Title: A Feasibility Study of High Intensity Interval Training (HIIT) to Reduce Cardiometabolic Disease Risks in Individuals with Acute Spinal Cord Injury
Funder: Department of Health and Social Care

Abstract: There are an estimated 40,000 individuals living with spinal cord injury (SCI) in the United Kingdom. With recent improvements in technology and medical and rehabilitative care, individuals with SCI are now living 30-40 years post injury. Consequently, individuals ageing with SCI experience an accelerated trajectory of diseases and disorders that resemble those experienced with ageing alone. In view of the high prevalence, health consequences and costs associated with these disorders in individuals with SCI, a greater emphasis needs to be placedon identifying effective therapeutic interventions.Currently, an effective, evidence-based approach toward managing this problem does not exist. Research question Is it feasible to conduct a randomised, controlled trial of an early exercise intervention in individuals with SCI to improve physiological health? Aims and Objectives To determine the feasibility of undertaking a randomised controlled trial (RCT) of early intervention upper-body high intensity interval training (HIIT) in individuals with acute SCI with regards to: 1) recruitment rate, 2) retention and adherence, 3) acceptability of the intervention, and 4) data collection and analysis. Methods We will conduct a single-centre, two parallel-arm, randomised feasibility study of an exercise intervention in individuals with acute SCI ( Timelines for delivery Months 1-4: Establish project infrastructure, liaise with SDH team, secure ethics approvals, review study research and recruitment processes. Months 5-20: Recruit 40 participants, secure consent, randomization, and complete assessments. Months 6-23: Delivery of intervention, all assessments. Months 24-26: Data analysis (quantitative and qualitative) Month 27: Manuscript preparation, initiate HTA proposal for full RCT, reporting and study closure. Anticipated Impact and Dissemination This feasibility study will inform a longer-term, definitive, multicentre randomised controlled clinical trial, which is necessary to establish the impact of this exercise intervention in maintaining the cardiometabolic health of patients during the acute phase following SCI. Results will be disseminated in different formats including peer reviewed papers, conference presentations and websites to a wide audience including clinicians, researchers and individuals with SCI. If successful we intend to promote the routine adoption of HIIT across all spinal injury recovery units in the UK.

Lay abstract: People with Spinal Cord Injury (SCI) experience difficulty in doing exercise which can lead to serious health problems such as diabetes or heart disease. This research tests a new exercise programme that can be started in hospital by people who have recently suffered an SCI. We also want to provide the right skills so people can carry on their exercises when they are back at home. There are approximately 40,000 people in the UK who have SCI and this number is rising. The NHS does not offer a clear way to exercise for these patients, so many people struggle to keep fit and control their weight. This can affect their quality of life, and result in health problems that can be very costly for the NHS. This research involves short intense exercise training to give a safe but challenging workout, three times a week for 18 weeks using an arm cycle. The project will discover if patients are willing to sign up to the study whilst in hospital, to find out if the exercise is manageable, and to discover if people are happy to keep up the exercise when they go home. We will also ask the NHS physiotherapy and occupational therapy staff about their views on the new programme and how it is delivered. Forty patients with SCI will be asked to take part in this research. They will be recruited from the Duke of Cornwall Spinal Treatment Centre, Salisbury District Hospital and will be chosen at random to either take part in the exercise group or to continue usual standard care. Patients will be asked to fill in questionnaires and have physical tests on health and fitness at the beginning, middle and end of the study. A small sample of patients, physiotherapists and occupational therapists will be interviewed at the beginning and end of the project to find out more about their experiences with the new exercise training during the research. We have asked patients in the Hospital about this project and they were supportive of the idea and keen to take part. The group did raise some concerns about being able to keep up the exercises when at home so we will look more into this, so that exercise can be continued for many years to come. People living with SCI will be invited to sit on committees and advise on the progress of the research, plan public and patient involvement events and help with report writing. The group will spread the results with local patient groups and clinicians. If we can show the intervention is feasible we intend to conduct a larger study to measure how much it improves fitness and health.

Research activity codes: 6.7 PHYSICAL
Health categories: INJURIES AND ACCIDENTS