Virtual Strategies for the Broad Delivery of High Intensity Exercise in Persons With Spinal Cord Injury: Ongoing Studies and Considerations for Implementation

McMillan, David W.; Astorino, Todd A.; Correa, Michael A.; Nash, Mark S.; Gater, David R.

doi:10.3389/fspor.2021.703816

Cited by 6 publications

(2 citation statements)

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“…In the current review, a number of HIIT-based ACE, wheelchair propulsion, and FES hybrid cycling and skiing interventions demonstrated improvements in CRF [ 69 , 92 , 128 , 136 – 140 ]. The potential of “real-world” strategies such as virtual HIIT have also been discussed in a recent review by McMillan and colleagues [ 141 ]. Future exercise interventions should look to compare the effects of different HIIT modalities/protocols (i.e., virtual home-based HIIT versus supervised arm-crank HIIT, the most appropriate number and/or length of intervals and recovery periods, vigorous or supramaximal exercise intensities) before concrete recommendations can be made on the most optimal HIIT prescription for improving CRF.…”

Section: Discussionmentioning

confidence: 99%

Exercise and aerobic capacity in individuals with spinal cord injury: A systematic review with meta-analysis and meta-regression

Hodgkiss,

Bhangu,

Lunny

et al. 2023

PLoS Med

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Background A low level of cardiorespiratory fitness [CRF; defined as peak oxygen uptake (V˙O2peak) or peak power output (PPO)] is a widely reported consequence of spinal cord injury (SCI) and a major risk factor associated with chronic disease. However, CRF can be modified by exercise. This systematic review with meta-analysis and meta-regression aimed to assess whether certain SCI characteristics and/or specific exercise considerations are moderators of changes in CRF. Methods and findings Databases (MEDLINE, EMBASE, CENTRAL, and Web of Science) were searched from inception to March 2023. A primary meta-analysis was conducted including randomised controlled trials (RCTs; exercise interventions lasting >2 weeks relative to control groups). A secondary meta-analysis pooled independent exercise interventions >2 weeks from longitudinal pre-post and RCT studies to explore whether subgroup differences in injury characteristics and/or exercise intervention parameters explained CRF changes. Further analyses included cohort, cross-sectional, and observational study designs. Outcome measures of interest were absolute (AV˙O2peak) or relative V˙O2peak (RV˙O2peak), and/or PPO. Bias/quality was assessed via The Cochrane Risk of Bias 2 and the National Institute of Health Quality Assessment Tools. Certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Random effects models were used in all meta-analyses and meta-regressions. Of 21,020 identified records, 120 studies comprising 29 RCTs, 67 pre-post studies, 11 cohort, 7 cross-sectional, and 6 observational studies were included. The primary meta-analysis revealed significant improvements in AV˙O2peak [0.16 (0.07, 0.25) L/min], RV˙O2peak [2.9 (1.8, 3.9) mL/kg/min], and PPO [9 (5, 14) W] with exercise, relative to controls (p < 0.001). Ninety-six studies (117 independent exercise interventions comprising 1,331 adults with SCI) were included in the secondary, pooled meta-analysis which demonstrated significant increases in AV˙O2peak [0.22 (0.17, 0.26) L/min], RV˙O2peak [2.8 (2.2, 3.3) mL/kg/min], and PPO [11 (9, 13) W] (p < 0.001) following exercise interventions. There were subgroup differences for RV˙O2peak based on exercise modality (p = 0.002) and intervention length (p = 0.01), but there were no differences for AV˙O2peak. There were subgroup differences (p ≤ 0.018) for PPO based on time since injury, neurological level of injury, exercise modality, and frequency. The meta-regression found that studies with a higher mean age of participants were associated with smaller changes in AV˙O2peak and RV˙O2peak (p < 0.10). GRADE indicated a moderate level of certainty in the estimated effect for RV˙O2peak, but low levels for AV˙O2peak and PPO. This review may be limited by the small number of RCTs, which prevented a subgroup analysis within this specific study design. Conclusions Our primary meta-analysis confirms that performing exercise >2 weeks results in significant improvements to AV˙O2peak, RV˙O2peak, and PPO in individuals with SCI. The pooled meta-analysis subgroup comparisons identified that exercise interventions lasting up to 12 weeks yield the greatest change in RV˙O2peak. Upper-body aerobic exercise and resistance training also appear the most effective at improving RV˙O2peak and PPO. Furthermore, acutely injured, individuals with paraplegia, exercising for ≥3 sessions/week will likely experience the greatest change in PPO. Ageing seemingly diminishes the adaptive CRF responses to exercise training in individuals with SCI. Registration PROSPERO: CRD42018104342

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Section: Discussionmentioning

confidence: 99%

Exercise and aerobic capacity in individuals with spinal cord injury: A systematic review with meta-analysis and meta-regression

Hodgkiss,

Bhangu,

Lunny

et al. 2023

PLoS Med

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“…For individuals with SCI, engaging in sports is complicated by multiple infrastructural (eg, inadequate accessibility to buildings), internal (eg, not knowing how to exercise), and monetary barriers [ 18 - 20 ]. Digital exercise platforms have the potential to overcome these barriers and promote exercise participation because they do not require transportation, offer a guided program addressing the needs of individuals with SCI, and may be cheaper than a gym membership or personal training [ 21 ]. Using a digital exercise platform has been shown to promote adherence to exercise guidelines in able-bodied individuals during the COVID-19 pandemic, when access to sports facilities was restricted [ 22 ].…”

Section: Introductionmentioning

confidence: 99%

Feasibility, Usability, and Safety of ParaGym, an Intelligent Mobile Exercise App for Individuals With Paraplegia: Protocol for a Pilot Block-Randomized Controlled Trial

Bolz,

Löscher,

Muhl

et al. 2023

JMIR Res Protoc

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Background Exercise is crucial for individuals with paraplegia to reduce the risk of secondary diseases and improve independence and quality of life. However, numerous barriers such as inadequate accessibility restrict their participation in exercise programs. Digital exercise apps can help overcome these barriers. Personalization is considered a crucial feature of mobile exercise apps, as people with paraplegia have individual requirements regarding exercise programs depending on their level of impairment. Despite the increasing popularity of mobile exercise apps, there are none available that target the individual needs of this cohort. The ParaGym mobile exercise app prototype was designed to automatically tailor exercise sessions to the individual needs of users with paraplegia. Objective This study aims to evaluate the feasibility, usability, safety, and preliminary effectiveness of the ParaGym mobile exercise app prototype. Methods This pilot block-randomized controlled feasibility trial will include 45 adult participants with paraplegia. Eligible participants will be block randomized to either the intervention or waitlist control group. The intervention group will perform a 6-week exercise program using the ParaGym mobile exercise app, comprising three 35-minute exercise sessions per week. The waitlist control group will continue their usual care and receive access to the app after study completion. Participants will record all exercise sessions conducted with the app as well as additional exercise sessions conducted during the study period using exercise diaries. The primary outcomes include feasibility, usability, and safety. Feasibility will be assessed through semistructured interviews, study adherence, and retention rates. Usability will be measured using the System Usability Scale. Safety will be determined by the occurrence of adverse events. Secondary outcomes include the effects of the intervention on peak exercise capacity (VO2 peak); handgrip strength; independence, which will be measured using the Spinal Cord Independence Measure III (SCIM III); and health-related quality of life, which will be measured using the Short Form–36 Health Survey (SF-36). Results Recruitment commenced in November 2022. Overall, 12 participants were enrolled at the time of submission. Data collection commenced in January 2023, with completion expected in April 2023. Conclusions To the best of our knowledge, this is the first study to assess the feasibility, usability, and safety of an intelligent mobile exercise app for individuals with paraplegia. Thereafter, the app should be adapted according to the findings of this trial. Future trials with an updated version of the app should aim for a larger sample size, longer intervention duration, and more diverse target group. In the long term, a fully marketable version of the ParaGym app should be implemented. This would increase the access to personalized, independent, and evidence-based exercise training for this cohort and, in the future, other people who use wheelchairs. Trial Registration German Clinical Trials Register DRKS00030370; https://drks.de/search/de/trial/DRKS00030370 International Registered Report Identifier (IRRID) DERR1-10.2196/45652

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Application and Efficacy of Virtual Sailing as an Exercise Therapy: A Narrative Review

Xiao

2024

J. of SCI. IN SPORT AND EXERCISE

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Purpose The concept of virtual exercise is still a nascent domain for therapeutic intervention. In light of the importance of exercise and the fast development of digital technologies, virtual exercise possesses a promising potential for future development. Sailing is a recreational exercise that has helped the rehabilitation of patients with neurological and physiological disorders and improved their quality of life. However, challenges exist in implementing physical sailing as an intervention, due to the cost and the extent of uncertainty of this sport. While studies remain limited, over the past twenty years, simulated sailing that combines virtual reality with complex motor learning and optimum decision-making is emerging as a potential digital exercise that possesses broad therapeutic applications for future exploration. This review aims to have a more complete understanding of the clinical application of virtual sailing as an emerging exercise therapy. Methods Literature searches were performed using PubMed, EMBASE and MEDLINE bibliographic databases for research articles published from January 1994 to January 2024 (inclusive). We performed a Strength, Weakness, Opportunity and Threat (SWOT) analysis to evaluate the implementation of virtual sailing as a new therapeutic intervention, opening unanswered questions for future investigation. Results Out of 205 articles searched from databases, 31 advanced to full-text screening and 7 articles were eligible for inclusion in this narrative review. This review summarises the application and therapeutic efficacy of virtual sailing in improving both motor and psychosocial functions. We also shared our perspectives on developing virtual sailing as an exercise therapy for treating neurodegenerative diseases, focusing on pre-clinical and clinical evidence as well as the proposed mechanism by which virtual sailing could influence neural plasticity in the central nervous system. Conclusion Virtual sailing is a promising exercise therapy feasible for future implementation, although large-scale trial studies involving a diverse range of clinical conditions are required.

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Virtual Strategies for the Broad Delivery of High Intensity Exercise in Persons With Spinal Cord Injury: Ongoing Studies and Considerations for Implementation

Cited by 6 publications

References 108 publications

Exercise and aerobic capacity in individuals with spinal cord injury: A systematic review with meta-analysis and meta-regression

Exercise and aerobic capacity in individuals with spinal cord injury: A systematic review with meta-analysis and meta-regression

Feasibility, Usability, and Safety of ParaGym, an Intelligent Mobile Exercise App for Individuals With Paraplegia: Protocol for a Pilot Block-Randomized Controlled Trial

Application and Efficacy of Virtual Sailing as an Exercise Therapy: A Narrative Review

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