Katherine Froehlich-Grobe

Background: Exercise training is established as an effective approach for secondary and tertiary prevention among people with multiple sclerosis (MS); however, there are currently no evidence-based exercise training programs for people with MS who use wheelchairs. A 3-step, community-engaged research process was initiated to develop an exercise training intervention to help people with MS who use wheelchairs manage the consequences of MS and optimize their health. The current study investigated the feasibility, acceptability, and preliminary efficacy of the novel program. Methods: Twenty-four participants were enrolled, and 23 were randomly assigned into the 16-week exercise intervention or a wellness control condition. Feasibility outcomes included recruitment and retention rates as well as safety. Acceptability outcomes included postintervention surveys and semistructured interviews to measure participant satisfaction and perceptions. Efficacy outcomes included changes in metabolic health biomarkers, in self-reported MS symptoms, and in self-reported and device-measured physical activity behavior. Results: Participant satisfaction was high across both conditions (4.5 and 4.6 out of 5). We conducted a rapid qualitative data analysis of semistructured interviews on participants’ experiences, barriers, and future research interests. Preliminary efficacy outcomes indicated that 50% or more of intervention participants achieved at least a 0.5 SD change in high-density lipoprotein cholesterol, total self-reported physical activity, and depression. Only 1 study-related adverse event was reported. Conclusions: The stakeholder-informed exercise training program was feasible, safe, and acceptable among people with MS who use wheelchairs. The results support a larger clinical trial to assess the efficacy of the exercise intervention in improving metabolic health and MS symptoms.

Background/Objectives: Wheelchair users with multiple sclerosis (MS) often face barriers that restrict participation in physical activity and exercise training. This manuscript reports on participant feedback to guide evaluating and refining a novel exercise training program, Seated Physical activity INtervention (SPIN). SPIN was adapted from the Guidelines for Exercise in MS (GEMS) approach using a three-step community-engaged research framework based on meeting the needs of wheelchair users with MS. Methods: Semi-structured interviews were conducted with 9 participants who completed the 16-week SPIN intervention. The key SPIN intervention components were the exercise prescription, exercise equipment, and behavioral coaching grounded in Social Cognitive Theory. Formative interview domains included overall experience, enjoyable and missing components, delivery modifications, barriers, lessons learned, and additional research topics of interest. Data were analyzed and reported using a rapid qualitative analysis approach. Results: Interviews averaged 16 ± 10 min. Participants reported enjoying SPIN, noting program strengths as being flexible and appropriate for individuals with MS, receiving coaching calls by knowledgeable staff that offered support and accountability, and receiving exercise equipment and video demonstrations. Participants also identified strategies for enhancing the program such as including peer support, offering real-time feedback during exercise, and adding other wellness behavior topics (e.g., diet). Conclusions: The results offer helpful ideas to consider when developing exercise training programs for wheelchair users with MS and other disabilities that may improve health and well-being.

Individuals with spinal cord injury (SCI) experience an increased risk for obesity and cardiometabolic disease. Recommendations to prevent and treat obesity for those with SCI follow those of the US Department of Agriculture to adopt a healthy eating pattern that includes eating a variety of fruits, vegetables, grains, dairy, and protein, plus limiting added sugars, saturated fats, and sodium. Yet, people with SCI eat too many calories, fat, and carbohydrates and too few fruits, vegetables, and whole grains. The study is based on secondary analyses of SCI participants (n = 122) who enrolled in a weight loss study to determine how SCI may impact their ability to prepare food at home. We hypothesize those with higher-level spinal injuries (specifically, those with cervical versus those with thoracic or lumbar/sacral injuries) experience significantly greater difficulty and are more likely to rely on others’ assistance to perform meal preparation tasks. Physiologic (weight, BMI, blood pressure, hemoglobin A1c) and self-reported data (demographic plus responses to the Life Habits Short Survey and meal prep items) were collected at baseline and qualitative data were obtained from a subsample after the intervention during phone interviews. Participants’ average age was 50 ± 14.7 years old, they lived with SCI for an average of 13.0 ± 13.1 years, and their average BMI was 32.0 ± 6.5. Participants were predominantly white (76.1%) men (54.1%) who had some college education (76.3%), though only 28.8% worked. A substantial proportion of respondents (30% to 68%) reported difficulty across the 13 tasks related to purchasing and preparing meals, with a proxy reported as the most common assistance type used across all tasks (17% to 42%). Forty-nine percent reported difficulty preparing simple meals, with 29% reporting a proxy does the task. More than half reported difficulty using the oven and stove, though between 60% to 70% reported no difficulty using other kitchen appliances (e.g., coffee machine, food processor, can opener), the refrigerator, or microwave. There was a significant difference in kitchen function by injury level. Those living with cervical-level injuries had significantly greater limitations than those with thoracic-level injuries. Spouses, other family members, and caregivers were most likely to serve as proxies and these individuals exerted both positive and negative influences on respondents’ dietary intake, based on qualitative data obtained during interviews. The results suggest that many people living with SCI experience functional and environmental barriers that impact their ability to prepare food and use kitchen appliances. Future research should examine how SCI-related functional limitations, transportation access, accessibility of the kitchen, ability to use appliances, availability of financial resources, and assistance by others to prepare foods impact people’s ability to follow a healthy eating pattern.

Background: People with spinal cord injury (SCI) are less likely to be physically active and have higher chronic disease risk than those in the general population due to physical and metabolic changes that occur postinjury. Few studies have investigated approaches to promote increased physical activity (PA) for people with SCI despite evidence that they face unique barriers, including lack of accessible transportation and exercise equipment. To address these obstacles, we adapted an evidence-based phone-delivered intervention that promoted increased PA among people with SCI into a web-based platform, titled the Workout on Wheels internet intervention (WOWii). The adapted program provides participants with weekly skill-building information and activities, basic exercise equipment, and ongoing support through weekly group videoconferencing. Objective: This pilot study was conducted to assess the feasibility of using a web-based and virtual format to deliver the WOWii program in a randomized controlled trial. Methods: We assessed the feasibility of the web-based program by delivering an abbreviated, 4-week version to 10 participants with SCI. Rates of weekly videoconference attendance, activity completion, and exercise activity as tracked by an arm-based activity monitor were recorded for all participants. Results: Participants averaged 3.3 of 4 (83%) weekly group videoconferences attended, 3.4 of 4 (85%) web-based module activities completed, and 2.3 of 4 (58%) weeks of using the arm-based activity monitor. The majority of the sample (9/10, 90%) synced their arm-based PA monitor at least once, and overall engagement as an average of each component across the 4 weeks was 75%. Conclusions: The intervention had sufficiently high levels of engagement to be used in a full randomized controlled trial to test its effectiveness in improving levels of PA among people with SCI. The knowledge we gained from this pilot study informed improvements that were made in the full randomized controlled trial.

Background: Individuals living with spinal cord injury (SCI) have a high prevalence of obesity and unique barriers to healthy lifestyle. Objective: To examine barriers and facilitators to engagement and weight loss among SCI participants enrolled in the Group Lifestyle Balance Adapted for individuals with Impaired Mobility (GLB-AIM), a 12-month intensive lifestyle intervention. Methods: SCI participants (N = 31) enrolled in a wait-list, randomized controlled trial where all participants received intervention between August 2015 and February 2017. Analyses of pooled data occurred in 2020 to examine cross-sectional and prospective associations of hypothesized barriers and facilitators with (1) intervention engagement, comprised of attendance and self-monitoring, and (2) percent weight change from baseline to 12 months. We performed multivariable linear regression on variables associated with outcomes at p < .05 in bivariate analyses and controlled for intervention group. Results: Participants were middle-aged (mean age, 48.26 ± 11.01 years), equally male (50%) and female, White (80.7%), and unemployed (65.6%). In participants who completed baseline surveys ( n = 30), dietary self-efficacy explained 26% of variance in engagement ( p < .01); among the 12-month study completers ( n = 22, 71.0%), relationship issues explained 23% of variance in engagement ( p < .01). Money problems, health issues unrelated to SCI, lack of motivation, and experimental group explained 57% of variance in weight loss ( p for model < .01), with lack of motivation uniquely explaining 24% of variance (p < .01). Conclusion: Improving engagement and weight loss for persons with SCI in the GLBAIM program may be achieved by addressing lack of motivation, relationship issues, and nutrition self-efficacy.

BACKGROUND People with spinal cord injury (SCI) are less likely to be physically active and have higher chronic disease risk than those in the general population due to physical and metabolic changes that occur postinjury. Few studies have investigated approaches to promote increased physical activity (PA) for people with SCI despite evidence that they face unique barriers, including lack of accessible transportation and exercise equipment. To address these obstacles, we adapted an evidence-based phone-delivered intervention that promoted increased PA among people with SCI into a web-based platform, titled the Workout on Wheels internet intervention (WOWii). The adapted program provides participants with weekly skill-building information and activities, basic exercise equipment, and ongoing support through weekly group videoconferencing. OBJECTIVE This pilot study was conducted to assess the feasibility of using a web-based and virtual format to deliver the WOWii program in a randomized controlled trial. METHODS We assessed the feasibility of the web-based program by delivering an abbreviated, 4-week version to 10 participants with SCI. Rates of weekly videoconference attendance, activity completion, and exercise activity as tracked by an arm-based activity monitor were recorded for all participants. RESULTS Participants averaged 3.3 of 4 (83%) weekly group videoconferences attended, 3.4 of 4 (85%) web-based module activities completed, and 2.3 of 4 (58%) weeks of using the arm-based activity monitor. The majority of the sample (9/10, 90%) synced their arm-based PA monitor at least once, and overall engagement as an average of each component across the 4 weeks was 75%. CONCLUSIONS The intervention had sufficiently high levels of engagement to be used in a full randomized controlled trial to test its effectiveness in improving levels of PA among people with SCI. The knowledge we gained from this pilot study informed improvements that were made in the full randomized controlled trial.

BACKGROUND: Evidence suggests Functional Electrical Stimulation leg cycle ergometry (FES-LCE) is beneficial for people living with chronic spinal cord injury (SCI). However, approaches to implement FES-LCE during acute rehabilitation are not established. OBJECTIVE: Describe the process of developing and implementing a FES-LCE program for SCI patients within acute rehabilitation. METHODS: Implementing an FES-LCE program required developing patient inclusion/exclusion criteria, training protocols for staff, patient, and family/caregivers, and procedures for scheduling patients with devices. RESULTS: Our FES-LCE program experienced a 263.6% increase in utilization from 2016 (354 FES-LCE sessions) to 2017 (1,404 sessions) including 390.3% increased weekend use (31 sessions to 152 sessions). From 2016 to 2018, our evening community fitness program participation significantly increased after incorporating FES-LCE as an exercise option. Implementation barriers included patient concerns (e.g., injury level, family/caregiver support), clinician considerations (e.g., staffing, scheduling), and institutional issues (e.g., internet connectivity). CONCLUSIONS: FES-LCE can be successfully implemented within inpatient rehabilitation among patients with SCI, yet hinges upon ease of access for clinicians and patients. Our program allowed SCI patients to achieve use following dosing parameters without interfering in the 3-hours of activity-based therapies potential benefits. Future research should examine short- and long-term effects of FES-LCE use on patient outcomes.