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 1 National Rehabilitation Hospital Washington DC 1 National Rehabilitation Hospital, Washington, DC National Rehabilitation Hospital, Washington, DC National Rehabilitation Hospital Washington DC 2 University of Dundee, Scotland University of Dundee, Scotland ASIA/ISCoS Annual Meeting ASIA/ISC S A ASIA/ISC S A ASIA/ISCoS Annual Meeting l M l M ti ti June 27, 2006, Boston, MA June 27, 2006, Boston, MA 1
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 p j j y 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 2
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 j y y p 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) 3
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) – lack of resources (e.g., cost of the exercise l lack of resources (e.g., cost of the exercise l k k f f ( ( t t f th f th i i 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 Hedrick, 1997 Hedrick, 1997 4
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 p y 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) Reduced quality of life Reduced quality of life (Lucke, 1999) (Lucke 1999) (Lucke, 1999) 5
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? 6
Methods Methods Methods Methods Cross Cross-sectional design Cross Cross sectional design sectional design sectional design Self Self- -reported mail survey reported mail survey Adults ( Adults ( ≥ 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 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 Multiple logistic regression Multiple logistic regression 7
Sample Characteristics Sample Characteristics (n=355) Sample Characteristics (n=355) Sample Characteristics (n=355) (n=355) Male Male Male Male 59 4% 59 4% 59.4% 59.4% Hispanic origin Hispanic origin 5.1 5.1 White race White race White race White race 87 9 87 9 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 Some college/college graduates Some college/college graduates 49 0 49 0 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) Average age at injury (year) Average age at injury (year) 31.6 31 6 31 6 31.6 14.2 14 2 14.2 14 2 Average years since injury Average years since injury 15.7 15.7 12.0 12.0 8
Sample Characteristics Sample Characteristics (Cont ) Sample Characteristics Sample Characteristics (Cont.) (Cont ) (Cont.) Injury level Injury level j j y 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 Unknown Unknown 5 3 5.3 5.3 5 3 Incomplete SCI Incomplete SCI 53.2 53.2 Wheelchair users Wheelchair users Wheelchair users Wheelchair users 86.8 86.8 86.8 86.8 – Power Power 34.7 34.7 – Manual Manual 65.3 65.3 9
Functional Conditions Functional Conditions Functional Conditions Functional Conditions Need help with … ‘all the time’ Need help with … ‘all the time’ % 100 80 60 40 28.7 28.2 26.2 25.1 20 5.9 5.1 0 ide the home f chair & bed /showering t/commode Dressing Eating Bathing/show Using toilet/com Dress Getting in/out of cha Getting around inside t Eat 10 10
Functional Conditions Functional Conditions Functional Conditions (Cont.) Functional Conditions (Cont ) (Cont ) (Cont.) ‘all the time ‘ ‘ Need help with … all the time Need help with … all the time Need help with Need help with ‘all the time % 100 80 60 60 53.2 53.2 40 24.5 19.7 19 7 16.3 20 7.9 3.1 0 0 Preparing own Shopping for Managing Using Doing heavy Doing light meals personal items money telephone work around work around the house the house 11 11
Top Five Chronic Conditions Top Five Chronic Conditions Top Five Chronic Conditions Top Five Chronic Conditions % 100 80 60 42.8 40 40 30.4 26.8 22.0 19.7 20 0 Incontinence Depression Osteoporosis Arthritis High cholesterol 12 12
Exercise Activities Exercise Activities Exercise Activities Exercise Activities % 100 80 60 40.0 40 28.7 19 2 19.2 20 12.1 0 Exercise at Exercise at Exercise at Exercise at Exercise Exercise No exercise No exercise home & home only outside of outside of home only home 13 13
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