Lifestyle Physical Activity for Individuals with Spinal Cord Injury: A Pilot Study

Purpose.

To evaluate the acceptability and feasibility of a lifestyle physical activity program for people with spinal cord injury (SCI).

Methods.

Sixteen nonexercising adult volunteers with SCI participated in a single group pre-post–test of the “Be Active in Life Program” comprising stage-matched educational materials, home visit by a nurse, construction of a personal plan to increase activity, and four follow-up phone calls. Program acceptability, stage of change, barriers to health-promoting activities, abilities for health practices, health, depression, and muscle strength were rated. Physical activity was monitored using actigraphy and a self-report record.

Results.

Participants rated the program positively, although some preferred a structured exercise approach. Eighty-one percent of participants progressed in stage of change and 60% increased physical activity. There were significant changes in motivational barriers, exercise self-efficacy, self-rated health, and muscle strength.

Discussion.

Lifestyle physical activity is feasible and acceptable and could be effective in promoting greater physical activity among people with SCI.

Correlates of physical activity in adults with mobility limitations

This study identified the correlates of objectively and subjectively measured physical activity in adult wheelchair users. Fifty participants wore an activity monitor for a week and completed a questionnaire about factors associated with physical activity. Objectively measured activity correlated significantly with body mass index. Subjectively measured activity correlated significantly with age, stage of change, health, healthcare providers discussing exercise, and social support for exercise. Research on the effect of body mass index on activity in this population is needed. Intervention planners should plan programs that place emphasis on modifying the social environment (including healthcare providers) and removing attitudinal barriers.

Actigraphy as a measure of physical activity for wheelchair users with spinal cord injury

BACKGROUND

Research has indicated that actigraphy is valid and reliable for measuring low levels of physical activity among ambulatory individuals, and that it may be a valid indicator of energy expenditure for wheelchair users in laboratory conditions, but there are no reports of its evaluation in free-living conditions.

OBJECTIVE

To assess the suitability and validity of actigraphy as a measure of free-living physical activity for wheelchair users with spinal cord injury.

METHODS

In a methodologic descriptive correlational study, measures of physical activity by an actigraph and a self-report physical activity record were obtained for six individuals in laboratory conditions and 22 individuals in free-living conditions during a 4-day period. At the completion of the home monitoring trial, all the participants completed a questionnaire about their experience wearing the monitor and maintaining the record.

RESULTS

Mean activity counts by actigraphy during active tasks were significantly different from the counts during inactive tasks (p =.003). During home monitoring, the participants wore the monitor, on the average, 95% of the prescribed wearing time, rated it as very comfortable, and were willing to wear it again. Pearson correlation coefficients of activity counts with self-reported activity intensity varied from.30 to.77 (p <.01) for individual participants. The mean correlation across the sample was.60 (p <.01). Activity counts varied with reported activity, indicating concurrence between the two activity measurement methods.

CONCLUSIONS

Actigraphy is suitable as a measurement of activity for people with spinal cord injury. This initial investigation suggests that it has concurrent validity with a self-report measure of activity intensity and frequency, as evidenced in this sample of wheelchair users in free-living conditions.

Recruiting adults with osteoarthritis into an aquatic exercise class: strategies for a statewide intervention

OBJECTIVE

Although research suggests that regular exercise can be helpful in reducing the dysfunction and discomfort of osteoarthritis, promoting exercise among older adults within this population is neither straightforward nor easily accomplished. This article describes the various methods, and their relative success rates, that were employed to recruit older adults throughout the state of Washington into an aquatic exercise program.

METHODS

Strategies included a recruitment letter distributed to Arthritis Foundation (AF) members in Washington state, local media news coverage, physician referrals, and advertisements in local papers and newsletters.

RESULTS

The most successful methods for enrolling participants were through the AF recruitment letters and local television coverage. The AF recruitment letter was the most expensive method of generating responses, while the television coverage was the least expensive.

CONCLUSIONS

Collaborating with a well-reputed community-based organization and capitalizing on available publicity resources are important strategies researchers can use to gain access to a difficult and geographically dispersed population.

Comparison of self-reported fatigue in rheumatoid arthritis and controls

OBJECTIVE

To compare self-reported fatigue in adults with rheumatoid arthritis (RA) with age and sex matched healthy controls without RA and to determine the relationships of fatigue to pain, sleep, functional status, depressive symptoms, and disease activity.

METHODS

A sample of 51 patients with RA and 46 age and sex matched controls without RA completed self-administered questionnaires 3 times at 6-8 week intervals. Questionnaires included the Multidimensional Assessment of Fatigue scale, Sleep Survey, Health Assessment Questionnaire, and the Profile of Mood States. Patients had blood drawn for hematocrit (Hct) and C-reactive protein on the same day the questionnaires were completed.

RESULTS

Fatigue scores were significantly higher in persons with RA compared to healthy controls. Fatigue did not change significantly in either group over time. Fatigue was strongly associated with poor sleep, functional disability, greater pain, more depressive symptoms, and lower Hct.

CONCLUSION

The importance of assessing fatigue in RA is confirmed. Effective management is needed to control clinical manifestations of RA that were found to be strongly associated with fatigue such as poor sleep, functional disability, pain, depressive symptoms, and lower Hct.

Correlates of fatigue in older adults with rheumatoid arthritis

The purposes of this study were to describe the prevalence of fatigue, examine the association between fatigue and doctor visits, and identify correlates of fatigue in rheumatoid arthritis (RA). On average, a high degree of fatigue was reported to occur every day, to remain constant during the course of a week, and to most often affect walking and household chores. When controlling for disease severity and insurance coverage, respondents who reported more fatigue made more visits to the rheumatologist than those reporting less fatigue. A regression model with fatigue as the dependent variable revealed that the following variables explained a significant amount of variance: pain rating, functional status, sleep quality, female gender, comorbid conditions, and duration of disease.