A Randomized Comparative Effectiveness Trial to Evaluate Two Programs for Promotion of Physical Activity after Spinal Cord Injury in Manual Wheelchair Users

Jenna M Martinez ^1,2 Lisa L Haubert ¹ Valerie Eberly ¹ Walter Weiss ¹ Jeffery W Rankin ^3*

• ¹ Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center, Downey, United States
• ² University of California, Irvine School of Medicine, Irvine, United States
• ³ Rancho Los Amigos National Rehabilitation Center, Downey, United States

Objective: The goal of this study was to determine the effectiveness of a novel whole of day activity accumulation (WODAA) physical exercise program. WODAA physical activity and physiological outcomes were compared to outcomes from individuals using a traditional planned arm crank exercise (PACE) program. Both programs included progressive exercise instruction, goal setting over a 4-month period, and utilization of a wrist-worn activity monitor (Fitbit Blaze/Versa, Fitbit Inc., San Francisco, CA).Design: Longitudinal, randomized, comparative effectiveness trial with collaborative goal setting.Setting: Research laboratory at a rehabilitation hospital and in participant’s homes and communities. Participants: Forty-nine manual wheelchair users with paraplegia.Outcome measures: Physical activity measurements and cardiometabolic data were collected before, during, and after the program. The primary measures were amount of daily arm activity (Steps) and time spent in different activity and heart rate zones. Results: Relative to baseline measures, participants in the WODAA group had significantly more daily arm movement/propulsion activity (Steps) and time spent in the Fairly and Very Active Zones and the Cardio Heart Rate Zone compared to those in the PACE group over the final month of the intervention (p<0.05). Minutes spent in other Activity and Heart Rate Zones were similar between groups. At final evaluation, diastolic blood pressure after a 6-Minute Push Test was significantly lower in the WODAA group, while no differences were found in distance traveled, systolic, or pre-test diastolic blood pressures. Metabolic bloodwork and shoulder pain scores did not change and were similar between groups. Conclusion: Depending on the measure used, these findings suggest that a WODAA approach to PA is comparable or more effective than a traditional PACE program in promoting physical activity in low-active manual wheelchair users with paraplegia.