UWC researcher Aeysha Gabriels found participants’ physical activity levels were well below global health guidelines.Image: Supplied

South Africa has one of the highest rates of traumatic spinal cord injury in the world, disproportionately affecting young men. However, a new study from the University of the Western Cape (UWC) reveals that people living with these injuries engage in alarmingly low levels of physical activity, placing them among the most inactive populations internationally.

According to the research, the lack of physical activity increases their risk of chronic illnesses such as obesity, diabetes and heart disease, which are leading causes of death in South Africa.

Published in the South African Journal of Physiotherapy, the study found that both those using wheelchairs and the individuals with limited movement (ambulatory) as a result of traumatic spinal cord injuries spent most of their time either sitting or doing very minimal activity. This is the first study to objectively measure physical activity in adults with spinal cord injuries in South Africa. Previous research has shown that despite the intensive physical activity during inpatients’ rehabilitation after their injuries, their exercise levels often drop sharply once they return to their communities. 

To address this gap, Aeysha Gabriels from the Department of Physiotherapy undertook a Master’s research project to investigate physical activity among adults living with spinal cord injuries in South Africa. She conducted the study with her research team, including Prof Conran Joseph, head of the Physiotherapy Division at Stellenbosch University; Dr Toughieda Ismail, a lecturer at Stellenbosch University; and Dr Lucian Bezuidenhout from the same division.

They found that physical activity among study participants became so limited that it fell well below internationally recommended levels for achieving meaningful health benefits. 

While the World Health Organisation (WHO) generally recommends 150–300 minutes of moderate exercise, such as brisk walking, or 75–150 minutes of vigorous exercise per week, these targets are often not realistic for people with spinal cord injuries. Instead, physical activity guidelines for people with spinal cord injuries recommend progressive training, starting with about 20 minutes of moderate-to-vigorous aerobic exercise twice a week and gradually increasing to 30 minutes, three times a week.

In 2021, the WHO estimated that over 15 million people globally live with a spinal cord injury, making it a public health concern. South Africa has one of the highest rates of traumatic spinal cord injury in the world, with an estimated 76 cases per million people, a figure that is significantly higher than those reported in many developed Western countries. 

Using wearable physical activity trackers called accelerometers, the researchers found that older participants aged 40 and above, and those with more recent spinal cord injuries, engaged in slightly more moderate-to-vigorous physical activity than younger participants and those with longer-standing spinal cord injuries. Among wheelchair users, nearly four-fifths (77.6%) of the day was spent sitting or inactive, about one-fifth (20.7%) in light activities, and less than 2% (around 17 minutes) in moderate to vigorous physical activity. 

Conversely, ambulatory participants were found to be more inactive, spending about 98.1% of their day inactive. Only 1.9% of their day was spent engaging in moderate to vigorous exercise, which is needed to protect their long-term health.

Researchers noted that the latest findings point to an urgent need for ongoing targeted support to help people with spinal cord injuries remain active beyond the early stages of rehabilitation.

Physical activity not only helps prevent chronic diseases such as diabetes and heart disease, but in people with spinal cord injuries, it’s also been linked to improved physical functioning, such as stronger muscles, weight management, and improved breathing. It also supports independence, boosts confidence, and improves mental health.

The study also found that spinal cord injuries in South Africa disproportionately affect young men aged 18 to 29. Researchers say that identifying and addressing the barriers that prevent people with spinal cord injuries from being physically active is crucial for designing effective, targeted interventions. They warn that without proper support and accessible opportunities to stay active, persistently low levels of activity could lead to serious, lifelong health complications.

“The results of our study may provide a hopeful possibility that participants using wheelchairs to aid their mobility are finding ways to be more active within their home and community environments and to include physical activity into their daily routines,” researchers noted.