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There is an urgent need for valid and reliable measures of physical activity (PA) participation for use among people with physical and/or sensory disabilities. This study involved adapting the Leisure Time PA Questionnaire for People with Spinal Cord Injury for use in individuals with disabilities (i.e., the LTPAQ-D) and performing a preliminary evaluation of its content validity, construct validity, and same-day test–retest reliability in people with disabilities. User interviews assessed the content validity (n = 5). A cross-sectional study assessed the construct validity and same-day test–retest reliability (n = 27, 45 ± 21 years). Participants completed the LTPAQ-D, other self-report measures of aerobic and strength training PA, as well as tests of cardiorespiratory fitness (i.e., peak oxygen consumption (V˙O2peak)) and muscular strength. LTPAQ-D measures of min/week of aerobic LTPA, aerobic moderate-to-vigorous PA (MVPA), and strength training shared medium-to-large correlations with other self-report measures of aerobic and strength training PA (r = 0.458–0.942, ps < 0.01). After controlling for age, aerobic LTPA and MVPA shared moderate partial correlations with V˙O2peak (r = 0.341 and 0.356, respectively). Min/week of strength training, measured by the LTPAQ-D, was associated with predicted maximal strength on the chest press (r = 0.621, p = 0.009). All LTPAQ-D measures demonstrated good-to-excellent test–retest reliability (intraclass correlations = 0.709–0.948, ps < 0.01). This study provides preliminary evidence of the validity and reliability of the LTPAQ-D as a measure of LTPA among people with disabilities.

Abstract Background Individuals with spinal cord injury (SCI) report high levels of neuropathic pain. Current treatment options are primarily pharmaceutical, despite their limited effectiveness. Exercise may reduce neuropathic pain among persons with SCI; however, the optimal dose of exercise required to elicit analgesic effects remains unknown. The purpose of this study was to compare neuropathic pain intensity, pain catastrophizing, use of coping strategies, and positive affect and well-being among Paralympic versus recreational athletes with SCI who experience chronic neuropathic pain. Forty-seven athletes with SCI (25 Paralympic, 27 recreational) completed the International SCI Pain Basic Data Set, Douleur Neuropathique-4, coping strategies questionnaire, pain catastrophizing scale, and SCI-quality of life assessment. Results Paralympic athletes reported significantly greater neuropathic pain (p = 0.032) and positive affect and well-being (p = 0.047) than recreational athletes. No other comparisons were significant (ps > 0.09). Significant, medium-sized positive correlations were observed between neuropathic pain and total minutes of moderate-intensity exercise (r = 0.335, p = 0.023) and average minutes per day of moderate-intensity exercise (r = 0.375, p = 0.010) over the past week. Conclusions The results suggest that frequent moderate- to high-intensity exercise may exacerbate neuropathic pain sensations for persons with SCI. Research should investigate psychosocial and physiological mechanisms by which exercise may influence neuropathic pain to explain how Paralympic athletes with SCI are able to continue exercising while maintaining positive affect despite neuropathic pain.

Approximately 1·5 billion people worldwide live with a physical, mental, sensory, or intellectual disability, about 80% of which are in low-income and middle-income countries. This Series paper provides a global overview of the prevalence, benefits, and promotion policies for physical activity for people living with disabilities (PLWD). PLWD are 16-62% less likely to meet physical activity guidelines and are at higher risk of serious health problems related to inactivity than people without disabilities. Meta-analyses have shown that physical activity has beneficial effects on cardiovascular fitness (average standardised mean difference [SMD] 0·69 [95% CI 0·31-1·01]), musculoskeletal fitness (0·59 [0·31-0·87]), cardiometabolic risk factors (0·39 [0·04-0·75]), and brain and mental health outcomes (0·47 [0·21-0·73]). These meta-analyses also show that health benefits can be achieved even with less than 150 min of physical activity per week, and suggest that some physical activity is better than none. Meta-analyses of interventions to increase physical activity for PLWD have reported effect sizes ranging from SMD 0·29 (95% CI 0·17-0·41, k=10) to 1·00 (0·46-1·53, k=10). There is increasing awareness among policy makers of the needs of PLWD for full participation in physical activity. Physical activity action plans worldwide must be adequately resourced, monitored, and enforced to truly advance the fundamental rights of PLWD to fully participate in physical activity.

• One to three sessions of 20-60 minutes of exercise per week of mixed exercise programs, ie, programs combining aerobic exercise with strengthening or balance exercise improves balance, walking speed, walking endurance, and transfer ability in adults with lower limb amputation. • Further high-quality studies are needed to increase confidence on the effect of exercise training programs to improve cardiorespiratory health, muscle strength, flexibility, and functional status in adults with lower limb amputation. • There is a need to develop guidelines specific to people with physical disabilities, and extrapolating guidelines from the able-bodied population may be inappropriate or even potentially harmful. • The results of this review and the exercise descriptions will provide the basis for the development of physical activity guidelines for adults with lower limb amputation. To answer the following questions: (1) Do physical activity (PA) and exercise improve fitness, mobility, and functional capacity among adults with lower limb amputation (LLA) and (2) What is the type and minimum dose of PA (frequency, intensity and duration) needed? Systematic review. Outpatient intervention, outside of the prosthetic rehabilitation phase. Adults with lower limb amputation living in the community. Any physical activity or exercise intervention. Any fitness, mobility, or functional capacity indicators and measurements. Twenty-three studies were included, totaling 408 adults with LLA. Studies evaluated the effect of structured PA sessions on fitness, mobility, and functional capacity. The highest evidence is for mixed exercise programs, that is, programs combining aerobic exercise with strengthening or balance exercise. There is moderate confidence that 1-3 sessions of 20-60 minutes of exercise per week improves balance, walking speed, walking endurance, and transfer ability in adults with LLA above the ankle. As for flexibility, cardiorespiratory health, lower-limb muscles strength, and functional capacity, there was low confidence that exercise improves these fitness components because of the lack of studies. Exercise 1-3 times per week may improve balance, walking speed, walking endurance, and transfer ability in adults with LLA, especially when combining aerobic exercises with lower limb strengthening or balance exercises. There is a need for most robust studies focusing on the effect of PA on cardiorespiratory health, muscles strength, flexibility, and functional status. [ABSTRACT FROM AUTHOR]

Introduction: Persons with spinal cord injury (SCI) often report high levels of neuropathic pain (NP) and poor well-being, which may result from increased inflammation. This study examined the impact of sub-maximal aerobic exercise on NP, inflammation and psychological affect among adults with SCI.Methods: Eight active adults with tetraplegia (n-4, AIS A-C) and paraplegia (n = 4, AIS A-C) performed 30-min of arm-crank aerobic exercise and reported their ratings of perceived exertion (RPE) each minute. Measures of NP, affect, and inflammatory cytokines (IL-6, IL-10, IL-1ra, TNF-α) were taken pre-(T0), immediately post-(T1), and 90-min post-exercise (T2).Results: NP decreased between T0 and T1 for tetraplegics (−60%, d = 0.47; CI = −0.32, 2.02) and paraplegics (−16%, d = 0.15; CI = −0.30, 0.90). Correlations between change in cytokines and change in NP were medium-to large for tetraplegics (rs ranged from −0.820 to 0.965) and paraplegics (rs ranged from −0.598 to 0.833). However, the pattern of correlations between change in cytokines and affect was inconsistent between groups. Lower baseline levels of IL-1ra predicted greater decreases in NP immediately post-exercise (r = 0.83, p = 0.01).Conclusion: Sub-maximal exercise can positively impact NP for some persons with SCI. Further experimental research should identify the optimal exercise intensity to reduce NP for persons with SCI, in addition to understanding biomarkers which may predict changes in NP.Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT03955523.

Objectives: To assess the presence of depressive symptoms among older adults with long-term spinal cord injury and investigate the association with sociodemographic and injury characteristics; and to determine how potentially modifiable factors, i.e. secondary health conditions, sense of coherence, coping strategies and leisure-time physical activity, are associated with depressive symptoms. Design: Cross-sectional study. Subjects: A total of 122 individuals (70% men, injury levels C1–L5, American Spinal Injury Association Impairment Scale A–D), mean age 63 years, mean time since injury 24 years. Methods: Data from the Swedish Aging with Spinal Cord Injury Study, collected using the Geriatric Depression Scale-15, the 13-item Sense of Coherence Scale, the Spinal Cord Lesion-related Coping Strategies Questionnaire and the Physical Activity Recall Assessment for people with Spinal Cord Injury. Associations were analysed using multivariable linear regression. Results: A total of 29% reported clinically relevant depressive symptoms and 5% reported probable depression. Sense of coherence, the coping strategy Acceptance, neuropathic pain and leisure-time physical activity explained 53% of the variance in depressive symptoms. Conclusion: Older adults with long-term spinal cord injury report a low presence of probable depression. Mental health may be supported through rehabilitation that strengthens the ability to understand and confront life stressors, promotes acceptance of the injury, provides pain management and encourages participation in leisure-time physical activity.

Objective To synthesize current knowledge of the modifiable psychosocial constructs associated with physical activity (PA) participation in people with multiple sclerosis. Data Sources A search was conducted through October 2015 in 8 electronic databases: CINAHL, PubMed, SPORTDiscus, Web of Knowledge, MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and PsycINFO. Study Selection Cohort and intervention studies were included if they (1) included an objective or subjective measure of PA; (2) measured at least 1 modifiable psychosocial construct; and (3) reported bivariate correlations (or these could be extracted) between the PA and psychosocial construct measures. A total of 13,867 articles were screened for inclusion, and 26 were included in the final analysis. Data Extraction Meta-analyses of correlations were conducted using the Hedges-Olkin method. Where a meta-analysis was not possible, results were reported descriptively. Data Synthesis Meta-analyses indicated a pooled correlation coefficient between (1) objective PA and self-efficacy (n=7) of r =.30 ( P <.0001), indicating a moderate, positive association; (2) subjective PA and self-efficacy (n=7) of r =.34 ( P <.0001), indicating a moderate, positive association; (3) subjective PA and goal-setting (n=5) of r =.44 ( P <.0001), indicating a moderate-to-large positive association; and 4) subjective PA and outcome expectancies (n=4) (physical: r =.13, P =.11; social: r =.19, P <.0001; self-evaluative: r =.27, P <.0001), indicating small-moderate positive associations. Other constructs such as measures of health beliefs, enjoyment, social support, and perceived benefits and barriers were reported to be significantly correlated with PA in individual studies, but the number of studies was not sufficient for a meta-analysis. Conclusions Future PA interventions should continue to focus on the psychosocial constructs of self-efficacy and goal-setting. However, there is a need to explore the associations between other constructs outside those reported in this review. [ABSTRACT FROM AUTHOR]

Objective To examine sex differences in theory-based predictors of leisure time physical activity (LTPA) among men and women with spinal cord injury, and secondarily, to identify factors that might explain any sex differences in social cognitions. Design A secondary analysis of Study of Health and Activity in People with Spinal Cord Injury survey data. Setting Community. Participants Community-dwelling men (n=536) and women (n=164) recruited from 4 rehabilitation and research centers. Interventions Not applicable. Main Outcome Measures Subjective norms, attitudes, barrier self-efficacy, perceived controllability (PC), and intentions. Results Men had stronger PC and barrier self-efficacy than women. Hierarchical regression analyses revealed that social support significantly predicted PC for both sexes, and health, pain, and physical independence also significantly predicted PC for men. Social support, health, and pain significantly predicted barrier self-efficacy for men. Social support was the only significant predictor of barrier self-efficacy for women. Conclusions Women felt significantly less control over their physical activity behavior and had lower confidence to overcome barriers to physical activity than did men. Although social support predicted PC and barrier self-efficacy in both men and women, men seemed to take additional factors into consideration when formulating their control beliefs for LTPA. [ABSTRACT FROM AUTHOR]

Abstract: Using the exercise and self-esteem model as a guiding framework, this study examined variables related to body image change among 88 overweight and obese women (M age =28.4±7.8; M BMI =31.6±3.5) participating in a 16-week diet and exercise weight-loss intervention. Measures of body image and potential mechanisms of body image change (actual and perceived physical changes, self-efficacy) were administered at baseline, Weeks 8 and 16. Body image improved significantly over the study time-points (ps<.001). Perceived physical changes accounted for most explained variance (12–37%) in body image change (total R 2 adj =.21–.50). Improved perceptions of body fat were a particularly important predictor in each model (ps≤.04). Results support the notion that to improve body image, perceived changes to the body are more important than actual changes. Such information is integral to developing theories to explain body image change and interventions to maximize it. [Copyright &y& Elsevier]

Abstract: Martin Ginis KA, Phang SH, Latimer AE, Arbour-Nicitopoulos KP. Reliability and validity tests of the Leisure Time Physical Activity Questionnaire for People with Spinal Cord Injury. Objective: To examine the criterion validity and test-retest reliability of the Leisure Time Physical Activity Questionnaire for People with Spinal Cord Injury (LTPAQ-SCI), a brief measure of leisure time physical activity (LTPA) for people with spinal cord injury (SCI). Design: Survey with a 1-week follow-up. Setting: General community. Participants: Men and women with SCI (N=103; mean age ± SD, 48.1±12.7y; mean years postinjury ± SD, 17.9±11.9) who used a wheelchair as the primary mode of mobility. Interventions: Not applicable. Main Outcome Measures: Participants completed the Physical Activity Recall Assessment for People with SCI (PARA-SCI) and the LTPAQ-SCI. A subset of the participants (n=35) completed the LTPAQ-SCI a second time, 7 days later. Results: Statistically significant, positive correlations emerged between the LTPAQ-SCI and PARA-SCI measures of mild, moderate, and heavy intensity LTPA as well as total LTPA. All 4 intraclass correlation coefficients were significant across the test-retest period. Conclusions: This study provides preliminary evidence of the criterion validity and reliability of the LTPAQ-SCI as a brief measure of LTPA performed by people with SCI. [Copyright &y& Elsevier]

Abstract: This study examined the validity of a state version of the Social Physique Anxiety Scale () by conducting tests of concurrent and discriminative validation. Participants were four separate samples of young women (N =221) who exercised ≤2 days/week and who participated in various experiments examining body image and self-presentation. Participants’ scores on the state SPAS (S-SPAS) were significantly correlated, in expected directions, with scores on both trait and state measures of body image and self-presentation, and with body mass index (BMI). In addition, S-SPAS scores discriminated between women who exercised in a mixed-sex versus a same-sex environment, but trait SPAS scores did not. Together, these results provide evidence of construct validity of a state version of the SPAS and demonstrate that social physique anxiety can be conceptualized and measured as a situational variable. The S-SPAS, rather than the trait SPAS, should be employed in experiments designed to detect differences in state social physique anxiety. [Copyright &y& Elsevier]

Abstract: Martin Ginis KA, Arbour-Nicitopoulos KP, Latimer AE, Buchholz AC, Bray SR, Craven BC, Hayes KC, Hicks AL, McColl M, Potter PJ, Smith K, Wolfe DL. Leisure time physical activity in a population-based sample of people with spinal cord injury part II: activity types, intensities, and durations. Objective: To describe the types, intensities, and average duration of leisure time physical activities (LTPAs) performed by people with chronic spinal cord injury (SCI). Design: Cross-sectional telephone survey. Setting: General community. Participants: Men and women with SCI (N=347) who reported engaging in LTPA over the previous 3 days. Interventions: Not applicable. Main Outcome Measures: Mean minutes a day of LTPA performed at mild, moderate, and heavy intensities; proportion of respondents performing specific types of LTPA. Results: Participants reported a mean ± SD of 55.15±59.05min/d of LTPA at a mild intensity or greater. Median LTPA was 33.33min/d. More activity was done at a moderate intensity (mean ± SD, 25.49±42.11min/d) than mild (mean ± SD, 19.14±37.77min/d) or heavy intensities (mean ± SD, 10.52±22.17min/d). Most participants reported mild (54%) or moderate intensity LTPA (68%), while a minority reported heavy intensity LTPA (43%). The 3 most frequently reported types of LTPA were resistance training (33%), aerobic exercise (25%), and wheeling (24%). Craftsmanship (mean ± SD, 83.79±96.00min/d) and sports activities (mean ± SD, 60.86±59.76 min/d) were performed for the longest durations. Conclusions: There is considerable variability in daily LTPA among active people with SCI and variability across different types of LTPA in terms of typical durations and intensities. This information can be used to help people with chronic SCI become more active by highlighting activities that meet individual abilities, needs, and desires. [Copyright &y& Elsevier]

Abstract: Martin Ginis KA, Latimer AE, Arbour-Nicitopoulos KP, Buchholz AC, Bray SR, Craven BC, Hayes KC, Hicks AL, McColl M, Potter PJ, Smith K, Wolfe DL. Leisure time physical activity in a population-based sample of people with spinal cord injury part I: demographic and injury-related correlates. Objectives: To estimate the number of minutes a day of leisure time physical activity (LTPA) performed by people with chronic spinal cord injury (SCI) and to identify the demographic and injury-related characteristics associated with LTPA in a population-based sample of people with chronic SCI. Design: Cross-sectional telephone survey. Setting: General community. Participants: Men and women with SCI (N=695). Interventions: Not applicable. Main Outcome Measures: The number of minutes/day of LTPA performed at a mild intensity or greater. Results: Respondents reported mean minutes ± SD of 27.14±49.36 of LTPA/d; however, 50% reported no LTPA whatsoever. In a multiple regression analysis, sex, age, years postinjury, injury severity, and primary mode of mobility each emerged as a unique predictor of LTPA. Multiple correspondence analysis indicated that being a man over the age of 34 years and greater than 11 years postinjury was associated with inactivity, while being a manual wheelchair user and having motor complete paraplegia were associated with the highest level of daily LTPA. Conclusions: Daily LTPA levels are generally low in people with SCI. Women, older adults, people with less recent injuries, people with more severe injuries, and users of power wheelchairs and gait aids are general subgroups that may require special attention and resources to overcome unique barriers to LTPA. Specific subgroups may also require targeted interventions. [Copyright &y& Elsevier]

Abstract: Arbour-Nicitopoulos KP, Martin Ginis KA, Latimer AE. Planning, leisure-time physical activity, and coping self-efficacy in persons with spinal cord injury: a randomized controlled trial. Objective: To examine the effects of action and coping planning (ACP) on leisure-time physical activity (LTPA) and coping self-efficacy in exercise initiates living with spinal cord injury (SCI). Design: Ten-week, single-blind randomized controlled trial. Setting: General community. Participants: Adults (N=44) with SCI (mean age ± SD, 49.70±12.71y) were randomly assigned to either an action planning only (APO; n=22) or an ACP (n=22) condition. Intervention: Participants in the APO condition formed action plans for LTPA at weeks 1 and 5, and self-monitored their LTPA behavior. Those in the ACP condition formed coping plans for managing self-identified activity barriers, in addition to forming action plans and self-monitoring. Main Outcome Measures: Measures of intentions, coping self-efficacy, and behavior were assessed at weeks 1, 5, and 10. Results: Intention-to-treat analyses indicated that persons in the ACP condition reported significantly greater LTPA, scheduling, and general barriers self-efficacy at weeks 5 and 10, in comparison with those in the APO condition. Scheduling self-efficacy mediated the effects of the intervention on LTPA, accounting for 38% of the total effect of the intervention on week 5 LTPA. Conclusions: These findings illustrate the effectiveness of supplementing action plans with coping plans for enhancing LTPA and coping self-efficacy beliefs among exercise initiates living with SCI. [Copyright &y& Elsevier]

Abstract: This study examined sex differences in body image change and its correlates over the course of a 12-week strength-training program. Participants were 28 men and 16 women (M age=21.6, SD =2.4) who completed pre- and post-intervention measures of body image (Body Areas Satisfaction Scale, Social Physique Anxiety Scale, and Drive for Muscularity Scale) and subjective and objective assessments of body fat, muscularity, and strength. They participated in a 12-week, 5-day/week full-body progressive resistance training program. Significant body image improvements were found for both sexes (p <.05). Correlates of body image change varied somewhat between the sexes. For men, body image improvements were correlated only with subjective physical changes. For women, body image improvements were correlated with subjective physical changes as well as objective increases in strength. These results suggest that although men and women derive body image improvements from strength training, they may benefit for different reasons. [Copyright &y& Elsevier]

Abstract: Most adults with multiple sclerosis (MS) are physically inactive. Physical activity guidelines are an important tool for exercise prescription, promotion, and monitoring. This article describes the application of international standards for guideline development in the creation of evidence-based physical activity guidelines for people with MS. The development process was informed by the Appraisal of Guidelines Research and Evaluation II instrument. The evidence base for the guidelines consisted of a systematic review of research examining the effects of exercise on fitness, fatigue, mobility, and health-related quality of life among people with MS. A multidisciplinary consensus panel deliberated the evidence and generated the guidelines and a preamble. Expert and stakeholder reviews of the materials led to refinement of the wording of both components of the guidelines. The resulting guidelines state that to achieve important fitness benefits, adults with MS who have mild to moderate disability need at least 30 minutes of moderate intensity aerobic activity 2 times per week and strength training exercises for major muscle groups 2 times per week. Meeting these guidelines may also reduce fatigue, improve mobility, and enhance elements of health-related quality of life. People with MS and health professionals are encouraged to adopt these rigorously developed guidelines. [Copyright &y& Elsevier]

Abstract: Objective: To conduct a systematic review of evidence surrounding the effects of exercise training on physical fitness, mobility, fatigue, and health-related quality of life in adults with multiple sclerosis (MS). Data Sources: The databases included EMBASE, 1980 to 2011 (wk 12); Ovid MEDLINE and Ovid OLDMEDLINE, 1947 to March (wk 3) 2011; PsycINFO, 1967 to March (wk 4) 2011; CINAHL all-inclusive; SPORTDiscus all-inclusive; Cochrane Library all-inclusive; and Physiotherapy Evidence Database all-inclusive. Study Selection: The review was limited to English-language studies (published before December 2011) of people with MS that evaluated the effects of exercise training on outcomes of physical fitness, mobility, fatigue, and/or health-related quality of life. Data Extraction: One research assistant extracted data and rated study quality. A second research assistant verified the extraction and quality assessment. Data Synthesis: From the 4362 studies identified, 54 studies were included in the review. The extracted data were analyzed using a descriptive approach. There was strong evidence that exercise performed 2 times per week at a moderate intensity increases aerobic capacity and muscular strength. The evidence was not consistent regarding the effects of exercise training on other outcomes. Conclusions: Among those with mild to moderate disability from MS, there is sufficient evidence that exercise training is effective for improving both aerobic capacity and muscular strength. Exercise may improve mobility, fatigue, and health-related quality of life. [Copyright &y& Elsevier]

Abstract Background The impending public health impact of Alzheimer’s disease is tremendous. Physical activity is a promising intervention for preventing and managing Alzheimer’s disease. However, there is a lack of evidence-based public health messaging to support this position. This paper describes the application of the Appraisal of Guidelines Research and Evaluation II (AGREE-II) principles to formulate an evidence-based message to promote physical activity for the purposes of preventing and managing Alzheimer’s disease. Methods A messaging statement was developed using the AGREE-II instrument as guidance. Methods included (a) conducting a systematic review of reviews summarizing research on physical activity to prevent and manage Alzheimer’s disease, and (b) engaging stakeholders to deliberate the evidence and formulate the messaging statement. Results The evidence base consisted of seven systematic reviews focused on Alzheimer’s disease prevention and 20 reviews focused on symptom management. Virtually all of the reviews of symptom management conflated patients with Alzheimer’s disease and patients with other dementias, and this limitation was reflected in the second part of the messaging statement. After deliberating the evidence base, an expert panel achieved consensus on the following statement: “Regular participation in physical activity is associated with a reduced risk of developing Alzheimer’s disease. Among older adults with Alzheimer’s disease and other dementias, regular physical activity can improve performance of activities of daily living and mobility, and may improve general cognition and balance.” The statement was rated favourably by a sample of older adults and physicians who treat Alzheimer’s disease patients in terms of its appropriateness, utility, and clarity. Conclusion Public health and other organizations that promote physical activity, health and well-being to older adults are encouraged to use the evidence-based statement in their programs and resources. Researchers, clinicians, people with Alzheimer’s disease and caregivers are encouraged to adopt the messaging statement and the recommendations in the companion informational resource.