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The Effects of a Patient and Provider Co-Developed, Behavioral Physical Activity Intervention on Physical Activity, Psychosocial Predictors, and Fitness in Individuals with Spinal Cord Injury: A Randomized Controlled Trial

Abstract

Background

Physical activity (PA) interventions in people with spinal cord injury (SCI) have been limited by a shortage of (1) evidence for sufficient increases in unsupervised PA to improve aerobic fitness and (2) stakeholder involvement in intervention design.

Objectives

This study examined the effects of a theory-based PA intervention, developed in collaboration with nearly 300 stakeholders, on PA levels, aerobic fitness, and psychosocial predictors of PA among individuals with SCI.

Methods

A randomized controlled trial (RCT) was conducted with 28 men and women with chronic SCI (age 45.0 ± 11.5 years, years post-injury 16.4 ± 12.4). Participants randomized to the intervention group (n = 14) received an introductory personal training session followed by eight weekly 15-min PA behavioral coaching sessions per week. PA was assessed using self-report and accelerometers. Aerobic fitness and psychosocial predictors of exercise were evaluated using an incremental exercise test and survey methods, respectively.

Results

At post-intervention, controlling for baseline, the intervention group showed fivefold greater self-reported moderate to vigorous physical activity [mean difference 247.9 min/day; 95% confidence interval (CI) 92.8–403.1; p = 0.026, d = 1.04], 17% greater accelerometer-measured PA (mean difference 3.9 × 105 vector magnitude counts; 95% CI 1.1 × 104–7.7 × 105; p = 0.014, d = 0.31), and 19% higher peak oxygen uptake (VO2Peak; mean difference 0.23 L/min; 95% CI 0.12–0.33; p < 0.001, d = 0.54) compared with the control group. Mean values of psychosocial predictors of PA were also significantly improved in the intervention group compared with controls.

Conclusion

To our knowledge, this co-created behavioral intervention produced the largest effect size to date for change in self-reported PA in an RCT involving people with physical disability. This is also the first RCT in people with SCI to demonstrate that a behavioral intervention can sufficiently increase unsupervised PA to improve aerobic fitness.

Trial Registration

ClinicalTrials.gov, NCT03111030, 12 April 2017, https://clinicaltrials.gov/ct2/show/NCT03111030?term=NCT03111030&rank=1.

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Acknowledgements

The authors thank all the participants for their time and effort in designing and completing the trial.

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Authors

Contributions

JM contributed to study conceptualization, data collection, analysis, and writing of the manuscript. CW contributed to study conceptualization, analysis, and review of the manuscript. KMG contributed to study conceptualization, analysis, writing and review of the manuscript.

Corresponding author

Correspondence to Jasmin K. Ma.

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Funding

This work was supported by an Ontario Neurotrauma Foundation/Rick Hansen Institute grant (2015-RHI-PEPA-998). The funding body did not contribute to the design of the project, collection, analysis, and interpretation of data, or in writing the manuscript.

Conflict of Interest

Dr. Jasmin Ma, Dr. Christopher West, and Dr. Kathleen Martin Ginis have no conflicts of interest that are directly relevant to the content of this article.

Ethics approval and consent to participate

Ethics approval for the protocol was granted by the Clinical Research Ethics Board at the University of British Columbia. Written informed consent was obtained from each of the participants. This study was performed in accordance with the standards of ethics outlined in the Declaration of Helsinki.

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Ma, J.K., West, C.R. & Martin Ginis, K.A. The Effects of a Patient and Provider Co-Developed, Behavioral Physical Activity Intervention on Physical Activity, Psychosocial Predictors, and Fitness in Individuals with Spinal Cord Injury: A Randomized Controlled Trial. Sports Med 49, 1117–1131 (2019). https://doi.org/10.1007/s40279-019-01118-5

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