The dementia-inclusive choices in exercise project: Using participatory action research to improve physical activity supports for persons with dementia.

Persons with dementia have the right to equal inclusion in rehabilitation, including physical activity. However, the perspectives of persons with dementia are rarely integrated into decision-making related to physical activity programming, services, and supports. Here, we describe the participatory action research (PAR) approach used to develop the Dementia-Inclusive Choices for Exercise (DICE) toolkit, which aims to increase the quality and number of physical activity opportunities available to persons with dementia. The DICE Research Team included persons with dementia, a family care partner, exercise professionals, community and dementia service providers, health care professionals, and researchers who worked to: 1) Engage/maintain the Research Team; 2) Set/navigate ways of engagement; 3) Understand barriers to physical activity; 4) Prioritize the audience and actions; 5) Develop the toolkit; 6) Conduct usability testing; and 7) Implement and evaluate. Guided by the Behaviour Change Wheel, and informed by interviews, focus groups, and existing research, our PAR Team chose to prioritize training exercise providers; exercise providers can enable exercise for persons with dementia if they understand common changes with dementia and how to support persons with dementia in exercise. The content and format of the toolkit was co-developed: drafted by our Research Team, adapted through a stakeholder workshop, and refined through iterative development and usability testing. The product of our PAR process, the DICE toolkit, includes videos meant to destigmatize dementia, training modules and a training manual for exercise providers, a physical activity handout for persons with dementia, and wallet cards to help persons with dementia communicate their abilities, needs, and preferences. Our usability study indicated that the toolkit could be used by exercise providers and may improve attitudes about dementia. Our vision is that our co-developed DICE toolkit will empower exercise providers to improve physical activity opportunities and support for persons with dementia.

Health risks and mitigation strategies from occupational exposure to wildland fire: a scoping review.

OBJECTIVES: Due to accelerating wildland fire activity, there is mounting urgency to understand, prevent, and mitigate the occupational health impacts associated with wildland fire suppression. The objectives of this review of academic and grey literature were to: 1. Identify the impact of occupational exposure to wildland fires on physical, mental, and emotional health; and 2. Examine the characteristics and effectiveness of prevention, mitigation, or management strategies studied to reduce negative health outcomes associated with occupational exposure to wildland fire. METHODS: Following established scoping review methods, academic literature as well as government and industry reports were identified by searching seven academic databases and through a targeted grey literature search. 4679 articles were screened using pre-determined eligibility criteria. Data on study characteristics, health outcomes assessed, prevention or mitigation strategies studied, and main findings were extracted from each included document. The results of this scoping review are presented using descriptive tables and a narrative summary to organize key findings. RESULTS: The final sample was comprised of 100 articles: 76 research articles and 24 grey literature reports. Grey literature focused on acute injuries and fatalities. Health outcomes reported in academic studies focused on respiratory health (n = 14), mental health (n = 16), and inflammation and oxidative stress (n = 12). The identified studies evaluated short-term outcomes measuring changes across a single shift or wildland fire season. Most research was conducted with wildland firefighters and excluded personnel such as aviation crews, contract crews, and incident management teams. Five articles reported direct study of mitigation strategies, focusing on the potential usage of masks, advanced hygiene protocols to reduce exposure, fluid intake to manage hydration and core temperature, and glutamine supplementation to reduce fatigue. CONCLUSIONS: While broad in scope, the evidence base linking wildland fire exposure to any one health outcome is limited. The lack of long-term evidence on changes in health status or morbidity is a clear evidence gap and there is a need to prioritize research on the mental and physical health impact of occupational exposure to wildland fire.

Barriers to physical activity for adults in rural and urban Canada: A cross-sectional comparison.

BACKGROUND: Individual differences in physical activity behavior are associated with a collection of individual and environmental factors manifesting as barriers to participation. Understanding how barriers to physical activity differ based on sociodemographic characteristics can support identification and elimination of health inequities. OBJECTIVES: To compare the odds of reporting individual and environmental barriers to physical activity in rural and urban adults, and explore interactions between rural-urban location and sociodemographic factors to characterize patterns in barriers to physical activity. DESIGN: Cross-sectional. METHODS: We analyzed the 2017 Canadian Community Health Survey Barriers to Physical Activity Rapid Response, with a final weighted sample of 24,499,462 (unweighted n=21,967). The likelihood of reporting each barrier domain based on rural-urban location was examined using binary logistic regression following a model-fitting approach with sociodemographic characteristics as covariates or interaction terms. RESULTS: Adjusting for sociodemographic factors, rural residents showed 85% higher odds of reporting at least one social or built environmental barrier (OR=1.85 [1.66, 2.07]). Compared to urban residents, rural residents showed significantly higher odds of reporting barriers to facility access (OR=4.15 [3.58, 4.83]) and a lack of social support to be active (OR=1.17 [1.04, 1.32]). Urban residents reported lower preference for physical activity, lower enjoyment of physical activity and lower confidence in their ability to regularly engage in physical activity. Interactions between socioeconomic status and location were identified related to enjoyment and confidence to be active. There was no effect of location on predicting the odds of reporting an individual resource-related variable (e.g., time, energy). CONCLUSIONS: Despite being more likely than urban residents to prefer and enjoy physical activity, rural residents have fewer opportunities and receive less social support to be active. It is important to consider geographic location when characterizing barriers to physical activity and in the development of context-specific health promotion strategies.

Likelihood of meeting physical activity guidelines in rural and urban adults: cross-sectional analysis of the Canadian Community Health Survey.

OBJECTIVES: The goal of this study was to compare the odds of meeting physical activity (PA) guidelines among adults living in rural and urban areas of Canada. METHODS: Data from the 2017 cycle of the Canadian Community Health Survey were analyzed using binomial logistic regression with a sample of 47,266 adults representing a survey-weighted total of 25,669,018. The odds of meeting PA guidelines were determined based on self-reported moderate-to-vigorous PA (<150 min per week or ≥150 min per week). Communities were categorized as urban or rural based on population size and density. Individual-level correlates included in the model were self-identified sex, age, body mass index, highest level of education, household income, perceived health, and sense of belonging to community. RESULTS: Approximately 56.6% of rural and 59.3% of urban adults reported meeting recommended PA levels when location was examined as a sole predictor. The best-fit model adjusted for all individual-level factors showed a significant sex × location interaction. Males in rural communities were more likely to report meeting PA guidelines (odds = 0.90 or 47.4%) than males in urban areas (odds = 0.78 or 43.8%), whereas females living in rural communities (odds = 0.58 or 36.7%) were less likely to report meeting PA guidelines than females in urban areas (odds = 0.65 or 39.4%). CONCLUSION: The association between rural-urban residence and meeting PA guidelines appears to be contingent on self-identified sex differences. Future work should explore how gender- and location-related variables interact to influence self-reported PA engagement.

RéSUMé: OBJECTIFS: Le but de cette étude était de comparer les probabilités de respecter les recommandations en matière d'activité physique (AP) liées à la santé de la population chez les adultes vivant dans les communautés rurales et urbaines du Canada. MéTHODES: Les données du cycle 2017 de l'Enquête sur la santé dans les collectivités canadiennes ont été analysées à l'aide de régressions logistiques binomiales avec un échantillon pondéré de 47 266 participants adultes représentant 25 669 018 adultes. Les probabilités de respecter les lignes directrices de l'AP ont été déterminées en fonction de l'AP modérée à vigoureuse déclarée (<150 minutes par semaine ou ≥150 minutes par semaine) et les communautés ont été classées comme urbaines ou rurales selon la taille et la densité de la population. Les corrélats au niveau individuel inclus dans le modèle étaient les suivants : sexe auto-identifié, âge, indice de masse corporelle, niveau de scolarité le plus élevé, revenu du ménage, état de santé autoévalué et sentiment d'appartenance à la communauté. RéSULTATS: Environ 56,6 % des adultes vivant en milieu rural et 59,3 % des adultes en milieu urbain ont déclaré avoir atteint les niveaux d'AP recommandés lorsque l'emplacement a été examiné comme seul prédicteur de l'activité. Le meilleur modèle après ajustement pour tous les facteurs au niveau individuel a révélé une interaction significative entre les variables sexe x emplacement. Les hommes des communautés rurales étaient plus susceptibles de déclarer respecter les directives d'AP (odds = 0,90 ou 47,4 %) que ceux des zones urbaines (odds = 0,78 ou 43,8 %), tandis que les femmes vivant dans les communautés rurales (odds = 0,58 ou 36,7 %) étaient moins susceptibles de déclarer avoir respecté les directives d'AP par rapport à celles des communautés urbaines (odds = 0,65 ou 39,4 %). CONCLUSION: L'association entre la ruralité d'une communauté et la déclaration des AP semble dépendre des différences sexuelles auto-identifiées. Les travaux futurs devraient explorer comment les variables liées au sexe et au lieu interagissent pour influencer la participation rapportée des Canadiens aux taux AP rapportés.

Children's Independent Mobility and Physical Activity during the COVID-19 Pandemic: A Qualitative Study with Families.

Children's independent mobility (CIM) is the freedom of children to move around their neighbourhood without adult supervision and is closely related to overall physical activity participation. The COVID-19 pandemic has impacted movement behaviours for children, with evidence indicating a decrease in physical activity. The aim of this study was to explore experiences of CIM and physical activity during the COVID-19 pandemic from the perspectives of children and their parents. We completed 21 family (at least one parent and one child aged 7-12) semi-structured interviews with 45 participants living in small urban and rural areas of British Columbia, Canada. Three themes were identified through a reflexive thematic analysis: (1) keeping everyone safe from COVID-19; (2) change in pattern and types of activity; (3) social impacts with family, friends, and community. Participants expressed a perceived increase in unstructured activity and a decrease in structured physical activity during the pandemic, which many parents viewed as a positive change. Parents and children indicated negative feelings due to spending less time with peers and reflected positively about spending more time with family. Parents and children expressed fear and anxiety in trying to keep their families safe from virus spread and creativity in adapting play behaviours. Findings highlight the impact of the pandemic on social friendship networks for families and a shift in activity patterns for children toward unstructured play.

Understanding physical literacy in the context of health: a rapid scoping review.

BACKGROUND: Physical literacy is a multidimensional concept that describes a holistic foundation for physical activity engagement. Understanding the utilization and effectiveness of physical literacy in the context of health and the health care setting will support clinical and population health programming. The purpose of this rapid scoping review was to: 1) map the conceptualization of physical literacy as it relates to health; 2) identify and describe the utilization of physical literacy in the context of health and engagement of health care providers; and 3) better understand the relationship between physical literacy, physical activity, and health. METHODS: Following established scoping review methods adapted for a rapid review approach, we searched electronic databases Medline OVID, CINAHL Ebsco, PsycInfo Ebsco, Web of Science ISI, and ERIC Ebsco from conception until September 2019. Tabulation coding was used to identify the key themes across included articles and synthesize findings. The review follows an integrated knowledge translation approach based on a partnership between the health system, community organizations, and researchers. RESULTS: Following removal of duplicates, our search identified 475 articles for title and abstract screening. After full text review, 17 articles were included (12 original research papers and five conceptual or review papers). There was near consensus among included papers with 16 of 17 using the Whiteheadian definition of physical literacy. There was limited involvement of health care providers in the concept of physical literacy. Physical literacy was connected to the following health indicators: BMI and body weight, waist circumference, cardiorespiratory fitness, physical activity, and sedentary behaviour. The primary demographic focus of included studies was children and there was a conceptual focus on the physical domain of physical literacy. CONCLUSIONS: Despite growing popularity, the empirical evidence base linking physical literacy and health outcomes is limited and the relationship remains theoretical. Physical literacy may present a novel and holistic framework for health-enhancing physical activity interventions that consider factors vital to sustained participation in physical activity across the life course. Future work should continue to explore the nature and direction of the relationship between physical activity and physical literacy to identify appropriate focused approaches for health promotion.

Implementation of Physical Activity Interventions in Rural, Remote, and Northern Communities: A Scoping Review.

Compared with urban centers, rural, remote, and northern communities face substantial health inequities and increased rates of noncommunicable disease fuelled, in part, by decreased participation in physical activity. Understanding how the unique sociocultural and environmental factors in rural, remote, and northern communities contribute to implementation of physical activity interventions can help guide health promotion policy and practice. A scoping review was conducted to map literature describing the implementation of physical activity interventions in rural, remote, and/or northern communities. Databases MEDLINE, PsycINFO, EMBASE, CINAHL, and SPORTDiscus were searched using a predetermined search strategy. Outcomes of interest included community demographics, program characteristics, intervention results, measures of implementation, and facilitators or barriers to implementation. A total of 1672 articles were identified from a search of databases, and 8 from a targeted hand search. After screening based on inclusion and exclusion criteria, 12 articles were summarized in a narrative review. Prominent barriers to physical activity program implementation included transportation, lack of infrastructure, sociocultural factors, and weather. Facilitators of program success included flexibility and creativity on the part of the implementation team, leveraging community relationships, and shared resources. Few papers reported on traditional implementation outcomes such as fidelity, dose, and quality. There is a lack of rigorous implementation evaluations of physical activity interventions delivered in rural, remote, or northern communities. Positive aspects of rural life, such as social cohesion and willingness to share resources, appear to contribute to successful program implementation.

"Not Everybody's an Athlete, But They Certainly Can Move": Facilitators of Physical Activity Maintenance in Older Adults in a Northern and Rural Setting.

Although the benefits of maintaining a physical activity regime for older adults are well known, it is unclear how programs and facilities can best support long-term participation. The purpose of this study is to determine the facilitating factors of physical activity maintenance in older adults at individual, program, and community levels. Nine semistructured interviews were conducted with individuals aged 60 years and older and long-term participants (>6 months) in community-based group exercise at a clinical wellness facility in northern British Columbia, Canada. Interviews were audio recorded, transcribed, and analyzed via inductive thematic analysis. Themes identified as facilitators of physical activity included (a) social connections, (b) individual contextual factors, and (c) healthy aging. Older adults are more likely to maintain physical activity when environments foster healthy aging and provide opportunity for social engagement.

Exploring prevention and mitigation strategies to reduce the health impacts of occupational exposure to wildfires for wildland firefighters and related personnel: protocol of a scoping study.

BACKGROUND: With an increase in wildfire activity across the globe and growing numbers of personnel involved each year, it is necessary to explore the health impacts of occupational exposure to wildfires and the practices and policies that can be implemented to mitigate these effects. The aim of this work is to (1) identify the impact occupational exposure to wildfires has on health outcomes including physical, mental, and social wellbeing; (2) examine the characteristics and effectiveness of mitigation strategies or policies to reduce negative health impacts as reported by current literature and reports; and (3) develop a program of research to address and understand the health impacts of occupational exposure to wildfires based on gaps in the literature and stakeholder priorities. METHODS: This scoping study will be conducted in two phases: (1) scoping literature review and (2) modified Delphi process. The literature review will follow a methodologically rigorous scoping review approach that includes (a) identifying the research question (and protocol development), (b) identifying literature (an iterative process), (c) selecting relevant studies, (d) extracting data into tables, and (e) synthesizing, summarizing, and reporting results. Alongside this, a modified Delphi process will be conducted to define priorities for wildland fire occupational health research. A partnership with the British Columbia (BC) Wildfire Service will enable exploring the appropriateness of identified mitigation strategies and health risks for the BC context. DISCUSSION: This two-phase approach will provide an in-depth review of the literature of the health impacts of occupational exposure to wildfires and identify mitigation strategies or policies implemented to protect workers and reduce negative health impacts. It is anticipated that these findings may provide recommendations for "quick wins" or initial action that can be implemented within the BC context to reduce negative health outcomes, and inform gaps in context-specific research that needs to be addressed through a strategic, collaborative research program over the next 5 years. SYSTEMATIC REVIEW REGISTRATION: Open Science Framework osf.io/ugz4.

Exploring the perspectives of community members as research partners in rural and remote areas.

BACKGROUND: Community engagement in research has the potential to support the development of meaningful health promotion interventions to address health inequities. People living in rural and remote areas face increased barriers to participation in health research and may be unjustly excluded from participation. It is necessary to understand the process of patient and public engagement from the perspective of community members to support partnered research in underserved areas. The aim of this project was to increase understanding on how to include community members from rural and remote areas as partners on research teams. METHODS: Using purposive sampling, we completed semi-structured interviews with a representative sample of 12 community members in rural and remote areas of northern British Columbia, Canada. Interviews were audio recorded and transcribed verbatim. Following an integrated knowledge translation approach, an inductive thematic analysis was completed to incorporate researcher and knowledge user perspectives. RESULTS: The factors important to community members for becoming involved in research include: 1) relevance; 2) communication; and 3) empowering participation. The analysis suggests projects must be relevant to both communities and individuals. Most participants stated that they would not be interested in becoming partners on research projects that did not have a direct benefit or value for their communities. Participants expressed the need for clear expectations and clarification of preferred communication mechanisms. Communication must be regular, appropriate in length and content, and written in a language that is accessible. It is essential to ensure that community members are recognized as subject matter experts, to provide appropriate training on the research process, and to use research outcomes to support decision making. CONCLUSIONS: To engage research partners in rural and remote communities, research questions and outcomes should be co-produced with community members. In-person relationships can help establish trust and bidirectional communication mechanisms are prudent throughout the research process, including the appropriate sharing of research findings. Although this project did not include community members as research team members or in the co-production of this research article, we present guidelines for research teams interested in adding a patient or public perspective to their integrated knowledge translation teams.

Participation in moderate-to-vigorous leisure time physical activity is related to decreased visceral adipose tissue in adults with spinal cord injury.

Increased visceral adiposity places individuals with chronic spinal cord injury (SCI) at increased risk of cardiometabolic disease. The purpose of this study was to identify if people with chronic SCI who participate in any moderate- to vigorous-intensity leisure time physical activity (LTPA) have lower visceral adipose tissue (VAT) area compared with those who report none. Participants included 136 adult men (n = 100) and women (n = 36) with chronic (mean (±SD) 15.6 ± 11.3 years post-injury) tetraplegia (n = 66) or paraplegia (n = 70) recruited from a tertiary rehabilitation hospital. VAT area was assessed via whole-body dual-energy X-ray absorptiometry using a Hologic densitometer and the manufacturer's body composition software. Moderate-to-vigorous LTPA was assessed using the Leisure Time Physical Activity Questionnaire for People with SCI (LTPAQ-SCI) or the Physical Activity Recall Assessment for People with SCI (PARA-SCI). Summary scores were dichotomized into any or no participation in moderate-to-vigorous LTPA to best represent the intensity described in current population-specific physical-activity guidelines. Data were analyzed using univariate and multiple regression analyses to identify the determinants of VAT. Overall, the model explained 67% of the variance in VAT area and included time post-injury, age-at-injury, android/gynoid ratio, waist circumference, and moderate-to-vigorous LTPA. Participation in any moderate-to-vigorous LTPA was significantly (95% confidence interval: -34.71 to -2.61, p = 0.02) associated with VAT after controlling for injury-related and body-composition correlates. Moderate-to-vigorous LTPA appears to be related to lower VAT area, suggesting potential for LTPA to reduce cardiometabolic disease risk among individuals with chronic SCI.

A systematic review of physical activity interventions to improve physical fitness and health outcomes among Indigenous adults living in Canada.

The Indigenous population of Canada faces an increased burden of chronic disease, leading to decreased life expectancy. Physical activity is an important health behaviour that improves chronic disease risk factors and physical fitness. The objective of this systematic review was to evaluate physical activity interventions in the Indigenous population in Canada to determine effects on physical activity rates, physical fitness, and health outcomes. MEDLINE, PsycINFO, EMBASE, and CINAHL were searched for peer-reviewed journal articles. Inclusion criteria were studies that examined a physical activity intervention delivered in Indigenous communities in Canada for adults over 18 years of age. Data was extracted and two authors independently rated quality of the evidence. Five studies were included in the narrative synthesis. Interventions were community-based, and three were multi-component interventions focused on preventing or managing type II diabetes. The interventions varied in their success in altering physical activity rates, with increases (n = 2), a decrease (n = 1), or non-significant changes reported (n = 2). No study reported any measure of physical fitness. BMI was reported in four studies, with only one reporting a significant decrease. Decreases in systolic blood pressure and total cholesterol were reported in two studies. There is limited evidence and a lack of robust interventions that examine the impacts of physical activity on health and fitness status in the Canadian Indigenous population. Validated, culturally relevant tools for measuring physical activity may aid in program evaluation and focused educational materials could better support population health initiatives. TRIAL REGISTRATION: The review protocol was registered prospectively with PROSPERO (registration number: CRD42017055363).

Sarcopenic Obesity in Adults With Spinal Cord Injury: A Cross-Sectional Study.

OBJECTIVES: To describe (1) the frequency and utility of clinically relevant spinal cord injury (SCI)-specific and general population thresholds for obesity and sarcopenic obesity; and (2) the fat and lean soft tissue distributions based on the neurologic level of injury and the American Spinal Injury Association Impairment Scale. DESIGN: Cross-sectional. SETTING: Tertiary SCI rehabilitation hospital. PARTICIPANTS: Persons (N=136; men, n=100; women, n=36) with chronic (mean ± SD: 15.6±11.3y postinjury) tetraplegia (n=66) or paraplegia (n=70). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Body composition was assessed with anthropometrics and whole-body dual-energy x-ray absorptiometry. Muscle atrophy was quantified using a sarcopenia threshold of appendicular lean mass index (ALMI) (men, ≤7.26kg/m2; women, ≤5.5kg/m2). Obesity was defined by percentage body fat (men, ≥25%; women, ≥35%), visceral adipose tissue (≥130cm2), and SCI-specific obesity thresholds (body mass index [BMI] ≥22kg/m2; waist circumference ≥94cm). Sarcopenic obesity was defined as the presence of both sarcopenia and obesity. Groups were compared based on impairment characteristics using an analysis of covariance. RESULTS: Sarcopenic obesity was prevalent in 41.9% of the sample. ALMI was lower among participants with motor-complete (6.2±1.3kg/m2) versus motor-incomplete (7.5±1.6kg/m2) injuries (P<.01). Whole-body fat was greater among participants with tetraplegia (28.8±11.2kg) versus paraplegia (24.1±8.7kg; P<.05). Compared with general population guidelines (20.6%), SCI-specific BMI thresholds identified all the participants with obesity (77.9%) based on percentage body fat (72.1%). CONCLUSIONS: The observed frequency of sarcopenic obesity in this sample of individuals with chronic SCI is very high, and identification of obesity is dissimilar when using SCI-specific versus general population criteria.

Following the Physical Activity Guidelines for Adults With Spinal Cord Injury for 16 Weeks Does Not Improve Vascular Health: A Randomized Controlled Trial.

OBJECTIVE: To evaluate the effects of following the physical activity guidelines (PAG) for adults with spinal cord injury (SCI) for 16 weeks. DESIGN: Randomized controlled trial. SETTING: Community exercise program. PARTICIPANTS: Individuals with SCI (N=23; neurological level of injury, C3-T11; American Spinal Injury Association Impairment Scale A-C; time postinjury, 12.0±9.9 y; age, 41.4±11.6 y). INTERVENTIONS: Participants were randomly assigned to PAG training (n=12) or active control (n=11) groups. PAG training involved ≥20 minutes of moderate-vigorous aerobic exercise (rating of perceived exertion 3-6 on 10-point scale) and 3×10 repetitions of upper-body strengthening exercises (50%-70% 1 repetition maximum) 2 times per week. The control group maintained existing physical activity levels with no guidance on training intensity. MAIN OUTCOME MEASURES: Outcome measures were obtained pre- and postintervention. Vascular health indicators included arterial stiffness via carotid distensibility and pulse wave velocity, and endothelial function via flow-mediated-dilation. Fasted blood samples were analyzed for markers of cardiovascular disease (CVD) risk. Body composition was assessed via anthropometrics and with dual-energy x-ray absorptiometry. RESULTS: Twenty-one individuals completed the intervention (PAG=12, control=9). Group-by-time interactions were observed for whole-body mass (P=.03), whole-body fat (P=.04), visceral adipose tissue (P=.04), and carotid artery distensibility (P=.05), suggesting maintained body composition and carotid stiffness in the PAG group concurrent with declines in the control group. No changes were found in any other outcome measure. CONCLUSIONS: While 16 weeks of adherence to the PAG in adults with SCI is insufficient to improve many markers of CVD risk, it may prevent declines in others. The PAG should continue to be promoted as a means to increase physical fitness and maintain body composition in individuals with SCI, but changes may be needed to achieve other health outcomes.

Self-report of one-year fracture incidence and osteoporosis prevalence in a community cohort of canadians with spinal cord injury.

BACKGROUND: Sublesional declines in hip and knee region bone mass are a well-established consequence of motor complete spinal cord injury (SCI), placing individuals with SCI at risk for fragility fracture, hospitalization, and fracture-related morbidity and mortality. OBJECTIVES: To describe the 1-year incidence of fracture and osteoporosis prevalence in a community cohort of Canadians with chronic SCI. METHODS: As part of the SCI Community Survey, consenting adult participants with chronic SCI completed an online or telephone survey regarding their self-reported medical comorbidities, including fracture and osteoporosis, in the 12 months prior to survey conduct. Survey elements included sociodemographic and impairment descriptors and 4 identified risk factors for lower extremity fragility fracture: injury duration ≥ 10 years, motor complete and sensory complete (AIS A or A-B) paraplegia, and female gender. RESULTS: Consenting participants included 1,137 adults, 70.9% were male, mean (SD) age was 48.3 (13.3) years, and mean (SD) time post injury was 18.5 (13.1) years. Eighty-four participants (7.4%) reported a fracture in the previous 12 months and 244 (21.5%) reported having osteoporosis in the same time period, with corresponding treatment rates of 84.5% and 64.8%, respectively. The variables most strongly associated with fracture were osteoporosis (odds ratio [OR], 4.3; 95% CI, 2.72-6.89) and having a sensory-complete injury (OR, 2.2; 95% CI, 1.38-3.50) or a motor complete injury (OR, 1.7; 95% CI, 1.10-2.72). CONCLUSIONS: The discordance between fracture occurrence and treatment and the strength of the association between osteoporosis diagnosis and incident fractures necessitates improved bone health screening and treatment programs, particularly among persons with complete SCI.

Aerobic capacity, orthostatic tolerance, and exercise perceptions at discharge from inpatient spinal cord injury rehabilitation.

OBJECTIVE: To describe physical capacity, autonomic function, and perceptions of exercise among adults with subacute spinal cord injury (SCI). DESIGN: Cross-sectional. SETTING: Two inpatient SCI rehabilitation programs in Canada. PARTICIPANTS: Participants (N=41; mean age ± SD, 38.9 ± 13.7y) with tetraplegia (TP; n=19), high paraplegia (HP; n=8), or low paraplegia (LP; n=14) completing inpatient SCI rehabilitation (mean ± SD, 112.9 ± 52.5d postinjury). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Peak exercise capacity was determined by an arm ergometry test. As a measure of autonomic function, orthostatic tolerance was assessed by a passive sit-up test. Self-efficacy for exercise postdischarge was evaluated by a questionnaire. RESULTS: There was a significant difference in peak oxygen consumption and heart rate between participants with TP (11.2 ± 3.4;mL·kg(-1)·min(-1) 113.9 ± 19.7 beats/min) and LP (17.1 ± 7.5 mL·kg(-1)·min(-1); 142.8 ± 22.7 beats/min). Peak power output was also significantly lower in the TP group (30.0 ± 6.9W) compared with the HP (55.5 ± 7.56W) and LP groups (62.5 ± 12.2W). Systolic blood pressure responses to the postural challenge varied significantly between groups (-3.0 ± 33.5 mmHg in TP, 17.8 ± 14.7 mmHg in HP, 21.6 ± 18.7 mmHg in LP). Orthostatic hypotension was most prevalent among participants with motor complete TP (73%). Results from the questionnaire revealed that although participants value exercise and see benefits to regular participation, they have low confidence in their abilities to perform the task of either aerobic or strengthening exercise. CONCLUSIONS: Exercise is well tolerated in adults with subacute SCI. Exercise interventions at this stage should focus on improving task-specific self-efficacy, and attention should be made to blood pressure regulation, particularly in individuals with motor complete TP.

Muscle characteristics and fatigue properties after spinal cord injury.

Spinal cord injury (SCI) results in a myriad of changes in paralyzed skeletal muscle. Many of these changes stem from the disruption in nerve activation and lead to a loss of muscle mass and the transformation of muscle fiber types to a predominance of type II fast-twitch fibers. Changes to muscle contractile properties are also commonly reported, however, the results are not yet conclusive and appear to vary with the muscle examined. The presence or absence of spasticity also appears to be a significant variable, acting to preserve some muscle characteristics following paralysis. The purpose of this review is to summarize the current literature examining changes in skeletal muscle after SCI, with a particular focus on the effect on fatigue resistance. Mechanisms of fatigue in able-bodied muscle are discussed in the context of their potential to explain the decreased fatigue resistance observed after SCI.