Mobile health-based physical activity intervention for individuals with spinal cord injury in the community: A pilot study

Low levels of physical activity (PA) and high levels of sedentary behavior in individuals with spinal cord injury (SCI) have been associated with secondary conditions such as pain, fatigue, weight gain, and deconditioning. One strategy for promoting regular PA is to provide people with an accurate estimate of everyday PA level. The objective of this research was to use a mobile health-based PA measurement system to track PA levels of individuals with SCI in the community and provide them with a behavior-sensitive, just-in-time-adaptive intervention (JITAI) to improve their PA levels. The first, second, and third phases of the study, each with a duration of one month, involved collecting baseline PA levels, providing near-real-time feedback on PA level (PA Feedback), and providing PA Feedback with JITAI, respectively. PA levels in terms of energy expenditure in kilocalories, and minutes of light- and moderate- or vigorous-intensity PA were assessed by an activity monitor during the study. Twenty participants with SCI took part in this research study with a mean (SD) age of 39.4 (12.8) years and 12.4 (12.5) years since injury. Sixteen participants completed the study. Sixteen were male, 16 had paraplegia, and 12 had complete injury. Within-participant comparisons indicated that only two participants had higher energy expenditure (>10%) or lower energy expenditure (<-10%) during PA Feedback with JITAI compared to the baseline. However, eleven participants (69.0%) had higher light- and/or moderate-intensity PA during PA Feedback with JITAI compared to the baseline. To our knowledge, this is the first study to test a PA JITAI for individuals with SCI that responds automatically to monitored PA levels. The results of this pilot study suggest that a sensor-enabled mobile JITAI has potential to improve PA levels of individuals with SCI. Future research should investigate the efficacy of JITAI through a clinical trial.

[1]  Sophia Kluge,et al.  Physiology of exercise. , 1966, Maryland state medical journal.

[2]  G. S. Reynolds.  A Primer of Operant Conditioning , 1968 .

[3]  P. London.  Injury , 1969, Definitions.

[4]  G. S. Reynolds.  A primer of operant conditioning, Rev. ed. , 1975 .

[5]  Richard Honeck,et al.  Experimental Design and Analysis , 2006 .

[6]  R. Robertson,et al.  Activity in the spinal cord-injured patient: an epidemiologic analysis of metabolic parameters. , 1986, Medicine and science in sports and exercise.

[7]  N. Larocca,et al.  The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. , 1989, Archives of neurology.

[8]  F. Wolfson.  National Center for Health Statistics data line. , 1989, Public health reports.

[9]  J. Ross Quinlan,et al.  C4.5: Programs for Machine Learning , 1992 .

[10]  S. Dworkin,et al.  Grading the severity of chronic pain , 1992, Pain.

[11]  D. Kirschenbaum,et al.  Self-monitoring may be necessary for successful weight control , 1993 .

[12]  K. Roach,et al.  Reliability and validity of the Wheelchair User's Shoulder Pain Index (WUSPI) , 1995, Paraplegia.

[13]  K. Roach,et al.  Development of the Wheelchair User's Shoulder Pain Index (WUSPI) , 1995, Paraplegia.

[14]  K. Maki,et al.  Energy cost and locomotive economy of handbike and rowcycle propulsion by persons with spinal cord injury. , 1995, Journal of rehabilitation research and development.

[15]  P. Thompson,et al.  ACSM's Guidelines for Exercise Testing and Prescription , 1995 .

[16]  D. Apple.  Physical fitness : a guide for individuals with spinal cord injury , 1996 .

[17]  G. Heath,et al.  Physical activity among persons with disabilities--a public health perspective. , 1997, Exercise and sport sciences reviews.

[18]  A. M. Purves,et al.  The Chronic Pain Grade questionnaire: validation and reliability in postal research , 1997, Pain.

[19]  B. Hedrick,et al.  DESCRIPTIVE EPIDEMIOLOGY OF PHYSICAL ACTIVITY IN UNIVERSITY GRADUATES WITH LOCOMOTOR DISABILITIES 106 , 1997 .

[20]  A. Batavia.  Of wheelchairs and managed care. , 1999, Health affairs.

[21]  A. M. Purves,et al.  Relationship between the chronic pain grade and measures of physical, social and psychological well-being , 1999, PAIN.

[22]  J. Stoker,et al.  The Department of Health and Human Services. , 1999, Home healthcare nurse.

[23]  A. Barnett,et al.  Evaluation of two time-specific back pain outcome measures. , 1999, Spine.

[24]  G. Savić,et al.  Sports, recreation and employment following spinal cord injury–a pilot study , 2000, Spinal Cord.

[25]  A. Dunn,et al.  Variables related to meeting the CDC/ACSM physical activity guidelines. , 2000, Medicine and science in sports and exercise.

[26]  A. Astrup,et al.  Obesity : Preventing and managing the global epidemic , 2000 .

[27]  B. Franklin,et al.  Physical Activity for the Chronically Ill and Disabled , 2000, Sports medicine.

[28]  C. Tudor-Locke,et al.  Challenges and Opportunities for Measuring Physical Activity in Sedentary Adults , 2001, Sports medicine.

[29]  J. Rimmer,et al.  A New Measure for Assessing the Physical Activity Behaviors of Persons with Disabilities and Chronic Health Conditions: The Physical Activity and Disability Survey , 2001, American journal of health promotion : AJHP.

[30]  C. Warms,et al.  Chronic pain associated with spinal cord injuries: a community survey. , 2001, Archives of physical medicine and rehabilitation.

[31]  P. Jacobs,et al.  Circuit training provides cardiorespiratory and strength benefits in persons with paraplegia. , 2001, Medicine and science in sports and exercise.

[32]  E. McAuley,et al.  The physical activity scale for individuals with physical disabilities: development and evaluation. , 2002, Archives of physical medicine and rehabilitation.

[33]  Aaron L. Souza,et al.  Propulsion patterns and pushrim biomechanics in manual wheelchair propulsion. , 2002, Archives of physical medicine and rehabilitation.

[34]  A. Hicks,et al.  Long-term exercise training in persons with spinal cord injury: effects on strength, arm ergometry performance and psychological well-being , 2003, Spinal Cord.

[35]  H. Hoenig,et al.  Activity Restriction Among Wheelchair Users , 2003, Journal of the American Geriatrics Society.

[36]  A. Buchholz,et al.  Physical activity levels are low in free-living adults with chronic paraplegia. , 2003, Obesity research.

[37]  T. Abel,et al.  Energy expenditure in wheelchair racing and handbiking - a basis for prevention of cardiovascular diseases in those with disabilities , 2003, European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology.

[38]  Stephen S. Intille,et al.  A new research challenge: persuasive technology to motivate healthy aging , 2004, IEEE Transactions on Information Technology in Biomedicine.

[39]  P. Kennedy,et al.  The association of sports and physical recreation with life satisfaction in a community sample of people with spinal cord injuries. , 2005, NeuroRehabilitation.

[40]  R. Wing,et al.  Long-term weight loss maintenance. , 2005, The American journal of clinical nutrition.

[41]  Dan Frankowski,et al.  How Do People's Concepts of Place Relate to Physical Locations? , 2005, INTERACT.

[42]  R. Waters,et al.  Preservation of Upper Limb Function Following Spinal Cord Injury: A Clinical Practice Guideline for Health-Care Professionals , 2005, The journal of spinal cord medicine.

[43]  A. Hicks,et al.  Development and evaluation of an activity measure for people with spinal cord injury. , 2005, Medicine and science in sports and exercise.

[44]  C. Warms.  Physical Activity Measurement in Persons With Chronic and Disabling Conditions: Methods, Strategies, and Issues , 2006, Family & community health.

[45]  J. Rimmer.  Use of the ICF in identifying factors that impact participation in physical activity/rehabilitation among people with disabilities , 2006, Disability and rehabilitation.

[46]  J. Nitz,et al.  Shoulder pain following tetraplegia: a follow-up study 2–4 years after injury , 2006, Spinal Cord.

[47]  A. Hicks,et al.  The physical activity recall assessment for people with spinal cord injury: validity. , 2006, Medicine and science in sports and exercise.

[48]  G. Hunter,et al.  PHYSIOLOGICAL RESPONSES OF SKILLED PLAYERS DURING A COMPETITIVE WHEELCHAIR TENNIS MATCH , 2006, Journal of strength and conditioning research.

[49]  M. Boninger,et al.  Assessing mobility characteristics and activity levels of manual wheelchair users. , 2007, Journal of rehabilitation research and development.

[50]  A. King,et al.  Dietary adherence and weight loss success among overweight women: results from the A TO Z weight loss study , 2008, International Journal of Obesity.

[51]  Sumi Helal,et al.  The Engineering Handbook of Smart Technology for Aging, Disability, and Independence , 2008 .

[52]  B. Fernhall,et al.  Health Implications of Physical Activity in Individuals with Spinal Cord Injury: A Literature Review , 2008, Journal of health and human services administration.

[53]  T. Abel,et al.  Energy expenditure in ball games for wheelchair users , 2008, Spinal Cord.

[54]  Rory A. Cooper,et al.  Technology for Successful Aging and Disabilities , 2008 .

[55]  J. Collinger,et al.  Shoulder ultrasound abnormalities, physical examination findings, and pain in manual wheelchair users with spinal cord injury. , 2008, Archives of physical medicine and rehabilitation.

[56]  W. Miller,et al.  Measuring fatigue in persons with spinal cord injury. , 2008, Archives of physical medicine and rehabilitation.

[57]  J. Eng,et al.  Physical activity is related to lower levels of pain, fatigue and depression in individuals with spinal-cord injury: a correlational study , 2009, Spinal Cord.

[58]  W. E. Langbein,et al.  Energy cost of physical activities in persons with spinal cord injury. , 2010, Medicine and science in sports and exercise.

[59]  D. Wolfe,et al.  Determinants of Physical Activity Among People with Spinal Cord Injury: A Test of Social Cognitive Theory , 2011, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[60]  L. Letts,et al.  Preferred methods and messengers for delivering physical activity information to people with spinal cord injury: a focus group study. , 2011, Rehabilitation psychology.

[61]  Stephen S. Intille,et al.  Design of a wearable physical activity monitoring system using mobile phones and accelerometers , 2011, 2011 Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[62]  M. Granat,et al.  Development and validation of a physical activity monitor for use on a wheelchair , 2011, Spinal Cord.

[63]  J. Hardin,et al.  Electronic feedback in a diet- and physical activity-based lifestyle intervention for weight loss: a randomized controlled trial , 2011, The international journal of behavioral nutrition and physical activity.

[64]  D. Wolfe,et al.  The development of evidence-informed physical activity guidelines for adults with spinal cord injury , 2011, Spinal Cord.

[65]  J. Rimmer,et al.  Obesity and Overweight Prevalence Among Adolescents With Disabilities , 2011, Preventing chronic disease.

[66]  R. Cooper,et al.  Predicting energy expenditure of manual wheelchair users with spinal cord injury using a multisensor-based activity monitor. , 2012, Archives of physical medicine and rehabilitation.

[67]  J. Rimmer,et al.  Effects of Disability-Associated Low Energy Expenditure Deconditioning Syndrome , 2012, Exercise and sport sciences reviews.

[68]  K. M. Martin Ginis,et al.  Reliability and validity tests of the leisure time physical activity questionnaire for people with spinal cord injury. , 2012, Archives of physical medicine and rehabilitation.

[69]  Stephen Sprigle,et al.  Validation of an accelerometer-based method to measure the use of manual wheelchairs. , 2012, Medical engineering & physics.

[70]  T. Wadden,et al.  Lifestyle Modification for Obesity: New Developments in Diet, Physical Activity, and Behavior Therapy , 2012, Circulation.

[71]  B. Spring,et al.  Technology Interventions to Curb Obesity: A Systematic Review of the Current Literature , 2012, Current Cardiovascular Risk Reports.

[72]  Shivayogi V. Hiremath,et al.  Physical Activity Monitoring System for Manual Wheelchair Users , 2013 .

[73]  B. Spring,et al.  Integrating technology into standard weight loss treatment: a randomized controlled trial. , 2013, JAMA internal medicine.

[74]  X. García-Massó,et al.  Validation of the use of Actigraph GT3X accelerometers to estimate energy expenditure in full time manual wheelchair users with spinal cord injury , 2013, Spinal Cord.

[75]  R. Cooper,et al.  Development and evaluation of a gyroscope-based wheel rotation monitor for manual wheelchair users , 2013, The journal of spinal cord medicine.

[76]  R. Wing,et al.  B-MOBILE - A Smartphone-Based Intervention to Reduce Sedentary Time in Overweight/Obese Individuals: A Within-Subjects Experimental Trial , 2014, PloS one.

[77]  Wendy Nilsen,et al.  Dynamic Models of Behavior for Just-in-Time Adaptive Interventions , 2014, IEEE Pervasive Computing.

[78]  Bin Bo,et al.  Development of a Smartphone Application to Measure Physical Activity Using Sensor-Assisted Self-Report , 2013, Front. Public Health.

[79]  Spinal Cord Injury Facts and Figures at a Glance , 2014, The journal of spinal cord medicine.

[80]  Stacy N. Scott,et al.  Predicting energy expenditure through hand rim propulsion power output in individuals who use wheelchairs , 2014, British Journal of Sports Medicine.

[81]  Natthasit Wongsirikul,et al.  FIELD-BASED USABILITY STUDY OF PHYSICAL ACTIVITY MONITORING AND SHARING SYSTEM FOR MANUAL WHEELCHAIR USERS WITH SPINAL CORD INJURY , 2014 .

[82]  Brett Smith,et al.  The barriers, benefits and facilitators of leisure time physical activity among people with spinal cord injury: a meta-synthesis of qualitative findings , 2014, Health psychology review.

[83]  Y. Muraoka,et al.  Preliminary study for the assessment of physical activity using a triaxial accelerometer with a gyro sensor on the upper limbs of subjects with paraplegia driving a wheelchair on a treadmill , 2014, Spinal Cord.

[84]  T. Nightingale,et al.  Predicting physical activity energy expenditure in manual wheelchair users. , 2014, Medicine and science in sports and exercise.

[85]  Misha Pavel,et al.  Building new computational models to support health behavior change and maintenance: new opportunities in behavioral research , 2015, Translational behavioral medicine.

[86]  Ambuj Tewari,et al.  Microrandomized trials: An experimental design for developing just-in-time adaptive interventions. , 2015, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[87]  Julia O. Totosy de Zepetnek,et al.  A 16-week randomized controlled trial evaluating the physical activity guidelines for adults with spinal cord injury , 2014, Spinal Cord.

[88]  Inbal Nahum-Shani,et al.  Building health behavior models to guide the development of just-in-time adaptive interventions: A pragmatic framework. , 2015, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[89]  Dan Ding,et al.  Detection of physical activities using a physical activity monitor system for wheelchair users. , 2015, Medical engineering & physics.

[90]  Dan Ding,et al.  Validity of activity monitors in wheelchair users: A systematic review. , 2016, Journal of rehabilitation research and development.

[91]  Ambuj Tewari,et al.  Sample size calculations for micro‐randomized trials in mHealth , 2015, Statistics in medicine.

[92]  H. Stam,et al.  A behavioural intervention increases physical activity in people with subacute spinal cord injury: a randomised trial. , 2016, Journal of physiotherapy.

[93]  Aditya Ponnada,et al.  μEMA: Microinteraction-based ecological momentary assessment (EMA) using a smartwatch , 2016, UbiComp.

[94]  Rory A. Cooper,et al.  Estimation of Energy Expenditure for Wheelchair Users Using a Physical Activity Monitoring System. , 2016, Archives of physical medicine and rehabilitation.

[95]  B. Spring,et al.  Effects of an Abbreviated Obesity Intervention Supported by Mobile Technology: The ENGAGED Randomized Clinical Trial , 2017, Obesity.

[96]  J. Steeves,et al.  Evidence-based scientific exercise guidelines for adults with spinal cord injury: an update and a new guideline , 2017, Spinal Cord.

[97]  Aditya Ponnada,et al.  Microinteraction Ecological Momentary Assessment Response Rates , 2017, Proc. ACM Interact. Mob. Wearable Ubiquitous Technol..

[98]  J. Steeves,et al.  Correction: Evidence-based scientific exercise guidelines for adults with spinal cord injury: an update and a new guideline , 2018, Spinal Cord.

[99]  Ambuj Tewari,et al.  Just-in-Time Adaptive Interventions (JITAIs) in Mobile Health: Key Components and Design Principles for Ongoing Health Behavior Support , 2017, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[100]  Ian M. Mitchell,et al.  Data logger technologies for manual wheelchairs: A scoping review , 2018, Assistive technology : the official journal of RESNA.

[101]  Nicholas J. Seewald,et al.  Efficacy of Contextually Tailored Suggestions for Physical Activity: A Micro-randomized Optimization Trial of HeartSteps. , 2018, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[102]  Mark Payne,et al.  Health and Human Services , 2020, Congress and the Nation 2013-2016, Volume XIV: Politics and Policy in the 113th and 114th Congresses.