Abstract
BackgroundSpinal 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.ObjectiveTo 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.MethodsFour 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.ResultsParticipants 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.ConclusionA 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.
Highlights
In the United States, approximately 300,000 adults are currently living with a spinal cord injury (SCI) [1], and 50% of them report performing little to no physical activity other than their activities of daily living [2]
Data were recorded in real time by the teleexercise system and categorized into either light/rest, moderate, or vigorous intensity exercise
Five major themes emerged from the qualitative interview data: (1) barriers to exercise at typical fitness facilities; (2) teleexercise as a solution to exercise barriers, (3) positive outcomes associated with teleexercise, (4) importance of the telecoach as a motivator, and (5) suitability of the employed teleexercise technology
Summary
In the United States, approximately 300,000 adults are currently living with a spinal cord injury (SCI) [1], and 50% of them report performing little to no physical activity other than their activities of daily living [2]. Because only a small percentage of persons with SCI are able to meet the national physical activity guidelines of 150 minutes per week of moderate aerobic exercise, it is not surprising that poor metabolic [6] and cardiovascular health [7] is often observed in this population. Those who are chronically inactive are at risk for secondary conditions including pressure ulcers, infections, and depression, which may even reduce life expectancy [8]. Study results are promising but warrant further investigation in a larger sample
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