Physical Activity and Sedentary Behavior From Discharge to 1 Year After Inpatient Rehabilitation in Ambulatory People With Spinal Cord Injury: A Longitudinal Cohort Study

Exploring lifestyle components and associated factors in newly injured individuals with spinal cord injury

STUDY DESIGN

Cross-sectional analysis from the Inception Cohort of the Swiss Spinal Cord Injury Study (SwiSCI).

OBJECTIVES

To describe five lifestyle components in newly injured individuals with spinal cord injury (SCI), explore co-occurrence of these components, and identify associated personal and clinical factors.

SETTINGS

Initial rehabilitation stay following traumatic and non-traumatic SCI.

METHODS

Lifestyle components including overweight/obesity, low diet score, physical inactivity, smoking, and alcohol consumption were used independently and to calculate a composite lifestyle score. Analyses were conducted using descriptive statistics, co-occurrence analysis, and multivariate logistic regression.

RESULTS

We included 251 individuals, of whom 77.7% were male, 73.7% suffered from traumatic SCI, and 59.8% had paraplegia. The median age was 51 years (IQR 36-64). Approximately twelve weeks after the injury, more than two-thirds of the study population met the criteria for overweight/obesity, and consumed insufficient amounts of fruits and vegetables, and excessive amounts of meat. Alcohol was consumed by 85.3% of individuals, and 26.8% were current smokers. Almost all study participants met the physical activity guidelines (90 min of moderate to strenuous activity physical activity per week). One-quarter of study participants experienced the co-occurrence of overweight/obesity, low diet score and alcohol consumption. Female sex, younger age and higher education were associated with healthier lifestyle components.

CONCLUSION

Despite methodological limitations, this study underscores the complexities of healthy lifestyle adherence among individuals newly injured with SCI. It highlights the necessity of improving and implementing screening strategies throughout the continuum of SCI care as early as possible following the trauma.

A Scoping Review of Acute Sedentary Behaviour Studies of People with Spinal Cord Injury

People with a spinal cord injury (SCI) report less physical activity than other populations and may engage in more sedentary behaviour (SB), especially sitting time. SB negatively impacts physiological and psychosocial outcomes in the general population, yet minimal research has explored the effects in people with SCI. The goal of this scoping review was to catalogue and describe the effects of acute SB among people with SCI. We searched four databases before February 2024 for studies in which people with any SCI sat, laid, or reclined for more than one hour in a day, and any physiological, psychological, or behavioural (i.e., SB time) outcome was measured. In total, 2021 abstracts were screened, and eight studies were included (n = 172 participants). The studies were characterized by varied definitions, manipulations, and measures of SB. Most measured outcomes were physiological (e.g., metabolic, blood pressure), followed by behavioural (e.g., SB time) and psychological (e.g., well-being, affect). When SB was interrupted, only postprandial glucose and affect improved. Based on two studies, participants engaged in 1.6 to 12.2 h of SB per day. Average uninterrupted wheelchair sitting bouts lasted 2.3 h. Based on the very limited body of research, it is impossible to draw any conclusions regarding the nature, extent, or impact of SB in people with SCI. There is much work to carry out to define SB, test its effects, and determine if and how people with SCI should reduce and interrupt SB.

Are Middle- or Older-Aged Adults With a Spinal Cord Injury Engaging in Leisure-Time Physical Activity? A Systematic Review and Meta-Analysis

Objectives

To investigate the amount of Leisure-Time Physical Activity (LTPA) that people over 45 years with a spinal cord injury (SCI) performed and to determine the frequency, duration, intensity, and modality of LTPA performed.

Data Sources

We searched 5 major electronic databases (CINAHL, SCOPUS, EMBASE, MEDLINE, and PubMed) from inception to March 2023.

Study Selection

Cross-sectional, longitudinal studies and control arm of controlled trials that assessed LTPA in participants over 45 years old, with a SCI. We included 19 studies in the review and 11 in the meta-analysis.

Data Extraction

We followed the PRISMA checklist for Systematic Reviews. Two review authors independently assessed the risk of bias and extracted data on participants' demographics, injury characteristics, and LTPA participation of the included studies. Risk of bias was assessed using the Joanne Briggs Institute critical appraisal tool for cross-sectional studies. Any conflicts were resolved by a third author.

Data Synthesis

We found considerable variability in LTPA participation in adults 45 years and older with SCI. An estimated 27%-64% of participants did not take part in any LTPA. A random effects meta-analysis model was completed for studies that reported total or moderate-to-heavy LTPA scores in minutes per week. Overall, participants (n=1675) engaged in 260 [205;329] (mean [95% CI]) mins/week of total LTPA. Those participating in moderate-heavy intensity LTPA (n=364) completed 173 [118; 255] (mean [95% CI]) mins/week. LTPA modalities included walking, wheeling, hand-cycling, basketball, and swimming, among others.

Conclusions

While many older adults with SCI seem to be meeting the recommended weekly physical activity volume, many still remain sedentary. There was significant variation in reporting of frequency, intensity, and duration of LTPA and reporting on modality was limited. Because of differences in reporting, it was challenging to compare results across studies. Data constraints prevented subgroup analysis of LTPA disparities between paraplegia and tetraplegia.

Correlates of physical activity in ambulatory people with spinal cord injury during the first year after inpatient rehabilitation

STUDY DESIGN

Longitudinal cohort study.

OBJECTIVES

Examine the longitudinal association between mobility and level of physical activity (PA) and explore which other factors are also associated with level of PA in ambulatory people with Spinal Cord Injury (SCI) during the first-year post-inpatient rehabilitation.

SETTING

Three SCI-specialized rehabilitation centers and the Dutch community.

METHODS

Forty-seven adults with recent SCI and ambulatory function were included. All had motor incomplete lesions, 49% had tetraplegia, and the mean age was 55 ± 13 years. Duration of accelerometry-based all-day PA and self-reported level of mobility, exertion of walking, pain, fatigue, depressive mood symptoms, fear of falling, exercise self-efficacy, and attitude toward PA were measured just before discharge from inpatient rehabilitation and 6 and 12 months after discharge. All data were longitudinally analyzed using generalized estimating equations analyses. Models were corrected for age, lesion level, and time since injury.

RESULTS

Mobility was longitudinally associated with level of PA (beta: 4.5, P < 0.001, R2: 41%). In addition, lower levels of exertion of walking (beta: -5.6, P < 0.001), fear of falling (beta: -34.1, P < 0.001), and higher levels of exercise self-efficacy (beta: 2.3, P = 0.038) were associated with higher levels of PA. Exertion of walking and fear of falling were associated with level of PA independent of mobility.

CONCLUSIONS

Mobility, exertion of walking, fear of falling, and exercise self-efficacy seem to be correlates of level of PA in ambulatory people with SCI during the first year after inpatient rehabilitation. Targeting these factors using an interdisciplinary approach may enhance levels of PA in this population.

Physical activity behaviour up to 1 year post-rehabilitation among adults with physical disabilities and/or chronic diseases: results of the prospective cohort study ReSpAct

BACKGROUND

Little is known of physical activity behaviour among adults with a disability and/or chronic disease during and up to 1 year post-rehabilitation. We aimed to explore (1) dose characteristics of physical activity behaviour among adults with physical disabilities and/or chronic diseases during that period, and (2) the effects of personal characteristics and diagnosis on the development of physical activity over time.

METHODS

Adults with physical disabilities and/or chronic diseases (N=1256), enrolled in the Rehabilitation, Sports and Active lifestyle study, were followed with questionnaires: 3-6 weeks before (T0) and 14 (T1), 33 (T2) and 52 (T3) weeks after discharge from rehabilitation. Physical activity was assessed with the adapted version of the Short Questionnaire to ASsess Health enhancing physical activity. Dose characteristics of physical activity were descriptively analysed. Multilevel regression models were performed to assess physical activity over time and the effect of personal and diagnosis characteristics on physical activity over time.

RESULTS

Median total physical activity ranged from 1545 (IQR: 853-2453) at T0 to 1710 (IQR: 960-2730) at T3 min/week. Household (495-600 min/week) and light-intensity (900-998 min/week) activities accrued the most minutes. Analyses showed a significant increase in total physical activity moderate-intensity to vigorous-intensity physical activity and work/commuting physical activity for all time points (T1-T3) compared with baseline (T0). Diagnosis, age, sex and body mass index had a significant effect on baseline total physical activity.

CONCLUSION

Physical activity is highly diverse among adults with physical disabilities and/or chronic diseases. Understanding this diversity in physical activity can help improve physical activity promotion activities.