Physical activity participation directly impacts the body function and structures of
individuals living with spinal cord injury (SCI). Physical inactivity can initiate and
exacerbate secondary conditions that individuals with SCI are predisposed to including
pressure sores, urinary tract infections, sleep disorders, and chronic pain.
Kinesiophobia, a symptom related to pain, addresses an excessive and often debilitating
fear of physical movement and activity and is associated with reduced level of physical
activity. Individuals with newly acquired SCI have shown elevated levels of kinesiophobia
during inpatient rehabilitation which remained unchanged at one-year. Specific to this
proposal, there are numerous psychosocial benefits for individuals with SCI who
participate in physical activity. These include reduction of depression and negative
mood, increased self-confidence, improved body image, and enhanced quality of life.
Qualitative findings support these outcomes in individuals with SCI who reported that
physical activity reduced depressive moods, facilitated optimism and positive outlook,
and helped manage stress; thus enhancing overall psychological well-being and mental
health. Engagement in physical activity is positively associated with social quality of
life. Participation created larger social networks and increased social achievement.
Nearly 80% of individuals with SCI indicate that physical activity is important and
express interest in maintaining an active lifestyle. However, internal barriers such as
motivation and negative perceptions of physical activity have a strong association with
exercise participation. Physical and financial barriers including inaccessible
facilities, transportation complications, and cost of equipment further limit physical
activity participation. Our recent work has further elucidated that barriers to
community-based exercise with SCI have been exacerbated by the isolation required to
minimize deleterious effects of the COVID-19 pandemic. Psychological and social isolation
is increased in individuals with disabilities compared to nondisabled peers. These
internal and external barriers highlight health and community inclusion disparities for
individuals with SCI. Community inclusion provides people living with SCI equal access
and opportunity to healthy living.
While there are numerous psychological and social benefits of exercise for individuals
living with SCI, nearly 50% of this population is physically inactive. Tele-interventions
have the potential to enhance physical activity participation and community inclusion
through reducing barriers such as transportation and cost while improving access for
individuals with SCI. Telehealth, or internet-based healthcare services, improve social
support and increase cost-effectiveness as compared to standard of care practices.
Telehealth has been cited as a successful strategy to mitigate SCI-related healthcare
disparities and chronic health condition management. For example, telehealth is an
effective intervention to manage pressure ulcer development in SCI. However, these
findings are limited to case-based examination of healthcare provider clinical services.
Evidence to support tele-interventions that also impact social engagement, such as group
tele-exercise, is lacking. One small case-series demonstrated that participants with SCI
valued group tele-exercise as a tool to overcome barriers to physical activity
participation. Our study will provide evidence of the effectiveness of a community-based
tele-exercise intervention for individuals with SCI to promote psychosocial well-being
along with enhanced physical activity engagement.
This pragmatic effectiveness study will use a parallel, mixed methods, wait-list control
group design. In order to more rigorously investigate the effectiveness of the
tele-exercise intervention on psychological and social wellbeing, a subset of
participants (n=10) will serve as controls through a waitlist control approach. To
achieve this control group, following informed consent, the initial 20 participants will
be randomized to immediate intervention group or waitlist control group, with the final
12 participants in the immediate intervention group. As the group tele-exercise
intervention encourages participant interaction, the randomization will be in clusters of
6-10 participants. The immediate intervention group will participate in the
pre-intervention a semi-structured interview or small focus group and quantitative
measures will be obtained. They will participate in the tele-exercise intervention
biweekly for 8 weeks with all measures (qualitative and quantitative) obtained at 8-weeks
(post-intervention), with leisure time physical activity and quality of life assessed at
16-weeks following initiation of the program. The waitlist control group will complete
all quantitative measures as a baseline (baseline-control) and will be instructed to
continue their activities as usual, with measures obtained again at 8-weeks
(post-control/pre-program). Following the initial 8-week baseline, each waitlist group
will participate in pre-intervention semi-structured interview or small focus group with
the post-control measures as pre-intervention assessment. They will join the
tele-exercise intervention with all measures at 8-weeks (post-intervention) and with
leisure time physical activity and quality of life assessed at 16-weeks following
initiation of the program. All participants will be provided a logbook with instructions
to document physical activity, reflections and associated emotions and behaviors.