Wheelchair user physical activity training intervention to enhance cardiometabolic health (WATCH): A community-based randomized control trial - Project Summary: Low levels of physical activity (PA) are common in individuals who use wheelchairs due to physical disability. Wheelchair users (WU) are also at greater risk for obesity and cardiometabolic health-related diseases compared to the general population. Regular PA is widely recognized as being beneficial to the health of persons without a disability and is believed to hold similar benefits for WU. However, WU face barriers to PA, including considerable lack of accessible, community-based facilities, limited access to adapted equipment, lack of knowledge on how to exercise safely, and proper support. Additionally, it is unclear what type of PA intervention is most effective to facilitate WU in achieving current PA recommendations and reversing or preventing cardiometabolic health-related diseases. Thus, evaluating a structured, community-based PA training intervention with education and support is critical and will have significant implications for WU health, future PA guidelines for WU, and the activities of community-based organizations serving WU. The extensive health benefits of aerobic and strength training are well established for the general population, and randomized controlled trials studying the impact of PA for WU suggest programs that provide support and education in accessible, community-based environments are effective for improving outcomes such as strength and pain. However, there is insufficient evidence on whether these interventions result in cardiometabolic health (i.e., VO2peak) improvements in WU. Previous evidence demonstrates these interventions may be inadequate to reach the recommended frequency, intensity, and duration of PA. Preliminary data suggest guiding PA intensity may be essential to improving cardiometabolic health outcomes in WU. The current study proposes a hybrid I randomized controlled trial to test the cardiometabolic effects of a tailored intensity-controlled physical activity training (I PAT) intervention compared to education and access to a community-based accessible gym (EA). The following specific aims will be tested in WU randomized to either the IPAT or the EA intervention groups (N = 54 for both). Specific Aim #1: To compare the effectiveness of the IPAT to EA on cardiorespiratory fitness, vascular function, and body composition. Specific Aim #2: To identify barriers and facilitators to WU engaging in PA at a community-based, accessible gym. Specific Aim #3: To examine the mediators (e.g., self-efficacy) and moderators (e.g., age, race, duration of disability) of the expected intervention effect to understand differences in physiologic response. Moderate-to-vigorous intensity aerobic and strength training will be used to study the effects of interventions delivered in a community-based accessible gym on cardiometabolic related health outcomes such as cardiorespiratory fitness (VO2peak) and vascular function (endothelial function) in WU. Successful completion of the proposed study will generate data to inform future PA guidelines and strengthen the evidence base for safe and effective PA interventions.
