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

STUDY DESIGN

Cross-sectional.

OBJECTIVES

Examine exercise perceptions of SCI individuals enrolled in an exercise trial about their: (a) reasons for enrolling, (b) barriers to exercise, and (c) solutions to address barriers.

SETTING

World-wide web.

METHODS

US individuals ≥18 years old with SCI completed password-protected free-response surveys (n = 144) as part of a larger internet-based intervention to promote exercise. Participants' online reporting about their motivations to exercise, barriers, and solutions to identified barriers were analyzed using an inductive thematic qualitative approach. Participants could enter up to 10 responses for each category.

RESULTS

Study staff analyzed 956 participant responses across questions regarding their motivations, barriers, and solutions. Leading reasons reported for enrolling were to improve their physical health (69%), function (61%), and attitude (59%) while commonly reported barriers were time constraints (54%), lack of motivation (31%), accessibility issues (24%), and SCI-specific barriers (23%). Participant-generated solutions were scheduling exercise (47.9%) for time constraints, making exercise more fun (21.8%) to increase motivation, obtaining home exercise equipment (30.3%), and locating accessible facilities (27.3%) to resolve accessibility barriers. Solutions for SCI-specific barriers of temperature control, skin breakdown, and pain included getting adapted equipment or finding exercises they could perform independently (29.3%) and enlisting support from friends or family (24.4%).

CONCLUSIONS

The results offer insights about exercise motivators and barriers reported by people with SCI who enrolled in an exercise intervention program and offer insights regarding topics to address for SCI-tailored exercise programs. Further research should examine what strategies are most useful in helping people with SCI engage in exercise.

Inflammatory Stress Effects on Health and Function After Spinal Cord Injury

Background: Injury to the spinal cord produces immediate, adaptive inflammatory responses that can exacerbate the initial injury and lead to secondary damage. Thus far, researchers and clinicians have focused on modulating acute inflammation to preserve sensorimotor function. However, this singular approach risks overlooking how chronic inflammation negatively impacts the broader health of persons with a spinal cord injury (SCI). Objective: The aim of this monograph was to discuss interrelated processes causing persistent inflammatory stress after SCI, along with associated health risks. We review archetypal factors that contribute to a chronic inflammatory state, including response to injury, acute infection, and autonomic dysreflexia. Secondary complications producing and exacerbating inflammation are also discussed, including pain, depression, obesity, and injury to the integumentary and skeletal systems. Finally, we discuss the role of bacteria and the gut microbiome in this process and then conclude with a discussion on how a pro-inflammatory phenotype promotes an elevated risk for cardiovascular disease after injury. Conclusions: Effectively managing chronic inflammation should be a high priority for clinicians and researchers who seek to improve the health and life quality of persons with SCI. Chronic inflammation worsens secondary medical complications and amplifies the risk for cardiometabolic disorders after injury, directly impacting both the quality of life and mortality risk after SCI. Inflammation can worsen pain and depression and even hinder neurological recovery. It is, therefore, imperative that countermeasures to chronic inflammation are routinely considered from the point of initial injury and proceeding throughout the lifespan of the individual with SCI.

Changes in traditional chronic disease risk factors over time and their relationship with leisure-time physical activity in people living with spinal cord injury

This study examined whether levels of chronic disease risk factors change over time, and whether leisure-time physical activity (LTPA) can explain any of the variation in those risk factors that change, in a sample of community-dwelling people living with spinal cord injury (SCI) in or near Hamilton, Ontario, Canada. LTPA was measured using the Physical Activity Recall Assessment for People with SCI at baseline (n = 76 adults with chronic (≥1 year) paraplegia or tetraplegia), at 6 months (n = 71) and at 18 months (n = 63). Body mass index, waist circumference at the lowest rib (WClowest rib) and iliac crest (WCiliac crest), fat mass, blood pressure, and biochemical data were collected at all 3 time points. Women’s BMI was higher at baseline (least square means (LSM) = 26.2 ± SE = 1.56 kg·m–2, p = 0.0004) and 6 months (25.9 ± 1.6, p = 0.0024) than at 18 months (22.1 ± 1.72). Men’s WClowest ribincreased from baseline (92.1 ± 1.87 cm) to 18 months (93.6 ± 1.87, p = 0.0253). Women who were active vs. inactive at baseline had a lower BMI at 6 months (23.1 ± 2.91 vs. 29.7 ± 2.52, p = 0.0957) and WCiliac crestat 6 months (82.8 ± 6.59 vs. 97.7 ± 5.10, p = 0.0818). Women who were active vs. inactive at 6 months had a lower WCiliac crestat 18 months (73.4 ± 14.3 vs. 102.5 ± 6.41, p = 0.0723). There was little change in traditional risk factors over 18 months. Future studies should extend beyond 18 months in a larger sample, and explore traditional vs. novel risk factors and onset of cardiovascular disease and diabetes in the SCI population.

A review of the potential for cardiometabolic dysfunction in youth with spina bifida and the role for physical activity and structured exercise

Children and adolescents who have decreased mobility due to spina bifida may be at increased risk for the components of metabolic syndrome, including abdominal obesity, insulin resistance, and dyslipidemia due to low physical activity. Like their nondisabled peers, adolescents with spina bifida that develop metabolic risk factors early in life have set the stage for adult disease. Exercise interventions can improve metabolic dysfunction in nondisabled youth, but the types of exercise programs that are most effective and the mechanisms involved are not known. This is especially true in adolescents with spina bifida, who have impaired mobility and physical function and with whom there have been few well-controlled studies. This paper highlights the current lack of knowledge about the role of physical activity and the need to develop exercise strategies targeting the reduction of cardiometabolic risk and improving quality of life in youth with spina bifida.

Safety, tolerance, and efficacy of extended-release niacin monotherapy for treating dyslipidemia risks in persons with chronic tetraplegia: a randomized multicenter controlled trial

OBJECTIVE

To test the safety, tolerance, and efficacy of extended-release niacin monotherapy on dyslipidemia in persons with chronic tetraplegia.

DESIGN

Placebo-controlled, blinded, multicenter, randomized controlled trial.

SETTING

Three spinal cord injury research/rehabilitation centers.

PARTICIPANTS

Persons with chronic tetraplegia (N=54) and low plasma high-density lipoprotein cholesterol (HDL-C) levels.

INTERVENTION

Extended-release niacin monotherapy (48 weeks; n=31) on a dose-titration schedule versus matched placebo (n=23).

MAIN OUTCOME MEASURES

Safety was assessed by using percentages of treatment-emergent adverse events and increased levels of hepatic transaminases, uric acid, glycosylated hemoglobin, and fasting glucose. Tolerance was assessed by using participant reports for frequency and intensity of adverse effects of extended-release niacin. Primary effectiveness outcomes were fasting HDL-C level and plasma total cholesterol (TC)/HDL-C ratio. Secondary outcomes included plasma low-density lipoprotein cholesterol (LDL-C) and TC levels and LDL-C/HDL-C ratio.

RESULTS

Significant increases in fasting HDL-C levels (24.5%) were accompanied by decreases in TC/HDL-C and LDL-C/HDL-C ratios, LDL-C levels, and TC levels (all P<.05). No evidence of sustained hepatotoxicity or hyperglycemia was observed. Treatment-emergent withdrawals (12.9%) accompanied flushing (n=1), hypotension/presyncope (n=1), and diarrhea (n=2). One subject experienced transient hyperuricemia. Other drug-reported symptoms did not differ from those for placebo.

CONCLUSIONS

Extended-release niacin monotherapy is safe, tolerated, and effective for most persons with chronic tetraplegia. Special precautions for changes in bowel habits and postadministration hypotension should be observed.