Exercise for Everyone: A Randomized Controlled Trial of Project Workout on Wheels in Promoting Exercise Among Wheelchair Users

Abstract

Objective To compare the effectiveness of two home-based behavioral interventions to promote wheelchair users exercise adoption and maintenance over 12 months. Design Randomized controlled trial, with participants stratified into groups based on disability type (stable, episodic, progressive) and support partner availability. Setting Exercise occurred in participant preferred locations (e.g., home, recreation center), with physiological data collected at the university-based exercise lab. Participants One hundred twenty-eight inactive wheelchair users (64 women) with sufficient upper arm mobility for arm-based exercise enrolled. Participants on average were 45 years old, lived with their impairment for 22 years, with spinal cord injury (46.1%) most commonly reported as causing mobility impairment. Interventions Both groups received home-based exercise interventions. The staff-supported group (n= 69) received intensive exercise support, while the self-guided group (n= 59) received minimal support. Both received exercise information, resistance bands, instructions to self-monitor exercise, regularly-scheduled phone calls, and handwritten cards. Main Outcome Measures The primary outcome derived from weekly self-reported exercise. Secondary outcomes included physical fitness (aerobic/muscular) and predictors of exercise participation. Results The staff-supported group reported significantly greater exercise (~ 16 minutes/week) than the self-guided group over the year (t=10.6, p=0.00), with no significant between group difference in aerobic capacity (t=0.76, p=0.45) and strength (t=1.5, p=0.14). Conclusions Although the staff-supported group reported only moderately more exercise, the difference is potentially clinically significant as they also exercised more frequently. The staff-supported approach holds promise for encouraging exercise among wheelchair users, yet additional support may be necessary to achieve more exercise to meet national recommendations.

SCIPA Com: outcomes from the spinal cord injury and physical activity in the community intervention

“…8,9 In agreement with other studies, interventions delivered by exercise professionals via SCIPA Com showed increased physical activity uptake and reduced expenses, while making these services available to others in the community. 8,21 The 'T3-SCI' course also provided exercise professionals with an opportunity to adapt their knowledge in health and fitness for clients with SCI. Their lack of experience with people with disabilities did not deter development of effective programs.…”

“…18 The average improvement was remarkably higher in this study compared with similar programs that resulted in improvements between 17 and 155 min of LTPA per week. 8,9 This difference was possibly due to the alignment of exercise programs with the patient's expectations and capabilities.…”

“…Previous studies reinforce this demand with reported high attendance rates in health promotion initiatives, hosting between 140 health professionals 5 and 135 wheelchair users. 8 However, the large number of exercise professionals who did not follow through with 'T3-SCI' indicated difficulties in their engagement. Exercise professionals had the autonomy to complete the online course at their convenience, which was a different approach from that adopted by 'SCI Action Canada' and 'SCI Ontario' events.…”

“…[1][2][3][4] Active lifestyles among the SCI population have been facilitated through referral systems from rehabilitation services to the community setting, 3 increased community involvement 5 and customized physical activity programs. 6,7 Additional studies 8,9 revealed benefits from interventions in community-based facilities, which reduced associated costs and transportation times.…”

Age-related variation in mobility independence among wheelchair users with spinal cord injury: A cross-sectional study

“…"necessitating wheelchair use for mobility outside the home." 61 Recognizing that the "International SCI Activity and Participation Basic Data Set" 62 includes the item "mobility moderate distances (10 to 100 m)" which is consistent with the relevant SCIM item (whereas items on indoor mobility and mobility outdoors >100 m are not included), we chose to define wheelchair users as participants who stated to use a wheelchair at this item. This will facilitate future comparisons of our sample with samples of other studies.…”