Community-based Virtual Reality Group Exercise Training in Persons with Spinal Cord Injury

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1 Community-based Virtual Reality Group Exercise Training in Persons with Spinal Cord Injury Jennifer L. Trilk, Ph.D. SCSCIRF Board Presentation April 8, 2016

2 Director, Human Performance Lab Assistant Professor, Physiology and Exercise Science Measuring the 4 Cornerstones of Physiological Health Patients evaluated at the Human Performance Lab s state-of-the-art equipment to help improve participant outcomes Cardiorespiratory Fitness Metabolic Fitness Muscular Strength Body Composition Maximal Rate of Oxygen Consumption (VO 2max ) Lactate Threshold Muscle Mitochondrial Oxidative Capacity Maximal Power Output Maximal Strength Fat Free Mass/Lean muscle Fat Mass -Visceral Adipose Tissue Bone Mineral Density

3 Exercise Physiologist for Roger C. Peace Paracycling Team Athletes with limb amputees, spinal cord injury, visually impaired, traumatic brain injury, and stroke. Categories C 1-5 H 1-5 Trike Tandem

4 Exercise and physical activity are important to health and the prevention and treatment of many chronic diseases More should be done to address physical activity and exercise in healthcare settings

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6 Teaching Exercise and Lifestyle Medicine at USCSOMG USCSOMG is a leading institution incorporating Exercise and Lifestyle Medicine into all 4 years of curriculum to educate future physicians on the beneficial effects of exercise for all populations

7 Background of the Study Sedentary behavior in persons with Spinal Cord Injury subsequently increases risk of cardiovascular disease, obesity, metabolic syndrome, type 2 diabetes, osteoporosis, as well as depression, anxiety and reduced quality of life

8 Exercise Interventions in persons with SCI Alternatively, persons with SCI who choose to be physically active or train and compete in athletic events are likely to have better cardiometabolic health, body composition (lower fat mass and higher skeletal muscle mass), and improved quality of life compared to sedentary persons with SCI en.wikipedia.org;

9 Virtual Reality (VR) Handcycling Advocates believe VR exercises are fun, increase motivation for exercise, and offer major advantages VR exercise in a group-exercise setting may improve psychosocial health through increasing social capital Community-based group handcycling also may have a further reach beyond the intervention and serve as a gateway to increase the SCI person s affiliations with other cycling organizations in the community No study to our knowledge has examined the effects of VR technology in a group setting on cardiometabolic health, psychosocial health and QOL in persons with SCI

10 Specific Aims and Hypotheses Specific Aim 1: To compare differences in cardiometabolic health, psychosocial health and QOL between athletes and non-athletes with SCI. Hypothesis 1: SCI athletes will have a better cardiorespiratory fitness, metabolic fitness, greater upper body strength and function, and better psychosocial health and QOL than sedentary persons with SCI. Specific Aim 2: To examine the effects of a community-based, 8-week VR group hand cycle exercise training program in sedentary persons with SCI on cardiometabolic health, psychosocial health and QOL, and whether these effects are maintained 3 months post-intervention. Hypothesis 2: Sedentary persons with SCI who participate in 8 weeks of community-based, group VR hand cycle training will improve cardiorespiratory fitness, metabolic fitness, upper body strength and function, and have increased social capital, psychosocial health and QOL at 8 weeks and at 3 months post-intervention compared to sedentary persons with SCI who undergo standard-of-care.

11 Research Design, Participants: AIM 2 Effects of the exercise intervention between a hand cycling (VR) group and a waitlist/control group (WC) determined using a mixed-model, repeated measures design Sedentary SCI patients randomly assigned to the VR group and train 2 days/week (1 2 days rest between sessions) for 8 weeks, or the WC group, who maintained current physical activity level for 8 weeks, and then enter the intervention

12 Participants SCI individuals >1 year post-injury Inclusion criteria: any level of injury that allowed participants the ability to participate in arm exercise Exclusion criteria: engagement in more than 1 day/week of moderate intensity physical activity

13 Methods Exercise Training 8 weeks, 2x/week, 1-hour sessions on a hand-cycle at Greenville Cycling and Multisport progression of duration and intensity occurring as participants became more fit Virtual reality cycling consisted of computer-based programs that changed the intensity of the cycling effort during the session

14 Methods Testing: VO 2 max and Lactate Threshold Power output started at 20-30W and increased progressively by 10-15W every 3 min until the subject reached LT, then increased W every 2 min until he/she could no longer continue Oxygen uptake (VO 2 ) obtained by open-circuit spirometry (Parvo Medics, Inc., Salt Lake City, UT) Lactate testing performed via capillary ear-lobe blood analysis (Lactate Plus, Sports Resource Group, Inc., Toronto, Canada)

15 Methods Testing: Body Composition Total body mass, percent fat mass, percent fat-free mass, volume of visceral adipose tissue (VAT), and bone mineral density measured by dual-energy X-ray absorptiometry (idxa, GE Healthcare-Lunar, Madison, WI, USA).

16 Outcome Metrics Overview Domain Test Methods Physiological Health Cardiorespiratory Fitness (VO 2 max) Whole Body Metabolic Fitness (Lactate Threshold) Muscular Power Participants will perform a graded hand cycling exercise test (GXT) using the Computrainer (RacerMate, Seattle, Washington) with power output starting at 20W and increasing progressively by 10-15W every 3 min until the subject reaches LT, and then increasing W every 1 min until he/she can no longer continue. Oxygen uptake (VO 2 ) will be obtained by open-circuit spirometry (Parvo Medics, Inc., Salt Lake City, UT). Lactate testing will be performed via capillary ear-lobe blood analysis (Lactate Plus, Sports Resource Group, Inc., Toronto, Canada). Hand cycling power output at VO 2 max Psychosocial health and QOL Body Composition Psychological Health and Quality of Life specific to SCI Total body mass, percent fat mass, percent fat-free mass, volume of visceral adipose tissue (VAT), and bone mineral density will be measured by dual-energy X-ray absorptiometry (idxa, GE Healthcare-Lunar, Madison, WI, USA). The Spinal Cord Injury Quality of Life Measurement System (SCI-QOL) is a spinal cord injury (SCI)-specific patient-reported outcome (PRO) measure of health-related quality of life (QOL) covering multiple domains of functioning, including physical, emotional, and social health.

17 Current Results Study is still in production. Currently, 4 SCI have completed the WC and 8 have completed VR. An improvement in VO 2 max observed in VR (17.3%) vs. WC (5.7%), with a trend toward differences between groups (p=0.050). 25 VO2max (ml/kgbw/min) WC VR 0 Pre VO2max Post VO2max

18 Current Results Exercise HR improved 6% with light exercise, & 7.5% with intense exercise in VR; statistical differences between groups (*p=0.028, p=0.016) Low Intensity HR (bpm) PreHRStage1 6.5%* PostHRStage1 WC VR High Intensity HR (bpm) PreHRStage5 7.5%* PostHRStage5 WC VR No statistically-significant differences were observed between groups in RHR (p=0.425), SBP (p=0.069), or DBP (P=0.553)

19 Current Conclusion A trend toward improved cardiorespiratory fitness with 8-weeks of handcycling has preliminarily been observed within the VR group compared to WC group No differences between groups in resting values of heart rate, blood pressure or lipid profiles Still to be analyzed: Quality of Life and Exercise Motivation Scales More SCI individuals are being recruited to determine group differences

20 Psychosocial Factors: Increasing Social Capital Furman 5K Run (and now Ride!) for Soteria Community Development fundraiser

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22 Excerpts from Testimonials I went into the study unsure of what to expect. The training sessions were hard but very enjoyable. I learned many things about conditioning and my personal health. Over just eight weeks my performance improved just over 20%. The whole process was very professional and efficient. I can honestly say the people I came into contact with were the type of people I would invite over to my house for dinner which means I was very comfortable with everyone. If an opportunity arises in the future to work with this group again I would not hesitate to participate year old male My dream was to ride the Swamp Rabbit Trail but I knew I would need help with my cardio. Jim and Jason from Greenville Cycling and Multi Sport were very encouraging and coached our group on the fundamentals of cycling. In the middle of the program I began to realized some improvements that helped me stay focused and try harder to finish. I began to sleep better my appetite improved and my overall attitude improved. On June 23rd I was able to fulfill my dream of riding The Swamp Rabbit Trail. In 97 degree weather I rode 6 miles and rested a few minutes then rode another 4 miles. My overall health also improved year-old male It was a privilege to be involved in the handcycling study. It was hard work, but I fell in love with handcycling during the process. Then I began to reap health benefits from the exercise, the type of exercise that is very difficult for a paraplegic to achieve in other ways. My upper body strength, respiration and cholesterol really improved. Socially I made new friends and now participate in the handcycle events offered by RCP. I plan to continue to handcycle as much and as often as possible. I really appreciate all the benefits this study has given me year-old male 22

23 Thank You! 23

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