Accommodation of wheelchair-reliant individuals by community fitness facilities.

BACKGROUND: Adhering to the recommended healthy physical activity guidelines can be difficult for individuals with spinal cord injury (SCI), stroke or other paralytic conditions. Ordinary community structures such as curbs, stairs and narrow passageways can present as major obstacles for individuals who are reliant on wheelchairs. The Americans with Disabilities Act (ADA) of 1990 mandates that public facilities, including community fitness centers, should be accessible to everyone. STUDY DESIGN: Analysis of compliance of the ADA and accommodation of wheelchair-reliant individuals. OBJECTIVES: To determine the level of compliance with ADA and the degree of accommodation of wheelchair-reliant individuals. SETTING: Community fitness centers in the Hattiesburg, Mississippi metropolitan area. METHODS: Ten fitness centers consented to unfettered access for evaluation of ADA compliance and accommodation of wheelchair-reliant individuals using an 82-item checklist. RESULTS: All surveyed facilities were found to be partially compliant, with none of the facilities being 100% compliant. The areas of least compliance were access to and free movement around exercise equipment and full access to restrooms. Beyond ADA accessibility, only 20% of the participating facilities provided suitable adaptive equipment, and no facilities employed staff trained for the special needs of those with paralytic conditions. CONCLUSION: Beyond mandated physical accessibility, accommodation of individuals who are reliant on wheelchairs because of SCI or other paralytic conditions was found to be lacking. It remains important for health-care professionals and other advocacy groups to stress the need for inclusion and accommodation of individuals with disabilities to community fitness facilities allowing wellness needs to be met.

Body composition changes after 12 months of FES cycling: case report of a 60-year-old female with paraplegia.

STUDY DESIGN: Single-subject (female, 60 years of age) case. OBJECTIVES: The purpose of this case report is to document body composition changes in a 60-year-old female with chronic paraplegia after 12 months of home-based functional electrical stimulation lower extremities cycling (FES-LEC). SETTING: Home-based FES-LEC with internet connection. Southeastern United States. METHODS: FES-LEC three sessions per week for 12 months in participant's home and monitored by the research staff via internet connection. Pre- and post-exercise program testing for body composition including percent body fat, fat mass (FM), lean mass (LM) and whole-body bone mineral density (BMD) via dual-energy x-ray absorptiometry (DXA). RESULTS: There was a 7.7% increase in total body LM and a 4.1% increase in legs LM. There was a 1.2% decrease in total body FM and a 9.9% decrease in legs FM. Percent body fat decreased from 48.4 to 46.3 and whole-body BMD was increased from 0.934 to 1.023, which resulted in an improvement in the DXA T-score from -2.4 to -1.3. CONCLUSION: Positive body compositional changes during this study support the idea that long-term FES-LEC can help restore healthier ratios of LM and FM and possibly decrease the risk of associated diseases. Increased whole-body BMD provides hope that long-term FES-LEC may be beneficial regarding bone health.

Feasibility of home-based functional electrical stimulation cycling: case report.

STUDY DESIGN: Single-subject (male, 64 years of age) case. OBJECTIVES: To determine the feasibility of a home-based FES-LEC (functional electrical stimulation lower extremities cycling) program and effects on body composition, quality of life (QOL) and seat pressure mapping in an older individual with spinal cord injured (SCI). SETTING: Home-based FES-LEC with internet connection. Southeastern United States. METHODS: FES-LEC three sessions per week for 9 weeks in the participant's home and monitored by the research staff via internet connection. Pre- and post-exercise program testing of seat pressure mapping, QOL and body composition including percent body fat (%BF), fat mass (FM), lean mass (LM) and bone mineral density (BMD). RESULTS: The participant completed 25 of 27 recommended exercise sessions over 9 weeks for a 93% compliance rate. Cycling distance increased from 3.98 to 9.00 km (126%). Total body LM increased from 48.94 to 53.02 kg (8.3%). The %BF decreased from 29.6 to 28.4(-1.2%). Total body weight, FM and BMD remained unchanged. Average static seat pressure decreased from 55.5 to 52.59 mm Hg (5%), whereas maximum seat pressure decreased from 120.76 to 91.5 mm Hg (24%). The psychological domain (perception of body image, appearance and self-esteem) of the QOL questionnaire improved from 12.67 to 14. CONCLUSION: Positive changes in this study regarding body composition, QOL and seat pressure mapping support results of clinical studies using FES-LEC training on younger adults with SCI. The high percentage of exercise adherence and positive results on body composition, QOL and seat pressure provide support for the feasibility of home-based FES-LEC.

The effects of spinal cord injury and exercise on bone mass: a literature review.

INTRODUCTION: Bone loss is a common and often debilitating condition that accompanies spinal cord injury. Because bone loss after spinal cord injury is multifactorial, it can be difficult to assess and treat. This process becomes even more complex as secondary conditions associated with aging are introduced. PURPOSE: There are two purposes of this literature review. The first is to summarize information concerning the mechanisms of bone loss and osteoporosis after spinal cord injury. The second is to summarize existing data concerning the effects of exercise on bone loss after spinal cord injury. METHOD: Literature was reviewed concerning the bone loss process and the non-pharmacological treatment options for ameliorating bone loss after spinal cord injury. RESULTS: (Part One) Osteoporosis is universal in persons with chronic complete spinal cord injury, which increases the risk of bone fracture. Bone loss after spinal cord injury is both sublesional and regional with the greatest areas of bone demineralization being in the sublesional trabecular laden areas of the distal and proximal epiphyses of the femur and tibia. (Part Two) While passive weight bearing of paralyzed lower extremities appears to be ineffective, stressing the bones through muscular contractions initiated by electrical stimulation (FES) have yielded positive results in some cases. The intensity, frequency, and duration of stress to the bones appear to be important determinants of improved bone parameters. Although further quantification of these components is needed, some generalized guidelines can be deduced from completed research. Intensities showing positive results have been loads of one to one and a half times body weight for FES exercise or having participants FES cycle at their highest power output. Safety precautions must be used to decrease risk of bone fracture. Generally, the frequency is effective with three or more weekly exercise sessions. Studies of duration suggest that several months to one or more years of FES are necessary. DISCUSSION: In order to promote healthy and independent aging in patients with spinal cord injury, it is important to understand the processes, consequences and effective treatments involved with bone loss.