A Virtual, Group-Based Exercise Platform May Help People with Spinal Cord Injury Increase Their Physical Activity

A study funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR).

A spinal cord injury (SCI) is an injury to the spinal column, resulting in temporary or permanent changes in movement, strength, sensation, and body functions below the place of injury, including paralysis in some or most of the body. People with SCI may use a wheelchair or other mobility device to get around. Physical activity has been found to positively affect the psychological well-being, fitness, and functions of adults with SCI. However, studies have shown that adults with SCI may be less likely to engage in physical activity due to physical limitations, lack of knowledge about what exercise they can do, or access to accessible fitness facilities in the community.

In a recent NIDILRR-funded study, researchers wanted to know if an internet-based exercise intervention with virtual group meetings would help adults with SCI to exercise more often, improve their fitness, and feel more confident in their ability to engage in physical activity. 

Researchers enrolled 143 people with SCI in a study to test the Workout on Wheels internet intervention (WOWii), a 16-week group-based exercise program that included an online platform, exercise instruction, and virtual meetings with group members. Participants were 18 years old or older, with an average age of about 50. All had lived with their SCI for at least six months, used a wheelchair for mobility more than half the time, and had sufficient arm movement to be able to perform arm-based exercises. All of the participants were cleared by their physician to begin a physical activity program. None were engaging in 150 minutes or more of physical activity per week before the start of the study.

Participants were randomly put into two groups. Half of the participants were immediately enrolled in the 16-week WOWii program, the other half were a wait list. Participants enrolled in the immediate group received a starter package of exercise equipment including resistance bands, a seated aerobics DVD, and a tabletop pedal exerciser. They also received a wrist-worn activity monitor and a chest-based heart rate strap to record and measure their exercise intensity. Participants also had access to the WOWii website with informational resources and weekly modules on various self-management topics. During the 16-week program, the immediate group participants attended weekly virtual group meetings led by a staff member where they discussed the modules and were encouraged to support each other’s efforts. Participants were also invited to join a closed Facebook group. The wait list group began the same program four months after the immediate group, including access to the same equipment, website, and support resources.

Before they started the study, both the immediate and wait list participants completed questionnaires about how much physical activity they engaged in each week, including exercise, housework, and yard work. They also answered questions about their ability to engage in healthy behaviors such as exercising, maintaining a nutritious diet, and watching their physical and mental health; any barriers to maintaining healthy behaviors; and their confidence in setting and reaching goals and controlling changes in their behavior. They completed the same questionnaires after the immediate group had finished the 16-week program and before the wait list group began their program. Finally, each group completed the questionnaires again two months after they finished the program. The activity monitors recorded their workouts throughout the study period and saved the data to the WOWii website, where the researchers could track exercise participation. Researchers also tracked the number of virtual meetings each participant attended and the number of modules they completed. After they finished the program, participants were asked how satisfied they were with it, how useful they found it overall, and how useful they found the videos, virtual meetings, and other facets of the program.

The researchers found that, right after completion of the 16-week program, the participants in the immediate group had greater increases in vigorous physical activity and improvements in confidence in having control over changes than the participants in the wait list group. When they looked at the results after both groups had completed the program, they found that:

• Participants gradually spent more time engaging in aerobic exercise and were engaging in 150 minutes of aerobic activity per week by week 9 through 16. They also engaged in more strength training over the study period.
• Participants progressively increased how often they exercised in a week, from less than 3 days a week to more than 3.5 times a week by week 10 of the study.
• Participants reported an increase in their ability to set and achieve their goals and a decrease in barriers to exercise after completing the 16-week program.

The authors noted that most participants missed one or more weeks of virtual meetings and exercise but nearly half of the participants were involved in exercise and virtual sessions for all four months and most participants completed the online activities. According to the authors, the group-based virtual sessions helped participants find support in their peers and greatly contributed to the program’s success. The program’s length gave participants time to get to know each other and share their knowledge and experience. Participants rated the WOWii website as easy to use, with engaging content that conveyed useful information.

The authors suggested that an intervention that provides exercise equipment and draws on successful goal setting and self-monitoring strategies combined with group-based virtual sessions and online content may help people with SCI increase their engagement in healthy behaviors and help them exercise more. According to the authors, the online component of this study made it more accessible for people with SCI, especially during the COVID pandemic. For people with SCI, home- and community-based exercise programs like WOWii may increase their confidence in performing physical activity and becoming more engaged with their peers without barriers such as transportation and accessible facilities.

To learn more:

The Model Systems Knowledge Translation Center provides evidence-based information resources developed with the Model Spinal Cord Injury System Centers including a large collection of resources on exercise after SCI. This collection includes factsheets, videos, hot topic modules, and quick reviews of research on exercise and SCI.

The National Center on Physical Activity and Disability (NCHPAD) offers a wealth of information, videos, guides, and more on engaging in exercise, sports, and other physical activity. NCHPAD developed 14 Weeks to a Healthier You, a free, personalized, web-based physical activity and nutrition program for people with mobility limitations, chronic health conditions and physical disabilities.

The Research in Focus series examined the role of health and social support networks in the life of people with SCI.

• Many People with SCI May Turn to Complementary and Integrative Healthcare to Manage Their Health and Wellness, but May Need More Information About These Options
• For People with Traumatic Spinal Cord Injury, Relationships and Social Supports May be Linked to Life Satisfaction

To learn more about this study:

Froehlich-Grobe, K., Lee, J., Ochoa, C., Lopez, A., Sarker, E., Driver, S., Shegog, R.,Lin, SJ.(2022). Effectiveness and feasibility of the workout on wheels internet intervention (WOWii) for individuals with spinal cord injury: a randomized controlled trial. Spinal Cord, 60, 862-874. This article is available from the NARIC collection under Accession Number J90785 and free in full text from the publisher.