Exercise Training and Manual Wheelchair Users With SCI

People with spinal cord injuries (SCI) are at greater health risk for major health conditions
and poorer health outcomes than the population without disabilities. For people with SCI,
physical activity is critical for both physiological and psychosocial well-being, however 75%
of persons with SCI are not active enough to achieve activity-related health benefits. While
current exercise guidelines for persons with SCI are limited and vary, health authorities and
literature have focused more on recommendations for moderate-intensity exercise, however
recent studies have shown that, due to the reduced exercise capacity of the active muscles
used in persons with SCI, moderate-intensity exercise alone is inadequate to stimulate
meaningful improvements in cardiovascular disease risk. An alternative exercise approach that
has demonstrated significant reductions in cardiovascular disease risk and morality is
high-intensity interval training (HIIT). Participating in exercise protocols of higher
intensity may offer a more effective and time-efficient method of increasing cardiovascular
fitness and metabolic health in persons with SCI. However, few studies have evaluated the
efficacy of HIIT protocols to increase exercise intensity and clinically improve cardio
metabolic health and fitness in this population. The WheelMill System (WMS) is a wheelchair
roller-based system that allows persons with SCI to use their personal manual wheelchair for
wheelchair training or endurance exercise. With this study, we aim to assess the efficacy of
a HIIT intervention conducted on a wheelchair roller-based system in improving
cardiorespiratory and metabolic function, psychosocial well-being, and exercise intensity for
manual wheelchair users (MWUs) with SCI. We also aim to determine if the roller-based system
is a feasible platform for delivering HIIT for MWUs with SCI as well as identifying the
perspectives of the participants on the recruitment and enrollment process, the assessment
methods, and tolerance and acceptance of the intervention protocol. The long-term goal of
this research is to increase cardiorespiratory fitness and reduce cardiovascular and
metabolic disease risk in MWUs. This study will serve as the initial step toward that goal by
pilot testing a HIIT intervention to increase exercise intensity of MWUs with SCI to promote
physiological and psychosocial activity-related health benefits. We will recruit, enroll, and
randomize MWUs with SCI into a roller-based Intervention Group (IG) or the Control Group
(CG). Participants in the IG will complete an initial exercise education session and a
12-week (3 sessions/wk) evidence-based HIIT program using the roller-based system.
Participants in the CG will complete an initial exercise education session and enroll in a
12-week (3 sessions/wk) independent workout program at an accessible community-based fitness
facility. This study will measure the potential physiological, functional, and psychosocial
health benefits of participating in a HIIT program designed for MWUs with SCI. We will then
use the findings to define how exercise training at a higher intensity can support health
outcomes and improve therapeutic and community-based interventions to promote
cardiorespiratory and metabolic health and well-being of people with SCI.

Inclusion Criteria:

- Participants will have a diagnosis of spinal cord injury (SCI)

- be18 years or older

- have the ability to self-propel a manual wheelchair (MWC) bilaterally with their upper
extremities

- use a MWC for at least 75% of their daily activities

- participate in less than 60 minutes of moderate-intensity exercise per week in the
last month

- have written physician approval to participate in the study

- understand English at a sixth-grade level or higher

- be able to follow multi-step instructions

- independently provide informed consent

- be willing to participate in two assessments and 36 intervention sessions at the
Enabling Mobility in the Community Laboratory (EMC Lab).

Exclusion Criteria:

- maneuver MWC with their lower extremities or with only one upper extremity

- have bilateral incoordination due to strength inequality or neurological involvement
that impairs propulsion in a steady, straight line

- have had surgeries compromising the integrity of the upper extremities or
cardiovascular complications within the past year

- currently receive medical treatment for an acute upper extremity injury

- have a Stage IV pressure injury

- are currently hospitalized

- have a cognitive impairment that does not allow them to provide consent or follow
multi-step directions.