Exercise Impact on Cardiovascular Autonomic, Cerebrovascular, and Cognitive Dysfunction in Individuals With Spinal Cord Injury.

Spinal cord injury (SCI) disrupts autonomic nervous system (ANS) function, leading to cardiovascular, cerebrovascular, and cognitive impairments that significantly reduce quality of life. Although exercise is known to improve cardiovascular health in the general population, limited research has explored its effects on ANS function in persons with SCI (pwSCI). This communication uniquely synthesizes the current evidence on exercise effects on ANS-related cardiovascular (ANS-CV) function, cerebrovascular health, and cognitive performance in individuals with chronic SCI, addressing critical gaps in the literature. We highlight that moderate to high-intensity exercise, particularly arm cycling, improves ANS-CV function in this population. Long-term active exercise training may also introduce benefits to cerebrovascular and cognitive function. Key challenges in drawing definitive conclusions are the limited number of available studies, inconsistency in exercise protocols (eg, type, intensity, duration), and variability in measurement approaches across studies. Therefore, future studies should specifically define exercise type, intensity, and duration, ensuring the use of more precise measures to enable more conclusive findings. Studies should also focus on clarifying the effects of exercise on cerebrovascular function and exploring the physiological mechanisms underlying exercise-induced improvements in ANS-CV, cerebrovascular, and cognitive function. A better understanding of these effects could inform the development of targeted exercise interventions to address the complex health challenges faced by pwSCI. Based on the current evidence, clinicians may consider incorporating moderate to high-intensity exercise programs into rehabilitation protocols to address ANS dysfunction in SCI.