Home-based exercise enhances health-related quality of life in persons with spinal cord injury: A randomized controlled trial

Publication date: Available online 11 June 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Tom E. Nightingale, Peter C. Rouse, Jean-Philippe Walhin, Dylan Thompson, James L.J. Bilzon
ObjectiveTo 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).DesignThis 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 (INT, n = 13), or a lifestyle maintenance control group (CON, n = 8), for 6 weeks.SettingHome-based with short laboratory visits immediately before and after the intervention/control period.ParticipantsTwenty-one inactive participants with chronic (> 1 year) SCI (injury level range, T4 – L5).InterventionParticipants assigned to the exercise intervention group (INT) completed 4 x 45 min moderate-intensity (60-65% peak oxygen uptake [V̇O2 peak]) arm-crank exercise per week for 6 weeks. Participants assigned to the control group (CON) were asked to maintain their habitual physical activity behaviour.Main Outcome MeasuresSecondary outcome measures were assessed, including physical and emotional component scores (PCS and MCS) of health-related quality of life (SF-36), 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.ResultsChanges in the PCS (P = 0.017) of the SF-36, ESE (P = 0.011) and FSS (P = 0.036) were significantly different between the two groups, with moderate to large effect sizes (d = 0.75 – 1.37). Various HRQOL outcomes demonstrated 'likely' to 'very likely' positive inferences in favour of the INT group following the 6-week exercise intervention. Changes in ESE were significantly (P < 0.01) associated with changes in PCS (r = 0.62) and MCS (r = 0.71), FSS (r = -0.71) and global fatigue (r = 0.57).ConclusionsA 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 impact on perceived physical functioning, future interventions should aim to support social and mental functioning and exercise maintenance.



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