Effects of Paraplegia Fitness Integrated Training on Physical Function and Exercise Self-Efficacy and Adherence Among Individuals With Spinal Cord Injury

Objective@#To determine the effects of the Paraplegia Fitness Integrated Training (PARAFiT) program, which is an integrated graded physical exercise and health education program for individuals with spinal cord injury (SCI). @*Methods@#This nonrandomized single-blind study included 44 participants, who were assigned to either an intervention (PARAFiT) group or an active control (conventional physiotherapy) group. The intervention group underwent the PARAFiT program (8 weeks), which consisted of circuit-based interval training, progressive upper limb resistance training, and health education sessions. During the unsupervised period, the intervention group continuously underwent health education program once a month for 2 months (8 weeks). Repeated-measures analysis of variance was used for the analysis. @*Results@#The intervention group presented with a higher level of physical activity than did the control group; however, the difference was not significant (p=0.36). Additionally, the intervention group presented with better exercise self-efficacy and cardiorespiratory fitness and stronger bilateral shoulder muscle and handgrip than did the control group (all p<0.05). Exercise adherence was higher in the intervention group than in the control group during both the supervised (80% vs. 75%) and unsupervised (40% vs. 20%) periods. @*Conclusion@#The PARAFiT program enhanced the level of physical activity, exercise self-efficacy, physical fitness, and exercise adherence among the patients with SCI. Future studies should incorporate guidelines for home-based exercises and regular monitoring to promote long-term adherence to exercise and physical activity among individuals with SCI.

Home-Based Physical Activity in Patients With Type 2 Diabetes Mellitus: A Scoping Review

To promote optimal healthcare delivery in type 2 diabetes mellitus (T2DM) following the outbreak of coronavirus disease 2019, adopting home-based physical activity (PA) is being seriously considered. Therefore, this study aims to outline the characteristics of exercise protocols for home-based PA and the challenges and limitations in implementing home-based PA in patients with T2DM. This scoping review was carried out by identifying eligible studies in six different databases (Scopus, Cochrane Library, SpringerLink, ProQuest, Science Direct, and Google Scholar). The keywords used in the search strategies were: home-based physical activity, home-based exercise therapy, home-based physical exercise, home-based exercise, home-based exercise training, diabetes mellitus, and T2DM. Two reviewers independently screened all full-text articles to find articles that met the eligibility requirements. A total of 443 articles were identified in the search. Approximately 342 articles were excluded by screening titles and abstracts, which led to the selection of 44 articles relevant to the current study. Further screening of the full-text led to the subsequent removal of 34 other articles, leading to 10 studies that were eligible for data extraction. This review suggested that the exercise protocols for home-based PA include resistance exercise using free weight and own body weight with a frequency of two to three sessions per week at moderate intensity, along with aerobic exercise (particularly walking) with a frequency of three to five times per week at moderate intensity. A combination of resistance and aerobic exercise showed more significant benefits of PA in patients with T2DM. More studies regarding home-based PA in T2DM patients with metabolic disorders are warranted.

Barriers to Physical Activity and Exercise Amongst Persons With Physical Disability in a Government-funded Teaching Hospital, Kuala Lumpur

@#Introduction: Physical inactivity is common among persons with disabilities (PWDs), thereby leading to harmful secondary complications. Therefore, this cross-sectional study aimed to identify the barriers to physical activity and exercise amongst PWDs in Malaysia. Methods: A total of 102 adults (age 15–65 years) with physical disabilities were recruited from a government-funded hospital. The participants completed the ‘Barriers to Physical Exercise and Disability’ questionnaire via interview by telephone calls or a one-to-one approach. Results: Most participants (90.2%) were interested in engaging in exercise programs. However, the mean concern index score was 2.83 ± 1.35. The majority of the respondents identified five major barriers. These barriers include health concerns (36.3%), transport barriers (36.3%), lack of energy and motivation (36.3%, 31.4%), and exercise program costs (23.54%). Conclusion: Many participants were interested in beginning an exercise program despite the barriers. This observation shows that if the barrier is eliminated, then, this community would be able to participate in an exercise program regularly. Results from the study can inspire health care providers to devise strategies for the promotion of physical activity participation and long-term adherence between PWDs.

Effects of Graded Exercises Integrated with Education on Physical Fitness, Exercise Self-Efficacy, and Activity Levels in People with Spinal Cord Injury: A Quasi-Experimental Study Protocol

STUDY DESIGN: A quasi-experimental single-blinded study. PURPOSE: To investigate the effects of ‘graded exercise integrated with education’ on physical fitness, exercise self-efficacy (ESE), and physical activity (PA) levels among subacute and chronic wheelchair-dependent paraplegia patients. OVERVIEW OF LITERATURE: Most of the chronic spinal cord injury (SCI) patients had low physical fitness due to a sedentary lifestyle and lack of ESE after discharge from a rehabilitation program. Education may encourage them to engage with exercise to regain and maintain their physical fitness. However, there is a lack of research to support the effects of exercise integrated with education after an SCI. METHODS: A total of 44 participants will be assigned to either the experimental group (graded exercise integrated with education) or active control (conventional physical therapy). The experimental group will receive graded strength and aerobic exercise training according to their progression criteria. They will attend an education program during and after the rehabilitation program. The control group will only receive conventional physical therapy during their in-rehabilitation program. This study will be conducted during a period of 16 weeks, consisting of 8 weeks of in-rehabilitation and 8 weeks post-rehabilitation. Statistical analysis will be performed using the IBM SPSS ver. 21.0 (IBM Corp., Armonk, NY, USA) at a significance level of p≤0.05. RESULTS: The primary outcome measures will be upper-limb isokinetic strength, isometric grip strength, and cardiorespiratory fitness. The secondary outcomes will be ESE and PA levels. CONCLUSIONS: An intervention that combines exercise training and education may be warranted to enhance the physical fitness, ESE, and PA levels in SCI patients. This trial was registered with ClinicalTrials.gov (NCT03420170).

Barriers to participation in physical activity and exercise among middle-aged and elderly individuals

INTRODUCTION Although the benefits of physical activity and exercise are widely acknowledged, many middle-aged and elderly individuals remain sedentary. This cross-sectional study aimed to identify the external and internal barriers to physical activity and exercise participation among middle-aged and elderly individuals, as well as identify any differences in these barriers between the two groups. METHODS Recruited individuals were categorised into either the middle-aged (age 45-59 years, n = 60) or elderly (age ≥ 60 years, n = 60) group. Data on demographics, anthropometry, as well as external and internal barriers to participation in physical activity and exercise were collected. RESULTS Analysis showed no significant differences in the total scores of all internal barriers between the two groups (p > 0.05). The total scores for most external barriers between the two groups also showed no significant differences (p > 0.05); only 'cost' (p = 0.045) and 'exercise interferes with social/family activities' (p = 0.011) showed significant differences. The most common external barriers among the middle-aged and elderly respondents were 'not enough time' (46.7% vs. 48.4%), 'no one to exercise with' (40.0% vs. 28.3%) and 'lack of facilities' (33.4% vs. 35.0%). The most common internal barriers for middle-aged respondents were 'too tired' (48.3%), 'already active enough' (38.3%), 'do not know how to do it' (36.7%) and 'too lazy' (36.7%), while those for elderly respondents were 'too tired' (51.7%), 'lack of motivation' (38.4%) and 'already active enough' (38.4%). CONCLUSION Middle-aged and elderly respondents presented with similar external and internal barriers to physical activity and exercise participation. These factors should be taken into account when healthcare policies are being designed and when interventions such as the provision of facilities to promote physical activity and exercise among older people are being considered.