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Exercise for Everyone: a randomized controlled trial of Project Workout On Wheels in promoting exercise among wheelchair users
Froehlich-Grobe K, Lee J, Aaronson L, Nary DE, Washburn RA, Little TD
Archives of Physical Medicine and Rehabilitation 2014 Jan;95(1):20-28
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: No; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: To compare the effectiveness of two home-based behavioral interventions to promote wheelchair users exercise adoption and maintenance over 12 months. DESIGN: Randomized controlled trial, with participants stratified into groups based on disability type (stable, episodic, progressive) and support partner availability. SETTING: Exercise occurred in participant preferred locations (eg, home, recreation center), with physiological data collected at the university-based exercise lab. PARTICIPANTS: One hundred twenty-eight inactive wheelchair users (64 women) with sufficient upper arm mobility for arm-based exercise enrolled. Participants on average were 45 years old, lived with their impairment for 22 years, with spinal cord injury (46.1%) most commonly reported as causing mobility impairment. INTERVENTIONS: Both groups received home-based exercise interventions. The staff-supported group (n = 69) received intensive exercise support, while the self-guided group (n = 59) received minimal support. Both received exercise information, resistance bands, instructions to self-monitor exercise, regularly-scheduled phone calls, and handwritten cards. MAIN OUTCOME MEASURES: The primary outcome derived from weekly self-reported exercise. Secondary outcomes included physical fitness (aerobic/muscular) and predictors of exercise participation. RESULTS: The staff-supported group reported significantly greater exercise (approximately 16 minutes/week) than the self-guided group over the year (t = 10.6, p = 0.00), with no significant between group difference in aerobic capacity (t = 0.76, p = 0.45) and strength (t = 1.5, p = 0.14). CONCLUSIONS: Although the staff-supported group reported only moderately more exercise, the difference is potentially clinically significant as they also exercised more frequently. The staff-supported approach holds promise for encouraging exercise among wheelchair users, yet additional support may be necessary to achieve more exercise to meet national recommendations.

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