Circuit Training Program for Persons With Spinal Cord Injury

Study Overview
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Brief Summary
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This initiative represents development and pilot testing of a circuit training exercise program for persons with spinal cord injury (SCI) to be implemented within a rehabilitation centre. The program will integrate members of the community who are > 18 months post-injury with those currently participating in SCI rehabilitation as inpatient.

Detailed Description
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This initiative represents development and pilot testing of a 16 week circuit training exercise program for persons with spinal cord injury (SCI) to be implemented within a rehabilitation centre (Parkwood Institute, London, ON). The primary purpose of this trial is one of feasibility - i.e., testing out several aspects of the trial for the purposes of determining what features of the exercise intervention and the various outcome measurements might be a part of subsequent trials. In addition, a subset of this data will serve as preliminary comparison information for Dr. Dany Gagnon's study at the University of Montreal. In this way, this is not a true multi-centre trial in that we are not conducting an identical protocol to a study he is conducting. Rather, we are using some of the same outcome measures and an exercise intervention that has some similar parameters to one that he is implementing in Montreal - with a view to providing a preliminary comparison of outcomes of a subset of participants in our study so as to inform the development of future studies. For this reason, the group of community-dwelling persons with SCI will have more cardio-metabolic outcome measurements taken, as they represent the primary group of interest to Dr. Gagnon. Overall, the program will integrate members of the community who are > 18 months post-injury (n=8) with those currently participating in SCI rehabilitation as inpatients (n=8). Outcomes will be collected to test the effects of the program on an array of cardio-metabolic measures in those participants with chronic SCI, as well as the feasibility of the program for all participants (N=16). Note: although a participant can decline to continue participation at any time, it is likely that many inpatient participants will choose to not continue participation if this proves logistically difficult (if they move back to their home community away from London).

Official Title
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Circuit Training Program Tom Improve Endocrine-Metabolic Function in Persons With Spinal Cord Injury

Conditions
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Spinal Cord Injuries

Intervention / Treatment
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* Other: Upper Body Circuit Training Program


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Community: Chronic traumatic or non-traumatic SCI between level C6 and T10 >18 months post injury manual wheelchair as the primary mode of mobility no existing conditions that would make it unsafe to participate in an exercise program (e.g., fractures). Ability to understand and communicate in English. 18 years or older. Inpatients: Chronic traumatic or non-traumatic SCI between level C6 and T10 manual wheelchair as primary mode of mobility no existing conditions that would make it unsafe to participate in an exercise program (e.g., fractures). Ability to understand and communicate in English. 18 years or older. Exclusion Criteria: Power wheelchair users (Non manual wheelchairs) Have an existing condition that would make it unsafe to participate in an exercise program (e.g., fracture)

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Upper Body Exercise<br>Seated upper body circuit training program for 16-weeks. Frequency - 1 to 3 one-hour sessions per week. | Other: Upper Body Circuit Training Program<br>* 16 week seated upper body exercise for persons with Spinal Cord Injuries. Participants will attend 2-3 exercise sessions a week, sessions have a mix of SCI community members and inpatients.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Feasibility survey | Feasibility question options range from -3 to +3 on a likert scale, higher scores indicated a greater level of feasibility. | After Study Completion (16 weeks) | 
| Injury Characteristics Survey | Date of injury (DD/MM/YYYY) | Baseline | 
| Injury Characteristics Survey | Diagnosis - Traumatic SCI or Non-Traumatic SCI | Baseline | 
| Injury Characteristics Survey | Classification of SCI using the AIS (ASIA Impairment Scale) - A, B, C, D or E | Baseline | 
| Injury Characteristics Survey | Neurological Level or Injury (NLI) | Baseline | 
| Change in Spinal Cord Injury Independence Measure - Mobility | Assessment of degree to which participant can independently preform mobility tasks, such as transfers, and the ue of mobility aids. | Baseline and 16 weeks | 
| Change in Upper and Lower Extremity Strength by a manual muscle test (MMT) | Assessment of joint (Shoulder, elbow, wrist, hip, knee and ankle) muscle strength using a Manual muscle test. | Baseline and 16 weeks | 
| Change in Upper and Lower Extremity Range of Motion | Assessment of joint range of motion in the upper and lower extremities (Shoulder, elbow, wrist, hip, knee and ankle) | Baseline and 16 weeks | 
| Change in Spasticity in upper and lower extremities using the Modified Ashworth Scale | Assessment of muscle tone through range of motion, on a scale of 0-4 (0= no increase in muscle tone; 4 = rigidity in flexion or extension) | Baseline and 16 weeks | 
| Change in Maximal Safe Wheel chair speed measured using the Propulsion Speed Test | 20 meter straight line wheel chair speed test. 3 trails were be preformed at a comfortable speed and 3 trials will be preformed at a maximal but safe speed. | Baseline and 16 weeks | 
| Change in Ability to safety navigate wheel chair using the Slalmon Speed test | Objective is to weave between a set of cones without touching them as fast as safely possible. 3 attempts will be given. | Baseline and 16 weeks | 
| Demographics and Lifestyle Questionnaires | Age in years | Baseline | 
| Demographics and Lifestyle Questionnaires | Gender (Women, Man or Other) | Baseline | 
| Demographics and Lifestyle Questionnaires | Marital Status | Baseline | 
| Demographics and Lifestyle Questionnaires | Ethnicity | Baseline | 
| Demographics and Lifestyle Questionnaires | Highest Education Level completed | Baseline | 
| Demographics and Lifestyle Questionnaires | Currently Employment situation | Baseline | 
| Demographics and Lifestyle Questionnaires | Family income ($ in last year) | Baseline | 
| Demographics and Lifestyle Questionnaires | List of Medical/health problems | Baseline | 
| Demographics and Lifestyle Questionnaires | Smoking levels (yes/no and how many years) | Baseline | 
| Demographics and Lifestyle Questionnaires | Cannabis Use (yes/no, frequency, types of products) | Baseline | 
| Demographics and Lifestyle Questionnaires | Vaping (Yes/no, frequency) | Baseline | 
| Demographics and Lifestyle Questionnaires | Alcohol consumption (frequency and beverages consumed when drinking) | Baseline | 
| Demographics and Lifestyle Questionnaires | Physical Activity levels (minutes/week) | Baseline | 
| Change in Medications | List of medication and supplements currently being taken. | Baseline and 16 weeks | 
| Change in Experienced Pain | The international Spinal Cord Injury Pain Data Set will be used to evaluate the presence and severity of pain. Description of 3 main pain concerns and there intensity. Intensity ranges from 0 = no pain to 10 = worst possible pain. | Baseline and 16 weeks | 
| Change in Wheel Chair skills ability using the Wheel Chair skills Test Questionnaire | Questionnaire assesses the ability and confidence in preforming numerous wheel chair skills (ex: turning the wheelchair around a small space) Questions answers include 'No' 'partially' 'yes' 'very well'. | Baseline and 16 weeks | 
| Change in Well Being measured by the General Wellbeing Index | Assessment of emotional wellbeing, on a scale of 0-5. | Baseline and 16 weeks | 
| Change in Quality of life and health measured by the WHOQOL-BREF | Self reported questionnaire assessing quality of life (physical, social, environment and psychological health) on a scale of 1 - 4 (1=poor/not al all; 5= very good/extreme amount) | Baseline and 16 weeks | 
| Change in aerobic capacity (VO2max) measured by 6-min wheelchair propulsion test | Objective is to get the largest total distance. Pylons are placed 25meters apart, participants starts in the middle go around the first cone to the let return to the middle and make a full stop, then continue to the right of second cone, go around it and back to the middle, making a figure 8. Continue that pattern for 6 minutes. | Baseline and 16 weeks | 
| Blood Test | Measurement of metabolic profile (ex: glucose, insulin, triglyceride) | Baseline and 16 weeks | 
| Blood Test | Measurement of bone markers (ex: osteocalcin) | Baseline and 16 weeks | 
| Change in Body composition measured by DEXA (Dual energy x-ray absorptiometry) | Measurement of bone mineral density of the full body (reported using a T score) | Baseline and 16 weeks | 
| Change in Body composition measured by DEXA (Dual energy x-ray absorptiometry) | Measurement of bone mineral density of the femoral head (reported using a T score) | Baseline and 16 weeks | 
| Change in Body composition measured by DEXA (Dual energy x-ray absorptiometry) | Measurement of bone mineral density of the lumbar spine (reported using a T score) | Baseline and 16 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Endocrine-Metabolic health, Cardio-Metabolic health