising.

In most people with paralysis, age-related target heart rate "zones" are not recommended.

Man playing an adaptive sport in a wheelchair. Beside him is a heartrate icon struck through to indicate that heartrate is a bad way to measure workout intensity.

SCI May Prevent or Limit Sweating

Many people with SCI are unable to produce sweat below the level of injury. Some can't produce sweat at all.

This can be dangerous when exercising since the body is unable to cool itself. It's important to remember that a lack of sweat doesn't mean your exercise isn't vigorous enough, especially when playing adaptive sports.

Woman in a wheelchair lifting weights. Beside her is an icon of her sweating, crossed out to indicate that sweating is a bad way to measure workout intensity.

Better Ways to Check Workout Intensity

Talk Tests (TT)

Man walking with leg braces, supporting himself using beams while speaking to perform a talk test.

The Talk Test is performed by checking how comfortably you can speak while working out. If sustained speech becomes difficult, it's a reliable indicator of a vigorous workout.

Talk Test Goal: Exercise hard enough to be breathing heavily, but not so hard that you're gasping for air.

Rating Perceived Exertion (RPE)

Perceived exertion is how hard you feel like your body is working. Pay attention to your heart rate (relative to your maximum heart rate), breathing, sweat, and muscle fatigue.

RPE is measured from 6-20 on the Borg scale, where 6 is "no exertion at all" and 20 is "maximal exertion".

Perceived Exertion Goal: Target the "somewhat hard" category, level 13-15 on the Borg scale.

Borg Rating of Perceived Exertion Scale

6 No Exertion
7-8 Easy
9-10 Very Light
11-12 Fairly Light
13-15 Somewhat Hard
16-17 Hard
18-19 Very Hard
20 Max Exertion

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Download the infographic to print (PDF) or to share online (PNG).


Goosey-Tolfrey, Victoria L., Hutchinson, Mike, and Sharpe, Lesley. Infographic. Field-based methods for assessing exercise intensity in adults with spinal cord injury. British Journal of Sports Medicine.

Kaupang, Kristin. Get Moving: Exercise and SCI. University of Washington Medical Center.

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