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Home-Based Exercise Enhances Health-Related Quality of Life in Persons With Spinal Cord Injury: A Randomized Controlled Trial

      Abstract

      Objective

      To assess the influence of a home-based exercise intervention on indices of health-related quality of life (HRQOL) in persons with spinal cord injury (SCI).

      Design

      This was a randomized controlled trial (HOMEX-SCI; ISRCTN57096451). After baseline laboratory testing and a week of free-living physical activity monitoring, eligible participants were randomly assigned (2:1 allocation ratio) to a home-based moderate-intensity upper-body exercise intervention group (INT, n=13), or a lifestyle maintenance control group (CON, n=8), for 6 weeks.

      Setting

      Home-based with short laboratory visits immediately before and after the intervention/control period.

      Participants

      Inactive participants (N=21) with chronic (>1yr) SCI (injury level <T4).

      Intervention

      Participants assigned to the INT completed 4, 45-minute moderate-intensity (60%-65% peak oxygen uptake) arm-crank exercise sessions per week for 6 weeks. Participants assigned to the control group (CON) were asked to maintain their habitual physical activity behavior.

      Main Outcome Measures

      Secondary outcome measures were assessed, including physical and mental component scores (PCS and MCS) of health-related quality of life (HRQOL), fatigue, global fatigue (FSS), and shoulder pain index (WUSPI). Cardiorespiratory fitness (CRF), objectively measured habitual moderate-to-vigorous physical activity (MVPA), and exercise self-efficacy (ESE) were also assessed at baseline and follow-up.

      Results

      Changes in the PCS (P=.017) of the Short Form 36 Health Survey (SF-36), ESE (P=.011), and FSS (P=.036) were significantly different between the 2 groups, with moderate to large effect sizes (d=0.75-1.37). Various HRQOL outcomes demonstrated likely to very likely positive inferences in favor of the INT group following the 6-week exercise intervention. Changes in ESE were significantly (P<.01) associated with changes in PCS (r=0.62), MCS (r=0.71), FSS (r=-0.71), and global fatigue (r=0.57).

      Conclusions

      A 6-week upper-body exercise intervention improved indices of HRQOL in persons with SCI. Improvements were associated with increases in ESE. While this intervention demonstrated a positive effect on perceived physical functioning, future interventions should aim to support social and mental functioning and exercise maintenance.

      Keywords

      List of abbreviations:

      CON (lifestyle maintenance control group), CRF (cardiorespiratory fitness), ESE (exercise self-efficacy), ESES (Exercise Self-Efficacy Scale), FSS (Fatigue Severity Scale), HOMEX-SCI (home-based upper-body exercise randomized controlled trial), HRQOL (health-related quality of life), INT (home-based moderate-intensity upper-body exercise intervention group), MVPA (moderate-to-vigorous physical activity), SCI (spinal cord injury), SF-36 (Short Form 36 Health Survey), Vo2peak (peak oxygen uptake), WUSPI (Wheelchair User Shoulder Pain Index)
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