Leisure time physical activity among older adults with long-term spinal cord injury

A Characterization of Physical Activity in People Living With Advanced Multiple Sclerosis

Little is known about physical activity (PA) participation in people with advanced multiple sclerosis (MS). The purpose of this study was to (a) characterize self-reported PA levels and (b) explore how PA levels might differ based on sociodemographic (e.g., gender) and clinical (e.g., MS clinical course) characteristics in people with advanced MS. We used a cross-sectional online survey design with 101 participants. PA was measured using the Physical Activity Scale for Individuals With Physical Disabilities. The mean score on the scale was 4.5 (SD = 5.9) metabolic equivalent hours per day. There was a significant difference in scores based on employment, population density, living situation, disability, and assistive-device type (all p < .05). PA levels were higher in those who were employed, lived alone, required bilateral support for mobility, and were manual wheelchair users (all p < .05). This study highlights low PA levels in people with advanced MS and potential variables that might impact PA in this MS subgroup.

Exploring the quality of participation and strategies to support meaningful engagement in an adapted paddleboard program among individuals with disabilities

AIM

Adapted paddleboard provides an outdoor leisure-time physical activities (LTPA) opportunity with many health benefits (e.g., physical activity, reduced stress, social engagement). However, nearly 50% of individuals with disabilities do not participate in any LTPA. Quality of LTPA participation influences sustainable adherence, while optimizing participant experiences. An adapted paddleboard program is offered in Quebec City, for adults with physical disabilities, but little is known about how participants perceive their quality of participation. This study aimed to describe individuals with disabilities' perceived quality of participation in the adapted paddleboard program, and to explore their suggestions of strategies to support meaningful engagement in the program.

METHODS

An ethnographic mixed-methods design was conducted, consisting of participant observations during the 13-week program and semi-structured interviews based on the Quality Parasport Participation Framework (QPPF). Measure of Experiential Aspects of Participation (MeEAP) questionnaire were collected. A mixed approach of data analysis was used for qualitative data and descriptive statistics were conducted for quantitative data.

RESULTS

Nine participants (8F) with various disabilities (42±15 years old) participated in the study. Emergent dimensions of quality of participation included belongingness and autonomy. Facilitators to participation were identified, such as autonomy support through volunteers and provision of adaptive equipment. Barriers to participation included water access and level of individual challenge. Suggested strategies to improve engagement included water access closer to parking and multiple groups for variable skill levels.

CONCLUSIONS

Participants expressed high-quality of participation in adapted paddleboarding. The study allows the development of knowledge about conditions that enhance the experience of participating in outdoor LTPA.

"I think it was helpful but not as helpful as it could have been" - a qualitative study of the experiences and perspectives of using fitness apps among manual wheelchair users with spinal cord injury

PURPOSE

To gain knowledge of the experiences and perceptions of using fitness apps by full-time wheelchair users with spinal cord injury (SCI) and to explore experiences and perceptions of using these apps in relation to barriers to and facilitators of physical activity (PA).

MATERIALS AND METHODS

A qualitative design was employed. Semi-structured interviews were conducted with ten manual wheelchair users with SCI. Data were analysed using reflexive thematic analysis.

RESULTS

Four themes were developed: 1) App functionality and experience, 2) Enhancing motivation, 3) Precursors to engagement and 4) Knowledge gaps. Experience and perception were strongly influenced by app design, particularly the presence or absence of features tailored for wheelchair users. Many apps incorporated the use wearable or mountable sensors. Fitness apps were perceived to increase motivation, although, this had its limitations. Conversely, apps were reported to have limited influence on commonly reported barriers to PA. Furthermore, the data highlighted gaps in knowledge which created barriers to effective app use.

CONCLUSIONS

Fitness apps were perceived to increase motivation to engage in PA in manual wheelchair users with SCI. However, more needs to be done to further develop app features for wheelchair users with SCI and to address remaining barriers to engagement.

Physical Activity Measurement in People with Spinal Cord Injury: A Comparative Review of Different Questionnaires

Physical activity (PA) provides great health benefits for people with spinal cord injury (SCI). Consequently, the design and implementation of PA interventions addressed to this population is needed. To rigorously evaluate these interventions, the use of valid and comprehensive PA measures is crucial. Since the suitability of PA assessment tools might differ among different populations, and considering that questionnaires are one of the most frequently used tools to quantify PA, the purpose of this comparative review was to examine nine questionnaires that have been used to assess PA in people with SCI. All the questionnaires were analyzed in depth in regard to three main dimensions: (1) SCI-specific development; (2) PA domains measured and PA intensity classification; and (3) reliability and validity. After careful consideration of the evidence available on all these aspects, it is suggested that the most suitable questionnaires to be used in PA research in the SCI population are the PARA-SCI and the LTPAQ-SCI[R]. To conclude, the strengths and limitations of these two questionnaires are discussed, and specific recommendations to SCI researchers and practitioners regarding the suitability, according to the context and characteristics, of the research/intervention are provided.

Leisure time physical activity in middle-aged and older adults aging with long-term spinal cord injury: Changes over six years

BACKGROUND

Regular leisure time physical activity (LTPA) has beneficial health effects in people with spinal cord injury (SCI). Yet, participation in LTPA is low, and little is known about changes many years after injury.

OBJECTIVES

To determine changes in LTPA in middle-aged and older adults with long-term SCI over six years, investigate associations with gender, age, injury characteristics and changes in secondary health conditions and activity limitations, and investigate factors related to being physically active or sedentary.

METHODS

Part of the Swedish Aging with Spinal Cord Injury Study (SASCIS). LTPA was assessed twice over a six-year period with the Physical Activity Recall Assessment for people with Spinal Cord Injury (n = 75; 32% women, mean age 67 years, mean time since injury 31 years, injury levels C1-L3, AIS A-D). Changes were assessed with paired t-tests, McNemar test and Wilcoxon signed-rank test, associations with multivariable regression and group comparisons with Mann-Whitney U test and Chi Square test.

RESULTS

On group level participation in LTPA did not change, but the variability was substantial on individual level. There were no significant associations between changes in LTPA and the investigated variables. Among sedentary participants, higher level and severity of injury were overrepresented and the activity limitations were greater.

CONCLUSION

Our findings indicate stability in LTPA over time, but with a large individual variation. In many participants LTPA was insufficient to reach positive health effects. Promoting participation in LTPA is therefore an important part of the long-term management of middle-aged and older adults aging with long-term SCI.

Leisure-Time Physical Activity Participation in Middle-Aged and Older Adults With a Spinal Cord Injury in Australia

Objectives

Adults with spinal cord injury (SCI) are often sedentary, increasing their risk of cardiometabolic diseases. Leisure-time Physical Activity (LTPA) is physical activity completed during recreation time for enjoyment. We aimed to quantify LTPA in people ≥45 years with SCI and to explore its relationship with participants' characteristics.

Methods

This is a secondary analysis on a subset of the Australian International SCI Survey in participants ≥45 years, at least 12 months post-injury. We described levels of LTPA and used multivariable regressions to estimate the associations between participant characteristics and LTPA.

Results

Of 1,281 participants (mean age: 62.7 years, mean time since injury: 18.7 years; 74% males) 44% reported no participation in LTPA. The average LTPA participation was 197 (SD 352) minutes per week (median: 50). Females (β = -62.3, 95% CI [-112.9, -11.7]), and participants with non-traumatic injuries (β = -105.2, 95% CI [-165.9, -44.6]) performed less LTPA. Time since injury was not associated with moderate-to-heavy LTPA (LR: Probability > F = 0.785).

Conclusion

LTPA promotion in the SCI population ≥45 years focusing on females and non-traumatic injuries is warranted.

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.

Community-based exercise goals of persons with spinal cord injury: Interpreted using the International Classification of Functioning, Disability, and Health

OBJECTIVE

To identify goals for exercising among community-dwelling persons with spinal cord injury (PwSCI).

DESIGN

Qualitative descriptive study.

SETTING

Community-based exercise facility for persons with a disability.

PARTICIPANTS

Fifty-five PwSCI identified their exercise goals prior to participation in a community-based exercise intervention.

INTERVENTIONS

None.

OUTCOME MEASURES

A modified version of the Canadian Occupational Performance Measure was used to ask about exercise goals. The International Classification of Functioning, Disability, and Health (ICF) was used to code the goals for themes.

RESULTS

The participants were predominantly male (76%) and Black (56%) with thoracic-level injury (51%) and a mean age of 39.44 (standard deviation [SD] 13.62). A total of 231 goals (mean 4.2 goals per participant; SD 1.25) were identified. Participants rated their performance and satisfaction with their goals as 4.256 (SD 1.55) and 3.57 (SD 1.67), respectively. Participants most frequently reported goals related to endurance, muscle strengthening, weight loss, activities of daily living, transferring, and home and community mobility. The most commonly reported goals fell into five ICF domains: Functions of Cardiovascular, Hematological, Immunological, and Respiratory Systems; Neuromusculoskeletal and Movement-Related Functions; Structures Related to Movement; Mobility; and Self-Care.

CONCLUSION

PwSCI have goals they would like to achieve through participation in exercise. The goals are multifaceted and encompass improving health and fitness as well as improving performance in everyday activities such as transferring and mobility. Identifying themes of goals for PwSCI to achieve through exercise is an important step in developing programs and interventions needed to support PwSCI living in the community.

Understanding factors influencing people with disabilities' participation in sports and cultural activities

BACKGROUND

Improving people with disabilities' participation in sports and cultural activities benefits their physical and mental health. However, only a few studies have examined the factors that influence participation systematically.

METHODS

Using the survey data gathered from 4,319 disabled people living in a district in Wuhan, China, this study explored the impacts of sports and cultural activity participation in terms of individual physiological characteristics, socioeconomic factors, and built environmental features. The sports and cultural facility supply and the walkability index of their community environment were calculated to assess built environment features. Binary logistic regression models were also used to investigate the influence of the aforementioned variables.

RESULTS

There is a significant positive correlation between sports and cultural activity participation and education (OR = 3.44, p < 0.01), employment status (OR = 2.04, p < 0.01), as well as the number of cultural facilities (OR = 1.33, p < 0.01) in the neighborhood area. No significant association was found between the inclination to participate frequently and individual psychological factors.

CONCLUSION

Regarding people with disabilities' participation in sports and cultural activities, socioeconomic and built environment factors are more influential than individual psychological ones. The findings can give ideas for identifying targeted and comprehensive interventions to promote a healthy lifestyle for people with disabilities.

Effect of Tele-exercise to Promote Empowered Movement for Individuals With Spinal Cord Injury (TEEMS) Program on Physical Activity Determinants and Behavior: A Mixed Methods Assessment

OBJECTIVE

To assess the effects of group tele-exercise participation on physical activity (PA) determinants and behavior as identified by social cognitive theory (SCT) in individuals with spinal cord injury (SCI).

DESIGN

This clinically registered non-randomized trial [NCT05360719] used a single-group parallel mixed methods design. Quantitative and qualitative primary measures were assessed at pre-program and after 8-week intervention completion (post-program), with an additional 8-week period retention to capture quantitative assessments only.

SETTING

Community.

PARTICIPANTS

Individuals with chronic SCI (N=22, injury duration 2-50 years) aged 26-68 years (10 male/12 female).

INTERVENTION

An 8-week group tele-exercise program for individuals with SCI consisting of biweekly 60-minute classes delivered via live Web-conferencing software.

MAIN OUTCOME MEASURES

Exercise self-efficacy (Exercise Self-efficacy Scale for SCI: ESES), outcome expectations for exercise (Multidimensional Outcome Expectations for Exercise: MOEES), weekly PA minutes measured through quantitative assessments (Leisure Time PA Questionnaire for SCI: LTPAQ), and parallel qualitative thematic analysis of focus group interview transcripts.

RESULTS

Congruence between numeric and thematic findings was present for exercise self-efficacy and self-evaluative exercise outcome expectations. Improved exercise self-efficacy was influenced by exercise knowledge gained during program participation. Increased expectations of internal exercise outcomes, such as influence on psychological state and overall mood, occurred after program participation. Participant descriptions of the portability and sustainability of the program leading to added movement in everyday life were not reflected in the numeric scores of LTPAQ assessment.

CONCLUSIONS

Participation in an 8-week group tele-exercise program positively affected personal determinants of PA behavior immediately after participation. Future investigations should include a control group and biophysical PA measures such as wearable digital health devices.

Exercise and aerobic capacity in individuals with spinal cord injury: A systematic review with meta-analysis and meta-regression

BACKGROUND

A low level of cardiorespiratory fitness [CRF; defined as peak oxygen uptake ([Formula: see text]O2peak) or peak power output (PPO)] is a widely reported consequence of spinal cord injury (SCI) and a major risk factor associated with chronic disease. However, CRF can be modified by exercise. This systematic review with meta-analysis and meta-regression aimed to assess whether certain SCI characteristics and/or specific exercise considerations are moderators of changes in CRF.

METHODS AND FINDINGS

Databases (MEDLINE, EMBASE, CENTRAL, and Web of Science) were searched from inception to March 2023. A primary meta-analysis was conducted including randomised controlled trials (RCTs; exercise interventions lasting >2 weeks relative to control groups). A secondary meta-analysis pooled independent exercise interventions >2 weeks from longitudinal pre-post and RCT studies to explore whether subgroup differences in injury characteristics and/or exercise intervention parameters explained CRF changes. Further analyses included cohort, cross-sectional, and observational study designs. Outcome measures of interest were absolute (A[Formula: see text]O2peak) or relative [Formula: see text]O2peak (R[Formula: see text]O2peak), and/or PPO. Bias/quality was assessed via The Cochrane Risk of Bias 2 and the National Institute of Health Quality Assessment Tools. Certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Random effects models were used in all meta-analyses and meta-regressions. Of 21,020 identified records, 120 studies comprising 29 RCTs, 67 pre-post studies, 11 cohort, 7 cross-sectional, and 6 observational studies were included. The primary meta-analysis revealed significant improvements in A[Formula: see text]O2peak [0.16 (0.07, 0.25) L/min], R[Formula: see text]O2peak [2.9 (1.8, 3.9) mL/kg/min], and PPO [9 (5, 14) W] with exercise, relative to controls (p < 0.001). Ninety-six studies (117 independent exercise interventions comprising 1,331 adults with SCI) were included in the secondary, pooled meta-analysis which demonstrated significant increases in A[Formula: see text]O2peak [0.22 (0.17, 0.26) L/min], R[Formula: see text]O2peak [2.8 (2.2, 3.3) mL/kg/min], and PPO [11 (9, 13) W] (p < 0.001) following exercise interventions. There were subgroup differences for R[Formula: see text]O2peak based on exercise modality (p = 0.002) and intervention length (p = 0.01), but there were no differences for A[Formula: see text]O2peak. There were subgroup differences (p ≤ 0.018) for PPO based on time since injury, neurological level of injury, exercise modality, and frequency. The meta-regression found that studies with a higher mean age of participants were associated with smaller changes in A[Formula: see text]O2peak and R[Formula: see text]O2peak (p < 0.10). GRADE indicated a moderate level of certainty in the estimated effect for R[Formula: see text]O2peak, but low levels for A[Formula: see text]O2peak and PPO. This review may be limited by the small number of RCTs, which prevented a subgroup analysis within this specific study design.

CONCLUSIONS

Our primary meta-analysis confirms that performing exercise >2 weeks results in significant improvements to A[Formula: see text]O2peak, R[Formula: see text]O2peak, and PPO in individuals with SCI. The pooled meta-analysis subgroup comparisons identified that exercise interventions lasting up to 12 weeks yield the greatest change in R[Formula: see text]O2peak. Upper-body aerobic exercise and resistance training also appear the most effective at improving R[Formula: see text]O2peak and PPO. Furthermore, acutely injured, individuals with paraplegia, exercising for ≥3 sessions/week will likely experience the greatest change in PPO. Ageing seemingly diminishes the adaptive CRF responses to exercise training in individuals with SCI.

REGISTRATION

PROSPERO: CRD42018104342.

Using remotely delivered Spring Forest Qigong™ to reduce neuropathic pain in adults with spinal cord injury: protocol of a quasi-experimental feasibility clinical trial

BACKGROUND

About 69% of Americans living with spinal cord injury (SCI) suffer from long-term debilitating neuropathic pain, interfering with the quality of daily life. Neuropathic pain is refractory to many available treatments-some carrying a risk for opioid addiction-highlighting an urgent need for new treatments. In this study, we will test our hypothesis that Spring Forest Qigong™ will reduce SCI-related neuropathic pain by improving body awareness. We will determine whether remotely delivered Qigong is feasible and we will collect data on neuropathic pain, and other reported associations with pain such as spasms frequency and/or severity, functional performance, mood, and body awareness.

METHODS

In this quasi-experimental pilot clinical trial study, adults with SCI will practice Qigong at home with a 45-min video, at least 3 × /week for 12 weeks. The Qigong practice includes movements with guided breathing and is individualized based on functional abilities, i.e., the participants follow along with the Qigong movements to the level of their ability, with guided breathing, and perform kinesthetic imagery by focusing on the feeling in the whole body as if doing the whole-body Qigong movement while standing. The highest, average, and lowest neuropathic pain ratings perceived in the prior week will be recorded weekly until the 6-week follow-up. The other outcomes will be collected at 5 time points: at baseline, midway during the Qigong intervention (6 weeks), after the Qigong intervention (12 weeks), after a 6-week and 1-year follow-up. Rate parameters for the feasibility markers will be estimated based on the participants who achieved each benchmark.

DISCUSSION

The University of Minnesota (UMN)'s Institutional Review Board (IRB) approved the study (IRB #STUDY00011997). All participants will sign electronic informed consent on the secure UMN REDCap platform. The results will be presented at academic conferences and published in peer-reviewed publications.

TRIAL REGISTRATION

ClinicalTrial.gov registration number: NCT04917107 , (this protocol paper refers to the substudy), first registered 6/8/2021.

Changes over 6 years in secondary health conditions and activity limitations in older adults aging with long-term spinal cord injury

BACKGROUND

The number of individuals aging with long-term spinal cord injury (SCI) is increasing. Still, there is limited knowledge about changes in secondary health conditions (SHCs) and activity limitations over time.

OBJECTIVES

To determine changes in SHCs and activity limitations in older adults aging with long-term SCI over 6 years, and to investigate how changes in SHCs and activity limitations are associated with gender, age, and injury characteristics.

DESIGN

Longitudinal cohort study from the Swedish Aging with Spinal Cord Injury Study (SASCIS).

SETTING

Community settings, Sweden.

PARTICIPANTS

From the initial 123 participants in the SASCIS: 78 individuals (32% women); mean age 68 years; mean time since injury 31 years; injury levels C1-L3, AIS A-D.

INTERVENTIONS

Not applicable MAIN OUTCOME MEASURE: Bowel and bladder function and problems, pain, spasticity, and the Spinal Cord Independence Measure (SCIM III).

RESULTS

Over 6 years, bowel-related problems increased (31% to 47%, p = .015) and the occurrence of constipation doubled to 24% (p = .013). There were increases in frequent urinary tract infections (10% to 26%, p = .004), use of indwelling urinary catheters (15% to 23%, p = .031), and other bladder-related problems (4% to 22%, p < .001). The occurrence of pain was high (85%), with no significant change. Spasticity increased from 41% to 62% (p < .001). Activity limitations increased (SCIM III total score mean 67 to 61, p < .001, with significant decreases in all subscales). The increase in bowel-related problems was greater in males, and the deterioration in self-care was greater in participants with longer time since injury and with traumatic injuries.

CONCLUSIONS

These findings support the notion that SHCs and activity limitations increase over time in older adults aging with long-term SCI. The results can inform clinicians and call for a proactive, holistic approach in the long-term follow-up to support healthy and active aging.

Expectations of a Health-Related Mobile Self-Management App Intervention Among Individuals With Spinal Cord Injury

Background

Our research team developed a mobile application (app) to facilitate health-related self-management behaviors for secondary conditions among individuals with spinal cord injury (SCI). To facilitate mobile app adoption and ongoing use into the community, it is important to understand potential users' expectations and needs.

Objectives

The primary objective of this study was to explore user expectations of a mobile app intervention designed to facilitate self-management behavior among individuals with SCI.

Methods

Data were collected via one-on-one, semi-structured interviews with a subsample of 20 community-dwelling participants enrolled in a larger, clinical trial. Analysis of the transcripts was undertaken using a six-phase process of thematic analysis.

Results

Our analysis identified three main themes for expectations of the mobile app intervention. The first theme, desiring better health outcomes, identified participants' expectation of being able to improve their psychological, behavioral, and physical health outcomes and reduce associated secondary conditions. The second theme, wanting to learn about the mobile app's potential, identified participants' interest in exploring the functionality of the app and its ability to promote new experiences in health management. The third theme, desiring greater personal autonomy and social participation, identified participants' desire to improve their understanding of their health and the expectation for the app to facilitate social engagement with others in the community.

Conclusion

By exploring end-users' expectations, these findings may have short-term effects on improving continued mobile health app use among SCI populations and long-term effects on informing future development of mobile app interventions among chronic disease populations.

Community exercise for individuals with spinal cord injury with inspiratory muscle training: A pilot study

Context/Objective: Respiratory disorders are a common cause of rehospitalization, and premature death in individuals with spinal cord injuries (SCI). Respiratory training combined with community exercise programs may be a method to reduce secondary complications in this population.Objective: The present study explores the inclusion of inspiratory muscle training (IMT) in an existing community exercise program.Design: Case series.Setting: Community.Participants: Participants (N = 6) completed the exercise program. Five were male and one was female; four reported incomplete injuries, and two reported complete injuries; four had cervical injuries, and two had thoracic injuries. The average age was 33 years (SD = 18.6) and time since injury was 7 years (SD = 4.0).Interventions: Participants completed an 8-week program, once-per-week for 4 h that included a circuit of resistance training, aerobic exercise, trunk stability, and education. IMT was completed as a home exercise program.Outcome Measures: Transfer test, T-shirt test, four-directional reach, four-directional trunk strength, weekly training diaries, and a subjective interview.Results: Twenty-eight training logs were collected. All measures improved: transfer test (mean = -14.62, SD = 7.00 s), T-shirt test (mean = -7.83, SD = 13.88 s), four-directional reach (mean = 3.75, SD = 8.06 in) and hand-held dynamometer (mean = 6.73, SD = 8.02 kg). Individuals reported a positive impact of the program.Conclusions: This pilot study demonstrated community exercise with IMT use may have positive impact on functional measures for people with SCI who are vulnerable to respiratory compromise. Continued education may increase successful health outcomes.Trial Registration: NCT03743077.

Validity of Two Wheelchair-Mounted Devices for Estimating Wheelchair Speed and Distance Traveled

This study evaluated the validity of two wheelchair-mounted devices-the Cateye® and Wheeler-for monitoring wheelchair speed and distance traveled. Speed estimates were validated against a calibrated treadmill at speeds from 1.5 to 10 km/hr. Twenty-five wheelchair users completed a course of known distance comprising a sequence of everyday wheelchair activities. Speed estimate validity was very good (mean absolute percentage error ≤ 5%) for the Wheeleri at all speeds and for the Cateye at speeds >3 km/hr but not speeds <3 km/hr (mean absolute percentage error > 20%). Wheeleri distance estimates were good (mean absolute percentage error < 10%) for linear pushing activities and general maneuvering but poor for confined-space maneuvering. Cateye estimates were good for continuous linear propulsion but poor for discontinuous pushing and maneuvering (both general and confined space). Both devices provided valid estimates of speed and distance for typical wheelchair-based exercise activities. However, the Wheeleri provided more accurate estimates of speed and distance during typical everyday wheelchair activities.

Physical Activity and Accomplishment of Recommendations in University Students with Disabilities: A Longitudinal Study

University settings are socio-environmental contexts that can reduce health disparities in students with disabilities. Therefore, the aim of this study was twofold: (a) to examine the longitudinal physical activity (PA) changes of Spanish university students with disabilities during a three-year period; and (b) to identify the accomplishment of the World Health Organization’s PA recommendations in this period. A three-year follow-up cohort study was conducted on 355 university students with disabilities (172 men, 183 women). The participants completed an electronic survey on PA after which a descriptive analysis, longitudinal (Wilcoxon tests) and cross-sectional pairwise comparisons (Mann–Whitney U and Kruskal–Wallis tests) were performed on non-normal data. The results show no significant PA changes during the three-year period. The cross-sectional comparisons between the waves presented a reduction in vigorous PA according to sex and similar values by age, origin of disability, and socioeconomic status. A global reduction of 0.6% was found in achieving the recommendations between the waves. We also found an increase of 5.3% in the participants classified as overweight–obese during this period. The findings offered in this study have important implications for university disability care services and sports services. University policies should focus on rethinking PA and sports programs for students with disabilities.

Exploring exercise participation and the usability of the adaptive rower and arm crank ergometer through wheelchair users' perspectives

PURPOSE

Arm crank ergometry and adaptive rowing are existing exercise options for wheelchairs users, but not commonly available. This study was conducted to explore exercise participation of wheelchair users, as well as the usability of the adaptive rowing ergometer (aROW) and arm crank ergometer (ACE).

METHODS

This mixed-methods study used a concurrent triangulation design. Following completion of both exercise sessions (5 min each), participants (n = 14) with spinal cord injury/disease (SCI/D) completed the System Usability Scale (SUS), and a semi-structured interview. Participants were asked about the use of both exercise modalities, and general exercise participation. SUS data were analyzed using a paired sample t-test and qualitative data were analyzed through conventional content analysis.

RESULTS

Wheelchair users exercised for improved physical and mental health, as well as for functional independence, and community participation; however, lack of accessible equipment was a prominent barrier. Both the aROW and ACE have high usability, but the aROW was perceived as more enjoyable and effective for cardiovascular exercise.

CONCLUSIONS

The implementation of the aROW into community gyms has the potential to help close the existing gap in inclusive equipment and may help people with disabilities to be more fully included in their community and lead healthier lives.Implications for rehabilitationWheelchair users perceive exercise as a meaningful activity that enhances physical health and risk of disease, functional independence, community participation, and overall social and emotional health.The adapted rowing machine was perceived as highly usable and was felt to be more enjoyable and effective for cardiovascular exercise compared to traditional arm crank ergometers.The adaptive rower provides an additional accessible equipment option for wheelchair users to obtain effective cardiovascular exercise.More available equipment may increase community participation and promote inclusion for wheelchair users.

A Study of Leisure Walking Intensity Levels on Mental Health and Health Perception of Older Adults

Research suggests that different levels of intensity of leisure walking can affect the mental health of older adults. Unfortunately, insufficient evidence exists as to the recommended intensity levels of leisure walking for their health benefits. The purpose of this study was to investigate how leisure walking intensity levels are associated with the mental health and health perceptions of older adults. Using a purposive sampling method, the data of 4,737 adults over the age of 65 were drawn from the 2017 California Health and Interview Survey. The results of analysis of these data showed that older adults who engaged in moderate and vigorous leisure walking reported higher health perceptions than those involved in light leisure walking. In addition, older adults who participated in moderate leisure walking reported higher mental health than those who engaged in light leisure walking. This study suggests that moderate and/or vigorous leisure walking can increase the mental health and health perceptions of older adults.

Global and domain-specific life satisfaction among older adults with long-term spinal cord injury

OBJECTIVE

Although life expectancy after spinal cord injury (SCI) has increased, knowledge of life satisfaction and associated factors among older adults with long-term SCI is still very limited. The objective of this study was, therefore, to assess global and domain-specific life satisfaction among older adults with long-term SCI and investigate the association with sociodemographics, injury characteristics and secondary health conditions.

DESIGN

Cross-sectional cohort study. Data from the Swedish Aging with Spinal Cord Injury Study (SASCIS).

SETTING

Community settings in southern Sweden.

PARTICIPANTS

Seventy-eight individuals (32% women, injury levels C1-L3, American Spinal Injury Association Impairment Scale (AIS) A-D) mean age 68 years, mean time since injury 31 years.

INTERVENTIONS

Not applicable.

OUTCOME MEASURES

The Life Satisfaction Questionnaire (LiSat-11).

RESULTS

The participants were at least rather satisfied with most of the 11 life domains. They rated the lowest satisfaction with sexual life, activities of daily living and somatic health. Having a partner and being vocationally active was associated with greater satisfaction with life as a whole and with several other life domains. Participants with AIS D injuries were less satisfied with their somatic health than those with tetraplegia AIS A-C and paraplegia AIS A-C injuries. More secondary health conditions were negatively associated with satisfaction in five life domains.

CONCLUSION

Life satisfaction can be affected many years after SCI. The social context, participation in meaningful activities and minimizing secondary health conditions seem to be important for maintaining life satisfaction in older adults with a long-term injury.

Comparing the causes, circumstances and consequences of falls across mobility statuses among individuals with spinal cord injury: A secondary analysis

OBJECTIVE

To compare the occurrence of falls and fall-related injuries, and the circumstances of falls among individuals with spinal cord injury (SCI) who ambulate full-time, use a wheelchair full-time and ambulate part-time.

DESIGN

A secondary analysis.

SETTING

Community.

PARTICIPANTS

Adults with SCI.

INTERVENTION

None.

OUTCOME MEASURES

The occurrence and circumstances of falls and fall-related injuries were tracked over six-months using a survey. Participants were grouped by mobility and fall status. A chi-square test compared the occurrence of falls and fall-related injuries, and the time and location of falls, and a negative binomial regression was used to predict the likelihood of falls by mobility status. Kaplan-Meier analysis was used to determine differences in the time to first fall based on mobility status. Group characteristics and causes of falls were described.

RESULTS

Data from individuals who ambulated full-time (n = 30), used a wheelchair full-time (n = 27) and ambulated part-time (n = 8) were analyzed. Mobility status was a significant predictor of falls (P < 0.01); individuals who used a wheelchair full-time had a third of the likelihood of falling than those who ambulated full-time (P < 0.01). Type of fall-related injuries differed by mobility status. Those who ambulated full-time fell more in the daytime (P < 0.01). Individuals who ambulated full-time and part-time commonly fell while walking due to poor balance, and their legs giving out, respectively. Those who used a wheelchair full-time typically fell while transferring when rushed.

CONCLUSION

Mobility status influences the likelihood and circumstances of falls. Mobility status should be considered when planning fall prevention education/training for individuals with SCI.

Development of community participation indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project

Community participation following spinal cord injury/disease (SCI/D) can be challenging due to associated primary impairments and secondary health conditions as well as difficulties navigating both the built and social-emotional environment. To improve the quality of SCI/D rehabilitation care to optimize community participation, the SCI-High Project developed a set of structure, process and outcome indicators for adults with SCI/D in the first 18 months after rehabilitation admission.

A pan-Canadian Working Group of diverse stakeholders: (1) defined the community participation construct; (2) conducted a systematic review of available outcomes and their psychometric properties; (3) constructed a Driver diagram summarizing available evidence associated with community participation; and (4) prepared a process map. Facilitated meetings allowed selection and review of a set of structure, process and outcome indicators.

The structure indicator is the proportion of SCI/D rehabilitation programs with availability of transition living setting/independent living unit. The process indicators are the proportion of SCI/D rehabilitation inpatients who experienced: (a) a therapeutic community outing prior to rehabilitation discharge; and, (b) those who received a pass to go home for the weekend. The intermediary and final outcome measures are the Moorong Self-Efficacy Scale and the Reintegration to Normal Living Index.

The proposed indicators have the potential to inform whether inpatient rehabilitation for persons with SCI/D can improve self-efficacy and lead to high levels of community participation post-rehabilitation discharge.

Changes in health-related quality of life among older adults aging with long-term spinal cord injury

STUDY DESIGN

Cross-sectional and longitudinal.

OBJECTIVES

To (i) describe health-related quality of life (HRQoL) and changes over 6 years in older adults aging with long-term spinal cord injury (SCI) and (ii) investigate how changes in HRQoL are associated with age, gender, and injury characteristics.

SETTING

Community in southern Sweden.

METHODS

From the initial 123 participants (years 2011-2012) in the Swedish Aging with Spinal Cord Injury Study (SASCIS), 77 individuals (32% women, C1-L3, AIS A-D, median age 66 years, median time since injury 31 years, 30% complete injuries) were assessed 6 years later. HRQoL was rated with the Spinal Cord Injury Quality of Life Questionnaire (SCI QL-23). Associations were investigated using multivariable linear regression analyses.

RESULTS

The median rating of global QoL (scale range 0-100) was relatively high at both assessments (67 and 83, respectively). There was a large variability in all HRQoL-domains and no significant changes over 6 years. As compared to an AIS D injury, a tetraplegia AIS A-C injury and tetraplegia and paraplegia AIS A-C injuries were associated with positive change in depressive symptoms and global QoL, respectively.

CONCLUSIONS

Older adults aging with long-term SCI show large variations in all HRQoL-domains and have the potential to maintain a high and stable level of HRQoL over time. Persons with AIS D injuries may need increased attention to mitigate negative changes in depressive symptoms and global QoL. Further studies are needed to identify modifiable factors associated with changes in HRQoL in older adults aging with long-term SCI.

Association of level of leisure-time physical activity with risks of all-cause mortality and cardiovascular disease in an elderly Chinese population: a prospective cohort study

BACKGROUND

Implementing the current guidelines for leisure-time physical activity (LTPA) provides significant health benefits, especially for middle-aged adults, but it is unclear whether LTPA also translates into cardiovascular health benefits among elderly people. Therefore, we aimed to assess the association of LTPA with the risks of cardiovascular disease (CVD), including coronary heart disease (CHD) and stroke, and all-cause mortality in an elderly population.

METHODS

In this prospective cohort study, 32, 942 participants aged 60 years or older who participated in a health check-up programme in China between 2010 and 2018 were included. We evaluated the morbidity and mortality risks through the Cox regression model, competing risk model and restricted cubic spline model.

RESULTS

During a median of 6.84 years of follow-up, there were 6, 857 elderly people with incident CVD; a total of 6, 324 deaths occurred due to all causes and 2, 060 deaths occurred due to CVD. Compared with the inactive group, reductions in CVD morbidity and mortality were observed, with hazard ratios (HRs) of 0.89 (95% CI: 0.83-0.96) and 0.81 (95% CI: 0.71-0.92) in the insufficiently active group, 0.86 (95% CI: 0.80-0.92) and 0.79 (95% CI: 0.69-0.90) in the sufficiently active group, and 0.79 (95% CI: 0.70-0.89) and 0.58 (95% CI: 0.45-0.76) in the highly active group, respectively; but no significant reductions were observed in the very highly active group, with HRs of 0.87 (95% CI: 0.71-1.06) and 0.99 (95% CI: 0.70-1.40), respectively. Compared with the inactive group, reductions in all-cause mortality were also observed, with a HR of 0.90 (95% CI: 0.84-0.97) in the insufficiently active group, 0.82 (95% CI: 0.77-0.89) in the sufficiently active group, 0.77 (95% CI: 0.67- 0.87) in the highly active group, and 0.80 (95% CI: 0.64-0.98) in the very highly active group. A restricted cubic spline diagram showed that there was an L-shaped association between LTPA and the risk of all-cause mortality but a U-shaped or reverse J-shaped relationship between LTPA and the risk of CVD morbidity and mortality, especially stroke. In addition, a subgroup analysis showed that elderly population who consistently performed LTPA for ten years or more had a lower risk of morbidity and mortality.

CONCLUSIONS

In an elderly population, even insufficient activity is associated with a decreased risk of all-cause mortality and CVD, and moderate levels of LTPA may be optimal for CVD prevention. In addition, elderly people who consistently perform LTPA over several years may experience greater health benefits.

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

OBJECTIVE

To evaluate changes in duration of physical activity (PA) and sedentary behavior (SB) from discharge to 1 year after inpatient rehabilitation in ambulatory people with spinal cord injury (SCI).

DESIGN

Longitudinal cohort study with objective measurements of physical behavior at discharge and at 6 and 12 months post discharge.

SETTING

Three rehabilitation centers and the participant's home environment.

PARTICIPANTS

Participants (N=47) with ambulatory function were consecutively recruited from the self-management and self-efficacy in patients with SCI cohort (age 18 years or older, recent SCI, expected inpatient stay ≥4wk). Mean age was 54.5±12.9 years, all had incomplete lesions, 53% were men, 49% had tetraplegia, and 51% were community ambulators at discharge.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Duration (min) of PA (summed duration of walking, cycling, running, and wheeling) and SB (sitting/lying).

RESULTS

Mean duration of PA increased by 21 min/d (95% confidence interval, 7-35) and SB decreased by 64 min/d (95% confidence interval, -94 to -35) from discharge to 6 months after inpatient rehabilitation. No changes were found in the second half-year. One year after discharge mean PA was 116±59 min/d and mean SB was 665±121 min/d. The increase in PA was the result of an almost doubling of time spent walking. Variability in physical behavior and its change was large. Older age and lower ambulation level were associated with lower PA, lower ambulation level with higher SB, and tetraplegia was associated with a reduced increase in PA.

CONCLUSIONS

At group level, duration of PA and SB improved following inpatient rehabilitation in ambulatory people with SCI. However, there were large differences between individuals. Levels 1 year after discharge were still unfavorable, particularly regarding SB.

The Swedish SPinal Cord Injury Study on Cardiopulmonary and Autonomic Impairment: Methodology, Cohort Demographics, and Initial Results

OBJECTIVE

The aim of the study was to present the methodology, cohort demographics, and initial results of the Swedish SPinal Cord Injury Study on Cardiopulmonary and Autonomic Impairment (SPICA).

DESIGN

The SPICA is based on the Swedish CArdioPulmonary BioImage Study, a study on cardiopulmonary diseases in a cohort of 30,000 people. The assessments in the SPICA cover the structure and function of the cardiopulmonary and autonomic systems using bioimaging and functional analyses, together with a study-specific questionnaire and generic and spinal cord injury-specific assessment tools. The inclusion criteria were as follows: age 50-65 yrs, traumatic spinal cord injury of 5 yrs or more, and injury levels C1-T6, American Spinal Injury Association Impairment Scale A-C.

RESULTS

Of 38 potential participants, 25 comprised the final sample (20% women, mean age 58 yrs, mean time since injury 28 yrs). Eight percent had sustained a cardiovascular event, and 72% were classified as a high risk for cardiovascular disease. Asthma was previously diagnosed in only 8%, and none had chronic obstructive pulmonary disease.

CONCLUSIONS

The risk for cardiovascular disease in people with severe high-level spinal cord injury is a major clinical concern. Forthcoming studies in the SPICA will provide new knowledge of cardiopulmonary health in this cohort, which can guide future research and be used to develop long-term management.

Changes in cardiorespiratory fitness and activity levels over the first year after discharge in ambulatory persons with recent incomplete spinal cord injury

Study design

Secondary analysis of a clinical trial.

Objectives

To investigate changes in cardiorespiratory fitness (CRF) and activity level in ambulatory persons with SCI during the first year after discharge from inpatient rehabilitation.

Setting

Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway.

Methods

Thirty persons with incomplete SCI, all community walkers (25 males and 5 females, 18–69 years old) were recruited to a clinical trial of a 12 weeks home-based aerobic exercise program of either high or moderate intensity. During the last week of inpatient rehabilitation (baseline), participants performed a maximal exercise test on a treadmill (peak oxygen uptake; peak VO₂) and a 6-min walking test (6MWT). Also, total daily energy expenditure (TDEE) and daily amount of steps were measured continuously during 7 days in the participants’ homes. All tests were repeated after 3 and 12 months (post tests).

Results

Twenty of the 30 clinical trial participants performed baseline and both posttests and are included in this secondary analysis. We found no statistically significant between-group differences in the time course over the first year of either peak VO₂, 6MWT, or physical activity outcomes. Therefore, data from both exercise groups and the control group were merged for secondary analyses, revealing statistically significant increase over time in peak VO₂, 6MWT, and TDEE. The increase over time in the average daily steps did not reach statistical significance.

Conclusions

Ambulatory persons with SCI were able to increase their CRF levels over the first year after discharge from inpatient rehabilitation, despite a minimal increase in activity levels.

Physical activity among individuals with spinal cord injury who ambulate: a systematic scoping review

STUDY DESIGN

Systematic scoping review.

OBJECTIVES

The purpose of this project was to conduct a scoping review to understand the amounts, types, correlates, and outcomes of physical activity (PA) participation for ambulators with SCI.

METHODS

A systematic search was employed among five large databases and two theses/dissertation databases, yielding 3257 articles. Following a two-phase screening process by independent coders, 17 articles were included in the review. Data were charted and summarized, and correlates were coded using the COM-B model.

RESULTS

11 studies were cross-sectional, 5 studies involved an exercise intervention, and 1 study used mixed methods. Overall, ambulators with SCI participated in low levels of PA. The type of PA investigated across all studies was leisure-time PA (e.g., sports, exercise). Psychological and physical capability (e.g., perceived behavioral control, fatigue), social and environmental opportunity (e.g., perceptions of disability, cost), and automatic and reflective motivation (e.g., boredom, intentions) were correlates of PA measured within studies. Exercise intervention studies measured physical (e.g., strength, fitness) and one psychological outcome (i.e., depression). No studies examined the quality of PA experiences.

CONCLUSIONS

Only leisure-time PA has been investigated among ambulators with SCI, and low levels of leisure-time PA have been reported. Correlates of leisure-time PA can be mapped onto all COM-B model constructs and are potential targets for PA-enhancing interventions. Further investigation is warranted into the physical and psychosocial outcomes across all types of LTPA in addition to understanding the quality of LTPA experiences.

From guidelines to practice: development and implementation of disability-specific physical activity guidelines

Purpose: Among people with physical disabilities, one of the most frequently-cited barriers to physical activity participation is a lack of basic information on what to do. Likewise, rehabilitation professionals often cite a lack of knowledge about what to recommend or prescribe, as their primary reason for not promoting physical activity to clients with disabilities. The development and implementation of disability-specific physical activity guidelines are important steps toward addressing informational barriers. This paper describes the reasoning behind disability-specific physical activity guidelines, the gold-standard process used to develop disability-specific guidelines for people with spinal cord injury and multiple sclerosis, and the "who, what, and how" of behavioural interventions and messaging to support people with disabilities in achieving physical activity guidelines.Materials and Methods: Not Applicable.Results: Not Applicable.Conclusions: The needs, values and preferences of people with disabilities must be taken into consideration when undertaking a disability-specific guideline development process. Guidelines can play an important role in physical activity promotion, but behavioural and other interventions are required to address the myriad physical activity barriers faced by people with disabilities.Implications for RehabilitationPeople with and without disabilities can achieve significant fitness and health benefits from activity well below the WHO's 150 minutes/week guideline.Disability-specific physical activity guidelines can alleviate informational barriers for people who want to get active and rehabilitation professionals who want to promote physical activity.Behavioural and other interventions are needed to support people's efforts to achieve physical activity guidelines.A physiotherapist-delivered intervention has shown promise for increasing physical activity in adults with a physical disability.

Supporting the need for community exercise programs: a case study

Introduction

Participation in exercise activities post spinal cord injury (SCI) can positively impact physical functioning and quality of life. Physically active individuals have improved functional performance compared with sedentary individuals with SCI. Consistent exercise interventions following SCI not only prompt neural recovery and offer myriad health benefits but they may also have persisting effects on functional abilities.

Case presentation

A 29-year-old male subject had a 15-year history of a C5-C6 AIS B SCI. The subject demonstrated improvements in the outcome measures and he reported enhanced ability to cough and to clear secretions, as well as an enhanced overall quality of life, after undergoing a 14-week course of Spinal Mobility training in combination with inspiratory muscle training (IMT). In addition to the Spinal Mobility training and IMT, he continued to partake in his normal exercise routine, which consisted of aerobic and strength training 3 days per week.

Discussion

This case reaffirms the benefits of consistent exercise training, in combination with IMT, for individuals with SCI. Community programs specifically targeted to individuals with SCI are needed. The subject's functional improvements demonstrate that incorporating Spinal Mobility training into a regular exercise routine may assist with functional gains in the chronic stage of SCI.

An E-Learning Program for Increasing Physical Activity Associated Behaviors Among People with Spinal Cord Injury: Usability Study

Background

The majority of people with spinal cord injury (SCI) in the United States are not meeting the recommended guidelines for regular physical activity. Behavior change techniques (eg, goal setting and action planning) that are framed within the principles of the social cognitive theory (self-efficacy and self-regulation) have the potential to enhance physical activity behavior.

Objective

The aim of the study was to develop and test the usability of an electronic learning (e-learning) program for improving social cognitive factors related to physical activity behavior among people with SCI.

Methods

The program was created through an iterative process of development and refinement, using a modification of a similar methodology used to develop evidence-informed guidelines in health promotion for people with disabilities (Guidelines, Recommendations, and Adaptations Including Disability; GRAIDs framework). The study included 4 phases: (1) initial product creation, (2) national survey, (3) expert review, and (4) usability testing. Usability testing included both quantitative and qualitative data collection and analyses.

Results

The review of the program by an expert panel (n=5) and the results from a national survey (n=142) led to several refinements. Usability testing demonstrated that the program could be completed in a timely manner (<30 min). Participants reported 5 themes: (1) the program improves social cognitions related to physical activity participation; (2) reflection of physical activity behavior; (3) positive perceptions of the quality of the program; (4) positive perceptions of the program operation and effectiveness; and (5) recommendations for improvement. Each item was incorporated into a revised program version 1.0.

Conclusions

This study incorporated an evidence-based framework for developing a brief 30-min e-learning program for increasing the physical activity behavior among people with SCI. The Exercise Strategies Through Optimized Relevant Interactive E-learning Storytelling (e-STORIES) program could be completed in a timely manner and was reported by participants as valuable and useful for enhancing intent-to-perform physical activity in individuals with SCI. The program has the potential to be applied in a variety of settings, but feasibility testing is required before implementing in a larger trial.

Exercise self-efficacy is weakly related to engagement in physical activity in persons with long-standing spinal cord injury

Aims: Many people with a long-standing spinal cord injury have an inactive lifestyle. Although exercise self-efficacy is considered a key determinant of engaging in exercise, the relationship between exercise self-efficacy and physical activity remains unclear. Therefore, this study examines the relationship between exercise self-efficacy and the amount of physical activity in persons with long-standing spinal cord injury.Methods: This cross-sectional study included 268 individuals (aged 28-65 years) with spinal cord injury ≥ 10 years and using a wheelchair. Physical activity was measured with the Physical Activity Scale for Individuals with Physical Disabilities. Exercise self-efficacy was assessed with the Spinal cord injury Exercise Self-Efficacy Scale. Univariate and multivariable regression analyses were performed to test for the association between exercise self-efficacy and physical activity, controlling for supposed confounders.Results: Univariate regression analysis revealed that exercise self-efficacy was significantly related to the level of daily physical activity (β = 0.05; 95% CI 0.04-0.07; 15% explained variance; p < 0.001). In multivariable regression analysis exercise self-efficacy remained, explaining a significant additional amount of the variance (2%; p < 0.001) of physical activity.Conclusion: Exercise-self efficacy is a weak but independent explanatory factor of the level of physical activity among persons with long-standing spinal cord injury. Longitudinal trials are needed to study the impact of interventions targeting an increase of exercise self-efficacy on the amount of physical activity performed.Implications for rehabilitationPre-intervention levels of exercise-self-efficacy might mediate the effectiveness of interventions that aim at increasing physical activities in people with a long-standing spinal cord injury.Enhancing exercise-self efficacy may improve levels of physical activity, even in people with a long-standing spinal cord injury.When it comes to enhancing physical activity, efforts to enhance non-structured daily physical activities such as household activities and gardening might be as important as efforts to enhance sports and other physical exercise.

Cardiovascular Risk Factors Among Older Adults With Long-Term Spinal Cord Injury

BACKGROUND

Individuals with spinal cord injury (SCI) now live longer, which increases the risk of cardiovascular disease. Knowledge of cardiovascular risk factors amenable to intervention are therefore needed to support their healthy aging.

OBJECTIVE

To describe the occurrence of cardiovascular risk factors among older adults with long-term SCI and investigate the association with sociodemographics and injury characteristics.

DESIGN

Cross-sectional descriptive cohort study.

SETTING

Home settings.

PARTICIPANTS

In total, 123 individuals (71% men, injury levels C1-L5, American Spinal Injury Association Impairment Scale A-D), mean age 63 years, mean time since injury 24 years.

METHODS

Data from the Swedish Aging with Spinal Cord Injury Study (SASCIS), collected through interviews and assessments during home visits and from medical records.

MAIN OUTCOME MEASURES

Anthropometric measurements, blood pressure, fasting plasma glucose and blood lipids, and data on cardiovascular comorbidity and tobacco use.

RESULTS

One third had a previous diagnosis of hypertension, and 55% presented with a blood pressure ≥ 140/90 mm Hg at the time of assessment. Sixteen percent had a history of diabetes and in 15% fasting glucose levels were ≥ 7 mmol/L. Dyslipidemia was present in 76%, whereas 16% had prediagnosed dyslipidemia. Mean body mass index (BMI) was 27 kg/m² and mean waist circumference was 101 cm. When SCI-adjusted BMI cut-off values were used, 93% were considered overweight (BMI ≥22 kg/m² ), and 60% had a waist circumference associated with cardiometabolic risk. A total of 16% smoked regularly. The median number of cardiovascular risk factors was 3. No significant associations were found between the total number of risk factors and sociodemographics and injury characteristics.

CONCLUSIONS

The high occurrence of cardiovascular risk factors among older adults with long-term SCI can pose additional consequences to their health. Regular assessments and interventions targeting cardiovascular risk in this population are therefore warranted. Further research is needed to identify modifiable factors associated with their risk profile.

LEVEL OF EVIDENCE

III.

Associations between leisure time physical activity and cardiovascular risk factors among older adults with long-term spinal cord injury

STUDY DESIGN

This is a cross-sectional study.

OBJECTIVES

To describe the association between cardiovascular risk factors (body mass index (BMI), waist circumference (WC), blood pressure, blood glucose and lipids) and leisure time physical activity (LTPA) in older adults with long-term spinal cord injury (SCI).

SETTING

Community settings, southern Sweden.

METHODS

Data from the baseline data collection of the Swedish Aging with Spinal Cord Injury Study (SASCIS) (n = 123, 71% men, injury levels C1-L5, American Spinal Injury Association Impairment Scale A-D, mean age 63 years, mean time since injury 24 years). Data were collected through home interviews, assessments and blood samples. The Physical Activity Recall Assessment for People with SCI was used to assess LTPA. Associations were investigated using multivariable linear regression analyses adjusted for age, gender, level and severity of injury, cause of injury, time since injury and tobacco use.

RESULTS

More minutes per day of moderate-to-heavy LTPA were significantly associated with a lower BMI (Beta = -0.31; p = 0.001) and a lower WC (Beta = -0.24; p = 0.009). More minutes per day of total LTPA (mild intensity or greater) were associated with a higher systolic blood pressure (Beta = 0.27; p = 0.041) among participants with tetraplegia. No other significant associations between the cardiovascular risk factors and total LTPA were found.

CONCLUSION

Participation in daily LTPA is associated with better cardiovascular health with regard to BMI and WC in older adults with long-term SCI. Further studies are needed to establish the specific amount of activity needed to obtain positive health effects in this group and the directional causality of the associations.

SPONSORSHIP

Not applicable.

Reliability of Wearable-Sensor-Derived Measures of Physical Activity in Wheelchair-Dependent Spinal Cord Injured Patients

Physical activity (PA) has been shown to have a positive influence on functional recovery in patients after a spinal cord injury (SCI). Hence, it can act as a confounder in clinical intervention studies. Wearable sensors are used to quantify PA in various neurological conditions. However, there is a lack of knowledge about the inter-day reliability of PA measures. The objective of this study was to investigate the single-day reliability of various PA measures in patients with a SCI and to propose recommendations on how many days of PA measurements are required to obtain reliable results. For this, PA of 63 wheelchair-dependent patients with a SCI were measured using wearable sensors. Patients of all age ranges (49.3 ± 16.6 years) and levels of injury (from C1 to L2, ASIA A-D) were included for this study and assessed at three to four different time periods during inpatient rehabilitation (2 weeks, 1 month, 3 months, and if applicable 6 months after injury) and after in-patient rehabilitation in their home-environment (at least 6 months after injury). The metrics of interest were total activity counts, PA intensity levels, metrics of wheeling quantity and metrics of movement quality. Activity counts showed consistently high single-day reliabilities, while measures of PA intensity levels considerably varied depending on the rehabilitation progress. Single-day reliabilities of metrics of movement quantity decreased with rehabilitation progress, while metrics of movement quality increased. To achieve a mean reliability of 0.8, we found that three continuous recording days are required for out-patients, and 2 days for in-patients. Furthermore, the results show similar weekday and weekend wheeling activity for in- and out-patients. To our knowledge, this is the first study to investigate the reliability of an extended set of sensor-based measures of PA in both acute and chronic wheelchair-dependent SCI patients. The results provide recommendations for sensor-based assessments of PA in clinical SCI studies.

Physical activity of university students with disabilities: accomplishment of recommendations and differences by age, sex, disability and weight status

OBJECTIVES

This article aims to study physical activity and the achievement of World Health Organization physical activity recommendations in university students with disabilities, and to examine differences by sex, age, disability characteristics and weight status.

STUDY DESIGN

Cross-sectional data from a wider research project conducted at the Spanish universities from Autumn 2016 to Autumn 2017 were analysed.

METHODS

The International Physical Activity Questionnaire-Short Form was administered to 1103 Spanish university students with different disabilities. Nonparametric tests were performed to examine the differences in physical activity based on the interest variables.

RESULTS

The mean metabolic equivalent (MET)-minutes/week was 1772.75 (±2161.00) for total physical activity, 642.93 (±1303.08) for vigorous physical activity, 344.31 (±699.53) for moderate physical activity and 785.50 (±1053.31) for walking intensity physical activity. Overall, 72.2% of the participants did not meet the recommendation of 75 min/week of vigorous physical activity, 80.3% did not meet the recommendation of 150 min/week of moderate physical activity and 63.1% did not meet any of these recommendations. Nonparametric tests revealed that students with multiple disabilities, chronic illnesses, acquired disabilities, older students, obese students and women were less active than their counterparts.

CONCLUSIONS

A high number of participants did not meet the World Health Organization physical activity recommendations, and some subgroups were especially inactive. Public health policies should implement interventions to encourage people with disabilities to engage in physical activity, paying extra attention to the most inactive subgroups.

Health status of regularly physically active persons with spinal cord injury

Study design

A non-controlled cross-sectional study.

Objectives

To make a descriptive examination of health status in persons with paraplegia and tetraplegia who exercise regularly according to Canadian guidelines.

Settings

Sunnaas Rehabilitation Hospital and the Norwegian School of Sport Sciences.

Methods

Eighteen persons (men/women = 9/9), aged 41‒72 years with spinal cord injury (SCI), who exercise regularly were included. Post-injury years ranged from 4 to 48 years. Clinical examination of body composition, bone mineral density (BMD), forced vital capacity (FVC), forced expiratory volume in one second (FEV₁), diffusion capacity (DL_CO), cardiorespiratory fitness (VO_2max), and self-reported quality of life (QOL) obtained by questionnaire was performed. Lung function results are presented as % predicted and VO_2max as absolute values relative to body weight. All results are given as median and range.

Results

Persons with paraplegia (n = 13) were defined as overweight with fat mass 42% (25‒51). BMD 1.047 g cm⁻² (0.885‒1.312) was within normal range. FVC 95% predicted (60‒131), FEV₁ 90% predicted (61‒119), DL_CO 77% predicted (56‒103), and VO_2max 16.66 ml kg⁻¹ min⁻¹ (12.15‒25.28) defined good aerobic capacity according to age controlled reference values (18). Persons with tetraplegia (n = 5) were slightly overweight with fat mass 35% (26‒47). BMD 1.122 g cm⁻² (1.095‒1.299) was within normal range. FVC 72% predicted (46‒91), FEV₁ 75% predicted (43‒83), DL_CO 67% predicted (56‒84), and VO_2max 16.70 ml kg⁻¹ min⁻¹ (9.91‒21.01) defined excellent aerobic capacity according to reference values (18). QOL was ranked as median 7.5 (0‒10 scale).

Conclusions

Persons with SCI who exercise regularly following the Canadian guidelines responded with rather positive associations for health outcomes. Additional research is needed to strengthen our findings.