Finding Function Through Fitness: Rethinking Exercise After Spinal Cord Injury

Dr. Nicholas H. Evans, MHS, PhD has been working at Shepherd Center, helping people with spinal cord injury engage in exercise and physical activity when transitioning from physical rehabilitation back to community.

At this years 3rd Annual Sara Mulroy Symposium, Dr. Nicholas Evans delivered an impactful presentation that explored how to improve function through fitness after spinal cord injury, specifically diving into the topic of Neuromotor Fitness.

To Kick things off, Dr.Evans began his talk with a strong reminder for us all:

“The purpose of exercise is not simply to get more years out of life, but to get more life out of years.”

This recap will cover the three key topics covered in the presentation:

1. The importance of skill based training for adults with SCI across age groups.

2. Key features of exercise programming to specifically target this aspect of fitness.

3. Impact and challenges from the research and application of neuromotor fitness training for individuals with SCI.

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(p.s. scroll to the end to access the link to the full video recap if you'd like to see the presentation in full)

Neuromotor fitness training and SCI

Neuromotor fitness is a skill based training that aims to enhance attributes of balance, coordination, reaction time, agility and movement speed. This type of training is important and consequential because individuals with spinal cord injury, especially those who are in later stages of aging, have diminished capacity for whole body coordination, movement speed, balance and reaction time.

Why Neuromotor Fitness Matters For Individuals With SCI

Dr. Evans emphasized that exercise isn’t just about building strength or endurance, it’s also about building the skills that shape how people move in daily life. Neuromotor fitness, a domain formally recognized by the American College of Sports Medicine in 2011, includes attributes like balance, coordination, agility, reaction time, and movement speed. For individuals with SCI, especially as they age, these attributes are critical. Impaired coordination, slowed reactions, and reduced balance can make daily life more challenging and increase fall risk.

The slide below from Dr.Evan's presentation illustrates all the ways Neuromotor fitness affects the rest of the body systems that play a role in exercise and daily movement:

A Training Circuit That Targets Neuromotor Skills

To address these needs, Dr. Evans and his team at Shepherd Center developed a Neuromotor skill training circuit that avoids expensive equipment while still pushing participants in meaningful ways.

The six exercises (ranging from multidirectional lunges to high-knee marching and rapid toe-taps) were designed to challenge speed, coordination, and balance.

Importantly, the circuit also incorporated intensity: participants worked at a moderate heart rate level to engage neuroplasticity and motor learning mechanisms.

Check out the full circuit shown in the presentation slide below:

Early Results Of Training

In their initial study with 25 adults with motor incomplete SCI, ages 18 to 70, participants completed the circuit over one week. The findings were compelling:

• Faster Walking: Both short- and long-distance walking speed improved significantly.

• Better Coordination: The weaker limb showed measurable gains without loss of quality in the stronger limb.

• Improved Balance: Both objective balance tests and participants’ confidence in avoiding falls improved.

Even those with greater impairments at baseline showed progress, and there were no study dropouts, an encouraging sign of accessibility across age and ability ranges.

This circuit was designed to be accessible and doable outside of the lab. With simple equipment and adaptable movements, it can be implemented at community gyms like the YMCA, and even at home with remote supervision. The team is also exploring neuromotor training for wheelchair users through virtual platforms, ensuring broader access.

Addressing Clinical Concerns and Challenges

A question often raised in therapy is whether intense exercise might worsen spasticity. Dr. Evans noted that while spasticity sometimes increased immediately after training, the longer trend over several days showed a decrease, suggesting that intensity may not pose long-term problems.

Another challenge that is faced when it comes to this type of training is that every person with SCI presents differently, even with similar injury levels. One-size-fits-all programming simply doesn’t work for everyone in the same way. Dr. Evans highlighted the need for data-driven approaches, including machine learning, to identify which training strategies benefit which individuals.

Additional Key Takeaways

• Skill-based training is a critical but underutilized component of SCI exercise programming.

• Targeted circuits can improve speed, coordination, and balance, boosting both function and confidence.

• Exercise intensity matters, not just for fitness, but for motor learning and neuroplasticity.

• Programs must adapt to individual needs, and future research will help refine “who responds best to what.”

• Community partnerships and technology will be essential to making these programs widely accessible.

To watch the full presentation click here