Website Redesign of a 16-Week Exercise Intervention for People With Spinal Cord Injury by Using Participatory Action Research

Developing a community-engaged wheelchair exercise program for persons with MS: community advisory board formation and feedback

PURPOSE

Exercise is a safe, evidence-based approach for improving symptoms such as mobility impairment, cognitive dysfunction, and fatigue; however, persons with multiple sclerosis (MS) who use wheelchairs for mobility have been excluded from most research. This paper describes our approach for recruiting ten community advisor board (CAB) members and partnering with them on developing a novel home-based exercise training program for wheelchair users with MS.

MATERIALS AND METHODS

The exercise training program, which was developed based on initial qualitative research, includes a progressive exercise prescription, equipment, and one-on-one behavioural coaching based on Social Cognitive Theory. The CAB members convened in groups of five people for five meetings online, using virtual conference software. The CAB meetings each lasted approximately 1-hour and notes were transcribed into digital format for data analyses.

RESULTS

Content analysis identified elements that aligned with meeting foci (i.e., prescription, equipment, coaching, and outcomes). Feedback was divided into categories to refine the program, specifically modifying, adding, or retaining content and/or activities. CAB member feedback was very positive and emphasised potential additions to the materials presented. The research team proposed implementing modifications based on the CAB member feedback such as adding wrist weights to the equipment options for completing resistance training exercises.

CONCLUSIONS

The overall CAB feedback was invaluable for assessing the appropriateness of the proposed exercise training program before initiating feasibility testing. This report provides a model and guidance for researchers who seek community-engaged research approaches in creating products and interventions.Implication for RehabilitationCommunity advisory board participation was invaluable in creating and modifying a novel exercise training programmes for wheelchair users with multiple sclerosis (MS).The current study provides a framework for the creation of exercise interventions for subpopulations of persons with MS that may provide substantial rehabilitation benefits such as improved symptoms and quality of life.Health behaviour interventists targeting individuals with disabilities may consider the benefits of recruiting stakeholders from the community in creation of novel programmes.

Physical activity programs for cardiovascular outcomes in community wheelchair users: A systematic review

Purpose

Physical inactivity is one of the important factors leading to chronic diseases including cardiovascular disease (CVD) in individuals with disabilities. However, not many Physical Activity (PA) interventions are available for improving the efficacy of PA and cardiovascular outcomes among community wheelchair users. Therefore, this systematic review will appraise the existing PA interventions for the community dwelling wheelchair users; we especially examined features of the PA programs that showed the improvements in PA and the CVD outcomes compared to the interventions that did not show any improvements in these outcomes among these population. The study also aimed to provide some recommendations for future research.

Materials and Methods

A comprehensive and systematic search of literature published between 2015 and 2020 using the databases Scopus, Pubmed, Embase, and Cochrane CENTRAL was conducted. This review has followed the Preferred Reporting Items for Systematic Review (PRISMA) guidelines. The quality of the evidence was assessed by Using Joanna Briggs Institute's critical appraisal tool. Studies that tested the efficacy of PA interventions for community-dwelling adult wheelchair users and published in English were involved. Two reviewers reviewed the literature and any disagreements among these reviewers were resolved by a third reviewer.

Results

Fourteen articles were selected for this review. Most of the studies reported improvements in PA. A few studies followed up the participants and majority of the studies have looked at the CVD outcomes.

Conclusion

Large-scale studies with follow-ups, and community participatory research that evaluates the effect of PA interventions on PA and CVD outcomes among wheelchair users are needed.

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.

Effectiveness and feasibility of the workout on wheels internet intervention (WOWii) for individuals with spinal cord injury: a randomized controlled trial

Study design

Randomized-controlled trial (RCT) with immediate intervention (IMM) and wait-list control (WLC) groups; WLC participants received the intervention during delivery to subsequent cohorts.

Objectives

Investigate the effectiveness and feasibility of a virtually-delivered exercise intervention.

Setting

Home and community.

Methods

A total of 168 middle-aged (49.6 [12.3] years old) men (57%) and women (43%) who lived an average 15.5 (12.3) years with spinal cord injury (SCI) participated. The 16-week program provides users (a) website access with exercise information, resources, and 16 skill-building modules; (b) virtual 60-minute, group-based weekly meetings; and (c) a starter package of exercise equipment. Primary outcomes included subjective physical activity (IPAQ) and objective exercise (Polar A300 wrist-based activity monitor and H7 heart rate strap). Secondary outcomes included fitness indices during a maximal arm crank test, plus self-reported exercise barriers, exercise self-efficacy, and goal-directed thinking.

Results

RCT results indicate significant between group differences in participants’ self-reported weekly time spent in vigorous-intensity PA and goal directed thinking but not for fitness changes. Data combined for IMM and WLC participants from Polar monitoring show participants performed 150 min per week of aerobic exercise plus reported significantly greater time spent in moderate-PA, vigorous-PA, self-efficacy for exercise and nutrition, goal directed thinking, and exercise barriers. Oxygen uptake (V̇O₂ peak) and power output (watts max) were the only physiologic measures to demonstrate significant change, with a moderate effect size.

Conclusion

This virtually-delivered program offers a promising approach to increase exercise among those with SCI and may help participants perceive fewer motivational barriers and greater self-efficacy.

Feasibility of an Internet-Based Intervention to Promote Exercise for People With Spinal Cord Injury: Observational Pilot Study

BACKGROUND

People with spinal cord injury (SCI) are less likely to be physically active and have higher chronic disease risk than those in the general population due to physical and metabolic changes that occur postinjury. Few studies have investigated approaches to promote increased physical activity (PA) for people with SCI despite evidence that they face unique barriers, including lack of accessible transportation and exercise equipment. To address these obstacles, we adapted an evidence-based phone-delivered intervention that promoted increased PA among people with SCI into a web-based platform, titled the Workout on Wheels internet intervention (WOWii). The adapted program provides participants with weekly skill-building information and activities, basic exercise equipment, and ongoing support through weekly group videoconferencing.

OBJECTIVE

This pilot study was conducted to assess the feasibility of using a web-based and virtual format to deliver the WOWii program in a randomized controlled trial.

METHODS

We assessed the feasibility of the web-based program by delivering an abbreviated, 4-week version to 10 participants with SCI. Rates of weekly videoconference attendance, activity completion, and exercise activity as tracked by an arm-based activity monitor were recorded for all participants.

RESULTS

Participants averaged 3.3 of 4 (83%) weekly group videoconferences attended, 3.4 of 4 (85%) web-based module activities completed, and 2.3 of 4 (58%) weeks of using the arm-based activity monitor. The majority of the sample (9/10, 90%) synced their arm-based PA monitor at least once, and overall engagement as an average of each component across the 4 weeks was 75%.

CONCLUSIONS

The intervention had sufficiently high levels of engagement to be used in a full randomized controlled trial to test its effectiveness in improving levels of PA among people with SCI. The knowledge we gained from this pilot study informed improvements that were made in the full randomized controlled trial.