Exercise and Secondary Exercise and Secondary Exercise and - - PowerPoint PPT Presentation

Exercise and Secondary Exercise and Secondary Exercise and Secondary Exercise and Secondary Conditions among Adults with Conditions among Adults with Spinal Cord Injury Spinal Cord Injury

Pei Pei-

• Shu Ho, Ph.D.

Shu Ho, Ph.D.1; Matthew Kehn, B.A. ; Matthew Kehn, B.A. 1; ; Melinda Neri, B.A. Melinda Neri, B.A. 1; Thilo Kroll, Ph.D. ; Thilo Kroll, Ph.D. 1,2

1,2 1National Rehabilitation Hospital Washington DC

National Rehabilitation Hospital Washington DC

1National Rehabilitation Hospital, Washington, DC

National Rehabilitation Hospital, Washington, DC

2 University of Dundee, Scotland

University of Dundee, Scotland

ASIA/ISC S A l M ti ASIA/ISC S A l M ti

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ASIA/ISCoS Annual Meeting ASIA/ISCoS Annual Meeting June 27, 2006, Boston, MA June 27, 2006, Boston, MA

Acknowledgements Acknowledgements Acknowledgements Acknowledgements

Funding agency Funding agency Funding agency Funding agency

– National Institute on Disability & Rehabilitation National Institute on Disability & Rehabilitation Research (NIDRR) Research (NIDRR)

Collaborators Collaborators

– National Spinal Cord Injury Association National Spinal Cord Injury Association p j y p j y – Midwest Center for Health Services & Policy Midwest Center for Health Services & Policy Research/VA Research/VA – Independent Living Research Utilization Independent Living Research Utilization

Study participants Study participants

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Background Background Background Background

People with disabilities in general are People with disabilities in general are People with disabilities, in general, are People with disabilities, in general, are less likely to be physically active as less likely to be physically active as compared to people without disabilities compared to people without disabilities compared to people without disabilities compared to people without disabilities

(Heath & Fentem, 1997) (Heath & Fentem, 1997)

The majority of adults with physical The majority of adults with physical j y p y j y p y disabilities live a sedentary lifestyle disabilities live a sedentary lifestyle

(Amosun, Mutimura, & Frantz, 2005; Ebrahim, Wannamethee, Whincup, (Amosun, Mutimura, & Frantz, 2005; Ebrahim, Wannamethee, Whincup, Walker Shaper 2000; Hofoss 2004) Walker Shaper 2000; Hofoss 2004) Walker, Shaper, 2000; Hofoss, 2004) Walker, Shaper, 2000; Hofoss, 2004)

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Background Background Background Background

Reasons for physical inactivity: Reasons for physical inactivity: Reasons for physical inactivity: Reasons for physical inactivity:

– mobility limitations mobility limitations – lack of transportation lack of transportation lack of transportation lack of transportation – poor accessibility of fitness facilities, health poor accessibility of fitness facilities, health clubs, & equipment clubs, & equipment – information information-

• related barriers (e.g., not knowing

related barriers (e.g., not knowing where to exercise) where to exercise) l k f ( t f th i l k f ( t f th i – lack of resources (e.g., cost of the exercise lack of resources (e.g., cost of the exercise program) program)

Ref: Rimmer, et al., 2005; Rimmer, et al., 2004; Rimmer, et al., 2000; Stuifbergen & Roberts, 1997; Washburn & Ref: Rimmer, et al., 2005; Rimmer, et al., 2004; Rimmer, et al., 2000; Stuifbergen & Roberts, 1997; Washburn & Hedrick 1997 Hedrick 1997 4 Hedrick, 1997 Hedrick, 1997

Background Background Background Background

People with SCI are at risk for a variety of People with SCI are at risk for a variety of p y p y secondary conditions resulting from the secondary conditions resulting from the sedentary lifestyle often associated with sedentary lifestyle often associated with disability disability disability disability (Case, 2004; Sable & Gravink, 1999).

(Case, 2004; Sable & Gravink, 1999).

Consequences of secondary conditions Consequences of secondary conditions

– Increasing health care costs Increasing health care costs

The annual cost of treating pressure sores alone was estimated at The annual cost of treating pressure sores alone was estimated at $1.2 billion $1.2 billion (Byrne & Salzberg, 1996).

(Byrne & Salzberg, 1996).

– Loss of productivity (time missed from work or school) Loss of productivity (time missed from work or school) – Delayed community reintegration Delayed community reintegration – Reduced quality of life Reduced quality of life (Lucke 1999)

(Lucke 1999) 5

Reduced quality of life Reduced quality of life (Lucke, 1999)

(Lucke, 1999)

Research Questions Research Questions Research Questions Research Questions

Of adults with SCI are there significant Of adults with SCI are there significant Of adults with SCI, are there significant Of adults with SCI, are there significant differences in the incidence of secondary differences in the incidence of secondary conditions between exercisers and non conditions between exercisers and non- conditions between exercisers and non conditions between exercisers and non exercisers? exercisers? How does exercise contribute to the How does exercise contribute to the How does exercise contribute to the How does exercise contribute to the decreased risks of secondary conditions in decreased risks of secondary conditions in adults with SCI? adults with SCI? adults with SCI? adults with SCI?

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Methods Methods Methods Methods

Cross Cross-sectional design sectional design Cross Cross sectional design sectional design Self Self-

• reported mail survey

reported mail survey Adults ( Adults (≥18 years old) with a SCI for at 18 years old) with a SCI for at Adults ( Adults (≥18 years old) with a SCI for at 18 years old) with a SCI for at least 1 year, living in U.S. least 1 year, living in U.S. Snowball sampling Snowball sampling Snowball sampling Snowball sampling Analysis Analysis

Descriptive Descriptive – Descriptive Descriptive – Independent t Independent t-

• test & chi

test & chi-

• square statistics

square statistics Multiple logistic regression Multiple logistic regression

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– Multiple logistic regression Multiple logistic regression

Sample Characteristics Sample Characteristics (n=355)

(n=355)

Sample Characteristics Sample Characteristics (n=355)

(n=355)

Male Male

59 4% 59 4%

Male Male

59.4% 59.4%

Hispanic origin Hispanic origin

5.1 5.1

White race White race

87 9 87 9

White race White race

87.9 87.9

Married/living with a partner Married/living with a partner

50.7 50.7

Some college/college graduates Some college/college graduates

49 0 49 0

Some college/college graduates Some college/college graduates

49.0 49.0

Average age (year) Average age (year)

46.4 46.4 12.6 12.6

Average age at injury (year) Average age at injury (year)

31 6 31 6 14 2 14 2

Average age at injury (year) Average age at injury (year)

31.6 31.6 14.2 14.2

Average years since injury Average years since injury

15.7 15.7 12.0 12.0

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Sample Characteristics Sample Characteristics (Cont )

(Cont )

Sample Characteristics Sample Characteristics (Cont.)

(Cont.)

Injury level Injury level j y j y

– Cervical Cervical 46.8% 46.8% – Thoracic Thoracic 40.0 40.0 – Lumbar Lumbar 7.6 7.6 – Sacral Sacral 0.3 0.3 – Unknown Unknown 5 3 5 3 Unknown Unknown 5.3 5.3

Incomplete SCI Incomplete SCI

53.2 53.2

Wheelchair users Wheelchair users

86.8 86.8

Wheelchair users Wheelchair users

86.8 86.8 – Power Power 34.7 34.7 – Manual Manual 65.3 65.3

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Functional Conditions Functional Conditions Functional Conditions Functional Conditions

Need help with … ‘all the time’ Need help with … ‘all the time’

100

%

60 80 28.7 26.2 25.1 28.2 40 5.9 5.1 20

/showering Dressing Eating f chair & bed t/commode ide the home 10 10 Bathing/show Dress Eat Getting in/out of cha Using toilet/com Getting around inside t

Functional Conditions Functional Conditions (Cont )

(Cont )

Functional Conditions Functional Conditions (Cont.)

(Cont.)

Need help with ‘all the time Need help with ‘all the time‘

‘

Need help with … all the time Need help with … all the time

100

%

53.2 60 80 19 7 53.2 24.5 40 60 19.7 16.3 7.9 3.1 20

11 11 Preparing own meals Shopping for personal items Managing money Using telephone Doing heavy work around the house Doing light work around the house

Top Five Chronic Conditions Top Five Chronic Conditions Top Five Chronic Conditions Top Five Chronic Conditions

%

80 100 42.8 40 60 30.4 26.8 22.0 19.7 20 40

Incontinence Depression Osteoporosis Arthritis High cholesterol

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Exercise Activities Exercise Activities Exercise Activities Exercise Activities

% 80 100 19 2 40.0 28.7 40 60 19.2 12.1 20 Exercise at Exercise at Exercise No exercise Exercise at home &

• utside of

home Exercise at home only Exercise

• utside of

home only No exercise

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Physical/Exercise Activities Physical/Exercise Activities Physical/Exercise Activities Physical/Exercise Activities

Aerobic activities Aerobic activities Aerobic activities Aerobic activities

– Arm/hand/leg cycling, walking/wheeling Arm/hand/leg cycling, walking/wheeling around, aerobic exercise, swimming/pool around, aerobic exercise, swimming/pool therapy therapy

Strengthening activities Strengthening activities

– Weight lifting, resistance training Weight lifting, resistance training

Flexibility activities Flexibility activities

– Stretching, standing (with walker/braces), Stretching, standing (with walker/braces), rang of motion (legs/arms) rang of motion (legs/arms)

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Major Reasons for not Major Reasons for not Exercising Exercising

Reasons for not exercising at home Reasons for not exercising at home Reasons for not exercising at home Reasons for not exercising at home

– Accessibility (lack of money, equipment, personal Accessibility (lack of money, equipment, personal help, & time) help, & time) – Physical conditions (pain, functional limitations, Physical conditions (pain, functional limitations, fatigue, lack of motivation or energy) fatigue, lack of motivation or energy) Other choices (gardening wheeling physical Other choices (gardening wheeling physical – Other choices (gardening, wheeling, physical Other choices (gardening, wheeling, physical activities, exercising in gyms or schools) activities, exercising in gyms or schools)

Reasons for not exercising outside the home Reasons for not exercising outside the home Reasons for not exercising outside the home Reasons for not exercising outside the home

– Accessibility (cost, inconvenience, transportation, Accessibility (cost, inconvenience, transportation, equipment, facility) equipment, facility)

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Are there significant differences in the incidence Are there significant differences in the incidence

• f secondary conditions between exercisers and
• f secondary conditions between exercisers and
• f secondary conditions between exercisers and
• f secondary conditions between exercisers and

non non-

• exercisers?

exercisers?

%

80 100

Exerciser Non-exerciser %

56.1 68.6 46.1 60 80 6 3 7.9 32 13.7 15.7 20 40 6.3 7.9 Bladder/kidney stones* Respiratory infection* UTI* Skin breakdown*

16 16 * p ≤ 0.05 *** p ≤ 0.001

Secondary Conditions & Exercise by Secondary Conditions & Exercise by S it L l S it L l Severity Level Severity Level

Exerciser Non-exerciser

%

80 100

%

With complete SCI (n=134) With incomplete SCI (n=189)

50.3 70.0 50.0

60 80

29.5 32.7 20.0 20.0

40

15.9 6.0 8.7

20

D i * Bl dd /Kid R i t UTI* Ski

17 17

Depression* Bladder/Kidney stones** Respiratory infection* UTI* Skin breakdown**

*p ≤ 0.05 ** ≤ p 0.01

How does exercise contribute to the decreased How does exercise contribute to the decreased i k f d diti ? i k f d diti ? risks of secondary conditions? risks of secondary conditions? Non Non-

• exercisers had

exercisers had increased risks of … increased risks of …

– Bladder or kidney stones Bladder or kidney stones OR=2 923 (p=0 008; OR=2 923 (p=0 008;

10

OR

OR=2.923 (p=0.008; OR=2.923 (p=0.008; 95% CI: 1.315 95% CI: 1.315-

• 6.498)

6.498) – Skin breakdown Skin breakdown OR 2 013 ( 0 007 OR 2 013 ( 0 007

2.923 4 6 8

OR= 2.013 (p=0.007; OR= 2.013 (p=0.007; 95% CI: 1.214 95% CI: 1.214-

• 3.337)

3.337) – Respiratory infection Respiratory infection

2.923 2.013 2.345 2 Bladder/kidney Skin Respiratory

p y p y OR=2.345 (p=0.028; OR=2.345 (p=0.028; 95% CI: 1.097 95% CI: 1.097-

• 5.014)

5.014)

stones Breakdown infection 18 18 * Controlling for gender, race, education, age at injury, completeness & level of injury, exercise frequency/duration

Conclusions Conclusions Conclusions Conclusions

Incidence of secondary conditions is significantly Incidence of secondary conditions is significantly y g y y g y lower in exercisers than in non lower in exercisers than in non-

• exercisers

exercisers among adults with SCI, particularly for those with among adults with SCI, particularly for those with incomplete SCI incomplete SCI incomplete SCI incomplete SCI Exercise is associated with the decreased risks Exercise is associated with the decreased risks

• f secondary conditions in adults with SCI
• f secondary conditions in adults with SCI
• f secondary conditions in adults with SCI
• f secondary conditions in adults with SCI

regardless of their socio regardless of their socio-

• demographics, injury

demographics, injury level/severity, & frequency/duration of exercise level/severity, & frequency/duration of exercise ti iti ti iti activities activities Accessibility is the common barrier for adults Accessibility is the common barrier for adults with SCI to engage in various types of exercises with SCI to engage in various types of exercises

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with SCI to engage in various types of exercises with SCI to engage in various types of exercises

Implications Implications Implications Implications

Adults with SCI can benefit greatly by Adults with SCI can benefit greatly by g y y g y y participating in exercise activities, but those participating in exercise activities, but those benefits can be enhanced by benefits can be enhanced by i ibili i ibili l d b i l d b i – removing accessibility removing accessibility-

• related barriers

related barriers – providing structured exercise activities that providing structured exercise activities that are appropriate for their physical capacity are appropriate for their physical capacity are appropriate for their physical capacity are appropriate for their physical capacity Longitudinal data are needed Longitudinal data are needed – to ascertain the causal relationship between to ascertain the causal relationship between – to ascertain the causal relationship between to ascertain the causal relationship between exercise & secondary conditions exercise & secondary conditions

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Implications Implications (Cont )

(Cont )

Implications Implications (Cont.)

(Cont.) The relationship between exercise & secondary The relationship between exercise & secondary The relationship between exercise & secondary The relationship between exercise & secondary conditions among adults with complete SCI can conditions among adults with complete SCI can be further studied using a larger/representative be further studied using a larger/representative sample & longitudinal data sample & longitudinal data

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