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

STUDY DESIGN

Cross-sectional.

OBJECTIVES

To describe participation in leisure time physical activity (LTPA) (amount, intensity and type) among older adults with long-term spinal cord injury (SCI), and to investigate the associations with sociodemographics, injury characteristics and secondary health conditions (SHCs).

SETTING

Home settings in southern Sweden.

METHODS

Data from the Swedish Aging with Spinal Cord Injury Study (SASCIS). The physical activity recall assessment for people with SCI was used to assess LTPA among 84 men and 35 women (mean age 63.5 years, mean time since injury 24 years, injury levels C1-L5, American Spinal Injury Association Impairment Scale A-D). Associations were analyzed statistically using hierarchical multivariable regression.

RESULTS

Twenty-nine percent reported no LTPA, whereas 53% performed moderate-to-heavy intensity LTPA. The mean minutes per day of total LTPA was 34.7 (±41.5, median 15, range 0-171.7) and of moderate-to-heavy LTPA 22.5 (±35.1, median 5.0, range 0-140.0). The most frequently performed activities were walking and wheeling. Sociodemographics, injury characteristics and SHCs (bowel-related and bladder-related problems, spasticity and pain) explained 10.6% and 13.4%, respectively, of the variance in total and moderate-to-heavy LTPA. Age and wheelchair use were significantly, negatively associated with total LTPA. Women, wheelchair users and employed participants performed significantly less moderate-to-heavy LTPA than men, those using walking devices/no mobility device and unemployed participants.

CONCLUSION

Many older adults with long-term SCI do not reach the amount or intensity of LTPA needed to achieve fitness benefits. Research is needed on how to increase LTPA and to identify modifiable factors that could enhance their participation.

Type, intensity and duration of daily physical activities performed by adults with spinal cord injury

STUDY DESIGN

Secondary analysis of cross-sectional data.

OBJECTIVES

To describe and compare (1) self-reported intensities and durations of specific types of daily physical activities and (2) minutes per day spent on daily physical activities across key demographic groups.

SETTING

Community (Ontario, Canada).

METHODS

Participants were 695 adults with spinal cord injury (SCI; 76% male, M_age=46.81±13.41 years, M_{years post injury}=15.19±11.10 years). Daily activities were assessed over the telephone using the Physical Activity Recall Assessment for People with SCI. Multivariate analyses of variance (MANOVA) were computed to test for differences in intensities and durations of different daily activities (objective 1) and between-group differences in minutes per day of daily activities (objective 2).

RESULTS

Overall, participants reported 127.92±142.79 min per day of daily physical activities with significantly more time spent in mild intensity (78.93±104.62 min per day) than moderate- (40.23±68.71 min per day) or heavy-intensity activities (8.75±24.53 min per day). Four patterns emerged with respect to type, duration and intensity, with some activities being typically performed at lighter or heavier intensities than others. There were significant differences in minutes per day of activity intensity and duration between groups based on education, injury severity and mode of mobility (P<0.05).

CONCLUSION

Given that some groups were more likely to engage in moderate-heavy-intensity activities, and some activities were more likely to be performed at moderate-heavy intensities, interventions that target key groups to increase certain daily activities may be one strategy to enhance overall physical activity participation among people with SCI.

A description and estimate of very low-intensity activity and inactive awake time in community-dwelling adults with chronic spinal cord injury

STUDY DESIGN

Secondary analysis of cross-sectional data.

OBJECTIVES

To estimate the amount of very low-intensity activity (VLPA) or inactive daily awake time that people with spinal cord injury (SCI) engage in and to determine correlates of VLPA/inactivity in this population.

SETTING

Community (Ontario, Canada).

METHODS

Participants with SCI (n=695; Mage=47 years; Myears post-injury=15 years, 76% men) completed telephone interviews. Demographic details and injury-related characteristics were self-reported. Total daily physical activity (for example, mild, moderate and heavy intensity) was measured using the Physical Activity Recall Assessment for People with SCI (PARA-SCI). VLPA/inactivity was calculated by subtracting total daily physical activity time from daily awake time. Correlates of VLPA/inactivity were assessed using a hierarchical linear regression where demographic variables were entered on the first step and injury-related characteristics were entered second.

RESULTS

Participants reported VLPA/inactivity for approximately 768±169 min per day, or 84%, of their awake time. The regression model predicting VLPA/inactivity was not significant.

CONCLUSION

People with SCI spend the majority of their awake time in VLPA/inactivity. However, VLPA/inactivity did not differ as a function of demographic or injury-related variables, suggesting that all segments of the SCI population could benefit from strategies to reduce inactivity.

Active Living Leaders Training Program for adults with spinal cord injury: a pilot study

STUDY DESIGN

Quasi-experimental pre-post design with 6-month follow-up.

OBJECTIVES

Active Living Leaders Training Program (ALLTP) equips individuals with knowledge and skills to encourage those with spinal cord injury (SCI) to increase their leisure-time physical activity (LTPA). The purpose of this pilot study was to, first, (i) evaluate participants' perceptions of the relevance/usefulness of ALLTP material/presentation, (ii) examine changes in participants' self-efficacy to promote LTPA, (iii) identify program components associated with greater self-efficacy and, second, measure participants' use of ALLTP skills and resources over the subsequent 6 months.

SETTING

Canada.

METHODS

Six SCI fitness trainers and six adults with SCI completed the three sections of ALLTP and, after each section, provided feedback. Six months later, participants' use of resources and skills was assessed. Means, standard deviations, repeated measures analysis of variance and Pearson's correlations were computed.

RESULTS

Relevance/usefulness of the program was rated favorably. Self-efficacy to speak about and encourage LTPA remained high throughout the ALLTP and was positively correlated with the relevance/usefulness of program content and presentation. At follow-up, participants had discussed LTPA with an average of seven people with disabilities and reported using at least one skill and resource from the ALLTP during those discussions.

CONCLUSIONS

Users had positive perceptions of ALLTP and reported using the training to promote LTPA to others with disabilities. Participant feedback has been used to improve ALLTP. ALLTP can now be used to train people with SCI and SCI fitness trainers to promote LTPA to others with disabilities.

Leisure-time physical activity and diet quality are not associated in people with chronic spinal cord injury

STUDY DESIGN

Cross-sectional.

OBJECTIVE

To determine the association between leisure-time physical activity (LTPA) and adherence to Eating Well with Canada's Food Guide (CFG) in community-dwelling adults with chronic Spinal Cord Injury (SCI).

SETTING

Ontario, Canada.

METHODS

Participants were recruited as part of the Study of Health and Activity in People with SCI (SHAPE-SCI). Dietary data were collected using 24-h recalls and analysed for adherence to CFG recommendations by age group and gender. LTPA was assessed using the Physical Activity Recall Assessment for Persons with SCI. Statistical analysis comprised correlations, multiple regression and χ(2).

RESULTS

We studied 75 adults (n=61 M; 42.4±11.8 years; 25.5±5.2 kg m(-2)) with chronic (≥1-year post-injury) SCI. Of these, 37% of participants were inactive, 29% were low-active and 33% were high-active. Fewer than 5% of participants were 100% adherent with CFG; 85% were adherent to ≤50%. Activity level and overall adherence to CFG were not correlated (r=-0.052, P=0.666). Although there were no associations between LTPA and vegetables and fruit, grain products, milk and alternatives, or other foods (all P>0.05), high activity was associated with consuming less than the minimum number of recommended servings of meat and alternatives (φ=-0.258, P=0.026).

CONCLUSION

Clinicians need to be aware of the poor diet quality, and low levels of physical activity, of people with chronic SCI. They should not assume that those who are more active consume better quality diets than those who are low active or inactive.

SPONSORSHIP

Canadian Institutes of Health Research.

Dietary supplement use in the spinal cord injury population

STUDY DESIGN

Longitudinal, non-experimental.

OBJECTIVES

To determine the following: (1) prevalence of supplement use in a representative sample of the chronic spinal cord injury (SCI) population; (2) most frequently consumed supplements; and (3) characteristics of consistent supplement users.

SETTING

Ontario, Canada.

METHODS

A structured questionnaire was used to collect demographic information from 77 community-dwelling adults with chronic SCI (50.6% paraplegia, 81.8% male, 42.4 + or - 11.9 years, body mass index (BMI) 25.4 + or - 5.1 kg m(-2)). A standardized form was used to record dietary intake, including supplements, in the previous 24 h, at three time points (baseline, 6 months and 18 months). Logistic regression and multivariate logistic regression were used to determine which characteristic(s) was (were) associated with consistent supplement use.

RESULTS

Seventy-one percent of the sample reported using supplements at least once, with 50.6% being classified as consistent supplement users (at least twice across the three time points). The top three supplements consumed were multivitamins (25%), calcium (20%) and vitamin D (16%). Supplement use status was not associated with gender, level of injury, age, education, physical activity, BMI, smoking or alcohol intake.

CONCLUSIONS

Dietary supplement use was common in our sample of individuals with long-standing SCI, but no common characteristics distinguished users from non-users. We suggest that health practitioners be aware of the high dietary supplement use in this population so that they can probe for type, dose and frequency, as supplements may have an important influence on dietary assessment results.

Improving body image one step at a time: greater pedometer step counts produce greater body image improvements

This randomized controlled trial examined whether the number of steps walked during an 11-week action planning intervention would mediate changes in sedentary women's body image. Seventy-five healthy, sedentary women were randomly assigned to either a control group, where they were required to self-monitor their daily pedometer-determined step count, or to an experimental group, where they were asked to self-monitor and form specific action plans for walking. Of the 75 participants randomized, 41 were included in the efficacy analyses. Measured outcomes were satisfaction with physical functioning and physical appearance, and daily pedometer-determined step counts. Greater satisfaction with physical functioning and higher step counts were found for the experimental group. Moreover, the total number of steps walked over Weeks 2-11 was shown to partially mediate the effect of the intervention on satisfaction with physical functioning. These findings suggest that walking greater distances is associated with greater improvement in at least one aspect of women's body images.

Exercising impressive impressions: the exercise stereotype in male targets

The main purpose of this study was to investigate the exercise stereotype and the non-exerciser stereotype on male targets, and the moderating effects of impression motivation in 184 female and 73 male Swedish undergraduate students. The participants read a description of one of the following male targets: a typical exerciser, an active living target, an excessive exerciser, a non-exerciser, or a control target, and then rated these targets on 12 personality (e.g. lazy-hard worker, dependent-independent) and eight physical (e.g. scrawny-muscular, sick-healthy) dimensions. They also completed the Impression Motivation scale of the Self-Presentation in Exercise Questionnaire, measuring motivation to self-present as an exerciser. MANCOVAs demonstrated a significant main effect for both personality and physical attributes (P<0.05). Overall, the typical exerciser, the active living target, and the excessive targets received more positive ratings than, in particular the non-exerciser target but also the control target. The non-exerciser target was rated less favorably compared with the control target. The impression motivation of the participants moderated the exercise status/rating relationship for the physical but not the personality attributes. The results of the study are discussed in the context of gender and cultural aspects of the exercise stereotype phenomenon.

Establishing evidence-based physical activity guidelines: methods for the Study of Health and Activity in People with Spinal Cord Injury (SHAPE SCI)

STUDY DESIGN

Prospective, observational cohort study.

OBJECTIVES

This paper describes the rationale and methodology for the Study of Health and Activity in People with Spinal Cord Injury (SHAPE SCI). The study aims to (1) describe physical activity levels of people with different injury levels and completeness, (2) examine the relationship between physical activity, risk and/or presence of secondary health complications and risk of chronic disease, and (3) identify determinants of physical activity in the SCI population.

SETTING

Ontario, Canada.

METHODS

Seven hundred and twenty men and women who have incurred a traumatic SCI complete self-report measures of physical activity, physical activity determinants, secondary health problems and subjective well-being during a telephone interview. A representative subsample (n=81) participate in chronic disease risk factor testing for obesity, insulin resistance and coronary heart disease. Measures are taken at baseline, 6 and 18 months.

CONCLUSION

SHAPE SCI will provide much-needed epidemiological information on physical activity patterns, determinants and health in people with SCI. This information will provide a foundation for the establishment of evidence-based physical activity guidelines and interventions tailored to the SCI community.

The effects of single bouts of body-weight supported treadmill training on the feeling states of people with spinal cord injury

STUDY DESIGN

Pre-test, post-test study of the relationship between exercise-related changes in feeling states and pain among persons with chronic incomplete spinal cord injury (SCI) who performed three separate exercise sessions consisting of body-weight supported treadmill training (BWSTT).

OBJECTIVES

To determine whether exercise-related changes in feeling states are related to exercise-related changes in pain and in-task pain.

SETTING

Hamilton, Ontario, Canada.

METHODS

A total of 14 men and women with chronic, incomplete SCI (ASIA B and C) performed three exercise sessions of BWSTT. Measures of pain and feeling states were administered before and after each session along with a measure of pain experienced while exercising.

RESULTS

Participants who experienced greater decreases in pain from pre- to post-exercise also experienced greater improvements in feeling states. Pain experienced during exercise was unrelated to changes in feeling states.

CONCLUSION

Among persons with SCI, exercise-related changes in pain can influence the effects of individual exercise bouts on feeling states.

Maintenance of exercise participation in individuals with spinal cord injury: effects on quality of life, stress and pain

STUDY DESIGN

Follow-up study of seven individuals with spinal cord injury (SCI) who completed a 9-month randomized control trial (RCT) of exercise training.

OBJECTIVE

In a 9-month RCT conducted in our lab, individuals with SCI who participated in a twice-weekly supervised exercise training reported greater perceived quality of life (PQOL), and less stress and pain than a nonexercising control cohort. The present follow-up study examined the voluntary continuation of exercise training after the study ended and the persistence of the accrued psychosocial benefits.

SETTING

Centre for Health Promotion and Rehabilitation, McMaster University, Hamilton, Ontario, Canada.

METHODS

Five men and two women (age 42.3+/-3.6 years) with SCI (C5-T12; ASIA A-D 12.7+/-8.2 years postinjury) were invited to continue supervised exercise training twice weekly at the completion of the 9-month RCT. Exercise adherence, PQOL, stress and bodily pain were measured at a 3-month follow-up and were compared to values obtained at baseline, and at 3, 6 and 9 months during the intervention.

RESULTS

There was a significant decrease in adherence at the 3-month follow-up compared to the overall 9-month adherence rate (42.7 versus 80.6%, respectively; P<0.01). There was also a significant decrease in PQOL (P<0.05) and a trend for increased pain (P=0.07) and stress (P=0.12), at follow-up compared to the end of the 9-month trial. Finally, there was a significant negative correlation between pain at the conclusion of the RCT and exercise adherence over the 3-month follow-up period (r=-0.91; P<0.01).

CONCLUSIONS

These findings emphasize the importance of continued exercise adherence to the maintenance of exercise-related increases in psychological well-being among individuals with SCI.