Perceived Barriers to Exercise in People with Spinal Cord Injury

Scelza, William M.; Kalpakjian, Claire Z.; Zemper, Eric D.; Tate, Denise G.

doi:10.1097/01.phm.0000171172.96290.67

Cited by 223 publications

(183 citation statements)

References 22 publications

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“…Prospective data on sports participation, its barriers, and its association with physical capacity are needed. 44 Contrary to others, our models revealed a positive predictive effect of both conservative and surgical stabilization of the spine. 17,21 Perhaps the immobilization period is shorter after surgical stabilization, resulting in an early start of rehabilitation and insignificant deconditioning.…”

Section: Prognostic Factorscontrasting

confidence: 99%

Prognostic Models for Physical Capacity at Discharge and 1 Year Postdischarge From Rehabilitation in Persons With Spinal Cord Injury

Haisma¹,

Woude²,

Stam³

et al. 2007

Archives of Physical Medicine and Rehabilitation

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ABSTRACT. Haisma JA, van der Woude LH, Stam HJ, Bergen MP, Sluis TA, de Groot S, Dallmeijer AJ, Bussmann JB. Prognostic models for physical capacity at discharge and 1 year postdischarge from rehabilitation in persons with spinal cord injury. Arch Phys Med Rehabil 2007;88:1694-703.Objective: To develop prognostic models for physical capacity at discharge and 1 year after discharge from inpatient rehabilitation in persons with spinal cord injury (SCI).Design: Inception cohort; data collected at start of rehabilitation (nϭ104), at discharge (nϭ81), and 1 year later (nϭ74).Setting: Eight Dutch rehabilitation centers. Participants:Patients with SCI at initial rehabilitation.Interventions: Not applicable. Main Outcome Measures: Physical capacity determined by endurance capacity (peak oxygen uptake [VO 2 peak, in L/min] and power output [POpeak, in watts]) during a maximal exercise test, arm muscle strength, and respiratory function. Multiple regression models, either with or without prior outcome, evaluated subject, lifestyle, and lesion-related predictors.Results: Only start VO 2 peak contributed to the prediction of discharge VO 2 peak (R 2 ϭ.51). Discharge VO 2 peak contributed to its prediction 1 year later (R 2 ϭ.75). Start POpeak, sex, age, and level of lesion contributed to discharge POpeak (R 2 ϭ.73). Discharge POpeak, hours of employment before injury, and level of lesion contributed to POpeak 1 year later (R 2 ϭ.81). Models without prior outcome explained less variance. Education, employment, body mass index, not smoking, and conservative stabilization of the spine positively contributed to endurance capacity. Muscle strength was well predicted (R 2 range, .68Ϫ.84). Without prior outcome, respiratory function was poorly predicted.Conclusions: Because prior outcome contributed to an accurate prediction, the early assessment of physical capacity is important in establishing prognoses. Although their accuracy warrants caution in their application, models could complement clinical expertise when informing patients about expected physical outcome and identifying those at risk of low physical capacity.

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Section: Prognostic Factorscontrasting

confidence: 99%

Prognostic Models for Physical Capacity at Discharge and 1 Year Postdischarge From Rehabilitation in Persons With Spinal Cord Injury

Haisma¹,

Woude²,

Stam³

et al. 2007

Archives of Physical Medicine and Rehabilitation

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“…5 Previous work examining exercise participation barriers among persons with SCI has focused on the topic of barrier prevalence. 4 An instinctive application of this work is to focus intervention efforts on reducing prevalence of the most common barriers. However, our results suggest that intervention-minded researchers and clinicians should be cautious as to which barriers they target, as barrier prevalence does not appear to index if and by how much a barrier decreases the odds of being an exerciser.…”

Section: Discussionmentioning

confidence: 99%

“…However, mixed disability focus groups have revealed 10 major groups of exercise participation barriers and facilitators: environmental, cost, equipment, laws and regulations, information, psychosocial, education and training, perceptions and attitudes, policies and procedures, and resource availability. 2 In 72 adults with SCI, Scelza et al 4 narrowed these to three primary categories of perceived exercise barriers: internal (lack of motivation, energy, interest, and so on); resources (cost, knowledge, and so on); and structural (accessibility and so on). Another small SCI study (N ¼ 26) utilized semistructured phone interviews to identify participant's experiences with exercise as well as barriers and facilitators to being active.…”

Section: Introductionmentioning

confidence: 99%

Exercise participation barrier prevalence and association with exercise participation status in individuals with spinal cord injury

2012

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Study design: Pass-code protected web survey. Objectives: Defining exercise participation barrier prevalence and association with exercise participation status in adults with spinal cord injury (SCI). Setting: World-wide web. Methods: Individuals Z18 years with ShCI in the United States completed a pass-code protected website survey (N ¼ 180). Odds ratios (OR) and OR 95% confidence interval (95% CI) assessed association between barrier presence and exercise participation. Results: No differences existed between exercisers and non-exercisers with respect to age, gender, injury level, injury duration, education level, or employment status. A larger percentage of non-exercisers reported household annual incomes o$7,500. The five most prevalent barriers were not associated with participation status (all OR 95% CI included 1). Low prevalence (p13%) characterized four of the five barriers most strongly related to being a non-exerciser. Identifying too lazy, too difficult, or no interest as a barrier decreased odds of being an exerciser by 86%, 83%, and 71%, respectively. Not liking exercise decreased the odds of being an exerciser by 90%. Conclusion: Highly prevalent barriers were not associated with exercise participation status, whereas low prevalence barriers were strongly related to being a non-exerciser. Internal barriers had the strongest association with exercise participation status. The possible association between socioeconomic factors and exercise participation may be underappreciated. The most effective interventions to increase exercise participation may be multifocal approaches to enhance internal perceptions about and motivation to exercise, increase knowledge of how and where to exercise, while also reducing program and transportation financial costs.

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“…However, SCIs create unique challenges that are not experienced by the able-bodied population. For one, individuals with SCI have reduced access to appropriate exercise facilities and equipment (4). This population also experiences physiologic risks of exercise including autonomic and circulatory dysregulation (22).…”

Section: Introductionmentioning

confidence: 99%

“…More than 240,000 Americans live with SCI-related disability, and the estimated annual cost of SCI in the United States averages $9.7 billion (1,3,4). Cardiovascular diseases (CVDs) are the most common cause of death in adults with chronic SCI (5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Effect of Exercise on Disorders of Carbohydrate and Lipid Metabolism in Adults With Traumatic Spinal Cord Injury: Systematic Review of the Evidence

Carlson

Wilt

Taylor

et al. 2009

The Journal of Spinal Cord Medicine

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Background/Objective: Carbohydrate and lipid metabolism disorders may affect adults with spinal cord injuries (SCIs) differently than able-bodied individuals because of reduced physical activity in the SCI population. The objective of this study was to conduct a systematic review to determine the effectiveness of exercise to improve carbohydrate and lipid metabolism disorders in adults with chronic SCI. Methods: Studies were identified in MEDLINE (1996MEDLINE ( -2008, Cochrane Library, bibliographies of identified articles, and expert recommendations. English language articles were included if they evaluated adults with chronic SCI; evaluated exercise; and reported carbohydrate-, lipid-, and/or cardiovascular disease-related outcomes. Results: Twenty-two studies met inclusion criteria, including 15 intervention case-series and 7 crosssectional surveys using self-reported physical activity measures. Intervention protocols involved active (n 5 7) or electrically stimulated (n 5 7) exercise or an educational program (n 5 1) from 8 to 52 weeks in duration. Frequency of exercise was typically 2 to 3 sessions/week, lasting 30 to 60 minutes/session. Totals of 150 and 369 subjects participated in studies with carbohydrate (n 5 12) or lipid and cardiovascular (n 5 16) outcomes, respectively; 78% were men. Level of SCI ranged from C4 to L5 and included both incomplete and complete lesions. Outcomes measures included fasting and postload blood glucose and insulin concentrations and serum cholesterol levels. Small sample sizes and variations in study design, intervention, SCI characteristics, and reported outcomes precluded quantitative pooling of results or reliable assessment of metabolic efficacy. No intervention studies assessed cardiovascular outcomes. Conclusions: Evidence is insufficient to determine whether exercise improves carbohydrate and lipid metabolism disorders among adults with SCI. Expert consensus, based on the preliminary evidence, is needed to inform future studies.

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Perceived Barriers to Exercise in People with Spinal Cord Injury

Cited by 223 publications

References 22 publications

Prognostic Models for Physical Capacity at Discharge and 1 Year Postdischarge From Rehabilitation in Persons With Spinal Cord Injury

Prognostic Models for Physical Capacity at Discharge and 1 Year Postdischarge From Rehabilitation in Persons With Spinal Cord Injury

Exercise participation barrier prevalence and association with exercise participation status in individuals with spinal cord injury

Effect of Exercise on Disorders of Carbohydrate and Lipid Metabolism in Adults With Traumatic Spinal Cord Injury: Systematic Review of the Evidence

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