Qualitative analysis of perceived motivators and barriers to exercise in individuals with spinal cord injury enrolled in an exercise study

Health action process approach and spinal cord injury: a scoping review

PURPOSE

Spinal cord injury may result in chronic pain, difficulty walking and breathing, and/or paralysis. People with spinal cord injury (PwSCI) experience increased risk for chronic diseases and psychosocial distress (e.g. type 2 diabetes, substance use disorders) and premature mortality. The Health Action Process Approach (HAPA) is a social cognitive health behavior framework validated to explain modifiable preventative health behaviors (e.g. physical exercise, healthy eating, substance misuse) among people with chronic conditions. The present scoping review investigates what, how, and how much peer-reviewed research literature applies HAPA to preventative health behaviors among PwSCI.

MATERIALS AND METHODS

A search was conducted in seven community health databases including PubMed, CINAHL, PsycINFO, SocIndex, Scopus, Web of Science, Sociological Abstracts, and Library and Information Science Source. Seven peer-reviewed articles were identified. Conventional content analysis was used in the full-text review to identify themes and calculate theme frequency.

RESULTS

All studies were quantitative and applied HAPA to physical exercise. HAPA explained differences in sports participation, leisure time physical activity, and strength training.

CONCLUSIONS

A strong predictor of physical exercise was belief in the capability to overcome psychosocial barriers. More attention is needed on HAPA-identified barriers, and customized HAPA-based interventions to promote physical exercise among PwSCI.

Enhancing Spinal Cord Injury Care: Using Wearable Technologies for Physical Activity, Sleep, and Cardiovascular Health

Wearable devices have the potential to advance health care by enabling real-time monitoring of biobehavioral data and facilitating the management of an individual's health conditions. Individuals living with spinal cord injury (SCI) have impaired motor function, which results in deconditioning and worsening cardiovascular health outcomes. Wearable devices may promote physical activity and allow the monitoring of secondary complications associated with SCI, potentially improving motor function, sleep, and cardiovascular health. However, several challenges remain to optimize the application of wearable technologies within this population. One is striking a balance between research-grade and consumer-grade devices in terms of cost, accessibility, and validity. Additionally, limited literature supports the validity and use of wearable technology in monitoring cardio-autonomic and sleep outcomes for individuals with SCI. Future directions include conducting performance evaluations of wearable devices to precisely capture the additional variation in movement and physiological parameters seen in those with SCI. Moreover, efforts to make the devices small, lightweight, and inexpensive for consumer ease of use may affect those with severe motor impairments. Overcoming these challenges holds the potential for wearable devices to help individuals living with SCI receive timely feedback to manage their health conditions and help clinicians gather comprehensive patient health information to aid in diagnosis and treatment.

Piloting the effectiveness of the Workout on Wheels Internet Intervention (WOWii) program among individuals with mobility disabilities

BACKGROUND

Doing any amount of moderate-to-vigorous physical activity yields health benefits. Individuals with mobility disabilities are among the least physically active Americans and limited evidence indicates effective strategies to promote physical activity among this group.

OBJECTIVE

Examine whether a 16-week virtual intervention program (Workout on Wheels internet intervention, WOWii) increases exercise engagement among mobility impaired individuals.

METHODS

Participants recruited through community organizations that provide services to individuals with disabilities. The WOWii program is comprised of 3 core components: 16 weeks of virtual intervention delivery and access to the WOWii website; staff and peer support; an exercise package that included an activity tracker and heart rate monitor, pedal exerciser, and therabands.

RESULTS

Ten people enrolled. Participants demonstrated good program engagement, attending an average of 14.1 ± 2.1 of the 16 virtual meetings and completing an average of 10.6 ± 5.6 weekly activities. Exercise data revealed that participants increased their time spent in aerobic exercise from an average of two days a week performing 32 ± 22 min during week one to an average of five days a week doing 127 ± 143 min in the final WOWii week. Only half continued to exercise over the two months once WOWii virtual meetings ended.

CONCLUSION

WOWii program delivery successfully promoted increased exercise participation for people with mobility disabilities over the 16 intervention weeks. Future studies should investigate approaches to promote exercise maintenance beyond program delivery.

Socio-ecological Barriers to Leisure Time Physical Activity in Spanish Wheelchair Users With Spinal Cord Injury: Associations With Sociodemographic Characteristics and Functional Independence

OBJECTIVE

(1) To assess prevalence and severity of socio-ecological barriers to leisure time physical activity (LTPA) in a sample of adults with spinal cord injury (SCI); (2) to examine the association of these barriers with sociodemographic characteristics and functional independence (FI); and (3) to explore which socio-ecological levels of barriers might be associated with LTPA.

DESIGN

Cross-sectional study.

SETTING

Neurorehabilitation Hospital specialized in SCI.

PARTICIPANTS

207 wheelchair users with SCI living in the community who attended a comprehensive check-up (22.7% women, 47.5±10.7 mean age; N=207).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The short version of the Barriers to Physical Activity Questionnaire for People with Mobility Impairments was used to measure socio-ecological barriers to LTPA. The Spinal Cord Independence Measure III was used to measure FI. The Physical Activity Recall Assessment for People with SCI was used to quantify LTPA. Several multiple linear regression models were computed to examine the associations between socio-ecological barriers and sociodemographic factors, LTPA and FI.

RESULTS

A high prevalence of barriers to LTPA was found. Seven of these barriers (2 intrapersonal, 3 organizational, and 2 community) were present for >60% of the participants. Intrapersonal and organizational barriers had a higher effect on participants with lower FI and women. Interpersonal barriers were higher for older participants and with lower FI, while community barriers were higher for unemployed participants. Finally, intrapersonal and interpersonal barriers were negatively associated with LTPA, and FI revealed as a moderator of the intrapersonal barriers-LTPA relation.

CONCLUSIONS

Given their high prevalence and their association with LTPA, the development of interventions targeting socio-ecological barriers to LTPA in people with SCI becomes crucial. The associations of these barriers with FI and sociodemographic characteristics should also be considered for these interventions to be as specific and effective as possible.

Electrical Stimulation Exercise for People with Spinal Cord Injury: A Healthcare Provider Perspective

Electrical stimulation exercise has become an important modality to help improve the mobility and health of individuals with spinal cord injury (SCI). Electrical stimulation is used to stimulate peripheral nerves in the extremities to assist with muscle strengthening or functional activities such as cycling, rowing, and walking. Electrical stimulation of the peripheral nerves in the upper extremities has become a valuable tool for predicting the risk of hand deformities and rehabilitating functional grasping activities. The purpose of this paper is to provide healthcare providers perspective regarding the many rehabilitation uses of electrical stimulation in diagnosing and treating individuals with SCI. Electrical stimulation has been shown to improve functional mobility and overall health, decrease spasticity, decrease the risk of cardiometabolic conditions associated with inactivity, and assist in the diagnosis/prognosis of hand deformities in those with tetraplegia. Studies involving non-invasive stimulation of the spinal nerves via external electrodes aligned with the spinal cord and more invasive stimulation of electrodes implanted in the epidural lining of the spinal cord have demonstrated improvements in the ability to stand and enhanced the stepping pattern during ambulation. Evidence is also available to educate healthcare professionals in using functional electrical stimulation to reduce muscle spasticity and to recognize limitations and barriers to exercise compliance in those with SCI. Further investigation is required to optimize the dose-response relationship between electrical stimulation activities and the mobility and healthcare goals of those with SCI and their healthcare providers.