Secondary complications and subjective well-being in individuals with chronic spinal cord injury: associations with self-reported adiposity.

STUDY DESIGN: This is a cross-sectional study. OBJECTIVES: To examine the associations between adiposity, secondary complications and subjective well-being (SWB) in individuals with spinal cord injury (SCI). SETTING: Parkwood Hospital (London); Hamilton Health Sciences-Chedoke Site and McMaster University (Hamilton); Toronto Rehabilitation Institute, Lyndhurst Centre (Toronto); and St Mary's of the Lake Hospital and Queen's University (Kingston), Ontario, Canada. METHODS: A total of 531 men and 164 women (N=695) enrolled in the Study of Health and Activity in People with Spinal Cord Injury (SHAPE-SCI) completed the Secondary Health Complications Survey, SF-36 pain subscale, Satisfaction with Life Scale (SWLS) and the Patient Health Questionnaire-9 (PHQ) during a telephone interview. Body mass index (BMI) measurements were obtained from a subsample of the SHAPE-SCI participants (n=73) during a home visit. RESULTS: Controlling for covariates, individuals who reported being overweight were more likely to have a history of overuse injuries and fatigue, experienced a greater impact of overuse injuries and fatigue, had greater pain and depressive symptoms, and had lower satisfaction with life than individuals who did not report being overweight. BMI was only associated with an increased likelihood of reporting spasticity. CONCLUSION: Self-reported overweight status was associated with an increased prevalence of certain secondary complications and lower SWB. Future prospective studies should examine whether reductions in adiposity are associated with changes in the prevalence and the impact of secondary complications and SWB.

The development of evidence-informed physical activity guidelines for adults with spinal cord injury.

OBJECTIVES: To systematically develop evidence-informed physical activity guidelines to improve physical fitness in people with spinal cord injury (SCI). SETTING: This study was conducted in Canada. METHODS: The Appraisal of Guidelines, Research and Evaluation II guideline development protocol was used to develop exercise guidelines to improve physical capacity and muscular strength. The evidence base for the guideline development process consisted of a systematic review and quality appraisal of research examining the effects of exercise on physical fitness among people with SCI. A multidisciplinary expert panel deliberated the evidence and generated the guidelines. Pilot testing led to refinement of the wording and presentation of the guidelines. RESULTS: The expert panel generated the following guidelines: for important fitness benefits, adults with a SCI should engage in (a) at least 20 min of moderate to vigorous intensity aerobic activity two times per week and (b) strength training exercises two times per week, consisting of three sets of 8-10 repetitions of each exercise for each major muscle group. CONCLUSION: People with SCI, clinicians, researchers and fitness programmers are encouraged to adopt these rigorously developed guidelines.

Planning, leisure-time physical activity, and coping self-efficacy in persons with spinal cord injury: a randomized controlled trial.

UNLABELLED: Arbour-Nicitopoulos KP, Martin Ginis KA, Latimer AE. Planning, leisure-time physical activity, and coping self-efficacy in persons with spinal cord injury: a randomized controlled trial. OBJECTIVE: To examine the effects of action and coping planning (ACP) on leisure-time physical activity (LTPA) and coping self-efficacy in exercise initiates living with spinal cord injury (SCI). DESIGN: Ten-week, single-blind randomized controlled trial. SETTING: General community. PARTICIPANTS: Adults (N=44) with SCI (mean age +/- SD, 49.70+/-12.71y) were randomly assigned to either an action planning only (APO; n=22) or an ACP (n=22) condition. INTERVENTION: Participants in the APO condition formed action plans for LTPA at weeks 1 and 5, and self-monitored their LTPA behavior. Those in the ACP condition formed coping plans for managing self-identified activity barriers, in addition to forming action plans and self-monitoring. MAIN OUTCOME MEASURES: Measures of intentions, coping self-efficacy, and behavior were assessed at weeks 1, 5, and 10. RESULTS: Intention-to-treat analyses indicated that persons in the ACP condition reported significantly greater LTPA, scheduling, and general barriers self-efficacy at weeks 5 and 10, in comparison with those in the APO condition. Scheduling self-efficacy mediated the effects of the intervention on LTPA, accounting for 38% of the total effect of the intervention on week 5 LTPA. CONCLUSIONS: These findings illustrate the effectiveness of supplementing action plans with coping plans for enhancing LTPA and coping self-efficacy beliefs among exercise initiates living with SCI.

Activities of daily living performed by individuals with SCI: relationships with physical fitness and leisure time physical activity.

STUDY DESIGN: Cross-sectional. OBJECTIVES: To examine patterns of participation in activities of daily living (ADL) and fitness-related factors associated with these patterns among individuals with spinal cord injury (SCI). SETTING: Centre for Health Promotion and Rehabilitation at McMaster University, School of Kinesiology and Health Studies at Queen's University. METHODS: Forty-eight participants completed the Physical Activity Recall Assessment for People with Spinal Cord Injury (PARA-SCI) and a fitness test assessing cardiovascular fitness (VO(2max) and peak power output (Po)). The most commonly reported ADL were extracted from the PARA-SCI data for analysis. RESULTS: Women tended to spend more time participating in domestic and personal care ADL than men. Compared to individuals with tetraplegia, individuals with paraplegia tended to spend more time transferring, cleaning and preparing food and less time wheeling, toileting and dressing. Fitness and participation in leisure time physical activity (LTPA) were associated with certain ADL. Participants with higher levels of fitness spent more time partaking in ADL wheeling and cleaning. Moreover, greater time spent participating in moderate- and heavy-intensity LTPA was positively correlated with time spent engaged in certain ADL. CONCLUSION: By identifying common ADL performed by individuals with SCI, the study findings begin to provide direction for developing strategies to optimize ADL participation. Future research should examine fitness as a way to help individuals with SCI optimize their ADL participation.

Establishing evidence-based physical activity guidelines: methods for the Study of Health and Activity in People with Spinal Cord Injury (SHAPE SCI).

STUDY DESIGN: Prospective, observational cohort study. OBJECTIVES: This paper describes the rationale and methodology for the Study of Health and Activity in People with Spinal Cord Injury (SHAPE SCI). The study aims to (1) describe physical activity levels of people with different injury levels and completeness, (2) examine the relationship between physical activity, risk and/or presence of secondary health complications and risk of chronic disease, and (3) identify determinants of physical activity in the SCI population. SETTING: Ontario, Canada. METHODS: Seven hundred and twenty men and women who have incurred a traumatic SCI complete self-report measures of physical activity, physical activity determinants, secondary health problems and subjective well-being during a telephone interview. A representative subsample (n=81) participate in chronic disease risk factor testing for obesity, insulin resistance and coronary heart disease. Measures are taken at baseline, 6 and 18 months. CONCLUSION: SHAPE SCI will provide much-needed epidemiological information on physical activity patterns, determinants and health in people with SCI. This information will provide a foundation for the establishment of evidence-based physical activity guidelines and interventions tailored to the SCI community.

The effects of single bouts of body-weight supported treadmill training on the feeling states of people with spinal cord injury.

STUDY DESIGN: Pre-test, post-test study of the relationship between exercise-related changes in feeling states and pain among persons with chronic incomplete spinal cord injury (SCI) who performed three separate exercise sessions consisting of body-weight supported treadmill training (BWSTT). OBJECTIVES: To determine whether exercise-related changes in feeling states are related to exercise-related changes in pain and in-task pain. SETTING: Hamilton, Ontario, Canada. METHODS: A total of 14 men and women with chronic, incomplete SCI (ASIA B and C) performed three exercise sessions of BWSTT. Measures of pain and feeling states were administered before and after each session along with a measure of pain experienced while exercising. RESULTS: Participants who experienced greater decreases in pain from pre- to post-exercise also experienced greater improvements in feeling states. Pain experienced during exercise was unrelated to changes in feeling states. CONCLUSION: Among persons with SCI, exercise-related changes in pain can influence the effects of individual exercise bouts on feeling states.

Maintenance of exercise participation in individuals with spinal cord injury: effects on quality of life, stress and pain.

STUDY DESIGN: Follow-up study of seven individuals with spinal cord injury (SCI) who completed a 9-month randomized control trial (RCT) of exercise training. OBJECTIVE: In a 9-month RCT conducted in our lab, individuals with SCI who participated in a twice-weekly supervised exercise training reported greater perceived quality of life (PQOL), and less stress and pain than a nonexercising control cohort. The present follow-up study examined the voluntary continuation of exercise training after the study ended and the persistence of the accrued psychosocial benefits. SETTING: Centre for Health Promotion and Rehabilitation, McMaster University, Hamilton, Ontario, Canada. METHODS: Five men and two women (age 42.3+/-3.6 years) with SCI (C5-T12; ASIA A-D 12.7+/-8.2 years postinjury) were invited to continue supervised exercise training twice weekly at the completion of the 9-month RCT. Exercise adherence, PQOL, stress and bodily pain were measured at a 3-month follow-up and were compared to values obtained at baseline, and at 3, 6 and 9 months during the intervention. RESULTS: There was a significant decrease in adherence at the 3-month follow-up compared to the overall 9-month adherence rate (42.7 versus 80.6%, respectively; P<0.01). There was also a significant decrease in PQOL (P<0.05) and a trend for increased pain (P=0.07) and stress (P=0.12), at follow-up compared to the end of the 9-month trial. Finally, there was a significant negative correlation between pain at the conclusion of the RCT and exercise adherence over the 3-month follow-up period (r=-0.91; P<0.01). CONCLUSIONS: These findings emphasize the importance of continued exercise adherence to the maintenance of exercise-related increases in psychological well-being among individuals with SCI.

Long-term exercise training in persons with spinal cord injury: effects on strength, arm ergometry performance and psychological well-being.

STUDY DESIGN: Randomized controlled trial of exercise training in persons with spinal cord injury. OBJECTIVE: The purpose of this study was to examine the effects of 9 months of twice-weekly exercise training on strength, arm ergometry performance, and indices of psychological well-being and quality of life. SETTING: Centre for Health Promotion and Rehabilitation, McMaster University, Hamilton, Ontario, Canada. METHODS: Thirty-four men and women (aged 19-65 years) with traumatic spinal cord injury (C4-L1; ASIA A-D) of 1-24 years duration volunteered to participate, and were randomized into exercise (EX; n=21) and control (CON; n=13) groups. Twenty-three subjects (11 EX; 12 CON) successfully completed the 9-month study. Subjects were assessed for one repetition maximum (1RM) strength, arm ergometry performance, and several indices of quality of life and psychological well-being at baseline, 3, 6, and 9 months. RESULTS: At baseline, there were no significant differences between groups in age, submaximal arm ergometry performance, muscle strength, or psychological well-being. Following training, the EX group had significant increases in submaximal arm ergometry power output (81%; P<0.05), and significant increases in upper body muscle strength (19-34%; P<0.05); no significant changes occurred in CON. Participants in EX reported significantly less pain, stress and depression after training, and scored higher than CON in indices of satisfaction with physical function, level of perceived health and overall quality of life (P<0.05). Exercise adherence (per cent of prescribed sessions attended) in those subjects who completed the 9 months of training was 82.5%. CONCLUSIONS: These results demonstrate that long-term twice-weekly exercise training in this population is feasible, and results in significant gains in both physical and psychological well-being.