A randomized comparative effectiveness trial to evaluate two programs for promotion of physical activity after spinal cord injury in manual wheelchair users

Front. Sports Act. Living, 2025 · DOI: 10.3389/fspor.2025.1504840 · Published: February 12, 2025

Simple Explanation

This study compares two different exercise programs for manual wheelchair users with spinal cord injuries. One program, called WODAA, focuses on increasing activity throughout the day. The other, PACE, involves planned arm crank exercises. Participants were monitored using wearable activity trackers to measure their daily arm movement and heart rate. The study looked at which program was more effective at increasing physical activity and improving cardiometabolic health. The results showed that the WODAA program was more effective than the PACE program in increasing daily arm movement and time spent in higher intensity activities. It also showed a small improvement in cardiovascular fitness.

Study Duration

4 Months

Participants

49 manual wheelchair users with paraplegia

Evidence Level

Level 1: Randomized comparative effectiveness trial

Key Findings

1
The WODAA group had significantly more daily arm movement/propulsion activity (Steps) compared to the PACE group over the final month of the intervention.
2
The WODAA group spent significantly more daily minutes in the Very Active Zone during both Month 3 and Month 4 compared to PACE.
3
At final evaluation, diastolic blood pressure after a 6-Minute Push Test was significantly lower in the WODAA group.

Research Summary

The study compared a whole of day activity accumulation (WODAA) program to a traditional planned arm crank exercise (PACE) program for physical activity promotion in manual wheelchair users with spinal cord injury. The WODAA intervention helped participants significantly increase daily activity (Steps) and total time spent in higher intensity activities when compared to the PACE program. The WODAA program may also improve cardiovascular fitness, as suggested by a small but significant decrease in diastolic blood pressure measured immediately following 6-MPT at program end compared to baseline.

Practical Implications

Clinical Practice

WODAA is a viable and potentially more accessible alternative to PACE for promoting PA in MWC users with SCI, especially for those with limited resources.

Technology Integration

Commercially available activity monitors can be effectively used to support and personalize PA programs for individuals with SCI, despite some accuracy limitations.

Further Research

Future studies should explore real-time PA feedback in PACE, nutritional interventions, and alternative activity measurement approaches for individuals with compromised cardiovascular responses.

Study Limitations

1
Commercially available activity monitors may not be specifically designed for MWC users, introducing potential measurement errors.
2
The age-adjusted estimation of maximum HR used in this study may have resulted in overestimation for participants with paraplegia.
3
The WODAA group received constant feedback while the PACE group received minimal feedback, potentially influencing participant performance.

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