Lifestyle physical activity in manual wheelchair users - an overlooked public health opportunity.

Public health guidelines and health promotion efforts have traditionally focused on weekly accumulation of moderate to vigorous physical activity (MVPA) via structured exercise. There has been a recent paradigm shift towards the organic incorporation of MVPA in daily leisure and non-leisure time, termed "Lifestyle Physical Activity" (LPA). However, this paradigm shift and the underlying research has neglected manual wheelchair users (MWCUs) with spinal cord injury (SCI), who could benefit from LPA. This article argues for expanding the LPA paradigm shift into research and health promotion efforts involving MWCUs with SCI. We suggest a working definition of LPA for MWCUs and candidate metrics for quantifying LPA. This is followed by brief overviews of LPA correlates, outcomes/consequences, and interventions and the need for theory based approaches to study these domains. We lastly suggest an approach for mitigating potential negative outcomes of increased LPA in MWCUs and suggest a research agenda.

The Use of Cognitive Cues for Anticipatory Strategies in a Dynamic Postural Control Task - Validation of a Novel Approach to Dual-Task Testing.

INTRODUCTION: Dual-task testing is relevant in the assessment of postural control. A combination of a primary (motor) and a secondary (distracting cognitive) tasks is most often used. It remains a challenge however, to standardize and monitor the cognitive task. In this study a new dual-task testing approach with a facilitating, rather than distracting, cognitive component was evaluated. METHODS: Thirty-one community-dwelling elderly and fifteen young people were tested with respect to their ability to use anticipatory postural control strategies. The motor task consisted of twenty-five repetitive tasks in which the participants needed to exceed their limit of stability in order to touch one out of eight lights. The participants performed three tests. In two of the tests the color cues of the lights allowed the participants to utilize cognitive strategies to plan their next movement and improve their performance time. RESULTS: The young performed the baseline motor task test in an average of 29 seconds, while the average time for the elderly was 44 seconds. When comparing the performance time with a leading cue to the time with no cue, the young group improved their performance time significantly better than the elderly did: young: 17% (5), elderly: 5% (8); p<0.001. Similar differences were seen with a more complicated leading cue: young: 12% (5), elderly: 4% (9); p<0.01. The reliability of the test showed moderate to substantial agreement (ICC = 0.74), with a small learning effect between two sessions. CONCLUSION: The dual-task test was sensitive enough to discriminate between elderly and young people. It revealed that the elderly did not utilize cognitive cues for their anticipatory postural control strategies as well as the young were able to. The test procedure was feasible and comprehensible for the participants, and it may be relevant to standardize a similar test for an alternative dual-task approach in the clinical setting.