Project Summary
The lack of regular physical activity (PA) in over 290,000 individuals with spinal cord injury (SCI) in the United
States (US) is an ongoing health crisis. This lack of activity has potentially devastating consequences because
low levels of PA in people with SCI elevates the risk of mortality due to cardiovascular diseases, diabetes, and
lung disease. Furthermore, low levels of PA in individuals with SCI have been associated with secondary
conditions such as pain, fatigue, weight gain, and deconditioning. Regular PA and exercise-based
interventions have been linked with improved outcomes and healthier lifestyles among those with SCI. Sensor-
based activity monitors can assess PA and exercise interventions by quantifying wheelchair movement,
movement of the individual, and physiological changes. However, these monitors do not provide real-time,
tailored feedback and recommendations that might help individuals with SCI increase their PA levels in the
community. The overarching goal of this proposal is to evaluate a sensor-enabled, just-in-time adaptive
intervention (JITAI) strategy to increase and sustain PA levels among individuals with SCI in their communities.
The long-term goal of this research is to effectively integrate a mobile health JITAI with existing PA intervention
programs to motivate health-related behavior change in individuals with SCI. A primary objective of this
proposal is to extend our pilot work to evaluate the integration of a JITAI with a web-based 14-week PA
intervention program from the National Center on Health, Physical Activity and Disability (Aim 1). We
hypothesize that the integration of web-based PA intervention program with JITAI will result in significantly
higher PA levels over 14 weeks compared to the standard we-based PA intervention program alone. A
secondary objective of this study is to extend existing algorithms that use commercial wearable technology to
robustly detect PA behaviors to facilitate the delivery of tailored just-in-time actionable feedback and PA
recommendations for individuals with SCI (Aims 3 and 4).
The integration of the JITAI, which provides feedback and PA recommendations due to sensor-based
assessments of PA, with the standard web-based PA intervention program will be tested via a clinical trial that
combines a randomized controlled trial and a micro-randomized trial. Our team includes investigators with
expertise in SCI research, mobile health, PA tracking, and behavioral change interventions. The proposed
study will yield novel insights about JITAIs and JITAIs combined with more traditional, web-based PA
intervention programs, which will help researchers design engaging PA interventions for individuals with
disability in the community that may improve their health and quality of life.
