Упражнения при травме спинного мозга (SCI) — Hicks 2011 SCI guidelines: 20 мин средне-интенсивной аэробики 2×/нед + сила 2×/нед БЕЗОПАСНЫ + улучшают CV + ментальное здоровье

Hicks 2011 SCI Action Canada Guideline + Martin Ginis 2018 + PVA/CMSC 2024 + ACSM 2022 framework. Spinal cord injury is traumatic or non-traumatic damage to the spinal cord leading to motor + sensory + autonomic loss below the level of injury. American Spinal Injury Association (ASIA) classification: AIS A (complete) → AIS B (incomplete sensory only) → AIS C (incomplete motor, <50% grade ≥3) → AIS D (incomplete motor, ≥50% grade ≥3) → AIS E (normal). Level of injury determines clinical picture: C1-C4 ventilator-dependent tetraplegia, C5-C8 tetraplegia with retained arm function, T1-T6 high paraplegia with AUTONOMIC DYSREFLEXIA risk (life-threatening hypertensive emergency triggered by bladder/bowel distension or any noxious stimulus below injury), T7-L5 paraplegia. Walking may be possible AIS C-D with bracing/AFO. Modern survival is decades; mortality drivers have shifted from respiratory/sepsis (managed by ventilator + antibiotics + UTI prevention) to CARDIOVASCULAR DISEASE (#1 — 40-50% higher than able-bodied per Cragg 2013), metabolic syndrome, pressure injury complications, and urosepsis. Hicks 2011 SCI Action Canada exercise guideline: 20 minutes moderate-vigorous aerobic 2×/week + strength training 3 sets × 8-10 reps 2×/week IS safe and improves CV fitness + reduces metabolic syndrome + chronic pain + mental health + bone density (with FES). PRESSURE INJURY PREVENTION non-negotiable: 30-second push-ups every 15-30 minutes, tilt/recline >65° regularly, skin inspection daily, adequate cushioning. OSTEOPOROSIS below injury level is severe — risk fragility fractures from minor trauma like transfers; standing frame + FES + risedronate/teriparatide all options.

Volya's catalogue carries the foundation moves adapted to SCI: supported-glute-bridge for posterior chain low-intensity (if incomplete with active hip extension), wall-push-up for upper-body push at low load (handrim propulsion overuse common), scapular-retraction for upper-back posture + shoulder protection (chronic propulsion shoulder injury rate ~30%), cat-cow for spinal mobility (if able), supine-knee-to-chest for low-back release + hip flexor stretch (if able), diaphragmatic-breathing as central respiratory training (high-level SCI respiratory weakness; abdominal binder may help), pursed-lip-breathing for dyspnea + respiratory muscle endurance, ankle-pump for circulation + DVT prevention (high VTE risk), chin-tuck for cervical posture (chronic computer/TV/phone use head-forward). The AI coach also knows the nutrition side — weight management THE most impactful lever (reduced caloric needs ~10-25% lower than able-bodied, easy weight gain → CV + transfer + pressure injury risk), protein 1.2-1.5 g/kg ideal weight + leucine 2.5-3 g per meal, cardiac protective Mediterranean + omega-3 + low-sodium + DASH-like pattern + cardiology team, bone density Ca 1200-1500 + vit D 1000-2000 IU + DEXA + standing programs + FES, bowel program nutrition (fiber 25-38 g + adequate fluid + timing), bladder management (~2-3 L fluid + AVOID caffeine + alcohol), wound healing nutrition (protein 1.5-2.0 g/kg during active pressure injury + arginine + zinc + vit C), neuropathic pain management (omega-3 + magnesium + B12), AVOID ultra-processed + SSBs + excess sodium + excess caffeine/alcohol + restrictive fad diets. CRITICAL: United Spinal Association + Christopher & Dana Reeve Foundation + Spinal Cord Society + Paralyzed Veterans of America (PVA) + American Spinal Injury Association (ASIA) + Spinal Cord Injury Model Systems + physiatry (SCI-experienced) + cardiology + urology + GI + dietitian familiar with SCI + wound-care team if pressure injury + PT/OT + mental health (depression + adjustment). This is NEVER a replacement for SCI-experienced multidisciplinary care.