M. Sol1, J. De Groot2, O. Verschuren3, H. Horemans4, P. Westers5, J. Visser-Meily6
1HU University of Apllied Sciences, Utrecht, Netherlands, 2HU University of Applied Sciences, Utrecht, Netherlands, 3De Hoogstraat Rehabilitation, Center of Excellence for Rehabilitation Medicine, Utrecht, Netherlands, 4Erasmus MC University Medical Centre Rotterdam, Department of Rehabilitation Medicine, Rotterdam, Netherlands, 5Julius Center, University Medical Center Utrecht, Department of Biostatistics and Research Support, Utrecht, Netherlands, 6University Medical Center Utrecht, Center of Excellence for Rehabilitation Medicine, Utrecht, Netherlands
Background: Youth with or without a disability benefit physically and mentally from a physical active lifestyle. Youth using a manual wheelchair are markedly less physically active than their ambulatory peers with or without a physical disability. These low levels of PA in youth using a wheelchair are worrisome and need attention.
Purpose: The first aim of this study was to evaluate both the short term and long term effects of a combination of wheelchair mobility skills (WMS) training and exercise training on physical activity and three determinants of physical activity: WMS, confidence in wheelchair mobility and physical fitness, in youth using a manual wheelchair. The second aim was to explore the differences in outcomes based on the order of training, i.e. WMS training before or after exercise training.
Methods: This practise based intervention consisted of exercise training (8wk), WMS training (8wk) and follow-up (16wk). A total of 60 youth using a manual wheelchair participated in this study. Half of the participants were enrolled in a pre-training waiting list period. Repeated measures included: Physical Activity (Activ8 monitor), WMS (Utrecht Pediatric Wheelchair Mobility Skills Test), Confidence in wheelchair mobility (Wheelchair Mobility Confidence scale) and Physical fitness (aerobic performance, cardiorespiratory fitness and anaerobic performance). The short and long term effects of the combined training and the effect of order of training were calculated per outcome parameter using multilevel model analyses. Secondary analysis included an unpaired sample t-test using the data of the waiting list period to determine if there was a significant difference in change during the training period compared to the waiting list period.
Results: Multilevel model analysis showed significant positive training effects for physical activity (p = 0.01), WMS (p< 0.001), confidence in wheelchair mobility (p<0.001), aerobic performance (p<0.001) and anaerobic performance (p<0.001). The short term effects post-training were maintained in the long term for all these outcomes, with the exception of anaerobic performance. Unpaired sample t-tests underscored these effects for physical activity (p<0.01), WMS (p <0.001) and confidence in wheelchair mobility (p=0.03). There we no short or long term training effects on cardiorespiratory fitness. The order of training only showed a significant effect for confidence in wheelchair mobility, with exercise before WMS training as the preferred order of training.
Conclusion(s): A combination of exercise and WMS training appears to have significant positive long term effects on physical activity, WMS, confidence in wheelchair mobility and aerobic performance in youth using a manual wheelchair. More insight is needed towards finding an effective form of exercise training to increase cardiorespiratory fitness in youth using a manual wheelchair.
Implications: Exercise training and wheelchair mobility skills training can lead to an sustained improvement in physical activity in youth using a manual wheelchair.
These combined trainings can also lead to a sustained increase in wheelchair mobility skills, confidence in wheelchair mobility and aerobic performance.
More attention is needed in clinical practice and in research towards improving physical activity in youth using a manual wheelchair.
These combined trainings can also lead to a sustained increase in wheelchair mobility skills, confidence in wheelchair mobility and aerobic performance.
More attention is needed in clinical practice and in research towards improving physical activity in youth using a manual wheelchair.
Funding, acknowledgements: This study was funded by SIA Raak (ref. no. PRO-4-03) and the Dutch Foundation for Disabled Children (NSGK).
Keywords: Physical activity, Wheelchair users, Youth
Topic: Disability & rehabilitation
Did this work require ethics approval? Yes
Institution: University Medical Center Utrecht
Committee: Institutional Review Board
Ethics number: 15-136
All authors, affiliations and abstracts have been published as submitted.
