Feasibility and Effectiveness of Community-Based Virtual Reality Group Exercise Training in Persons with Spinal Cord Injury

Abstract

Persons with spinal cord injury (SCI) are at an increased risk of physiological morbidity compared to their ambulatory counterparts in whom well-established, beneficial correlations exist between exercise, cardiorespiratory health and body composition. Furthermore, SCI who participate in sport may have reduced risk of physiological morbidity than SCI who are sedentary. PURPOSE: This pilot study was two-fold: 1) to determine whether differences exist in cardiorespiratory health and body composition between SCI athletes (ATHL) and sedentary SCI (SED), and 2) to determine whether an 8-week handcycle exercise training program is feasible in an SED SCI population, and if improvements in cardiorespiratory fitness and body composition occur. METHODS: Twenty-seven SED and six ATHL were recruited to participate in the study. All SCI completed a graded hand cycling maximal exercise test for cardiorespiratory fitness (VO2max) and body composition testing (iDEXA). SED participants were then randomized into a virtual reality intervention (VR) or waitlist (WL) group (e.g. offered VR after 8 weeks of WL). The intervention consisted of an 8-week community-based VR group hand cycling exercise training with a USA level 1 coach two days/week. Pre-post outcomes were measured in each group. RESULTS: Thirty-three SCI were recruited to participate (SED n=27; ATHL n=6). All ATHL and 17 SED participants (VR=9, WL=8) completed study protocol, with 10 (VR=1 and WL=9) lost to follow up. One participant was dropped from analysis due to not giving a full effort during testing as determined by investigators. ATHL had 23 physiological and anthropometric variables that were significantly different (p≤0.01) compared to SED including higher VO2max (19.1 ml/kg/min), lower BMI (-4.6 kg/m2), and lower total body fat percentage (-10.4%). VO2max increased 16% in VR and 9% in WL, which was not statistically different. CONCLUSION: This study demonstrates the feasibility of a hand cycling program in SCI. ATHL had better outcomes associated with long term health compared to their SED counterparts. Though no significant changes were noted in VR compared to WL, changes in VO2max may be clinically relevant. A larger sample size or longer training period may be needed to observe significant differences in physiological health in an SED SCI population.