Tesis sobre el tema "Spinal cord injury, physical activity, efficiency"

This doctoral work sought to describe and quantify current levels of leisure-time physical activity (LTPA) in Thai individuals with SCI (Thai-SCI) and relate these findings to barriers to exercise and health-related quality of life (HRQOL) measures by employing a variety of methodologies, including an overview of systematic reviews, translation of surveys, cross-sectional studies, and qualitative analysis of interviews. Key findings were; i) aerobic LTPA (>20 minutes per day) and resistance training (3 sets of 8-10 repetitions) both performed twice weekly for at least 6 weeks at moderate-to-vigorous intensity can improve aerobic fitness and muscle strength, respectively in people with SCI; ii) the proportion of Thai-SCI who were sedentary was high. The average time spent on moderate-to-vigorous intensity LTPA and daily-living activities were below SCI-specific PA recommendations and global health guidelines; iii) Thai-SCI who were injured for less than ten years, those who were on welfare and those who lived in a town or city area were more likely to engage in moderate-to-vigorous intensity LTPA. Significant predictors of participating in moderate-to-vigorous LTPA were the individuals’ personal attitudes to enjoyment of exercise, owning exercise equipment at home and having visited any community recreation facility prior. The significant predictors for not participating in moderate-to-vigorous intensity LTPA were being in a relationship and the lack of a personal assistant who could support the individual to undertake exercise or LTPA. Distinctive characteristics of exercisers versus non-exercisers emerged under six broad themes: a sense of control over injury and health complications, rehabilitation experience, attitudes about exercise, concerns about living conditions, supports and interaction with others, and perceived reasons for exercising/not exercising.

This thesis comprised of six critical studies divided into three phases, which evaluated the context, explored available alternatives to exercise and sought to improve the unsettling scenario of “sedentary” lifestyles among individuals with spinal cord injury (SCI). In the first phase, descriptive information on moderate to vigorous exercises and its associated barriers to participation were extracted among community-dwelling SCI. The approach used non-invasive instruments (validated questionnaires) which allowed description of activities and the associated barriers in large epidemiological studies. The second phase, sought to explore and provide a scientifically grounded alternative to exercise termed “exergaming” (a combination of exercise and gaming with body movements) for this population in the form of a systematic review and a pilot study. The third and final phase of the thesis involved comparing exergaming to conventional exercise counterparts whilst finding directions for improvement.

Philosophiae Doctor - PhD<br>Given the devastating and debilitating impact of spinal cord injuries (SCI) globally and the effects on any population, its impact extends far beyond just the victim to people and institutions surrounding them and supporting them post-injury. Of growing concern is the increased risk that individuals with SCI have been seen to have a three-fold greater risk of developing cardio-vascular disease (CVD) than their able-bodied counterparts. Prevention strategies to curtail the onset of CVD in the SCI population is limited, and often developed for individuals from developed countries. The overall aim of this study was to assess and explore the need to implement CVD prevention programmes in a regional South African population with individuals after sustaining a traumatic spinal cord injury (TSCI). The study employed a mixed methods approach and was conducted in four (4) phases. Permission and ethics clearance were obtained from the Research Ethics Committee at the University of the Western Cape (UWC) and the Western Cape Department of Health. Phase One of the study utilized a questionnaire to collect TSCI incidence data of which 108 of the eligible 132 cases consented to take part in the study. The demographic findings of this study indicated that a person sustaining a TSCI in the Cape Metropolitan area in South Africa is most likely to be a male, young (20 to 29 years of age), from a Black African or Coloured race group and living in the Cape Flats suburbs. The male to female ratio was 6.2:1. The main cause of TSCI was assault at 58.33% (n=63) with males accounting for the majority of cases (88.89%, n=65). According to the AIS classification, ASIA A and D were the most common classification seen in 38.89% (n=42) and 39.81% (n=43) of the cohort respectively. Phase Two utilized a questionnaire and looked at CVD risk factors of the original cohort. A large portion of the cohort was engaged in high-risk behaviours, i.e. smoking and alcohol consumption. A low number of individuals reported a baseline history of hypertension diagnosis prior to their TSCI (5.56%, n=6). Phase Three of the study emplored semi-structured interviews and a focus group discussion to explore the experiences of persons with a TSCI regarding their ability to be physically active once reintegrated back into the community. Despite understanding the associated benefits of physical activity, several barriers to being physically active were reported; factors within their homes, access within their community, and transportation. The present study’s findings illustrated a growing concern among the SCI population for increased risk for developing CVD due to decreased physical activity. Phase Four of the study utilised a scoping review to identify CVD prevention programmes for individuals with a TSCI. Physical activity has been shown to have numerous health benefits of which reducing the risk of CVD is one. Engaging in physical activity, whether it be structured, unstructred or through a sporting activity can play a major role in combating the onset of CVD. Other tools used in reducing the onset of CVD were seen to be self-management strategies of which contrayer views were seen both for and against their use. Conclusion: Better education during the rehabilitation phase might be a key component to individuals with TSCI injury making more informed decisions about prioritising physical activity as they attempt to reintegrate back into their respective communities. The removal of socio-environmental barriers could allow motivated TSCI individuals better access to choosing how to increase their physical activity levels.

Background: A spinal cord injury (SCI), results in a myriad of serious secondary health complications including cardiovascular disease, obesity, and pressure sores due to immobility. These health conditions could be reduced by improving fitness and mobility by participation in physical activity (PA) and exercise. However the SCI population has been found to have the lowest levels of PA when compared to the general population. The reasons for this have been attributed to the many extrinsic barriers that those living with an SCI face daily, including cost, transportation, and lack of adapted equipment or facilities. In May 2013, the Physical Activity Research Centre (PARC) at ICORD opened its doors in an effort to reduce the extrinsic barriers, however, this did not address the many intrinsic barriers to exercise participation, including lack of motivation, time, and knowledge about where or how to exercise. Previous studies have indicated that the preferred messenger for the delivery of PA knowledge includes peers, and health service providers. Here, our goal was to investigate whether peers can change PA behavior and bring this knowledge to action. Methods: In this pilot randomized controlled trial, ten individuals with a SCI were randomly assigned to meet with a peer or student trainer (control) to discuss the PA guidelines for SCI. After the initial intervention, we investigated the effectiveness of peer trainers, compared to student trainers, to translate the PA guidelines to a SCI participant. We then instructed participants to meet with their peer/student trainer as desired for the remainder of the 3-month study. Exercise self-efficacy and overall PA levels were compared between baseline, week 1 and week 12. During an exit interview we explored the effect on intrinsic barriers to exercise along with participant satisfaction with the study. Results: Overall no statistically significant findings were detected between groups, however nearly all participants scored well on knowledge acquisition and are now meeting the recommended PA guidelines. Conclusion: Our findings suggest that student trainers could be as effective as peer trainers as it relates to overcoming intrinsic barriers and increasing overall PA within the SCI population.<br>Education, Faculty of<br>Kinesiology, School of<br>Graduate

A lesão medular está associada a uma série de alterações bioquímicas e decomposição corporal. O aumento da gordura corporal e seu acúmulo na regiãoabdominal aliados a processos infecciosos decorrentes da lesão medular podemacarretar o incremento da concentração plasmática da proteína c-reativa (PCR).Tanto a gordura corporal quanto a elevada concentração da PCR estimulam aprodução de espécies reativas de oxigênio, favorecendo o desequilíbrio oxidativo e odesencadeamento de doenças. É possível que a prática de atividade física regularpossa atuar de modo benéfico através da melhor distribuição da gordura corporal eadaptação dos sistemas antioxidantes nesses indivíduos. Considerando aimportância deste tema e a escassos estudos sobre o assunto, o objetivo desteestudo foi comparar, em indivíduos com lesão medular cervical a composiçãocorporal e indicadores bioquímicos de estado antioxidante em indivíduos fisicamenteativos e não ativos. Participaram do estudo 24 tetraplégicos do gênero masculino(3210 anos de idade e 108 anos de tempo de lesão), divididos em dois grupos,fisicamente ativos (n=15, com pratica de atividade física há pelo menos 3 meses, 3vezes/semana ou mais, totalizando tempo mínimo de 150 minutos/semana) e nãoativos (n=9). A composição corporal foi determinada por absorciometria de duplaemissão de raio-X. Amostras de sangue foram coletadas após jejum de 12 horaspara determinação dos indicadores bioquímicos: de capacidade antioxidante, ácidoúrico, bilirrubina, albumina, alfa-tocoferol, malondialdeído e PCR no plasma eatividade da superóxido dismutase em eritrócitos. O grupo não ativo apresentoumaior IMC (=0,003), gordura total (%) e de tronco (%) (=<0,001) do que o grupoppfisicamente ativo. Foi encontrada relação entre a PCR e a porcentagem de gorduratotal (r=0,72, p=<0,001), de tronco (r=0,70, p=<0,001), massa gorda total (r=0,73,p=<0,001) e de tronco (r=0,67, p=0,001). Não houve diferença significativa entre osindicadores bioquímicos de estado antioxidante, exceto a concentração da PCR quefoi maior no grupo não ativo (p=0,034). Considerando todos indivíduos, 50% apresentavam deficiência de alfa-tocoferol (concentração plasmática <11,6 mol/L).Foi observada relação negativa entre a concentração plasmática de alfa-tocoferol e aPCR (r=-0,18, =0,038).No grupo ativo houve correlação positiva entre a razãoptempo de atividade física:tempo de lesão e concentração plasmática demalondialdeido (r=0,38, =0,014). Nossos resultados, analisados em conjunto,psugerem que prática contínua de atividade física após a lesão atua auxiliando a umamelhor composição corporal e, possivelmente, a uma menor concentraçãoplasmática de PCR. O estado nutricional inadequado em alfa-tocoferol podecomprometer capacidade antioxidante, sendo necessárias medidas de apoionutricional para adequar a ingestão de alfa-tocoferol para este grupo.<br>Spinal cord injury is associated with body composition and biochemical changes. In addition an increase of body fat and the accumulation in the trunk together the infectious process due to spinal injury can cause the increase in plasma concentration of C-reactive protein (CRP). Fat mass and the high concentration of CRP can stimulate the production of reactive oxygen species, favoring the oxidative imbalance and the onset of disease. It is possible that the practice of regular physical activity can act beneficially by contributing to a better body fat distribution and adaptation of antioxidant systems in these subjects. Considering the importance of this theme and few studies about this topic, the aim of this study was to compare body composition and biochemical markers of antioxidant status, in subjects with cervical spinal cord injury, physically active and not active. The study included 24tetraplegic male (32 10 y and 10 8 y of injury time), divided in two groups, physically active (n = 15, with practice of physical activity for at least 3 months, 3times / week or more, totaling a minimum period of 150 minutes / week) and non-active (n = 9). Body composition was determined by dual energy X-ray absorptiometry. Blood samples were collected after overnight fasting (12 hours) for determination of biochemical parameters: antioxidant capacity, uric acid, bilirubin, albumin, alpha-tocopherol, malondialdehyde and CRP in plasma, and activity of superoxide dismutase in erythrocytes. The active group showed no higher BMI (p =0.003), total fat (%) and trunk (%) (p = <0.001) than the physically active group. Relationship was found between CRP and percentagem of total fat (r=0,72,p=<0,001), trunk (r=0,70, p=<0,001), total fat mass (r=0,73, p=<0,001) and trunk(r=0,67, p=0,001).There was no significant difference between the biochemical indicators of antioxidant status, except by the concentration of CRP that was higherin the non-active group (p = 0.034). Considering the all subjects, 50% had deficiency of alpha-tocopherol (plasma concentration <11.6 mmol / L). Negative relationship was found between plasma alpha-tocopherol and CRP (r=-0.18, p=0.038). In theactive group was a positive relationship between the ratio time physical activity: time of injury and plasma malondialdehyde (r=0.38; p= 0.014). Our results, taken together, suggest that continued practice of physical activity after injury acts helping to better body composition and, possibly, a lower plasma concentration of CRP. The inadequate nutritional status in alpha-tocopherol can affect the antioxidant capacity, so actions are necessary to adjust the nutritional status of alpha-tocopherol for this group.

A lesão medular (LM) promove uma condição devastadora que resulta em comprometimentos sensorial e motor, impedindo o desempenho funcional do indivíduo. O entendimento sobre os mecanismos envolvidos na reorganização cortical após uma eficiente estratégia terapêutica pode fornecer informações relevantes para o aprimoramento de tecnologias assistivas, como neuropróteses. Este trabalho teve como objetivos investigar as alterações funcionais e estruturais no córtex sensório-motor de ratos Wistar submetidos à atividade física na esteira após a lesão medular contusa. O objetivo secundário foi investigar a reorganização de outras áreas relacionadas ao comportamento motor, como o estriado, a substância negra e a medula espinhal. 17 ratos foram divididos aleatoriamente em três grupos: treinado (TR, n = 6), controle (CTL, n = 7) e sham (n = 4). Todos os animais receberam um implante de matriz de micro-eletrodos no córtex sensório-motor. Os animais dos grupos TR e CTL foram submetidos à LM contusa e os do grupo sham somente ao procedimento cirúrgico sem a LM. Foi realizada a avaliação eletrofisiológica antes da LM e nos 1º, 3º, 5º, 7º, 14º, 21º, 28º, 35º, 42º, 49º e 56º dias pós-operatórios (dPO) da lesão. O grupo TR realizou treinamento motor em uma esteira com velocidade controlada, tendo início no 5º dPO e foi realizado por 15 minutos, cinco vezes na semana. Os outros dois grupos ficaram sem treinamento. No 57º dPO, os animais foram sacrificados, e as medulas espinhais e os encéfalos foram coletados para análise imunohistoquímica. Os resultados eletrofisiológicos mostraram que houve uma diminuição significativa do número de neurônios corticais registrados ao longo do tempo para os animais com LM; existem neurônios que disparam em função do movimento mesmo após a LM, sendo o número desses neurônios significativamente menor nos animais controles; observou-se um padrão de atividade de potencial de campo local do córtex sensório-motor que antecede a ativação muscular. A análise imunohistoquímica do encéfalo mostrou diminuição significativa da imunoreatividade para o marcador de neurofilamentos no córtex motor do grupo CTL e no estriado para os grupos CTL e TR; no córtex somatossensorial houve aumento significativo desta marcação para o grupo TR; não houve diferença da imunoreatividade entre os grupos para o marcador de neurofilamentos na substância negra e nem para a proteína de vesícula, sinaptofisina, nas diferentes áreas encefálicas. Na medula espinhal verificou-se, na região rostral à lesão, aumento significativo da imunoreatividade para os marcadores de proteína associada ao microtúbulo 2 (MAP2), da sinapsina (SYS) e da proteína glial fibrilar ácida (GFAP) para o grupo TR e diminuição significativa da SYS para o grupo CTL; no segmento central à lesão, houve diminuição significativa da imunoreatividade para os marcadores MAP2 e SYS e aumento significativo para GFAP e OX-42 para os grupos CTL e TR; no segmento caudal à lesão houve diminuição significativa da imunoreatividade para os marcadores GFAP, SYS, MAP2 e OX-42 para o grupo CTL e aumento significativo do marcador MAP2 para o grupo TR. Os resultados obtidos neste trabalho mostram que a atividade física realizada na esteira após a LM é capaz de promover reorganização cortical sensório-motora e medular por meio da neuroproteção e neuroregeneração<br>Spinal cord injury (SCI) results in a devastating condition, which leads to motor and sensory deficits that impair the injured person functional performance. The understanding about the mechanisms involved in cortical reorganization after an efficient therapeutic strategy can provide relevant information for the improvement of assistive technology, such as neuroprosthesis. This work aimed to investigate the functional and structural changes in the sensorimotor cortex of spinal cord injured Wistar rats, which were submitted to treadmill training. A secondary objective was to investigate the reorganization of other areas related to the movement, such as striatum, substantia nigra and spinal cord. 17 rats were randomly divided into three groups: trained (TR, n = 6), control (CTL, n = 7) and sham (n = 4). All animals received a microelectrodes array in the sensorimotor cortex. Control and trained animals were submitted to contusive SCI and the sham group only to the surgical procedure without the contusion. Electrophysiological assessments were accomplished before SCI and on the 1st, 3rd, 5th, 7th, 14th, 21st, 28th, 35th, 42nd, 49th and 56th post-operative days (POd). The TR group performed the motor training on a treadmill with controlled speed, starting on the 5th POd and it was done for 15 minutes, five times per week. The other two groups did not receive any training. On the 57th POd, the animals were sacrificed and the spinal cords and brains were collected for immunohistochemistry analysis. Electrophysiological data revealed that there was a significant decrease of the cortical neurons number with time for the injured animals; there was neurons that fire in function of the movement even after the SCI, but the number of these neurons was significant smaller in CTL group; it was observed a pattern of sensorimotor local field potential activation before the muscular activation. Brain immunohistochemistry data showed immunoreactivity significant decrease for neurofilament staining of the CTL motor cortex and CTL and TR striatum; the somatosensory cortex had a significant increase of this maker for TR group; there was no difference between groups for the neurofilament maker in the substantia nigra and neither to the vesicle protein maker, synaptophysin, in the different brain areas. In the spinal cord rostral to the lesion there were significant increase of the immunoreactivity for the microtubule associated protein 2 (MAP2), synapsin (SYS) and glial fibrillary acidic protein (GFAP) for the TR group and significant decrease of SYS for the CTL group; central to the lesion, there were immunoreactivity significant decrease for the MAP2 and SYS makers and a significant increase for the GFAP and OX-42 makers in CTL and TR groups; and caudal to the lesion, there were immunoreactivity significant decrease for the GFAP, SYS, MAP2 and OX-42 for the CTL group and significant increase of MAP2 maker for the TR group. Together these findings show that the physical activity on a treadmill after spinal cord injury is capable of producing sensorimotor cortex and spinal cord reorganization throughout the neuroprotection and neuroregeneration

Spinal cord injuries (SCI) or other lower-body disabilities can change the life of a person significantly both physically and psychologically. Chapter 1 describes how physical activity is associated with improved physical fitness, health and psychological well-being for people with lower-body disabilities but also that a number of limitations exist to potentially discourage this population from exercising. One of these limitations is a lack of exercise water activities as traditional aquatic sports such as rowing, kayak and canoe requires a level of trunk muscle activation that is often missing for people with SCI. The main aim of this dissertation has been to develop a human-powered watercraft that could be maneuvered by people with lower-body disabilities. This process is described in chapter 2 including the results of a study, which showed the metabolic expenditure when using the watercraft to be similar to other physical activities performed by people with lower-body disabilities. Moreover, the mechanical efficiency was found to be comparable to other human-powered watercrafts and could, as a result, be an alternative fitness tool especially for people with lower-body disabilities, who seek water activities. Chapter 3 describes the development of an improved version of the watercraft, and the results of testing that shows improved hydrodynamic resistance and relationship between mechanical power output and speed. Chapter 4 investigates how velocity fluctuations may affect the speed of the watercraft and if different propulsion modes have an influence. No significant differences are found but several ideas for further research are given. Finally, the interface pressure is evaluated in a setting that mimics the one on the watercraft. It is known that high interface pressure for long periods of time increases the risk of pressure ulcer development for people with SCI. Chapter 5 describes a case-study of an Italian handcycling champion arm cranking on an arm ergometer at two difference backrest inclinations while interface pressure and oxygen uptake was measured. The results showed a difference in pressure between backrest inclinations and from arm cranking and resting. This could help people with SCI to still be able to exercise even if suffering from pressure ulcers.

The spinal cord injured (SCI) population has been shown to be at risk of developing serious secondary complications after injury and many authors have attributed this in part to a sedentary life style. Consequently, this study was designed to examine the issues that encourage and discourage participation in physical activity and sport after a SCI. In recognition of the profound influence of society on disability, it was deemed important to explore fully the social, as well as individual, issues that affect participation. Semi-structured interviews were used to explore the experiences of individuals with paraplegia concerning their experiences with physical activity and sport. Analysis of their statements led to the development of overarching themes that were compared to the growing literature on disability and sport and physical activity. Through the words of eight participants, this study has confirmed the potential importance of physical activity and sport in an individual's life post-injury. More importantly, participants credited activities with providing profound meaning to their lives and a method of contrasting societal stigma as well as creating a positive identity. The potential role of physical activity in assisting in this process emerged as a predominant theme. The participants' narratives provide evidence that social factors do play a large role in enabling or disabling their participation in sport and physical activity after SCI. In addition to citing environmental barriers such as accessibility, availability of resources and equipment, and attitudinal barriers of others; their stories also reveal an internal process of redefining self that occurs after injury which profoundly impacts participation. This internal process, however, is likely in turn influenced somewhat by societal ideals, again outlining the profound influence of society. Consequently, the answer to the question 'What factors determine whether an individual will participate or not participate in physical activity and sport following a SCI?' appears to be complex, involving both internal and external factors. The information gained through the narratives of these eight individuals can help rehabilitation professionals, planners of physical activity and sport, and individuals with SCI, their families and their friends by providing needed insight into both the personal and societal challenges they face.

Abstract Purpose: To characterize physical activity of people using manual wheelchairs with spinal cord injury in Manitoba. Methods: An observational study of manual wheelchairs users with spinal cord injury. Participants completed surveys related to self-efficacy for exercise, physical activity participation, and shoulder pain. Accelerometers were worn for 7 days on the wrist and trunk (GT3X, 100 Hz, 5 s epochs) and completed an activity log concurrently. Individual specific thresholds were determined for moderate intensity during a pace graded wheeling trial. Physical activity and sedentary time were characterized using various derived variables. Results: Twenty five participants (12 tetra:13 para, 21M:4F) demonstrated excellent accelerometer adherence achieving an average of 6.2 days worn for over 13 hours per day. A total of 74.6 min (all activity) and 115 min (contiguous bouts of activity) were achieved over time worn (6.2 days), corresponding to 11.8 and 18.5 min/day respectively. The participants substantially exceeded the published SCI guidelines (40 min/week, P<0.01) but were under the able bodied threshold of 150 min/week (P<0.01). No relationships were observed between surveys and objectively measured PA. Characterization of PA bouts revealed few participants (n=7) exhibiting single bout durations greater than 10 minutes, with an average contiguous bout duration of 30 s. A new functional classification scheme revealed positive correlations to PA variables and wheeling performance. Sedentary times ranged from 6.25 to 8.4 hours per day depending upon accelerometer placement. Conclusion: Arm based accelerometry can be used to determine PA and sedentary characteristics of manual wheelchair users with individual specific moderate intensity thresholds. Participants exceeded the SCI specific activity guidelines in terms of time per week, and failed to reach bout durations of 20 min. This study supports the use of able-bodied PA guidelines as a target. A new functional classification scheme was derived based upon wheeling dependent muscle innervation that had enhanced prediction of PA relative to standard anatomical classification<br>October 2015

Thesis (Ph.D.)--University of Illinois at Urbana-Champaign, 2007.<br>Source: Dissertation Abstracts International, Volume: 68-11, Section: B, page: 7295. Adviser: Weimo Zhu. Includes bibliographical references (leaves 101-121) Available on microfilm from Pro Quest Information and Learning.

O objetivo desta tese foi perceber a influência potencial da atividade física e do exercício físico na aptidão física relacionada com a saúde, na independência funcional e na qualidade de vida de pessoas com paraplegia crônica, usuários de cadeira de rodas manual e habitantes da comunidade. Três estudos foram elaborados: o Estudo I reviu a literatura dos programas de exercício físico relativos à parte superior do corpo para pessoas com paraplegia crônica e usuários de cadeira de rodas manual que poderiam ser desenvolvidos em contexto comunitário e verificou os seus efeitos na independência funcional e na qualidade de vida dos mesmos. Foram pesquisadas as bases eletrônicas com acesso a estudos quasi-experimentais, ensaios clínicos controlados e não controlados publicados na língua Inglesa e que combinavam palavras chave, tais como, "paraplegia", "exercício físico", "independência funcional", "qualidade de vida" e respectivos sinônimos. Os outros estudos analisaram o papel desempenhado pelo desporto adaptado (Estudo II) e os efeitos de um programa de treino de resistência em circuito adaptado com pesos-livres e banda elástica (Estudo III) no nível de atividade física, aptidão física relacionada com a saúde, independência funcional e qualidade de vida de habitantes da comunidade com paraplegia crônica e usuários de cadeiras de rodas manual. O Estudo II englobou 25 indivíduos divididos em grupo desportivo e grupo não desportivo, enquanto que o Estudo III foi conduzido com um homem de 67 anos que participou num programa de 12 semanas. Ambos os estudos avaliaram: i) a atividade física através de acelerômetro (ActiGraph GT3X); ii) a independência funcional através do circuito de cadeira de rodas; iii) a qualidade de vida através do WHOQOL-BREF; iv) a aptidão física relacionada com a saúde: a composição corporal segmentada pela absorciometria radiológica de dupla energia (DEXA) (massa gorda, massa magra, massa total e percentual de gordura dos braços, tronco e do corpo inteiro; densidade mineral óssea do punho); a força muscular: força isocinética do ombro - avaliou bilateralmente os movimentos de flexão/extensão, adução/abdução rotação interna/externa a 60º/s, resultando em valores de pique torque (Nm) e do défice bilateral (%) (Estudo II e III), e força máxima - teste derepetição máxima (só o Estudo III); e a aptidão respiratória (VO2PICO) através do teste do tapete rolante. Esta tese verificou que, apesar da qualidade insuficiente dos achados, o exercício aeróbico (ergômetro de braço) e de resistência são os principais tipos de exercício desenvolvido em contexto de comunidade, principalmente em casa, ambos induzindo efeitos positivos na qualidade de vida. Adicionalmente, o exercício de resistência melhorou a independência funcional. A participação no desporto e no circuito de treino de resistência adaptado pareceu influenciar positivamente a independência funcional, o domínio físico e geral da qualidade de vida dos indivíduos com paraplegia, usuários de cadeira de rodas manual habitantes da comunidade Portuguesa. No entanto, só a prática desportiva mostrou um efeito positivo na aptidão cardiorrespiratória, enquanto a metodologia adotada no circuito de treino não foi suficiente para neutralizar o declínio da aptidão cardiorrespiratória num participante idoso. PALAVRAS CHAVE: LESÃO MEDULAR, ATIVIDADE FÍSICA, EXERCÍCIO FÍSICO, APTIDÃO FÍSICA RELACIONADA A SAÚDE, INDEPENDÊNCIA FUNCIONAL, QUALIDADE DE VIDA.<br>This thesis aimed to understand the potential influence of physical activity and physical exercise on health-related physical fitness, functional independence and quality of life of people with chronic paraplegia, manual wheelchair users and community dwellers. Three studies were conducted: Study I reviewed the literature of upper body exercise programs that could be developed in a community setting for people with chronic paraplegia and manual wheelchair users and verified their effects on functional independence and quality of life. Electronic databases with access to quasi-experimental studies have been searched for uncontrolled and controlled clinical trials published in English language, that combined the keywords paraplegia, exercise, functional independence and quality of life and respective synonyms. The other studies analyzed the role of adapted sport (Study II) and the effects of a circuit resistance training program adapted with free-weights and elastic-bands (Study III) on physical activity level, health-related physical fitness, functional independence and quality of life of community dwellers with chronic paraplegia and manual wheelchair users. Study II comprised 25 individuals divided into a sport and non-sport group, while Study III was conducted with a 67-year-old man who participated in a 12-week program. Both studies evaluated: i) physical activity by the accelerometer (ActiGraph GT3X); ii) functional independence through the wheelchair circuit; iii) quality of life by WHOQOL-BREF; iv) health-related physical fitness: body composition segmented by the absorption of dual energy X-rays-DXA (fat percentage and fat, lean and total mass of arms, trunk and whole body, and wrist bone mineral density); muscle strength: isokinetic shoulder strength -flexion/extension, adduction/abduction and internal/external rotation bilateral movements at 60º/sec, resulting in peak torque (Nm) and bilateral deficit (%), and maximal strength - the repetition maximum test (only Study III); and cardiorespiratory fitness (VO2PEAK) by the treadmill test. The present thesis has found that despite the insufficient quality evidence, aerobic (arm ergometer) and resistance exercise are the mainly type of exercise developed in the community setting, mainly home-based, inducing both positive effects on quality of life, and resistance exercise improved functional independence. Participation in sports and in the adapted circuit resistance training seems to influence positively functional independence and physical domain and general quality of life of individuals with paraplegia, manual wheelchair users and Portuguese community dwellers. Nonetheless, only sport practice has showed a positive cardiorespiratory fitness effect, while the current circuit training methodology was not enough to counteract the decline of cardiorespiratory fitness in an older man.

O objetivo desta tese foi perceber a influência potencial da atividade física e do exercício físico na aptidão física relacionada com a saúde, na independência funcional e na qualidade de vida de pessoas com paraplegia crônica, usuários de cadeira de rodas manual e habitantes da comunidade. Três estudos foram elaborados: o Estudo I reviu a literatura dos programas de exercício físico relativos à parte superior do corpo para pessoas com paraplegia crônica e usuários de cadeira de rodas manual que poderiam ser desenvolvidos em contexto comunitário e verificou os seus efeitos na independência funcional e na qualidade de vida dos mesmos. Foram pesquisadas as bases eletrônicas com acesso a estudos quasi-experimentais, ensaios clínicos controlados e não controlados publicados na língua Inglesa e que combinavam palavras chave, tais como, "paraplegia", "exercício físico", "independência funcional", "qualidade de vida" e respectivos sinônimos. Os outros estudos analisaram o papel desempenhado pelo desporto adaptado (Estudo II) e os efeitos de um programa de treino de resistência em circuito adaptado com pesos-livres e banda elástica (Estudo III) no nível de atividade física, aptidão física relacionada com a saúde, independência funcional e qualidade de vida de habitantes da comunidade com paraplegia crônica e usuários de cadeiras de rodas manual. O Estudo II englobou 25 indivíduos divididos em grupo desportivo e grupo não desportivo, enquanto que o Estudo III foi conduzido com um homem de 67 anos que participou num programa de 12 semanas. Ambos os estudos avaliaram: i) a atividade física através de acelerômetro (ActiGraph GT3X); ii) a independência funcional através do circuito de cadeira de rodas; iii) a qualidade de vida através do WHOQOL-BREF; iv) a aptidão física relacionada com a saúde: a composição corporal segmentada pela absorciometria radiológica de dupla energia (DEXA) (massa gorda, massa magra, massa total e percentual de gordura dos braços, tronco e do corpo inteiro; densidade mineral óssea do punho); a força muscular: força isocinética do ombro - avaliou bilateralmente os movimentos de flexão/extensão, adução/abdução rotação interna/externa a 60º/s, resultando em valores de pique torque (Nm) e do défice bilateral (%) (Estudo II e III), e força máxima - teste derepetição máxima (só o Estudo III); e a aptidão respiratória (VO2PICO) através do teste do tapete rolante. Esta tese verificou que, apesar da qualidade insuficiente dos achados, o exercício aeróbico (ergômetro de braço) e de resistência são os principais tipos de exercício desenvolvido em contexto de comunidade, principalmente em casa, ambos induzindo efeitos positivos na qualidade de vida. Adicionalmente, o exercício de resistência melhorou a independência funcional. A participação no desporto e no circuito de treino de resistência adaptado pareceu influenciar positivamente a independência funcional, o domínio físico e geral da qualidade de vida dos indivíduos com paraplegia, usuários de cadeira de rodas manual habitantes da comunidade Portuguesa. No entanto, só a prática desportiva mostrou um efeito positivo na aptidão cardiorrespiratória, enquanto a metodologia adotada no circuito de treino não foi suficiente para neutralizar o declínio da aptidão cardiorrespiratória num participante idoso.PALAVRAS CHAVE: LESÃO MEDULAR, ATIVIDADE FÍSICA, EXERCÍCIO FÍSICO, APTIDÃO FÍSICA RELACIONADA A SAÚDE, INDEPENDÊNCIA FUNCIONAL, QUALIDADE DE VIDA.<br>This thesis aimed to understand the potential influence of physical activity and physical exercise on health-related physical fitness, functional independence and quality of life of people with chronic paraplegia, manual wheelchair users and community dwellers. Three studies were conducted: Study I reviewed the literature of upper body exercise programs that could be developed in a community setting for people with chronic paraplegia and manual wheelchair users and verified their effects on functional independence and quality of life. Electronic databases with access to quasi-experimental studies have been searched for uncontrolled and controlled clinical trials published in English language, that combined the keywords paraplegia, exercise, functional independence and quality of life and respective synonyms. The other studies analyzed the role of adapted sport (Study II) and the effects of a circuit resistance training program adapted with free-weights and elastic-bands (Study III) on physical activity level, health-related physical fitness, functional independence and quality of life of community dwellers with chronic paraplegia and manual wheelchair users. Study II comprised 25 individuals divided into a sport and non-sport group, while Study III was conducted with a 67-year-old man who participated in a 12-week program. Both studies evaluated: i) physical activity by the accelerometer (ActiGraph GT3X); ii) functional independence through the wheelchair circuit; iii) quality of life by WHOQOL-BREF; iv) health-related physical fitness: body composition segmented by the absorption of dual energy X-rays-DXA (fat percentage and fat, lean and total mass of arms, trunk and whole body, and wrist bone mineral density); muscle strength: isokinetic shoulder strength -flexion/extension, adduction/abduction and internal/external rotation bilateral movements at 60º/sec, resulting in peak torque (Nm) and bilateral deficit (%), and maximal strength - the repetition maximum test (only Study III); and cardiorespiratory fitness (VO2PEAK) by the treadmill test. The present thesis has found that despite the insufficient quality evidence, aerobic (arm ergometer) and resistance exercise are the mainly type of exercise developed in the community setting, mainly home-based, inducing both positive effects on quality of life, and resistance exercise improved functional independence. Participation in sports and in the adapted circuit resistance training seems to influence positively functional independence and physical domain and general quality of life of individuals with paraplegia, manual wheelchair users and Portuguese community dwellers. Nonetheless, only sport practice has showed a positive cardiorespiratory fitness effect, while the current circuit training methodology was not enough to counteract the decline of cardiorespiratory fitness in an older man.

Il nostro lavoro ha analizzato vari possibili aspetti che sono essenziali per definire programmi di attività fisica adattata; ci sono molti strumenti che permettono di effettuare varie tipologie di valutazione e ovviamente non tutti possono essere considerati. Il primo studio intendeva fornire un metodo innovativo ed obiettivo per misurare il grado di fornitura / prelievo di ossigeno nel singolo muscolo durante esercizio controllato da una stimolazione incrementale del pool di unità motorie, attraverso una stimolazione elettrica che fosse indipendente dalla motivazione e dal controllo centrale dei soggetti testati. Successivamente ci si è spostati da una valutazione locale ad una globale, studiando diverse tipologie di attività motoria adattata in un contesto riabilitativo. Nel secondo e nel quarto studio abbiamo trattato due diversi tipi di attività fisica adattata per persone affette da lesione midollare. In particolare la spesa energetica e gli adattamenti metabolici durante un'attività che simulava delle discipline sportive mediante una consolle per videogiochi e durante attività di handbike su un ergometro progettato in modo specifico. Nel terzo studio è stato invece analizzato un tipico trattamento riabilitativo per pazienti affetti da ictus; il trattamento consisteva nel cammino in sospensione con scarico del peso corporeo su uno specifico nastro trasportatore. In questo studio abbiamo indagato l'influenza della percentuale di scarico del peso corporeo e della velocità del treadmill sulla spesa energetica e sul reclutamento muscolare dei muscoli responsabili del cammino. Riassumendo i quattro studi erano: 1. Differenza tra fornitura e prelievo di ossigeno durante stimolazione elettrica incrementale nel muscolo tibiale anteriore. 2. Spesa energetica in attività fisica durante videogioco in soggetti affetti da lesione midollare. 3. Indice di costo fisiologico e reclutamento muscolare durante cammino in sospensione al nastro trasportatore in soggetti sani e soggetti affetti da ictus. 4. Valutazione metabolica di atleti disabili durante attività fisica con un ergometro specificatamente progettato: risultati preliminari. Le conclusioni di ogni studio sono state: 1. Il nostro lavoro ha fornito uno strumento relativamente semplice per valutare obiettivamente il bilancio tra ossigeno fornito e prelevato, indipendentemente dalla motivazione del soggetto, nel muscolo scheletrico umano a vari livelli di forza prodotta. In particolare il sistema ha mostrato che, più alto era la concentrazione di O2Hb, migliore era la risposta del microcircolo nell'evitare che vi fosse una grossa differenza tra O2 fornita e prelevata. Inoltre, più il muscolo era affaticabile, più elevato era la differenza tra O2 fornito e prelevato. Questo fattore può essere relativo al livello di inadeguatezza del microcircolo a soddisfare l'aumentata richiesta di O2 via via che il livello di contrazione aumentava, nel quale sempre più emoglobina ossigenata doveva essere convertita in deossigenata. Questo sistema può essere usato per stimare la cinetica degli adattamenti aerobici durante I transienti dell'aumentata richiesta metabolica nei muscoli affetti da specifiche miopatie o in seguito a protocolli riabilitativi, di trattamento e/o programmi di allenamento. 2. Questo lavoro suggerisce che nei oggetti affetti da lesione midollare, la pratica di attività fisica con videogame che simulino sport reali, induce un incremento significativo dei parametri cardiopolmonari e metabolici. Gli adattamenti funzionali correlati, specialmente per la simulazione del pugilato, possono essere considerati come uno stimolo aerobico per promuovere la salute. Inoltre l'incremento di spesa energetica può giocare un ruolo importante nel computo calorico giornaliero quando i soggetti cercano di controllare i loro peso. 3. Il cammino in sospensione al nastro trasportatore per soggetti sani o soggetti con esiti di ictus, permette ai pazienti di avere delle sessioni di allenamento più lunghe ed efficaci con un inferiore indice di costo fisiologico. Questo parametro e il consumo di ossigeno, sono fortemente correlati e di conseguenza, l'indice di costo fisiologico può essere usato in un ambiente clinico in maniera economica, senza particolari strumentazioni, in modo da poter confrontare due o più soggetti. Il significato del miglior rapporto tra reclutamento elettrico dei muscoli degli arti inferiori e indice di costo fisiologico deve essere approfondito. Uno studio longitudinale potrebbe essere utile per verificare che la combinazione di riduzione del peso corporeo e velocità del nastro trasportatore sia la più favorevole per consentire un allenamento muscolare ed aerobico adeguati a ri-allenare pazienti con esiti di ictus. 4. I dati preliminari confermano che l'ergometro handbike, appositamente progettato può aiutare a controllare l'intensità dell'esercizio praticato. Una integrazione di successo di allenamenti aerobici in protocolli riabilitativi per soggetti affetti da lesione midollare può essere più semplice se l'esercizio è sicuro, facilmente adattabile a soggetti con scarsa capacità fisica, divertente, motivante e utile per l'attività di mobilità quotidiana. La pratica dell'hanbike soddisfa questi requisiti. Gli accorgimenti più importanti di questo ergometro sono un'adeguata ed ergonomica interfaccia ed un sistema di controllo preciso ed affidabile della potenza prodotta dal soggetto. Inoltre, un sistema che può essere usato sia per valutare che per allenare, può essere uno strumento molto utile nell'aiutare gli operatori dell'attività fisica adattata a pianificare specifici programmi di attività fisica. Ulteriori studi saranno necessari su un gruppo di individui simile, ma più numeroso.<br>Our research has analysed various possible aspects that are essential to define custom programs of Adapted Physical Activity; there are many tools that allow performing various types of assessments and obviously not everyone could be considered. Therefore the first study was aimed to provide a novel objective method to measure the degree of individual muscle oxygen supply/uptake balance during exertion through a controlled incremental activation of the motor unit (MU) pool through neuromuscular electrical stimulation (NMES) that is independent from motivation and central control of tested subjects. This tool could be applied to estimate the kinetics of aerobic adaptation to increasing metabolic demand in muscles affected by myopathies or subjected to rehabilitation or training programmes. Afterwards we have moved from local to global measures, studying different kinds of APA in a rehabilitation setting. In second and fourth study we treat two different special leisure time physical activities for SCI subjects. In particular, energy expenditure and metabolic adaptation during activity promoting video games (APVG) and during handbike exercise on a specific designed ergometer. At the end, in the research, we investigated a typical post stroke rehabilitation treatment, such as BWS, studying the influence of body weight reduction and walking speed on energy expenditure and lower limb muscles recruitment. Summarizing the four studies were: 1. Oxygen supply/uptake mismatch during incremental stimulation of human tibialis anterior. 2. Energy expenditure of activity-promoting video games in spinal cord injured subjects. 3. Physiological Cost Index and Muscular Recruitment during Body Weight Support Treadmill Training in Healthy and Stroke Patients 4. Metabolic evaluation of the disabled athlete during handcycling on a specific designed ergometer: preliminary results Conclusions of the four studies were: 1. Our work provided a relatively simple tool for the objective functional evaluation of the O2 supply/uptake balance, independent of subject motivation, in a single skeletal muscle in humans at increasing levels of output force. In particular its sensitivity showed that the higher the O2Hb concentration at rest, the better is the specific behaviour of the microvascular network response, with incremental stimulation, in limiting O2M. Indeed, Fig. 2.3 clearly shows that the higher the fatigability of the stimulated muscle, the higher the O2M area. This fact may be related to the degree of inadequacy of the microcirculation to match the increased O2 demand from one level of the evoked contractions to the next, more intense, level with more O2Hb to be deoxygenated to HHb. This tool could be applied to estimate the kinetics of aerobic adaptation during transients of increasing metabolic demand in muscles affected by specific myopathies or the effects of particular rehabilitation protocols, treatments and/or training programmes. 2. This work suggests that in spinal cord injured subjects APVG practice induces sizeable increases of cardiopulmonary and metabolic parameters. The related functional adaptations, especially for boxing, may be considered an aerobic training stimulus to promote health. Furthermore, the energy expenditure increase may play a role in total energy balance computation when subject weight control is sought for. 3. Body weight support treadmill training in healthy or post stroke subjects is well tolerated. This practice enables post stroke patients to have longer and more effective training session with a lower physiological cost index. This last and VO2 are strongly correlated so, the PCI can be evaluated inexpensively in a clinical setting, to get exercise capacity on treadmill and compare two or more patients. The best EMGTOT / PCI value significance requires further analysis. A longitudinal study will be suitable to check if the suggested combination of speed and BWR will be the most favourable to reach a valuable muscular and aerobic training stimuli to retain post stroke patient. 4. These preliminary results introduced a new instrumented handbike which will help to control handcycling intensity. A successful integration of aerobic exercise training into rehabilitation protocol of people with Spinal Cord Injury may be more likely if aerobic exercise is safe, easily adjustable to a low physical capacity subject, fun to do, motivating, and useful in daily mobility. Handbike practice may meet these requirements. Important features of this ergometer are an adequate ergonomic interface and an optimal system to impose a precise power exertion. A system that allows training and testing with the same device, may be a useful tools in helping Adapted Physical Activity operators to plan specific physical activity programs. Further studies need to be conducted with similar but larger populations.

Knowledge mobilization has been described as putting research in the hands of research users. Few studies have examined knowledge mobilization within community-based organizations (CBOs). To address this research gap, this dissertation examines knowledge mobilization within a CBO that supports people with spinal cord injury (SCI). Research suggests that communication channels, or the means by which a message is delivered, may affect knowledge mobilization. This dissertation presents four manuscripts examining how communication channels were used by the CBO to disseminate physical activity guidelines and intervention strategies to people with SCI. Manuscript 1 investigated reach and effectiveness of an event-based knowledge mobilization initiative delivered by the CBO using interpersonal communication channels to disseminate the guidelines to people with SCI. Results indicated that the event-based knowledge mobilization initiative was effective for initial dissemination of the guidelines. However, further long-term efforts are needed. Manuscript 2 describes how the event-based knowledge mobilization initiative was implemented by the CBO. Recognizing that support personnel are important messengers, the reach and effectiveness of the initiative for persuading support personnel to disseminate the guidelines was examined. Results indicated that an event-based knowledge mobilization initiative can be implemented by a CBO and may be an effective strategy for CBOs to disseminate information to support personnel. Manuscript 3 further examined the role of communication channels in the process of knowledge mobilization within the CBO using network analysis. Results indicated that CBO staff and volunteers’ integration within interpersonal communication channels was associated with greater knowledge of evidence-based physical activity resources and engagement in physical activity promotion behaviours. Manuscript 4 examined the feasibility of training peers with SCI to learn an evidence-based approach to physical activity promotion called Brief Action Planning. Findings indicated that Brief Action Planning is a tool that can be feasibly learned and potentially used by peers to promote physical activity to their mentees through interpersonal communication channels. Overall this dissertation contributes to a small but emerging body of literature examining knowledge mobilization in CBOs. Findings indicate that through a community-university multidisciplinary partnership and appropriate communication channels, a CBO can effectively and feasibly disseminate evidence-based physical activity information.<br>Thesis (Ph.D, Kinesiology & Health Studies) -- Queen's University, 2013-08-28 17:27:32.841