Development and Feasibility of a Group Tele-Exercise Program for Individuals With Spinal Cord Injury

BACKGROUND AND PURPOSE More than 50% of individuals with spinal cord injury (SCI) report no regular exercise due to numerous barriers to participation. Tele-exercise services offer viable solutions to reduce barriers. However, limited evidence for SCI-specific tele-exercise programs is available. The purpose of this study was to evaluate the feasibility of a synchronous group tele-exercise program designed for individuals with SCI. METHODS Explanatory sequential mixed-methods design assessed feasibility of a synchronous 2-month biweekly group tele-exercise program for individuals with SCI. Numeric measures of feasibility were first collected (recruitment rate, sample features, retention, attendance), followed by postprogram interviews with participants. Thematic analysis of experiential feedback elaborated on numeric findings. RESULTS Eleven volunteers (ages = 49.5 ± 16.7 years) with SCI (range: 2.7-33.0 years) enrolled within 2 weeks of recruitment initiation. Retention was 100% retention at program completion. Median number of live classes attended per participant was 10 (62.5%). Participants described that attendance and satisfaction were facilitated by program-specific features including coinstruction by instructors with SCI-specific knowledge and lived experience, as well as group structure. Participants reported increased exercise knowledge, confidence, and motivation. DISCUSSION AND CONCLUSIONS This study demonstrated feasibility of a synchronous group tele-exercise class for individuals with SCI. Key features facilitating participation include class length, frequency, coleadership by individuals familiar with SCI and exercise instruction, and group motivation. These findings begin to examine a viable tele-service strategy that could be employed as a bridge among rehabilitation specialists, community fitness instructors, and clients with SCI to increase physical activity access and behavior.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A442).

[1]  K. Fisher,et al.  Perspectives on Health With Spinal Cord Injury Now and in the Future: A Qualitative Descriptive Study. , 2023, Physical Therapy.

[2]  K. Fisher,et al.  PERSPECTIVES ON HEALTH AND AGING WITH SPINAL CORD INJURY: A QUALITATIVE DESCRIPTIVE STUDY , 2022, Innovation in aging.

[3]  Shivayogi V. Hiremath,et al.  Staying active after rehab: Physical activity perspectives with a spinal cord injury beyond functional gains , 2022, PloS one.

[4]  F. R. Neto,et al.  Synchronous and asynchronous tele-exercise during the coronavirus disease 2019 pandemic: Comparisons of implementation and training load in individuals with spinal cord injury , 2021, Journal of telemedicine and telecare.

[5]  M. Nash,et al.  A tele-health intervention to increase physical fitness in people with spinal cord injury and cardiometabolic disease or risk factors: a pilot randomized controlled trial , 2020, Spinal Cord.

[6]  Margaret A. Finley,et al.  Association of musculoskeletal pain, fear-avoidance factors, and quality of life in active manual wheelchair users with SCI: A pilot study , 2020, The journal of spinal cord medicine.

[7]  J. Rimmer,et al.  Correlates of adherence in a home-based, self-managed exercise program tailored to wheelchair users with spinal cord injury , 2020, Spinal Cord.

[8]  H. Gainforth,et al.  Delivering a tele-health intervention promoting motivation and leisure-time physical activity among adults with spinal cord injury: An implementation evaluation. , 2020 .

[9]  Jenay M. Beer,et al.  Perceptions from People Aging with a Mobility Impairment towards using Tele-Technology for Exercise , 2019, Proceedings of the Human Factors and Ergonomics Society Annual Meeting.

[10]  L. Warner,et al.  Perceived somatic and affective barriers for self-efficacy and physical activity , 2019, Journal of health psychology.

[11]  D. Kairy,et al.  Using tele-health to enhance motivation, leisure time physical activity, and quality of life in adults with spinal cord injury: A self-determination theory-based pilot randomized control trial , 2019, Psychology of Sport and Exercise.

[12]  T. Nightingale,et al.  Home-Based Exercise Enhances Health-Related Quality of Life in Persons With Spinal Cord Injury: A Randomized Controlled Trial. , 2018, Archives of physical medicine and rehabilitation.

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

[14]  J. Oetzel,et al.  Development of a Mixed Methods Investigation of Process and Outcomes of Community-Based Participatory Research , 2018, Journal of mixed methods research.

[15]  J. Gassaway,et al.  Effects of Peer Mentoring on Self-Efficacy and Hospital Readmission After Inpatient Rehabilitation of Individuals With Spinal Cord Injury: A Randomized Controlled Trial. , 2017, Archives of physical medicine and rehabilitation.

[16]  A. Gorgey,et al.  A feasibility pilot using telehealth videoconference monitoring of home-based NMES resistance training in persons with spinal cord injury , 2017, Spinal Cord Series and Cases.

[17]  K. M. Martin Ginis,et al.  Psychosocial factors associated with physical activity in ambulatory and manual wheelchair users with spinal cord injury: a mixed-methods study , 2017, Disability and rehabilitation.

[18]  L. Miller,et al.  Health and economic benefits of physical activity for patients with spinal cord injury , 2016, ClinicoEconomics and outcomes research : CEOR.

[19]  Emil Jovanov,et al.  Teleexercise for Persons With Spinal Cord Injury: A Mixed-Methods Feasibility Case Series , 2016, JMIR rehabilitation and assistive technologies.

[20]  J. Rimmer,et al.  Framing new pathways in transformative exercise for individuals with existing and newly acquired disability , 2015, Disability and rehabilitation.

[21]  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.

[22]  J. Wyatt,et al.  Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide , 2014, BMJ : British Medical Journal.

[23]  Michael D Fetters,et al.  Achieving integration in mixed methods designs-principles and practices. , 2013, Health services research.

[24]  K. Anderson,et al.  Exercise participation barrier prevalence and association with exercise participation status in individuals with spinal cord injury , 2012, Spinal Cord.

[25]  Chester H Ho,et al.  What's happening now! Telehealth management of spinal cord injury/disorders , 2011, The journal of spinal cord medicine.

[26]  Walter R. Thompson,et al.  WORLDWIDE SURVEY OF FITNESS TRENDS FOR 2019 , 2018, ACSM'S Health & Fitness Journal.

[27]  Mary Ann McColl,et al.  Leisure time physical activity in a population-based sample of people with spinal cord injury part I: demographic and injury-related correlates. , 2010, Archives of physical medicine and rehabilitation.

[28]  Thilo Kroll,et al.  Staying physically active after spinal cord injury: a qualitative exploration of barriers and facilitators to exercise participation , 2009, BMC public health.

[29]  Maria E Fernandez,et al.  How we design feasibility studies. , 2009, American journal of preventive medicine.

[30]  V. Braun,et al.  Using thematic analysis in psychology , 2006 .

[31]  M. Stockler,et al.  Health status rated with the Medical Outcomes Study 36-Item Short-Form Health Survey after spinal cord injury. , 2005, Archives of physical medicine and rehabilitation.

[32]  Steven A. Julious,et al.  Sample size of 12 per group rule of thumb for a pilot study , 2005 .

[33]  M. Nash,et al.  Exercise as a Health‐Promoting Activity Following Spinal Cord Injury , 2005, Journal of neurologic physical therapy : JNPT.

[34]  A. Bandura Health Promotion by Social Cognitive Means , 2004, Health education & behavior : the official publication of the Society for Public Health Education.

[35]  R. Scott,et al.  The socio-economic impact of telehealth: A systematic review , 2003, Journal of telemedicine and telecare.

[36]  J. Leeper,et al.  Development and evaluation of a social cognitive theory-based instrument to assess correlations for physical activity among people with spinal cord injury. , 2018, Disability and health journal.

[37]  D. Tate,et al.  Enhancing community re-integration following spinal cord injury. , 2004, NeuroRehabilitation.

[38]  M. Rodgers,et al.  Impact of Physical Exercise on Controlling Secondary Conditions Associated with Spinal Cord Injury , 2002 .