Response to Group Exercise Outcomes Differ by Baseline Physical Activity in Individuals With Spinal Cord Injury: An Exploratory Analysis

BACKGROUND AND PURPOSE: Nearly 50% of individuals with spinal cord injury (SCI) report no regular physical activity (PA). We developed a novel group tele-exercise program for individuals with SCI to address barriers to exercise and influence individual determinants of PA behavior. The purpose was to compare outcomes of exercisers versus non-exercisers based on self-reported PA at baseline following participation in an 8-week program, Tele-Exercise to promote Empowered Movement in individuals with SCI (TEEMS). METHODS: Individuals with chronic SCI (n = 51, 24 non-exercisers) participated. Primary outcomes (Exercise Self-Efficacy Scale for SCI, Multidimensional Outcome Expectations for Exercise, Leisure Time PA Questionnaire for SCI, Subjective Quality of Life) and secondary outcomes (sleep, pain interference, domains of SCI Quality of Life) were assessed pre-, post-, and 8 weeks following program completion (retention). RESULTS: Pre-program non-exercisers reported lower exercise expectations (P = 0.02), weekly minutes of moderate- to high-intensity PA (P < 0.001), total weekly PA (P < 0.001), and self-esteem (P = 0.01) compared with exercisers. Non-exercisers improved in exercise self-efficacy (P = 0.02) and increased moderate- to high-intensity PA (P = 0.01), eliminating the group difference. Non-exercisers demonstrated large effects for greater participation in social roles (d = 0.92), satisfaction with social roles (d = 1.0), and self-esteem (d = 0.92) post-program. Self-evaluative expectations of exercise improved in non-exercisers and exercisers (P < 0.001) with no difference between groups. Changes were maintained at retention. DISCUSSION AND CONCLUSIONS: For individuals with SCI, especially non-exercisers, participation in Tele-Exercise to promote Empowered Movement in individuals with SCI positively impacted personal determinants of PA behavior, along with improved self-esteem and social participation. Improved exercise self-efficacy, influenced by exercise knowledge gained during program participation and increased expectations of internal exercise outcomes, was found.