Teleexercise Programs for Spinal Cord Injury

R3.  A Scale Up Study Evaluating a Movement-to-Music Teleexercise Platform for Reaching a National Cohort of People with Spinal Cord Injury

Background

Physical inactivity is a serious public health issue in people with spinal cord injury (SCI)1, with less than 2% of their waking hours engaged in any type of structured exercise or leisure time physical activity as reported in the literature.  People with SCI, especially those with limited access to fitness facilities, could benefit from teleexercise2, given its potential to deliver customized exercise training through a supportive online platform.

We are in a unique position to advance a nationwide physical activity program delivered through an eHealth platform established in 2008 in our National Center on Health, Physical Activity and Disability (NCHPAD).  By revamping the eHealth platform, we are proposing to test two versions of a remotely-delivered, innovative and theory-based teleexercise program designed for adults with SCI.  One of the major strengths of this project is the potential to rapidly and effectively scale our findings to people with SCI across the country through NCHPAD.

Aims

  1. To compare the effects of two 8-week teleexercise interventions: movement-to-music (M2M) and standard exercise training (SET), delivered through the NCHPAD eHealth platform on physical activity and other related outcomes.
  2. To evaluate the demographic (age, race, sex), clinical (level of injury, type of injury), and psychosocial (social support, outcome expectations, self-efficacy, self-regulation) variables of two participant groups: 1) compliant participants who completed ≥ 50% of the intervention; 2) noncompliant participants who completed post-testing but < 50% of the intervention or who did not complete post-testing.

Methods

The proposed three-arm randomized pragmatic trial will examine two versions of a remotely-delivered, innovative, theory-based home exercise program with 327 adults with SCI who will be randomized into one of three groups: a) M2M, b) SET, and c) Attention control (ATT). A total of 327 individuals with SCI (18 to 65 yrs) will be recruited for the study.

Participants in the M2M and SET groups will receive their assigned intervention via the NCHPAD telehealth platform.  The platform will allow rolling admission so enrolled participants can register for their assigned exercise program at any time during the study period and begin the program on the following Monday.  Once registered, participants will be instructed to create a profile, choose a user ID and password, and answer a set of personalization questions regarding their function, health, and exercise preferences.

The week in which a participant registers will be considered the introductory week (week 0).  Throughout this week the participant will be oriented to the NCHPAD platform but access to the M2M or SET program will be restricted until the following Monday.  An introductory/training video will be given to the participant with a visual demonstration of how to set up a safe environment to exercise, basic movements, use of equipment, correct exercise posture, and safety guidelines specific to the assigned intervention.  Once the video is watched, the participant will then be given access to the first set of exercise routines.  A brief online program evaluation form will be sent to the participant at the end each week to obtain feedback on the program.

Participants in all 3 groups will be able to access the NCHPAD website where they will have access to live chat and a toll-free hotline in case they would like to speak to an information specialist to help answer any questions regarding exercise, disability or health.

Our M2M program has been developed for onsite instruction and will be repurposed into an eHealth version.  Movement and tempo-based adaptations will also be available.  A typical M2M session will consist of tailored movement routines starting with a warmup using range of motion exercises, followed by muscle strengthening, cardiorespiratory, and/or balance routines, and ending with a cool down emphasizing breathing and mindfulness.

The SET intervention is based on the NCHPAD 14-Weeks to a Healthier You program launched in 2008.  Exercise videos, which involve standard exercise training routines both seated and standing, have been developed and archived for use in this study.  The SET intervention will be delivered through the same platform as M2M.

The ATT group will be provided with NCHPAD’s online newsletter and will have access to NCHPAD’s toll-free telephone number, email address and website.

Table 2 summarizes the variables and data collection time points corresponding to each outcome measure.  All measures will be completed online.  We will use participant program engagement as an indicator of exercise adherence.  The platform is designed to electronically record timestamps and collect information when a participant logs into the platform, and every subsequent webpage/video being viewed.

Final Outcomes

  1. Participants in M2M and SET groups will have significantly greater increases in physical activity, decreases in pain and fatigue, and improvements in sleep quality and quality of life compared to ATT after an 8-week intervention and at 12-week follow-up.
  2. Participants in M2M will have significantly greater adherence and exercise enjoyment compared to SET.

 

References

  1. Latimer A, Martin Ginis KA, VCraven B, Hicks A. The physical activity recall assessment for people with spinal cord injury: validity. Med Sci Sports Exerc. 2006;38:208-216.

Lai B, Rimmer J, Barstow B, Jovanov E, Bickel CS. Teleexercise for persons with spinal cord injury: A mixed-methods feasibility case series. JMIR Rehab Assist Technol. 2016;3:1-15.Charlton ME GK, Munsinger T, Schmaderer L, Healey KM. Program evaluation results of a structured group exercise program in individuals with multiple sclerosis. Int J MS Care. 2010;12:92-96.