The co-development and evaluation of an e-learning course on spinal cord injury physical activity counselling: a randomized controlled trial.

BACKGROUND: Health, fitness and lifestyle professionals can play important roles in promoting physical activity in groups at risk of developing an inactive lifestyle, such as people with spinal cord injury (SCI). Tailored counselling is a promising tool to promote and improve physical activity levels. To support professionals to effectively have a conversation about physical activity with clients with SCI, evidence-based training and resources are needed. This project aimed to (1) co-develop an e-learning course on best practices for SCI physical activity counselling and, (2) examine the effectiveness and usability of this course. METHODS: Guided by the technology-enhanced learning (TEL) evaluation framework, we used a systematic, multistep approach to co-develop and evaluate an e-learning course. The development process was informed by input and feedback from a diverse group of end-users and experts (n > 160) via online surveys and (think-aloud) interviews. A randomized controlled trial was used to compare learning outcomes (post-knowledge and self-efficacy) between participants who completed the course (intervention group) and the wait-listed control group. Usability, learning experiences, and satisfaction were assessed among all participants. RESULTS: Forty-one participants (21 intervention-group; 20 control-group) with various backgrounds (e.g., lifestyle counsellors, physiotherapists, occupational therapists, recreation therapists, fitness trainers) enrolled in the randomized controlled trial. After completing the course, participants in the intervention group showed significantly improved knowledge on the best practices for SCI physical activity counselling and higher self-efficacy for using these best practices in conversations with clients with SCI compared to the control group (p <.001). Participants reported above average usability scores, positive learning experiences, and high levels of satisfaction when completing the course. CONCLUSION: We used a systematic, multi-step, theory-informed approach to co-develop and evaluate an evidence-based e-learning course on SCI physical activity counselling to support professionals to promote physical activity in their daily practices. The overall positive findings demonstrate that the e-learning course is feasible and ready for further implementation in various health and community settings. Implementation of the e-learning course can help professionals improve the physical activity support they provide to their clients, and subsequently increase physical activity participation in people with SCI.

Correlates of adherence in a home-based, self-managed exercise program tailored to wheelchair users with spinal cord injury.

STUDY DESIGN: Cross-sectional design. OBJECTIVES: To examine personal factors, secondary health conditions, and environmental factors as potential correlates of adherence to a 12-week home-based exercise trial in people with spinal cord injury. SETTING: Home METHODS: Participants (n = 28) were prescribed a set of exercise videos that they were asked to complete three times each week for 12 weeks (36 total sessions). The videos were accessible through a custom-designed mobile application and included movements targeting strength, cardiorespiratory fitness, and balance that were accompanied with music. Watched video minutes were automatically recorded on the web-based platform. At baseline, participants completed self-report questionnaires that measured personal (e.g., age, self-efficacy) and environmental (e.g., barriers) factors and secondary health conditions (e.g., depression). Data were analyzed using quantile (median) regression analysis. RESULTS: Race (African American; ß = -65.62, p = 0.004), community barriers (ß = -9.12, p = 0.026), anxiety (ß = -3.84, p = <0.001), depression (ß = -1.42, p = 0.038), physical function (ß = -1.35, p = 0.048), and self-efficacy (ß = -0.61, p = 0.007) were associated with a lower number of exercise video minutes. Pain intensity (ß = 2.03, p = 0.032), pain interference (ß = 1.84, p = 0.012), and age (ß = 1.13, p = 0.013) were associated with a higher number of exercise video minutes. Total variance explained by the model was 77% (pseudo R2 = 0.77). CONCLUSIONS: Factors associated with lower and higher adherence to home-based exercise should guide future research efforts in creating more precision-based approaches for self-managed home exercise.

Critical factors influencing the decision to enroll in a physical activity intervention among a predominant group of adults with spinal cord injury: a grounded theory study.

STUDY DESIGN: Grounded theory qualitative approach. OBJECTIVES: To examine critical factors associated with interest in enrolling in a physical activity (PA) research intervention among a predominant group of adults with spinal cord injury (SCI) and develop a theory that can enhance future recruitment success. SETTING: Participants were recruited through the network of a community exercise facility for people with physical disabilities. METHODS: Interviews were conducted with 22 wheelchair users (mean age 46 ± 13 years; SCI [n = 19], cerebral palsy [n = 1]; multiple sclerosis [n = 1]; and bilateral limb loss [n = 1]) in either a one-on-one format or focus group. Interview data were coded, and these codes were organized into conceptual categories using a constructivist grounded theory framework. RESULTS: Adults with SCI conceive three core concerns with enrolling into a PA trial: (1) capability to participate in the program due to scheduling, transportation, and secondary health conditions; (2) mental balancing of anticipated benefits versus the difficulty of starting the program; and (3) desirability of the program characteristics based on their preferences and needs. Concerns were organized into a theory that may enhance future recruitment success. CONCLUSIONS: Recruitment is often overlooked in PA research for people with SCI despite it being a primary rate-limiting factor that severely limits the external validity of published studies. Study findings identified core recruitment concerns that are likely similar with general barriers to PA participation. This paper proposed a 3-step decision-making process that can serve as a starting point for overcoming recruitment issues in PA research with people with SCI.

Evaluation of a Shoulder Injury Prevention Program in Wheelchair Basketball.

CONTEXT: Previous literature has theorized that alterations in shoulder physical characteristics are present in wheelchair athletes and contribute to shoulder pain and injury. Limited empirical evidence is present that evaluates the effectiveness of a shoulder injury prevention program focusing on improving these altered characteristics. OBJECTIVE: To evaluate the effectiveness of a 6-week intervention program at improving characteristics that increases the risk of developing pain or shoulder injury. DESIGN: Pretest and posttest. SETTING: Home-based and controlled laboratory. PARTICIPANTS: Seven college wheelchair athletes. INTERVENTIONS: Shoulder range of motion (ROM) and scapular muscle strength were assessed, and a 5-minute injury prevention program was taught to participants. Participants completed the intervention 3 times per week for 6 weeks. Following completion of the program, a postintervention screening was performed. MAIN OUTCOME MEASURES: Internal rotation (IR)/external rotation (ER) ROM, retraction strength, and IR/ER strength. RESULTS: Participants experienced a significant improvement in dominant limb shoulder IR ROM (t6 = 3.56, P = .01) with an average increase of 11.4° of IR ROM and a significant improvement in dominant limb shoulder ER ROM (t6 = 2.79, P = .03) with an average increase of 8.0° of ER ROM. There were no significant increases in shoulder IR or ER strength and scapular retraction strength (P > .05). CONCLUSIONS: Improvements in ROM have previously been linked to decreases in shoulder pain and injury in other upper-extremity dominant sports by improving scapular kinematics. These results provide evidence that a 6-week strengthening and stretching intervention program may decrease risk factors for shoulder injury in wheelchair basketball athletes.

Parent health literacy and adherence-related outcomes in children with epilepsy.

BACKGROUND: The relationship between parent health literacy and adherence to treatment in children with epilepsy has not been fully explored. The purpose of this study was to determine whether parent health literacy and other variables predicted factors associated with adherence, such as missed medication doses, missed medical appointments, and seizure frequency, in children with epilepsy between 1 and 12 years old. METHODS: It was hypothesized that parents with adequate parent health literacy would report fewer missed doses, missed appointments, and seizure occurrences. Using a nonexperimental, cross-sectional study design, interviews were conducted with 146 parents and guardians of children with epilepsy who resided in rural communities. Univariate analyses, including ANOVA, and multiple linear regressions were conducted. RESULTS: Results indicated that parent health literacy was the strongest predictor of two of the adherence-related factors. Higher health literacy scores were associated with fewer missed medication doses and seizure occurrences. However, health literacy was not associated with missed medical appointments. Among other study variables, higher household income was also predictive of fewer missed doses. CONCLUSION: The study findings suggest that inadequate health literacy among parents may serve as an independent risk factor for adherence-related outcomes among children with epilepsy. Further research, as well as effective, targeted parent health literacy strategies used to improve epilepsy management and care in children, is recommended.

Validity and Reliability of a Telehealth Physical Fitness and Functional Assessment Battery for Ambulatory Youth With and Without Mobility Disabilities: Observational Measurement Study.

BACKGROUND: Youth (age 15-24 years) with and without disability are not adequately represented enough in exercise research due to a lack of time and transportation. These barriers can be overcome by including accessible web-based assessments that eliminate the need for on-site visitations. There is no simple, low-cost, and psychometrically sound compilation of measures for physical fitness and function that can be applied to youth with and without mobility disabilities. OBJECTIVE: The first purpose was to determine the statistical level of agreement of 4 web-modified clinical assessments with how they are typically conducted in person at a laboratory (convergent validity). The second purpose was to determine the level of agreement between a novice and an expert rater (interrater reliability). The third purpose was to explore the feasibility of implementing the assessments via 2 metrics: safety and duration. METHODS: The study enrolled 19 ambulatory youth: 9 (47%) with cerebral palsy with various mobility disabilities from a children's hospital and 10 (53%) without disabilities from a university student population. Participants performed a battery of tests via videoconferencing and in person. The test condition (teleassessment and in person) order was randomized. The battery consisted of the hand grip strength test with a dynamometer, the five times sit-to-stand test (FTST), the timed up-and-go (TUG) test, and the 6-minute walk test (6MWT) either around a standard circular track (in person) or around a smaller home-modified track (teleassessment version, home-modified 6-minute walk test [HM6MWT]). Statistical analyses included descriptive data, intraclass correlation coefficients (ICCs), and Bland-Altman plots. RESULTS: The mean time to complete the in-person assessment was 16.9 (SD 4.8) minutes and the teleassessment was 21.1 (SD 5.9) minutes. No falls, injuries, or adverse events occurred. Excellent convergent validity was shown for telemeasured hand grip strength (right ICC=0.96, left ICC=0.98, P<.001) and the TUG test (ICC=0.92, P=.01). The FTST demonstrated good agreement (ICC=0.95, 95% CI 0.79-0.98; P=.01). The HM6MWT demonstrated poor absolute agreement with the 6MWT. However, further exploratory analysis revealed a strong positive correlation between the tests (r=0.83, P<.001). The interrater reliability was excellent for all tests (all ICCs>0.9, P<.05). CONCLUSIONS: This study suggests that videoconference assessments are convenient and useful measures of fitness and function among youth with and without disabilities. This paper presents operationalized teleassessment procedures that can be replicated by health professionals to produce valid and reliable measurements. This study is a first step toward developing teleassessments that can bypass the need for on-site data collection visitations for this age group. Further research is needed to identify psychometrically sound teleassessment procedures, particularly for measures of cardiorespiratory endurance or walking ability.

Telehealth Movement-to-Music With Arm-Based Sprint-Intensity Interval Training to Improve Cardiometabolic Health and Cardiorespiratory Fitness in Children With Cerebral Palsy: Protocol for a Pilot Randomized Controlled Trial.

BACKGROUND: Children with mobility disabilities, including those with cerebral palsy, have limited options and limited time to exercise to manage their cardiometabolic health and cardiorespiratory fitness. Regular cardiovascular exercise during childhood is a critical health behavior for preventing health decline in adulthood. Thus, there is an urgent need for accessible, age-appropriate, convenient exercise modalities in this group. Sprint-intensity interval training (SIT), combined with telehealth procedures, may be ideal for children with disabilities. SIT includes repetitive bouts of maximal exercise effort combined with rest periods, which can be effective in eliciting comparable results to moderate-exercise training with very short training durations. OBJECTIVE: This phase 1 pilot feasibility randomized controlled trial aims to investigate the potential effects of a 12-week SIT program on indicators of cardiorespiratory fitness and cardiometabolic health among children with cerebral palsy. An ancillary aim is to evaluate the feasibility of the program through several process feasibility metrics. METHODS: This study uses a 2-armed parallel group design. A total of 50 physically inactive children with cerebral palsy (aged 6-17 years) will be randomly allocated into 1 of 2 groups: a 12-week SIT or a waitlist control group that continues habitual activity for 12 weeks. The SIT prescription includes 3 tele-supervised sessions per week with 30 repeated sequences of 4 seconds of maximal arm exercise, with active recovery, warm-up, and cooldown periods (for an approximately 20-minute total session). SIT includes guided videos with child-themed arm routines and music. The exercise sessions will be remotely supervised through a web-based videoconference application and include safety monitoring equipment. Outcomes are measured at pre- and postintervention (weeks 0 and 13, respectively). Health outcome measures include peak oxygen consumption (VO2 peak), measured by a graded exercise test; high-sensitivity C-reactive protein and blood insulin, hemoglobin A1c, triglycerides, and cholesterol using a finger stick dried blood spot test; blood pressure, using a sphygmomanometer; and body composition (total mass, total lean mass, tissue % lean, and tissue % fat) using dual x-ray absorptiometry. Feasibility will be evaluated by the following metrics: adverse events or problems experienced throughout the intervention related to participant safety; perceived enjoyment; and recruitment, enrollment, and attrition rates. RESULTS: Recruitment procedures started in November 2023. All data are anticipated to be collected by February 2025. Full trial results are anticipated to be analyzed and submitted for publication by March 2025. Secondary analyses of data will be subsequently published. CONCLUSIONS: This trial tests an accessible and low-cost exercise program that leverages principles of high-intensity exercise to provide a convenient program for children with physical disabilities. Knowledge obtained from this study will inform the development of a larger trial for improving the cardiometabolic health, cardiorespiratory fitness, and well-being of children with physical disabilities. TRIAL REGISTRATION: ClinicalTrials.gov NCT05619211; https://clinicaltrials.gov/study/NCT05619211. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/56499.

Effects of a coach-guided videoconferencing acceptance and commitment therapy intervention combined with psychoeducation on distressed individuals living with spinal cord injury: a preliminary mixed-methods study.

PURPOSE: This study examined effects of coach-guided videoconferencing acceptance and commitment therapy (ACT) accompanied by psychoeducation on distressed individuals with spinal cord injury (SCI) and explored participants' experiences in the intervention. MATERIALS AND METHODS: Ten people with SCI participated in 8 individual videoconferencing sessions delivered by trained coaches. Data using self-reported questionnaires and individual interviews was collected at pretest and posttest and analyzing using Wilcoxon signed-rank tests and interpretative phenomenological analysis (ClinicalTrials.gov ID: NCT04670406). RESULTS: Statistically significant improvements were found in depression, anxiety, stress, grief, engagement in meaningful activities, and self-compassion with medium to large effect sizes. There was no significant change in quality of life, resilience, and ACT processes. Participants gained a new way of thinking by: being aware of thoughts and emotions; exploring perceptions of others; and focusing on the present. Also, the intervention equipped participants to deal with challenges by: improving coping with SCI-related conditions; practicing self-compassion, acceptance, and meditation; and acquiring skills of value-based decision making and committed action. CONCLUSIONS: Findings contribute to the limited evidence as the first study that measured effects of videoconferencing ACT on people with SCI. Future randomized controlled trials are needed to measure efficacy of internet-delivered ACT for people with SCI.IMPLICATIONS FOR REHABILITATIONGuided videoconferencing ACT may reduce depressive symptoms, anxiety, stress, and grief and increase engagement in meaningful activities and self-compassion in people with SCI.Professionals may consider ACT as a supportive or adjunct service for people with SCI who experience psychological distress.

Increasing Physical Activity in Persons With Spinal Cord Injury With an eHealth-Based Adaptive Exercise Intervention: Protocol for a Sequential Multiple Assignment Randomized Trial.

BACKGROUND: Participating in an adequate amount of physical activity to acquire health benefits is challenging for people with spinal cord injury (SCI) due to personal and logistic barriers. Barriers in the built and social environments may include lack of transportation, lack of accessible facilities or programs, and lack of training among fitness personnel. Low self-efficacy, lack of self-regulation skills, and improper outcome expectations are examples of personal barriers. Current approaches to investigating physical activity programs in people with SCI have been limited to traditional "one-size-fits-all" design, which has yielded low adherence rates, high dropout rates, and participants not maintaining physical activity levels at follow-up. OBJECTIVE: The primary aim of this study is to test the feasibility of a tele-exercise program that applies an adaptive intervention design for 30 adults with SCI, targeting increases in adherence to the exercise program and physical activity participation. METHODS: The Sequential Multiple Assignment Randomized Trial for Home-based Exercise and Lifestyle Tele-Health (SMART-HEALTH) is a 12-week, home-based, movement-to-music (M2M) program. The goal of a SMART-designed study is to develop an adaptive intervention that modifies support provisions based on response levels. In SMART-HEALTH, 2 groups of participants will undergo 3-week and 6-week asynchronous M2M interventions in the first phase. Participants who did not achieve the desired adherence rate (≥95% of video watch minutes) will be rerandomized into M2M Live (switch) or individualized behavioral coaching (augmented with the asynchronous M2M program). The study will primarily assess rates of recruitment or enrollment, adherence and retention, timing to identify nonresponders, and scientific outcomes (eg, physical activity and exercise self-efficacy). The study will qualitatively evaluate the acceptability of the study using semistructured interviews among participants who complete the 12-week intervention. RESULTS: Recruitment procedures started in June 2022. All data are expected to be collected by September 2023. Full trial results are expected to be published by March 2024. Secondary analyses of data will be subsequently published. Results will include exercise adherence rates; changes in self-reported physical activity levels and blood pressure; and changes in secondary conditions including pain, sleep, and fatigue. Thematic analysis of semistructured interviews will include results on participant enjoyment and acceptability of SMART-HEALTH and inform modifications for future delivery of the program. CONCLUSIONS: This study will strengthen our understanding of the potential benefits of the tele-exercise intervention for people with SCI and build upon adaptive intervention design and its delivery strategies that aim to increase adoption and sustainable exercise behavior. This pilot trial will inform future SMART-designed studies and provide new and innovative strategies for investigating intervention effects on physical activity behavior in the SCI population. TRIAL REGISTRATION: ClinicalTrials.gov NCT04726891; https://classic.clinicaltrials.gov/ct2/show/NCT04726891. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/47665.

Theory- and evidence-based best practices for physical activity counseling for adults with spinal cord injury.

OBJECTIVES: This project used a systematic and integrated knowledge translation (IKT) approach to co-create theory- and evidence-based best practices for physical activity counseling for adults with spinal cord injury (SCI). METHODS: Guided by the IKT Guiding Principles, we meaningfully engaged research users throughout this project. A systematic approach was used. An international, multidisciplinary expert panel (n = 15), including SCI researchers, counselors, and people with SCI, was established. Panel members participated in two online meetings to discuss the best practices by drawing upon new knowledge regarding counselor-client interactions, current evidence, and members' own experiences. We used concepts from key literature on SCI-specific physical activity counseling and health behavior change theories. An external group of experts completed an online survey to test the clarity, usability and appropriateness of the best practices. RESULTS: The best practices document includes an introduction, the best practices, things to keep in mind, and a glossary. Best practices focused on how to deliver a conversation and what to discuss during a conversation. Examples include: build rapport, use a client-centred approach following the spirit of motivational interviewing, understand your client's physical activity barriers, and share the SCI physical activity guidelines. External experts (n = 25) rated the best practices on average as clear, useful, and appropriate. CONCLUSION: We present the first systematically co-developed theory- and evidence-based best practices for SCI physical activity counseling. The implementation of the best practices will be supported by developing training modules. These new best practices can contribute to optimizing SCI physical activity counseling services across settings.

Exploring associations of psychological inflexibility with depressive symptoms, anxiety, and stress in individuals living with a spinal cord injury: A cross-sectional study.

PURPOSE/OBJECTIVE: This study explored associations of psychological inflexibility with depressive symptoms, anxiety, and stress in individuals living with spinal cord injuries (SCI). RESEARCH METHOD/DESIGN: The study used a cross-sectional design involving data of self-reported questionnaires collected from 92 adults with SCI in the United States. These questionnaires included measures of depressive symptoms, anxiety, and stress as the dependent variables and measures of potential independent variables, including demographic and SCI-related variables, psychological inflexibility, pain interference, independence, and ability to participate in and satisfaction with social roles and activities. Multivariable linear regression analyses were conducted. Stepwise method, forward selection, and backward elimination procedures, supplemented with the best subsets method, were used to obtain the most parsimonious set of independent variables for each of the depressive symptoms, anxiety, and stress scores. RESULTS: The current study showed that psychological inflexibility, employment status, and time since the injury were variables significantly associated with depressive symptoms, and that psychological inflexibility and ethnicity/race were variables significantly associated with anxiety. Psychological inflexibility was the only variable significantly associated with stress. CONCLUSIONS: Findings of the present study suggest the importance of psychological flexibility in depressive symptoms, anxiety, and stress in individuals with SCI by showing significant associations among these variables. This exploratory study informs the need for further studies involving interventions that aim to foster greater psychological flexibility, which may decrease mental health problems in individuals with SCI. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Retrospective evaluation of a pilot eHealth/mHealth telewellness program for people with disabilities: Mindfulness, Exercise, and Nutrition To Optimize Resilience (MENTOR).

Background: People with disabilities have few options to participate in wellness programs that are tailored to their health, functional level, specific interests/needs, and available in the comfort of their home. To address this need, we evaluated a mobile health wellness program for people with physical disabilities. Methods: Retrospective pilot evaluation of MENTOR (Mindfulness, Exercise, and Nutrition To Optimize Resilience), an 8-week, 40-hour online telewellness program adapted from the peer reviewed literature on wellness. The three core wellness domains-mindfulness, exercise, and nutrition-were delivered via Zoom to groups of participants with a disability. Each group met weekly with an assigned health coach who responded to Q&A about the program and presented new material on several additional wellness domains that could impact their health (e.g., relationships, contribution to society/community, spending outdoor time in nature). Pre/post measures included the Godin Leisure-Time Exercise Questionnaire (GLTEQ) and the UAB/Lakeshore Wellness Assessment (LWA). Participants were also interviewed and provided feedback after the program, which was thematically analyzed. Results: A total of 154 people from 15 states enrolled in the MENTOR program and 135 completed it (87.7% completers). Data were analyzed from a subset of participants (n=53) who were asked to complete a pre/post assessment and had complete data. Participants who were physically inactive at baseline improved their GLTEQ total activity (P=0.002; effect size =0.56) and moderate-to-vigorous activity scores (P=0.005; effect size =0.53). LWA results demonstrated that participants increased their exercise behavior (P=0.006; effect sizes =0.39) and contribution to society/community (P=0.013; effect size =0.37). Participants with low overall wellness (mental, physical & emotional health) at baseline had statistically significant improvements in exercise, nutrition, sleep, core values, self-care, hobbies, contribution to society/community, relationships, and overall wellness (all P<0.05 with effect sizes ranging from 0.43 to 1.07). Resultant qualitative themes were: (I) lifestyle transformation occurred through new positive experiences, physical and mental health benefits, and adoption of healthy behaviors; and (II) engagement through accessible online bonding through enjoyable and professional experiences. Conclusions: A pilot telewellness program for people with disabilities is feasible and potentially effective in improving several domains of wellness. There is a need for precision-based mobile health (mHealth) programs that are tailored for people with disabilities and that can be accessed from various portable devices including their phone and/or tablet.

How do people with physical/mobility disabilities benefit from a telehealth exercise program? A qualitative analysis.

People with neurological and physical disabilities (PWD) experience a myriad of secondary and chronic health conditions, thus, reducing their participation and quality of life. A telehealth exercise program could provide a convenient opportunity for improving health in this population. To describe participants' perceived benefits of a telehealth physical activity program among PWD, we conducted semi-structured interviews with 30 study participants after completing the 24-week program SUPER-HEALTH (Scale-Up Project Evaluating Responsiveness to Home Exercise and Lifestyle TeleHealth). Interview data were recorded, transcribed verbatim, and analyzed using inductive thematic analysis. The mean age of the sample was 51 ± 13 years, the primary disability was Multiple Sclerosis, and there were nine men (30%) and 21 (70%) women. Inductive thematic analysis resulted in four themes that include the following: (1) improved health and function, (2) increased activity participation, (3) improved psychosocial health, and (4) optimized performance and benefits. These preliminary findings provided support for the use of a home exercise program and recommendations to improve it to enhance benefits among PWD.

The Effects of Virtual Reality Tele-exergaming on Cardiometabolic Indicators of Health Among Youth With Cerebral Palsy: Protocol for a Pilot Randomized Controlled Trial.

BACKGROUND: Youth with cerebral palsy do not have enjoyable, accessible, and scalable exercise options that can empower them to independently maintain their cardiometabolic health. OBJECTIVE: The primary aim is to examine the preliminary efficacy of a 12-week home-based virtual reality tele-exergaming intervention on several indicators of cardiometabolic health in youth with cerebral palsy compared to the wait list control. A secondary aim is to describe feasibility metrics, namely, recruitment, retention, and adherence rates; perceived enjoyment; intervention safety; and management issues. The tertiary aim is to generate a theory that reveals critical behavioral mechanisms of adherence to tele-exergaming. METHODS: In this parallel group design randomized controlled trial, 34 inactive youths with cerebral palsy are randomly allocated to one of two groups: a group that immediately receives 12 weeks of virtual reality exergaming with tele-physical education or a wait list control group that undergoes their habitual activity for 12 weeks. Participants are recruited from a Children's Hospital and community network. At baseline (week 0), week 6, and week 12, high sensitivity C-reactive protein and blood insulin, hemoglobin A1c, triglycerides, cholesterol, and pressure are measured by the youth and a caregiver at home using a blood spot test kit and blood pressure cuff. They will also self-measure their lung function and body weight using a peak flow meter and bathroom scale, respectively. Collections are supervised by research staff via videoconference. Changes in outcomes are compared between and within groups using exploratory statistical analyses and descriptive statistics. At postintervention or dropout, participants will undergo semistructured interviews to identify behavioral mechanisms that underly participation. RESULTS: Recruitment procedures started in June 2022. All data are expected to be collected by October 2023. Full trial results are expected to be published by February 2024. Secondary analyses of data will be subsequently published. CONCLUSIONS: This trial tests an innovative serious exergaming virtual reality program that includes a completely remote enrollment, assessment, and intervention tele-protocol. The knowledge obtained will inform the development of a larger effectiveness trial for improving the health and well-being of youth with cerebral palsy. TRIAL REGISTRATION: ClinicalTrials.gov NCT05336227; https://clinicaltrials.gov/ct2/show/NCT05336227. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/40708.

Qualitative Evaluation of a Comprehensive Online Wellness Program (MENTOR) Among People With Spinal Cord Injury.

People with spinal cord injury (SCI) experience a plethora of health conditions that hinder their health and wellness. This qualitative retrospective evaluation describes the perceptions of 14 peoples with SCI, several months after they completed an eight-week telewellness community program (MENTOR-Mindfulness, Exercise and Nutrition To Optimize Resilience). The program offered daily online classes that covered three core wellness domains (mindfulness, exercise, nutrition) and one health coaching session to introduce participants to eight other wellness domains (sleep, self-care, core values, arts & leisure, outdoor time in nature; spiritual practice, relationships, contribution to others). Qualitative analysis resulted in 4 themes related to program benefits, likes, and improvement recommendations. First, participants valued the program for the social support provided by a sense of community and relationship building with peers. Second, self-regulation was facilitated by the comprehensiveness of the program components, easy online access, and shared lifestyle goals for self-improvement among peers. Third, participants reported improved psychological wellbeing and adopted healthy behaviors that were maintained long after the program. Last, future programs should include flexible class times, post-program support, specific exercise adaptations for people with limited arm function, and supplementary in-person meetings. These preliminary findings demonstrate that MENTOR may benefit the wellbeing of people with SCI and warrant further study.

Teleassessments for Enrollment of Adults With Physical or Mobility Disability in a Home-Based Exercise Trial in Response to COVID-19: Usability Study.

BACKGROUND: The Scale-Up Project Evaluating Responsiveness to Home Exercise And Lifestyle Tele-Health (SUPER-HEALTH) initiative is a large randomized controlled study that aims to overcome logistical barriers to exercise via telehealth for people with physical disabilities. However, at the start of the COVID-19 pandemic, enrollment was halted due to limited operations at the testing site, which included no onsite visits that involved participant data collection. In response to the limited operations, a modified data collection protocol was developed for virtual enrollment of study participants. OBJECTIVE: This paper presents feasibility data on using teleassessments to enroll people with mobility impairment into a home-based exercise trial. METHODS: The modified protocol replaced onsite enrollment and data collection visits with teleassessments using a computer tablet and testing equipment that was shipped to the participants' home address prior to the synchronous teleassessments conducted by an exercise physiologist through Zoom. The participants were mailed a teleassessment toolkit that included a digital blood pressure cuff, spirometer, hand dynamometer, mini disc cone, and measuring tape (to complete standardized testing). The teleassessment measures included resting blood pressure and heart rate, forced vital capacity, grip strength, Five Times Sit to Stand, and Timed Up and Go. Feasibility metrics included technological effectiveness, efficiency, and safety. The technological effectiveness of the telehealth assessment was determined by the percentage of sessions completed without technical issues with ≥90% criteria set a priori. Efficiency was measured by a session duration of ≤2 hours. Safety was measured by the number of adverse events related to the teleassessments reported. RESULTS: Data from 36 participants were included in this feasibility study, and 34 (94%) participants completed all teleassessments without technical issues. For efficiency, the teleassessment sessions were completed in a mean time of 65 minutes and a maximum session length of 110 minutes. There were no adverse events reported to indicate concerns with the safety of teleassessments. CONCLUSIONS: The modified teleassessment protocol, in response to COVID-19 restrictions, may be a feasible process for enrolling adults with mobility impairment into a home exercise trial who otherwise would have not been able to participate. TRIAL REGISTRATION: ClinicalTrials.gov NCT03024320; https://clinicaltrials.gov/ct2/show/NCT03024320.

The movement-to-music (M2M) study: study protocol for a randomized controlled efficacy trial examining a rhythmic teleexercise intervention for people with physical disabilities.

BACKGROUND: People with physical disabilities need exercise routines that are enjoyable, readily available in the home, adapted to their functional level, and eliminate common barriers to exercise participation related to transportation and time commitment. The purpose of the movement-to-music (M2M) study is to address these issues by establishing a remotely delivered, rhythmic exercise program for people with physical disabilities. METHODS: The study is a two-arm randomized controlled efficacy trial examining a 12-week remotely delivered M2M intervention (eM2M) in 108 people with physical disabilities. The primary outcomes are changes in cardiorespiratory fitness and muscle strength at post 12-week intervention. DISCUSSION: The eM2M study will enhance our understanding of an alternative intervention design and delivery mode that removes common barriers to exercise participation experienced by people with physical disabilities. The eM2M intervention may be an alternative option for people with physical disabilities to obtain regular exercise, especially during a pandemic when exercising in indoor facilities may be problematic. TRIAL REGISTRATION: ClinicalTrials.gov NCT03797378. Registered on January 9, 2019, with the trial name "Movement-to-Music: Lakeshore Examination of Activity, Disability, and Exercise Response Study (M2M LEADERS)".

Sustainability of exercise intervention outcomes among people with disabilities: a secondary review.

BACKGROUND: This review explored the sustainability of health and physical activity-based outcomes following exercise trials that were conducted for people with disabilities, and characterised the influence of technology and behaviour change strategies. METHODS: A total of 132 studies were screened from an existing database. RESULTS: Only 22 studies featured follow-up periods and met eligibility criteria. At follow-up, studies typically reported at least one significant health outcome that was maintained (n = 18/21; 86%). However, significant health outcomes accounted for only 32% of the total volume of outcomes that were measured at follow-up. For physical activity-based outcomes, six studies (n = 6/8; 75%) reported that intervention gains were maintained throughout follow-up. The incorporation of technology or behaviour change strategies appeared to be linked with sustainable intervention effects. CONCLUSIONS: Overall, some evidence demonstrated that post-intervention effects were sustainable. However, the strength of the evidence was weak and several existing gaps in knowledge were identified. Moreover, most studies did not focus on sustainability, but instead emphasised short-term effects of exercise participation on health and physical activity outcomes. Study findings call for greater research and programme efforts to maintain health, function, and physical activity behaviour after supports provided by research studies are removed. Implications for rehabilitation Short-term exercise programmes may require additional strategies designed specifically to enhance the sustainability of exercise outcomes and physical activity participation. Incorporating technology within exercise interventions may enhance the likelihood of sustaining health and function outcomes. Exercise programmes framed within behaviour change theory can equip individuals with the appropriate strategies necessary to maintain their physical activity participation.

A Mobile App to Promote Adapted Exercise and Social Networking for People With Physical Disabilities: Usability Study.

BACKGROUND: People with physical disabilities (PWD) experience several unique challenges that prevent them from participating in onsite exercise programs. Although mobile apps can provide a ubiquitous channel for delivering convenient exercise services within the community, no exercise apps have been designed for people with disabilities who experience certain functional limitations. OBJECTIVE: The aim of this study was to examine the usability of a mobile exercise app in PWD. METHODS: A sequential explanatory mixed-method design was used to holistically test usability in 4 core areas: effectiveness (ie, ease of use), efficiency (ie, operation speed), perceived satisfaction, and usefulness. Participants completed 7 face-to-face usability tasks and 1 structured interview. Equipment included a computer tablet that came preinstalled with the exercise app. The app included exercise videos that focused on several components of fitness: aerobic capacity, muscular strength, functional strength or balance, and range of motion. The app contained 3 different versions of the exercise program: (1) a program for people with the ability to use the upper and lower limbs, (2) a seated program for people with the ability to use only upper limbs, and (3) a program designed for people with hemiparesis. The app also included educational resources in the form of infographics aimed at addressing key social cognitive theory constructs included social support, outcome expectancies, self-efficacy, and barriers or facilitators to exercising. Participant characteristics and quantitative usability data were descriptively reported. Qualitative data were analyzed using thematic analysis. RESULTS: A total of 12 PWD tested the usability of the exercise app and completed 96% (69/72) of the usability tasks on the first attempt. Operation speed varied among users, which prompted the development team to make minor revisions to the app. Qualitative results demonstrated 3 overarching themes: facilitates exercise adoption, positive experiences of videos, and easy to learn. Participants noted that the app circumvented several barriers to exercise associated with leaving the home (eg, inclement weather conditions, exacerbations of health conditions or disability symptoms, difficulties with transportation, and social support). CONCLUSIONS: The mobile exercise app provided a simple platform that was effective, useful, and appreciated by PWD. Participants also perceived the app as easy to use and felt it was a valuable tool for assisting PWD to obtain regular exercise. Study findings also offered insight into the participants' preferences for mobile exercise apps that can aid future research and development projects. Future exercise trials are needed to determine the true impact of mobile app technology on lifestyle physical activity in people with disabilities. TRIAL REGISTRATION: Clinicaltrials.gov NCT03024320; https://clinicaltrials.gov/ct2/show/NCT03024320 (Archived by WebCite at http://www.webcitation.org/75hNLgRFH).