Functional Interval Training for People With Spinal Cord Injury and Their Care Partners (SCI-FIT)

Functional Interval Training for People with Spinal Cord Injury and Their Care Partners (SCI-FIT) aims to address barriers to physical activity for people with spinal cord injury and their care partners. This research study provides free, twice weekly group-based, adaptable exercise classes for people with spinal cord injury and their care partners.

Regular physical activity, and more specifically exercise, is beneficial for people with and without spinal cord injury (SCI). Unfortunately, people with spinal cord injury (pSCI) are less physically active than adults without SCI and are at an increased risk of cardiovascular disease. Care partners, or those who provide frequent assistance to those living with SCI, also achieve low physical activity levels and share similar health risks as a result. Often there are limited opportunities for pSCI to engage in regular exercise. In addition, pSCI and their care partners often face significant barriers to exercise including 1) lack of exercise participation opportunities; 2) cost of quality exercise instruction; 3) inaccessible exercise equipment or environments; 4) lack of social support from family and peers. This study, Functional Interval Training for People with Spinal Cord Injury and Their Care Partners (SCI-FIT) will explicitly address the barriers to exercise pSCI and their care partners often face with the primary goals of improving the health, physical activity levels, and quality of life of pSCI and their care partners. In order to address these goals, SCI-FIT will provide no-cost, twice weekly, group-based, adaptable exercise programming for pSCI and their care partners. All participants will be required to have physician or advanced practice provider clearance to exercise and will be evaluated by a physical therapist at no-cost prior to beginning the intervention to assess eligibility for the study. All eligible participants will complete a demographics questionnaire and will undergo a battery of baseline outcome assessments prior to undergoing the exercise intervention. Participants will complete 6-months of twice weekly group exercise classes aimed and hypothesized to increase physical activity levels, muscular strength, social support for exercise, functional mobility, peak power output, aerobic capacity, and quality of life for people with spinal cord injury and their care partners. Participants will repeat baseline outcome assessments at study midpoint (3-months) and study completion (6-months).

In this single group design, all participants will be provided with 6 months of twice weekly supervised group exercise.

Participants will participate in a maximum of twice weekly exercise classes (90 minutes each class) for a total of 6 months. While participants will be encouraged to attend as many classes as able, there is no minimum requirement for class attendance. During the exercise classes, participants will participate in a 10-minute warm up, followed by 30-60 minutes of aerobic, resistance and/or balance training up to a maximum intensity of 8/10 on the rating of perceived exertion scale. Participants will finish each class with a 10-minute cool-down consisting of lower intensity exercise.

Participants who are able to stand will complete this assessment of lower extremity strength over three trials.

Muscular strength of the upper extremities will be assessed via 3-trials of hand-held dynamometry of the shoulder flexor, shoulder extensor, elbow flexor and elbow extensor muscle groups as well as grip strength via a dynamometer.

Measures perceived self-efficacy for various types of physical activities for people with spinal cord injury. The scale has a minimum score of 10 and a maximum score of 40. Higher scores indicate greater confidence in planning and carrying out physical activities and/or exercise based on their own volition.

Self report measure for exercise self efficacy completed by care partner participants. The minimum score is 0 and maximum score is 90. A higher score indicates higher self-efficacy for exercise.

Self report measure for social support for exercise from family and friends. The scale has a minimum score of 46 and maximum score of 230. Higher scores indicate greater social support of friends and family for physical activity and exercise behaviors.

Self-reported measure of health related quality of life for participants who are care partners. The measure assesses eight health concepts through eight subscales (physical functioning, bodily pain, role limitations due to physical health problems, role limitations due to personal or emotional problems, emotional well-being, social functioning, energy/fatigue, and general health perceptions). Scores in each category are averaged and range from 0 to 100, with higher scores indicating better health-related quality of life.

Change in Quality of Life for People with Spinal Cord Injury as assessed by the Spinal Cord Injury - Quality of Life Measure [Emotional Health and Social Participation] at 6 months

Self report measure of quality of life related to Emotional Health (positive affect and well-being, resilience, self-esteem, and stigma) and Social Participation (independence) for people with spinal cord injury.

Self report measure of perceived functional abilities of people with spinal cord injury including self-care, basic mobility, ambulation, manual wheelchair, power wheelchair, and ambulation.

Physical activity levels will be measured via wrist worn Actigraph GT9X Link. The Actigraph is able to detect acceleration in multiple planes of motion. Through collecting acceleration data, different intensities of physical activity will be inferred (i.e light, moderate and vigorous intensity physical activity), with moderate-to-vigorous intensity physical activity being used as the primary outcome measure. At the four time points, participants will wear the Actigraph for 7 consecutive days. The Actigraph will not need to be removed for activities such as bathing and showering, however the device will be removed for activities such as swimming.

The number and percentage of participants who remain in the study through the final measurement point at 6 months.

Lower extremity strength will be measured via functional test (Five Times Sit to Stand). This test records the amount of time taken to rise and sit to and from a chair five consecutive times. Faster times indicate greater lower extremity strength.

The 6 Minute Walk Test measures a participants ability to cover as much distance (measured in meters) as possible while walking for 6 minutes. Participants will walk along a pre-defined pathway for 6 minutes, resting as needed. The test is a measure of walking endurance with further distances indicating greater endurance.

Participants will rate their perceived level of change on a 15-point Likert Scale ranging from -7 (a very great deal less/worse to +7 (a very great deal more/better) with 0 representing no change. They will use this scale to answer 4 separate questions: 1) amount of physical activity performed in an average week, 2) ability to walk or push leisurely, 3) ability to walk or push fast, 4) ability to walk or push for a long period of time.

Participants report their perceived physical activity levels compared to people their own age using a 5-point Likert Scale ranging from "much more active" to "much less active".

The number of participants recruited will be reported as a percentage of total participants contacted for study participation.

Inclusion Criteria: Spinal Cord Injury: Must have a clinical diagnosis of spinal cord injury at level C5 (ASIA A-D) and/or must possess at least 4/5 elbow flexion muscular strength Care Partners: self-identified care partner of a person with spinal cord injury participating in the study Must be at least 18 years of age Must be able to communicate and read in English Must have physician or advanced practice provider clearance to exercise Must provide their own transportation to and from the research study Must be able to ambulate independently and/or propel a power or manual wheelchair independently Care Partners: self-identified care partner of a person with spinal cord injury participating in the study Exclusion Criteria: Less than 4/5 elbow flexion muscular strength Unable to ambulate independently or propel a power or manual wheelchair independently Unable to provide transportation to and from the research study Unable to communicate in English Unable to present documented medical clearance to exercise from physician or advanced practice provider

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