Exercise Training for Wheelchair Users Living with Chronic Neurological Conditions: A Summary of Current Evidence and Future Research Directions

Abstract

Exercise training has emerged as a beneficial approach to chronic disease management for individuals living with chronic neurological conditions (CNCs). A variety of challenges (e.g., complex impairments, physiological deconditioning, environmental accessibility) may impact exercise engagement for individuals with CNCs at higher disability levels. Understanding the current landscape of the literature may help advance exercise research and implementation for this group. This thesis aimed to identify and summarize outcomes and exercise prescriptions in exercise training interventions for people living with CNCs who use wheelchairs for mobility. Five electronic databases were searched: Medline, Embase, CINAHL, SPORTDiscus, and Scopus for articles published up to May 2025. The search strategy incorporated terms related to 'chronic neurological conditions', 'wheelchair use', and 'exercise'. Outcomes were mapped to the International Classification of Functioning, Disability, and Health (ICF) Framework and compared to CNC-specific Brief ICF Core Sets. Exercise prescriptions were organized according to Frequency, Intensity, Time, and Type (FITT) components and compared to CNC-specific exercise recommendations. 176 articles were identified for inclusion. The most frequently identified ICF category was body functions (n=1613, 72%), followed by body structures (n=393, 18%). MS studies had the most outcome overlap (47%) between extracted outcomes and the ICF Core Set for MS. The most frequently reported FITT component was exercise type (100% exercise prescriptions), whereas exercise intensity was poorly reported (40% of exercise prescriptions). Only two (8%) exercise prescriptions met recommended targets overall. Future studies of exercise training should prioritize incorporating a range of outcomes with relevance to individuals living with CNCs, while also considering study design and sample characteristics. Improved reporting of FITT elements, particularly exercise intensity is needed. Addressing the disconnect between what is tested in the research setting and core outcome sets and exercise recommendations for use by public and healthcare providers should be considered in future work.