Framing new pathways in transformative exercise for individuals with existing and newly acquired disability

mHealth-Based Just-in-Time Adaptive Intervention to Improve the Physical Activity Levels of Individuals With Spinal Cord Injury: Protocol for a Randomized Controlled Trial

BACKGROUND

The lack of regular physical activity (PA) in individuals with spinal cord injury (SCI) in the United States is an ongoing health crisis. Regular PA and exercise-based interventions have been linked with improved outcomes and healthier lifestyles among those with SCI. Providing people with an accurate estimate of their everyday PA level can promote PA. Furthermore, PA tracking can be combined with mobile health technology such as smartphones and smartwatches to provide a just-in-time adaptive intervention (JITAI) for individuals with SCI as they go about everyday life. A JITAI can prompt an individual to set a PA goal or provide feedback about their PA levels.

OBJECTIVE

The primary aim of this study is to investigate whether minutes of moderate-intensity PA among individuals with SCI can be increased by integrating a JITAI with a web-based PA intervention (WI) program. The WI program is a 14-week web-based PA program widely recommended for individuals with disabilities. A secondary aim is to investigate the benefit of a JITAI on proximal PA, defined as minutes of moderate-intensity PA within 120 minutes of a PA feedback prompt.

METHODS

Individuals with SCI (N=196) will be randomized to a WI arm or a WI+JITAI arm. Within the WI+JITAI arm, a microrandomized trial will be used to randomize participants several times a day to different tailored feedback and PA recommendations. Participants will take part in the 24-week study from their home environment in the community. The study has three phases: (1) baseline, (2) WI program with or without JITAI, and (3) PA sustainability. Participants will provide survey-based information at the initial meeting and at the end of weeks 2, 8, 16, and 24. Participants will be asked to wear a smartwatch every day for ≥12 hours for the duration of the study.

RESULTS

Recruitment and enrollment began in May 2023. Data analysis is expected to be completed within 6 months of finishing participant data collection.

CONCLUSIONS

The JITAI has the potential to achieve long-term PA performance by delivering tailored, just-in-time feedback based on the person's actual PA behavior rather than a generic PA recommendation. New insights from this study may guide intervention designers to develop engaging PA interventions for individuals with disability.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05317832; https://clinicaltrials.gov/study/NCT05317832.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/57699.

Personalised exercise rehabilitation in cancer survivorship: the percs triage and referral system study protocol

BACKGROUND

To effectively embed exercise rehabilitation in cancer survivorship care, a co-ordinated system of acute and community exercise rehabilitation services, forming a stepped model of care, is recommended. Patients can be directed to the exercise rehabilitation service which best meets their needs through a system of assessment, triage and referral. Triage and referral systems are not yet widely applied in cancer survivorship practice and need to be evaluated in real-world contexts. The PERCS (Personalised Exercise Rehabilitation in Cancer Survivorship) study aims to evaluate the real-world application of an exercise rehabilitation triage and referral system in cancer survivors treated during the COVID-19 pandemic. Secondary aims are to evaluate change in physical and psychosocial outcomes, and to qualitatively evaluate the impact of the system and patient experiences, at three months after application of the triage and referral system.

METHODS

This study will assess the implementation of an exercise rehabilitation triage and referral system within the context of a physiotherapy-led cancer rehabilitation clinic for cancer survivors who received cancer treatment during the COVID-19 pandemic. The PERCS triage and referral system supports decision making in exercise rehabilitation referral by recommending one of three pathways: independent exercise; fitness professional referral; or health professional referral. Up to 100 adult cancer survivors treated during the COVID-19 pandemic who have completed treatment and have no signs of active disease will be recruited. We will assess participants' physical and psychosocial wellbeing and evaluate whether medical clearance for exercise is needed. Participants will then be triaged to a referral pathway and an exercise recommendation will be collaboratively decided. Reassessment will be after 12 weeks. Primary outcomes are implementation-related, guided by the RE-AIM framework. Secondary outcomes include physical function, psychosocial wellbeing and exercise levels. Qualitative analysis of semi-structured interviews guided by the Consolidated Framework for Implementation Research (CFIR) will provide insights on implementation and system impact.

DISCUSSION

The PERCS study will investigate the real-world application of a cancer rehabilitation triage and referral system. This will provide proof of concept evidence for this triage approach and important insights on the implementation of a triage system in a specialist cancer centre.

TRIAL REGISTRATION

This study is registered on ClinicalTrials.gov, registration number: NCT05615285, date registered: 21st October 2022.

A Community Needs Assessment and Implementation Planning for a Community Exercise Program for Survivors of Stroke: Protocol for a Pilot Hybrid Type I Clinical Effectiveness and Implementation Study

BACKGROUND

Physical activity and exercise are important aspects of maintaining health. People with mobility impairments, including survivors of stroke, are less likely to exercise and at greater risk of developing or worsening chronic health conditions. Increasing accessible, desired options for exercise may address the gap in available physical activity programs, provide an opportunity for continued services after rehabilitation, and cultivate social connections for people after stroke and others with mobility impairments. Existing evidence-based community programs for people after stroke target cardiovascular endurance, mobility, walking ability, balance, and education. While much is known about the effectiveness of these programs, it is important to understand the local environment as implementation and sustainment strategies are context-specific.

OBJECTIVE

This study protocol aims to evaluate community needs and resources for exercise for adults living with mobility impairments with initial emphasis on survivors of stroke in Richland County, South Carolina. Results will inform a hybrid type I effectiveness and implementation pilot of an evidence-based group exercise program for survivors of stroke.

METHODS

The exploration and preparation phases of the EPIS (Exploration, Preparation, Implementation, and Sustainment) implementation model guide the study. A community needs assessment will evaluate the needs and desires of survivors of stroke through qualitative semistructured interviews with survivors of stroke, rehabilitation professionals, and fitness trainers serving people with mobility impairments. Additional data will be collected from survivors of stroke through a survey. Fitness center sites will be assessed through interviews and the Accessibility Instrument Measuring Fitness and Recreation Environments inventory. Qualitative data will be evaluated using content analysis and supported by mean survey results. Data will be categorized by the community (outer context), potential participants (outer context), and fitness center (inner context) and evaluate needs, resources, barriers, and facilitators. Results will inform evidence-based exercise program selection, adaptations, and specific local implementation strategies to influence success. Pilot outcome measures for participants (clinical effectiveness), process, and program delivery levels will be identified. An implementation logic model for interventions will be created to reflect the design elements for the pilot and their complex interactions.

RESULTS

The study was reviewed by the institutional review board and exempt approved on December 19, 2023. The study data collection began in January 2024 and is projected to be completed in June 2024. A total of 17 participants have been interviewed as of manuscript submission. Results are expected to be published in early 2025.

CONCLUSIONS

Performing a needs assessment before implementing it in the community allows for early identification of complex relationships and preplanning to address problems that cannot be anticipated in controlled effectiveness research. Evaluation and preparation prior to implementation of a community exercise program enhance the potential to be successful, valued, and sustained in the community.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/55432.

Leveraging Emerging Technologies to Expand Accessibility and Improve Precision in Rehabilitation and Exercise for People with Disabilities

Physical rehabilitation and exercise training have emerged as promising solutions for improving health, restoring function, and preserving quality of life in populations that face disparate health challenges related to disability. Despite the immense potential for rehabilitation and exercise to help people with disabilities live longer, healthier, and more independent lives, people with disabilities can experience physical, psychosocial, environmental, and economic barriers that limit their ability to participate in rehabilitation, exercise, and other physical activities. Together, these barriers contribute to health inequities in people with disabilities, by disproportionately limiting their ability to participate in health-promoting physical activities, relative to people without disabilities. Therefore, there is great need for research and innovation focusing on the development of strategies to expand accessibility and promote participation in rehabilitation and exercise programs for people with disabilities. Here, we discuss how cutting-edge technologies related to telecommunications, wearables, virtual and augmented reality, artificial intelligence, and cloud computing are providing new opportunities to improve accessibility in rehabilitation and exercise for people with disabilities. In addition, we highlight new frontiers in digital health technology and emerging lines of scientific research that will shape the future of precision care strategies 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.

Digital Intervention Promoting Physical Activity in People Newly Diagnosed with Parkinson's Disease: Feasibility and Acceptability of the Knowledge, Exercise-Efficacy and Participation (KEEP) Intervention

Background

Exercise promotion interventions for people with Parkinson's disease (PD) are often offered on a face-to-face basis, follow a generic "one-size-fit-all" approach, and are not typically delivered at diagnosis. Considering PD's heterogenous nature, the existing evidence on the merits of exercise on symptom management and the expressed wishes of people living with PD for access to timely and tailored evidence-based information, there is a demand for interventions that are easily accessible, scalable and co-designed with people living with PD.

Objective

Evaluate the feasibility and acceptability of a co-designed digital intervention promoting exercise and physical activity, in people newly diagnosed with PD.

Methods

Thirty people living with PD for less than one year participated in an assessor-blinded randomized feasibility trial from June 2022 to April 2023. The intervention group received the 8-week Knowledge, Exercise Efficacy and Participation (KEEP) intervention comprising 6 interactive digital modules and 4 online live group discussions facilitated by a specialist physiotherapist. Assessments were performed at baseline, post intervention and at 6-month follow up.

Results

Thirty participants were recruited to target with a 64% recruitment rate (30/47). All but one participant completed the 6-month follow-up assessment. There was high retention (97%), module completion (91%), and online discussion attendance (88%). Outcome measure collection was feasible, including accelerometer data with a daily average wear time of 23.9 hours (SD:0.295).

Conclusions

The KEEP intervention was feasible and acceptable in people newly diagnosed with PD. A larger trial is needed to assess intervention efficacy and correlation between knowledge, self-efficacy, and activity levels.

Exercise prescription for persons with spinal cord injury: a review of physiological considerations and evidence-based guidelines

Persons with spinal cord injury (SCI) experience gains in fitness, physical and mental health from regular participation in exercise and physical activity. Due to changes in physiological function of the cardiovascular, nervous, and muscular systems, general population physical activity guidelines and traditional exercise prescription methods are not appropriate for the SCI population. Exercise guidelines specific to persons with SCI recommend progressive training beginning at 20 min of moderate to vigorous intensity aerobic exercise twice per week transitioning to 30 min three times per week, with strength training of the major muscle groups two times per week. These population-specific guidelines were designed considering the substantial barriers to physical activity for persons with SCI and can be used to frame an individual exercise prescription. Rating of perceived exertion (i.e., perceptually regulated exercise) is a practical way to indicate moderate to vigorous intensity exercise in community settings. Adapted exercise modes include arm cycle ergometry, hybrid arm-leg cycling, and recumbent elliptical equipment. Body weight-supported treadmill training and other rehabilitation modalities may improve some aspects of health and fitness for people with SCI if completed at sufficient intensity. Disability-specific community programs offer beneficial opportunities for persons with SCI to experience quality exercise opportunities but are not universally available.

Baseline Comparison of Exercisers and Nonexercisers With Spinal Cord Injury Enrolled in a Group Tele-Exercise Program

Background

Individuals with SCI are 1.5 times more likely to be sedentary compared to adults without disabilities or chronic health conditions. It is therefore imperative to develop and evaluate innovative facilitation strategies for physical activity behavior in this population.

Objectives

As an insightful step to creating and evaluating tailored physical activity interventions for individuals with SCI, we evaluated demographic, psychosocial, and physical characteristics of those who choose to engage in physical activity by enrolling in a group exercise study.

Design/Methods

We conducted a cross-sectional analysis detailing demographic features and baseline outcomes of those with SCI enrolled in a group tele-exercise study who were classified as regular exercisers versus nonregular exercisers per the American College of Sports Medicine exercise guidelines. Between-group differences for psychosocial and physical outcomes were assessed with chi-square and Mann-Whitney U tests (p < .05).

Results

Twenty-seven adult volunteers enrolled in the study (exercisers = 14, nonexercisers = 13). Groups were comparable for biological sex, gender identity, self-reported racial group(s), and current age. Exercisers demonstrated significantly shorter duration of injury compared to nonexercisers (p = .012). Exercisers exhibited significantly higher exercise self-efficacy (p = .017) and increased reported weekly minutes in vigorous intensity leisure time physical activity (p = .029).

Conclusion

Nonexercisers with SCI demonstrate increased injury duration and reduced exercise self-efficacy compared to active peers. These factors should be addressed in the design and delivery of SCI-specific physical activity interventions to increase the likelihood of this critical health behavior over time.

Development and Feasibility of a Group Tele-Exercise Program for Individuals With Spinal Cord Injury

BACKGROUND AND PURPOSE

More than 50% of individuals with spinal cord injury (SCI) report no regular exercise due to numerous barriers to participation. Tele-exercise services offer viable solutions to reduce barriers. However, limited evidence for SCI-specific tele-exercise programs is available. The purpose of this study was to evaluate the feasibility of a synchronous group tele-exercise program designed for individuals with SCI.

METHODS

Explanatory sequential mixed-methods design assessed feasibility of a synchronous 2-month biweekly group tele-exercise program for individuals with SCI. Numeric measures of feasibility were first collected (recruitment rate, sample features, retention, attendance), followed by postprogram interviews with participants. Thematic analysis of experiential feedback elaborated on numeric findings.

RESULTS

Eleven volunteers (ages = 49.5 ± 16.7 years) with SCI (range: 2.7-33.0 years) enrolled within 2 weeks of recruitment initiation. Retention was 100% retention at program completion. Median number of live classes attended per participant was 10 (62.5%). Participants described that attendance and satisfaction were facilitated by program-specific features including coinstruction by instructors with SCI-specific knowledge and lived experience, as well as group structure. Participants reported increased exercise knowledge, confidence, and motivation.

DISCUSSION AND CONCLUSIONS

This study demonstrated feasibility of a synchronous group tele-exercise class for individuals with SCI. Key features facilitating participation include class length, frequency, coleadership by individuals familiar with SCI and exercise instruction, and group motivation. These findings begin to examine a viable tele-service strategy that could be employed as a bridge among rehabilitation specialists, community fitness instructors, and clients with SCI to increase physical activity access and behavior.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A442 ).

High-Intensity Functional Training: Perceived Functional and Psychosocial Health-Related Outcomes from Current Participants with Mobility-Related Disabilities

BACKGROUND

People with mobility-related disabilities (MRDs) experience many personal and environmental barriers to engagement in community-based exercise programs. We explored the experiences of adults with MRD who currently participate in high-intensity functional training (HIFT), an inclusive and accessible community-based exercise program.

METHODS

Thirty-eight participants completed online surveys with open-ended questions, with ten individuals also participating in semi-structured interviews via telephone with project PI. Surveys and interviews were designed to examine changes to perceived health, and the elements of HIFT that promote sustained participation.

RESULTS

Thematic analysis revealed themes related to health changes following HIFT participation including improved physical, functional, and psychosocial health outcomes. Other themes emerged within the HIFT environment that promoted adherence for participants such as accessible spaces and equipment, and inclusive HIFT sessions and competitions. Additional themes included participants' advice for the disability and healthcare communities. The resulting themes are informed by the World Health Organization's International Classification of Functioning, Disability, and Health.

CONCLUSION

The findings provide initial data on the potential effects of HIFT on multiple dimensions of health outcomes and contribute to the growing literature on community-based programs that are adaptable and inclusive for people with MRD.

Exploring the organisational structure of networks for exercise oncology provision: a social network analysis of OnkoAktiv

BACKGROUND

Structured exercise programs provide considerable health benefits for cancer patients. Therefore, various OnkoAktiv (OA) networks were established in Germany with the aim to connect cancer patients with certified exercise programs. However, knowledge about the integration of exercise networks into cancer care systems and conditions of interorganisational collaboration is lacking. The aim of this work was to analyse the OA networks to guide further network development and implementation work.

METHODS

We used methods of social network analysis within a cross-sectional study design. Network characteristics were analysed such as node and tie attributes, cohesion and centrality. We classified all networks into their level of organisational form in integrated care.

RESULTS

We analysed 11 OA networks with 26 actors and 216 ties on average. The smallest network counted 12 actors/56 ties, the largest 52/530. 76% of all actors operated within the medical/exercise sector, serving 19 different medical professions. In smaller "linkage" networks, several individual professionals were linked "from service to service", whereas the more integrated networks revealed a core-periphery-structure.

DISCUSSION

Collaborative networks enable the involvement of professional actors from different operational fields. This study provides an in-depth understanding of underlying organisational structures that provides information for further development of exercise oncology provision.

TRIAL REGISTRATION

Not applicable, as no health care intervention was performed.

Development of a model of rehabilitation exercise and sports service delivery system for health promotion of people with disabilities

People with disabilities (PWD) suffer from chronic diseases and other problems due to their low physical activity compared to people without disabilities. Physical activity and exercise can prevent chronic diseases and improve health management. However, PWD do not receive proper rehabilitation exercise and sports services immediately after dicharge from hospitals. An effective model of rehabilitation exercise and sports service delivery system has not been established in Korea. This study aimed to present such a model for health promotion, which enables PWD to participate in exercise regularly in local communities. The model is presented by dividing it into sides of consumers and suppliers by analyzing domestic and foreign rehabilitation and sports service systems and expert meetings. The system presented in this study can help promote returning to normal social life and transition into sports in daily life for PWD. In addition, it is expected to positively affect local communities through training instructors in rehabilitation exercise and sports; it can serve as a bridge between rehabilitation in medical institutes and sports in daily life.

Potential of social engagement for overcoming barriers to physical activity in individuals with spinal cord injury

Introduction

Many barriers to physical activity (PA) exist for individuals with spinal cord injury (SCI). Social engagement may improve motivation to perform PA, which in turn may increase PA levels. This pilot study investigates how social engagement facilitated by mobile technology may reduce lack of motivation as a barrier to PA in individuals with SCI and demonstrates design implications for future technologies.

Methods

A user-needs survey was conducted with participants in the community. We recruited 26 participants (16 individuals with SCI and 10 family members or peers). A participatory design process using semi-structured interviews was used to identify themes relating to PA barriers.

Results

One theme related to PA barriers was lack of PA-focused forums to connect with peers. Participants with SCI considered connecting with other individuals with SCI more motivating than connecting with their family members. Another key finding was that participants with SCI did not perceive that personal fitness trackers were targeted towards wheelchair-based activities.

Conclusions

Engagement and communication with peers who have similar functional mobility levels and life experiences can potentially improve motivation for PA; however, PA-motivational platforms are not tailored towards wheelchair-users. Our preliminary findings show that some individuals with SCI are not satisfied with current mobile-technologies for wheelchair-based PA.

Models and materials for exercise promotion in comprehensive multiple sclerosis care: completion of the 'exercise in medicine' development process

PURPOSE

Health care providers have highlighted the need for tools and resources that support promotion of exercise behavior within comprehensive multiple sclerosis (MS) care. This study involved a final quality improvement evaluation of exercise promotion models and materials for inclusion within this setting.

METHODS AND MATERIALS

Our research team distributed a paper-based survey containing Likert scales, open answer questions, and copies of the models for editing. We distributed this survey among health care providers across the United States. We conducted a novel mixed-methods analysis evaluating quantitative, qualitative, and creative data.

RESULTS

We received completed surveys from 13 health care providers who strongly rated the clarity and applicability of the models and materials, and reported that no major improvements were necessary. The minor improvements were specific per comprehensive MS care center. The feedback indicated that the "Exercise in Medicine" models and materials are guides such that the processes should be integrated into real world practice by amending roles and responsibilities with the team members and structure per comprehensive MS care center.

CONCLUSION

This paper presents finalized models and materials for exercise promotion within comprehensive MS care that are ready to be tested for feasibility and efficacy in a clinical trial.IMPLICATIONS FOR REHABILITATIONHealth care providers require support to promote exercise within the context of comprehensive MS care.The practice models in this article provide guides regarding how to promote exercise in this context.Implementing these exercise promotion guides can reduce the burden of neurologists, and ensure patients receive exercise support from appropriate providers.These guides should be implemented within the context of each individual care center, and not as an explicit step by step guide as each care center is unique.

Physical activity behaviour up to 1 year post-rehabilitation among adults with physical disabilities and/or chronic diseases: results of the prospective cohort study ReSpAct

BACKGROUND

Little is known of physical activity behaviour among adults with a disability and/or chronic disease during and up to 1 year post-rehabilitation. We aimed to explore (1) dose characteristics of physical activity behaviour among adults with physical disabilities and/or chronic diseases during that period, and (2) the effects of personal characteristics and diagnosis on the development of physical activity over time.

METHODS

Adults with physical disabilities and/or chronic diseases (N=1256), enrolled in the Rehabilitation, Sports and Active lifestyle study, were followed with questionnaires: 3-6 weeks before (T0) and 14 (T1), 33 (T2) and 52 (T3) weeks after discharge from rehabilitation. Physical activity was assessed with the adapted version of the Short Questionnaire to ASsess Health enhancing physical activity. Dose characteristics of physical activity were descriptively analysed. Multilevel regression models were performed to assess physical activity over time and the effect of personal and diagnosis characteristics on physical activity over time.

RESULTS

Median total physical activity ranged from 1545 (IQR: 853-2453) at T0 to 1710 (IQR: 960-2730) at T3 min/week. Household (495-600 min/week) and light-intensity (900-998 min/week) activities accrued the most minutes. Analyses showed a significant increase in total physical activity moderate-intensity to vigorous-intensity physical activity and work/commuting physical activity for all time points (T1-T3) compared with baseline (T0). Diagnosis, age, sex and body mass index had a significant effect on baseline total physical activity.

CONCLUSION

Physical activity is highly diverse among adults with physical disabilities and/or chronic diseases. Understanding this diversity in physical activity can help improve physical activity promotion activities.

Medicalization of Exercise Through Vigilance, Productivity, and Self-Care: A Secondary Data Analysis of Qualitative Interviews Among Those With Multiple Sclerosis

Exercise is becoming more integrated into the management of multiple sclerosis (MS) and is promoted to manage impairments and symptoms. Whereas extensive research outlines factors impacting participation, less is known regarding how medicalized exercise promotion might impact views of exercise and self. We conducted a secondary data analysis to understand how medicalized exercise-promotion paradigms impact the meaning and roles of exercise among those with MS. Twenty-two interviews were selected for reanalysis with an interpretative phenomenological analysis methodology and a critical disability studies lens. Three themes were identified: Constant Vigilance (worry about exercise), Productivity and Social Engagement (exercise to feel productive, engage socially, and enhance self-worth), and Exercise as Medicine/Self-Care (exercise to manage MS, relax, improve mental well-being, prevent/reverse disability, and stay healthy). This research underscores that exercise occupies many contradictory roles reflecting a medicalized exercise-promotion paradigm for those with MS, and this should inform exercise promotion practices.

Staying active after rehab: Physical activity perspectives with a spinal cord injury beyond functional gains

Lifestyle physical activity following spinal cord injury (SCI) is critical for functional independence, mental wellness, and social participation, yet nearly 50% of individuals with SCI report no regular exercise. The objective of this study was to better understand factors leading to this participation gap by capturing the physical activity perspectives of individuals living with SCI. We completed small group interviews with nine individuals living with SCI across the United States. Iterative thematic analysis systematically revealed meaningful core concepts related to physical activity engagement with SCI. Emergent themes revealed challenges to lifestyle physical activity behavior including gaps in physical activity education, isolation during psychological adjustment, and knowledge limitations in community exercise settings. A secondary theme related to the COVID-19 pandemic emerged, highlighting additional environmental constraints affecting participation. Our findings suggest that most physical activity education is delivered during inpatient rehabilitation and is related to physical function. Lifetime physical activity strategies are achieved through self-education and peer networking. Personal motivators for physical activity include secondary condition prevention, while social and emotional barriers prevent regular adherence. These findings can inform the development and delivery of physical activity programs to maximize physical activity engagement in individuals living with chronic SCI.

Active Participation of Care Partners in a Physical Activity Intervention Alongside People with Stroke: A Feasibility Study

Purpose: This study investigated the feasibility of a physical activity intervention for people with stroke and their care partners and the role social support plays in physical activity adherence. Method: The study used a single-group, pretest-posttest design with follow-up. Participants were adults with chronic stroke and their care partners. The intervention consisted of 8 weeks of structured, group-based physical activity classes, followed by 19 weeks of self-directed physical activity. Recruitment, adherence, safety, and retention were assessed. Familial social support was assessed before and after the 8-week structured portion and again 19 weeks later. Results: A total of 21 participants (15 people with stroke, 6 care partners), mean age 67.6 (SD 11.6) years, were recruited; 19 (90.5%) completed the 19-week assessment. No adverse events were experienced during the programme. Attendance during the 8-week portion was better than during the 19-week portion (mean difference 0.95; p < 0.001; 95% CI: 0.71, 1.19 visits/wk). No relationship was found between social support and physical activity adherence (p > 0.05). Conclusions: Involvement of care partners in a physical activity intervention is feasible and safe. Both people with stroke and their care partners may require ongoing support to participate in long-term physical activity. The relationship between social support and physical activity adherence requires further study.

Current Practice of Physical Activity Counselling within Physiotherapy Usual Care and Influences on Its Use: A Cross-Sectional Survey

Physical activity counselling has demonstrated effectiveness at increasing physical activity when delivered in healthcare, but is not routinely practised. This study aimed to determine (1) current use of physical activity counselling by physiotherapists working within publicly funded hospitals; and (2) influences on this behaviour. A cross-sectional survey of physiotherapists was conducted across five hospitals within a local health district in Sydney, Australia. The survey investigated physiotherapists' frequency of incorporating 15 different elements of physical activity counselling into their usual healthcare interactions, and 53 potential influences on their behaviour framed by the COM-B (Capability, Opportunity, Motivation-Behaviour) model. The sample comprised 84 physiotherapists (79% female, 48% <5 years of experience). Physiotherapists reported using on average five (SD:3) elements of physical activity counselling with at least 50% of their patients who could be more active. A total of 70% of physiotherapists raised or discussed overall physical activity, but less than 10% measured physical activity or contacted community physical activity providers. Physiotherapists reported on average 25 (SD:9) barriers influencing their use of physical activity counselling. The most common barriers were related to "opportunity", with 57% indicating difficulty locating suitable community physical activity opportunities and >90% indicating their patients lacked financial and transport opportunities. These findings confirm that physical activity counselling is not routinely incorporated in physiotherapy practice and help to identify implementation strategies to build clinicians' opportunities and capabilities to deliver physical activity counselling.

Feasibility of integrating survivors of stroke into cardiac rehabilitation: A mixed methods pilot study

BACKGROUND

Survivors of stroke are often deconditioned and have limited opportunities for exercise post-rehabilitation. Cardiac Rehabilitation (CR), a structured exercise program offered post-cardiac event in the United States (U.S.), may provide an opportunity for continued exercise. The purpose of this study was to examine the feasibility of integrating survivors of stroke into an existing, hospital-based CR program through an assessment of (1) recruitment, uptake and retention, (2) adherence and fidelity, (3) acceptability and (4) safety.

METHODS

A mixed methods design combined a single group, pre-post design, pilot feasibility study with an imbedded qualitative inquiry. Survivors of stroke were recruited into a standard 12-week, 36 visit CR program.

RESULTS

Fifty-three survivors were referred, 29 started and 24 completed the program. Program uptake rate was 55% and completion rate was 83%. Eleven completers and one non-completer participated in the qualitative interviews. Program completers attended an average of 25.25 (SD 5.82) sessions with an average of 38.93 (SD 5.64) exercise minutes per session while reaching targeted rate of perceived exertion levels. Qualitative themes included perceived benefits of an individualized program in a group setting, positive interactions with qualified staff, opportunities for socialization, and regular monitoring and staff attentiveness promoting feelings of safety.

CONCLUSIONS

Survivors of stroke were able to meet Medicare standard dosage (frequency and session duration) and rate of perceived intensity goals, and perceived the program as needed regardless of their mobility limitations or previous exercise experience. Primary challenges included managing referrals and uptake. Results support feasibility and benefit for survivors to integrate into U.S. CR programs.

Leisure-time physical activity interventions for children and adults with cerebral palsy: a scoping review

AIM

To summarize current evidence on the effects and reach of leisure-time physical activity (LTPA) interventions among children and adults with cerebral palsy (CP).

METHOD

Systematic searches were conducted in PubMed, CINAHL, and Google Scholar to identify randomized controlled trials (RCTs) of LTPA interventions in CP. Data from eligible studies were extracted for qualitative synthesis.

RESULTS

Forty-nine studies enrolled a total of 1513 participants (mean [SD] age 13y [7y], range 5-43y; 818 males, 655 females, 40 not reported) and primarily included ambulatory children. RCTs underrepresented adults and people in Gross Motor Function Classification System (GMFCS) levels IV and V. Forty-one studies reported at least one favorable benefit from LTPA. Benefits included improvements to musculoskeletal strength, cardiorespiratory fitness, quality of life, spasticity, participation, and core aspects of physical function. Regarding reach, only 34% of people that were contacted to participate enrolled within a study. A smaller percentage of participants dropped out from intervention (8%) and follow-up periods (3%).

INTERPRETATION

Study findings highlight effective interventions to improve health, fitness, and function. To enhance the reach and generalizability of LTPA trials for CP, future studies should examine how to increase study sample sizes and aim to include a better representation of adults and people in GMFCS levels IV and V.

WHAT THIS PAPER ADDS

People with cerebral palsy (CP) may experience improvements in health, fitness, and physical function from leisure-time physical activity (LTPA) interventions. Effective interventions include exercise training, active video games, recreation activities, behavioral coaching, and motor skills training. Interventions that incorporate telehealth technology, behavioral coaching, and community resources may enhance LTPA. Interventions primarily include children in Gross Motor Functional Classification System (GMFCS) levels I to III. Adults, wheelchair users, and those in GMFCS levels IV and V are underrepresented.

Comparisons of leisure-time physical activity participation by adults with and without a disability: results of an Australian cross-sectional national survey

Objectives

The objective of this study was to describe and compare the amount and type of leisure-time physical activity, and motivations and barriers to participation among adults with and without a disability.

Methods

Analysis of deidentified data from an Australian cross-sectional national telephone-based survey (October 2015 to June 2018) of sport and physical recreation participation over the previous 12 months, and barriers and motivations to participation. Descriptive statistics (incorporating weighted proportions), χ² tests and regression analyses were conducted to describe aspects of participation and compare those with and without self-reported disability.

Results

Of the 54 343 adults surveyed, 15% reported a disability. Adults with a disability were half as likely to meet physical activity guidelines through sport and/or physical recreation than adults without a disability (OR 0.53, 95% CI 0.51 to 0.57). A greater proportion of adults with a disability participated in physical recreation only (40% vs 31%; χ²=187; p<0.001), whereas a greater proportion of adults without a disability participated in sport only (20% vs 12%; χ²=188; p<0.001). Adults with a disability were more motivated than adults without a disability to try a new activity for physical health or fitness benefits (55% vs 46%; χ²=36; p<0.001). The most reported barrier to participation for adults with a disability not currently participating in sport and/or physical recreation was poor health or injury (62%), whereas for adults without a disability it was lack of time/too many other commitments (43%).

Conclusion

Adults with a disability are less physically active and report different physical activity profiles and barriers to being active than adults without a disability. Urgent action is required to address this discrepancy.

From Cancer Rehabilitation to Recreation: A Coordinated Approach to Increasing Physical Activity

Participation in adequate physical activity improves the health status of cancer survivors, enhances their survival, and reduces their risk of cancer recurrence. However, cancer survivors engage in low levels of physical activity and have limited access to rehabilitation services that could increase their participation. No optimal framework has been developed that supports physical activity participation among cancer survivors. Given the growth in numbers of cancer survivors, development of a framework may provide a pathway to facilitate timely and appropriate care. This perspective paper describes the development of the Cancer Rehabilitation to Recreation (CaReR) Framework and its practical implications. The CaReR Framework uses a tailored, stepped approach to guide health services and clinicians on the design and implementation of interventions to promote physical activity among cancer survivors. Implementation of the CaReR Framework will improve continuity and quality of care for cancer survivors and promote physical activity with the ultimate aim of improving health outcomes.

An audit of physiotherapists' documentation on physical activity assessment, promotion and prescription to older adults attending out-patient rehabilitation

PURPOSE

Identify if physiotherapists document the assessment, promotion and prescription of physical activity to older adults attending out-patient rehabilitation and assist them in the transition to an active lifestyle.

METHODS

An audit of physiotherapists' documentation in medical records of older adults who attended an out-patient rehabilitation program at a tertiary hospital.

RESULTS

Fifty-six medical records were reviewed. Mean age (SD) of participants was 79 (7) years. No documentation was found on the use of validated tools to assess physical activity levels of older adults. Prescription of physical activity was documented in 55/56 (98%) medical records. Seven (12.5%) medical records included documentation on goal setting regarding physical activity participation. Advice on regular physical activity post-discharge from the rehabilitation program was documented in 28/56 (50%) medical records. Formal referral to community-based physical activity programs was documented in 4/56 (7%) medical records.

CONCLUSIONS

Evidence-practice gaps were found in physiotherapists' documentation of the promotion of physical activity to older adults attending out-patient rehabilitation, indicating a lack of assistance in the transition to an active lifestyle. These gaps were evident in the lack of; physical activity assessment, implementation of behaviour change strategies and formal referral to physical activity in the community post-discharge from out-patient rehabilitation.Implications for rehabilitationOur findings suggest that physiotherapists are not widely applying evidence-based practice to promote physical activity to older adults attending out-patient rehabilitation nor supporting them in the transition to engage in physical activity in the community post-discharge from rehabilitation program.Incorporating physical activity assessment and behaviour change strategies into usual care may enable physiotherapists to successfully promote physical activity to older adults attending out-patient rehabilitation.Collaboration between the health care system and community-based physical activity programs is imperative to facilitate the sustainability of an active lifestyle after discharge from rehabilitation program.

Enhancing Transitions From Rehabilitation Patient to Wellness Participant for People With Disabilities: An Opportunity for Hospital Community Benefit

Pressure is increasing on not-for-profit hospitals to demonstrate that they provide sufficient benefit to the community to justify their tax-exempt status. Many industry observers have suggested that this community benefit should address unmet medical needs within the community, deficits in the social determinants of health, or health disparities within communities. We argue that one area of clear unmet need is assistance in helping bridge the transition that people with disabilities (PWD) must make from rehabilitation patient to wellness participant. Programs to bridge this transition are necessary because many PWD struggle to identify strategies to maintain and maximize their own well-being after discharge from the healthcare system. As a result, PWD have worse health outcomes than non-disabled individuals. To address these needs, we propose hospitals take a leading role in establishing new, community-based efforts to provide PWD with benefits that will support their effort to self-manage health. Hospitals are well-suited to lead the creation of these programs because of the important role they play in providing services to PWD and because of their ability to bring together multiple stakeholders required to make supportive programs sustainable.

Are Aerobic Programs Similar in Design to Cardiac Rehabilitation Beneficial for Survivors of Stroke? A Systematic Review and Meta-Analysis

Background Survivors of stroke face movement disability and increased cardiovascular disease and stroke risk. Treatment includes rehabilitation focused on functional movement with less emphasis on aerobic capacity. After rehabilitation, survivors of stroke must self-manage activity with limited appropriate community programs. Lack of structured activity contributes to sedentary behavior. The objective of this systematic review and meta-analysis is to review aerobic programs for stroke survivors similar in activity and dosage to cardiac rehabilitation programs to determine their efficacy for improving aerobic and walking capacity. Methods and Results Preferred Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to review 5 databases. Group interventions for survivors of stroke with a primary aerobic component and dosage from 18 to 36 visits over 8 to 18 weeks (matching cardiac rehabilitation requirements in the United States) were included. The 6-minute walk test, maximal oxygen consumption (VO2) peak, and walking speed were included as measures of aerobic capacity. Summary effect sizes and outcome measure mean differences were calculated for preintervention to postintervention, and summary effect sizes were calculated for preintervention to follow-up. Activity type and initial 6-minute walk test moderator analyses were performed. Nineteen studies with 23 eligible groups were selected. Survivors of stroke improved their composite aerobic capacity with an effect size of 0.38 (95% CI, 0.27-0.49). Studies including 6-minute walk test demonstrated a pooled difference in means of 53.3 m (95% CI, 36.8-69.8 m). Follow-up data were inconclusive. Conclusions Survivors of stroke benefit from aerobic programs with similar dosing to cardiac rehabilitation in the United States. The potential integration into existing programs could expand the community exercise options.

A systematic scoping review: Resources targeting the training and education of health and recreation practitioners to support physical activity among people with physical disabilities

BACKGROUND

Health and recreation practitioners play an important role in promoting and supporting leisure time physical activity (LTPA) among persons with physical disabilities (PWPD), yet many practitioners lack training and education to provide the basic knowledge, skills, and resources necessary.¹ Little is known about existing LTPA information and training resources for health and recreation practitioners and there has been no known systematic effort to identify existing resources.

OBJECTIVE

The purpose of the current study was to engage systematic scoping methodologies to identify resources that target the training and education of health and recreation practitioners to promote and support LTPA among PWPD. To further analyze the identified resources, an assessment of quality was conducted.

METHODS

Systematic scoping review methodologies were employed, which included searches of academic and grey literature, online materials (i.e., Google search) and expert consultation.

RESULTS

Several (N = 46) resources were identified from academic, government and non-government, and professional organizations. Most resources were targeted to a specific PWPD population. The resources were of high technical quality.

CONCLUSION

The paper serves as a listing of existing resources for practitioners working with PWPD in LTPA settings. The review provides a catalyst for action in further research and practice regarding the analysis, design, development, implementation and evaluation of optimally effective resources targeting practitioners to promote and support LTPA among PWPD.

RESULTS

Several (N = 46) resources were identified from academic, government and non-government, and professional organizations. Most resources were targeted to a specific PWPD population. The resources were of high technical quality.

CONCLUSION

The paper serves as a listing of existing resources for practitioners working with PWPD in LTPA settings. The review provides a catalyst for action in further research and practice regarding the analysis, design, development, implementation and evaluation of optimally effective resources targeting practitioners to promote and support LTPA among PWPD.

An exploratory content analysis of how physiotherapists perceive barriers and facilitators to participation in physical activity among adults with disability

Purpose: To explore the perceived barriers and facilitators to participation in physical activity among adults with disability, from the perspective of physiotherapists. Method: A convenience sample of 20 participants recruited from delegates attending a symposium at the 2015 Australian Physiotherapy Association conference. The participants completed a brief questionnaire. Content analysis was completed using an inductive approach. Results: Participants reported 18 facilitators and 18 barriers to participation in physical activity among adults with disability. The top five reported facilitators were as follows: having support (n = 17 responses), having a choice of opportunities (n = 10 responses), access to suitable venues and equipment (n = 10 responses), enjoying physical activity (n = 8 responses), and high self-efficacy (n = 7 responses). The top five reported barriers were as follows: reduced access to programs and opportunities (n = 15 responses), lack of support or social isolation (n = 14 responses), lack of transport (n = 7 responses), financial strain (n = 7 responses), and physical ability (n = 7 responses). Conclusions: Physiotherapists who have a strong interest in the physical activity habits of adults with disabilities recognize a wide range of facilitators and barriers to their participation. Psychosocial beliefs and behaviors (i.e., self-efficacy, motivation, fear, and attitude) of adults with disability might be more important influencers of physical activity participation than impairments of body structure and function.

Exercise testing protocol using a roller system for manual wheelchair users with spinal cord injury

OBJECTIVE

Determine the validity and reliability of an exercise testing protocol to evaluate cardiorespiratory measures in manual wheelchair users (MWUs) with spinal cord injury (SCI) using a roller-based (RS) wheelchair system.

DESIGN

Repeated measures within-subject design.

SETTING

Community-based research laboratory.

PARTICIPANTS

Ten adults with SCI requiring the use of a manual wheelchair.

INTERVENTIONS

Not applicable.

OUTCOME MEASURES

Cardiorespiratory measures (peak oxygen consumption [VO₂peak], respiratory exchange ratio [RER], pulmonary ventilation [VE], energy expenditure [EE], heart rate [HR], accumulated kilocalories [AcKcal]) and perceived exertion (RPE) were measured during three separate maximal exercise tests using an arm crank ergometer (ACE) and an RS.

RESULTS

At maximal exertion, there were no significant differences in variables between groups, with moderate-to-strong correlations (P < 0.05, r = 0.79-0.90) for VO₂, HR, RPE, AcKcal, and rate of EE between RS and ACE trials. Significant moderate-to-strong correlations existed between RS trials for VO₂, AcKcal, rate of EE, and peak power output (P < 0.01, r = 0.77-0.97).

CONCLUSIONS

VO_2peak was highly correlated between ACE and RS trials and between the two RS trials, indicating the RS protocol to be reliable and valid for MWUs with SCI. Differences in perceived exertion and efficiency at submaximal workloads and maximal pulmonary ventilation at peak workloads indicated potential advantages to using the RS.

'A good stepping stone to normality': a qualitative study of cancer survivors' experiences of an exercise-based rehabilitation program

PURPOSE

Exercise-based rehabilitation is not routinely offered to patients. We explored the experience of cancer survivors completing an exercise-based cancer rehabilitation program with and without motivational interviewing.

METHOD

A qualitative study using semi-structured interviews and thematic analysis was completed with a purposive sample of 26 cancer survivors (n = 17 female, n = 18 post-treatment) participating in cancer rehabilitation at a tertiary hospital. Interviews were recorded and transcribed verbatim. Coding was completed by two reviewers independently and confirmed by a third reviewer.

RESULTS

The main theme that emerged was exercise-based rehabilitation facilitated a return to normality after diagnosis which included positive changes in physical activity behaviour. Sub-themes were that rehabilitation is person-centred, challenges expectations, empowering and facilitated by expert staff. Common themes emerged whether participants received additional motivational interviewing or not. However, participants who received motivational interviewing were more likely to report feeling accountable for their physical activity levels. Transition to ongoing independent physical activity remained a challenge for some people who did not feel empowered or socially supported.

CONCLUSION

Exercise-based cancer rehabilitation is important in facilitating 'return to normal' including increased participation in physical activity. To challenge expectations and to empower cancer survivors, rehabilitation programs should be person-centred and led by expert staff.

Effects of an ergonomic program on the quality of life and work performance of university staff with physical disabilities: A clinical trial with three-month follow-up

BACKGROUND

Problems related to physical disability may have an extremely negative impact in the work environment, reducing productivity and contributing to health problems and a worsening quality of life.

OBJECTIVE

To assess the effects of an ergonomic intervention program on the quality of life and the work performance of people with physical disabilities working in a university environment.

METHODS

A pilot clinical trial with three-month follow-up was conducted at the Physiotherapy Clinic of the Federal University of Paraíba (Brazil). Eight workers at the university took part in an ergonomic adjustment (using ErgoDis/IBV software) and physiotherapy program at their workplace for twelve weeks, in two 60-min sessions per week. The measuring instruments used were the WHOQoL-BREF questionnaire for quality of life and the Work Ability Index for work ability. A repeated-measures ANOVA analysis and Wilcoxon signed-rank test were also performed.

RESULTS

Significant intra-group changes were observed in the QoL subscales for the physical dimension (F = 5.487, p = 0.017) and the environment dimension (F = 7.510, p = 0.006). The post-treatment analysis revealed significant changes for both the physical dimension (Z = -2.552, p = 0.011) and the environment dimension (Z = -2.201, p = 0.028). After the three-month follow-up period, only the environment dimension recorded a significant change (Z = -1.965, p = 0.049). The effect sizes were large. Regarding work ability, the repeated-measures ANOVA analysis showed a significant time effect (F = 5.067, p = 0.022), with large pre-post treatment improvement (Z = -2.555, p = 0.011, d = 0.914).

CONCLUSIONS

The program based on ergonomic and physiotherapy program greatly enhanced the subjects' quality of life and work ability.

A systematic review of review articles addressing factors related to physical activity participation among children and adults with physical disabilities

Dozens of published papers cite factors related to leisure-time physical activity (LTPA) participation among people with physical disabilities. Unfortunately, there has been little effort to synthesise this literature in a manner that is accessible and useful to the sectors (e.g., health care, recreation) responsible for LTPA promotion in disability populations. In this systematic review, over 200 factors were extracted from 22 review articles addressing barriers and facilitators to LTPA in children and adults with physical disabilities. Factors were grouped according to common themes, classified into five levels of a social ecological model, and coded according to whether they could be affected by the health-care and/or recreation sectors. Findings are discussed with regard to key factors to target in LTPA-enhancing interventions, relevant theories and models in which to frame interventions, the levels at which the interventions can be implemented, and intervention priorities. The synthesis provides a blueprint and a catalyst for researchers and practitioners to shift focus from conducting studies that merely describe LTPA barriers and facilitators, to developing and delivering strategies to increase LTPA among persons with physical disabilities.

Teleexercise for Persons With Spinal Cord Injury: A Mixed-Methods Feasibility Case Series

Background

Spinal cord injury (SCI) results in significant loss of function below the level of injury, often leading to restricted participation in community exercise programs. To overcome commonly experienced barriers to these programs, innovations in technology hold promise for remotely delivering safe and effective bouts of exercise in the home.

Objective

To test the feasibility of a remotely delivered home exercise program for individuals with SCI as determined by (1) implementation of the intervention in the home; (2) exploration of the potential intervention effects on aerobic fitness, physical activity behavior, and subjective well-being; and (3) acceptability of the program through participant self-report.

Methods

Four adults with SCI (mean age 43.5 [SD 5.3] years; 3 males, 1 female; postinjury 25.8 [SD 4.3] years) completed a mixed-methods sequential design with two phases: an 8-week intervention followed by a 3-week nonintervention period. The intervention was a remotely delivered aerobic exercise training program (30-45 minutes, 3 times per week). Instrumentation included an upper body ergometer, tablet, physiological monitor, and custom application that delivered video feed to a remote trainer and monitored and recorded exercise data in real time. Implementation outcomes included adherence, rescheduled sessions, minutes of moderate exercise, and successful recording of exercise data. Pre/post-outcomes included aerobic capacity (VO₂ peak), the Physical Activity Scale for Individuals with Physical Disabilities (PASIPD), the Satisfaction with Life Scale (SWLS), and the Quality of Life Index modified for spinal cord injury (QLI-SCI). Acceptability was determined by participant perceptions of the program features and impact, assessed via qualitative interview at the end of the nonintervention phase.

Results

Participants completed all 24 intervention sessions with 100% adherence. Out of 96 scheduled training sessions for the four participants, only 8 (8%) were makeup sessions. The teleexercise system successfully recorded 85% of all exercise data. The exercise program was well tolerated by all participants. All participants described positive outcomes as a result of the intervention and stated that teleexercise circumvented commonly reported barriers to exercise participation. There were no reported adverse events and no dropouts.

Conclusion

A teleexercise system can be a safe and feasible option to deliver home-based exercise for persons with SCI. Participants responded favorably to the intervention and valued teleexercise for its ability to overcome common barriers to exercise. Study results are promising but warrant further investigation in a larger sample.